DRUG SUPPLY PROCESS The Global Factors

1
(No Transcript)
2
VISION AND REALITY Improving access and use of
medicines as a priority even in the 21st Century!
3
Our Vision

• Access
• Essential medicines are intended to be available
  within the context of functioning health systems
  at all times, in adequate amounts, in the
  appropriate dosage forms, with assured quality,
  and at a price the individual and the community
  can afford
• Rational use
• Appropriate indication
• Appropriate drug
• Appropriate administration, dosage and duration
• Appropriate patient
• Appropriate patient information
• Appropriate evaluation

4
This is where a large graphic or chart can go.
5
THE DRUG SUPPLY

• The Global Factors
• WTO TRIPS, patents, GATS etc.
• UN Influence by multinational companies
• Free trade negotiation and breakdown of working
  models
• Corporate financing and donations

6
(No Transcript)
7
FUNCTIONING HEALTH SYSTEMS Human resource issue
Brain-drain.. (HIF-net 2003)

• Loss of trained health professionals from
• Poorer to richer countries
• e.g. a pharmacist earn in Germany Euro 2700
• Uganda Euro 200
• Rural to urban
• 80 registered pharmacist in Ghana work and live
  in Greater Accra (Pop. urban vs Rural 36 vs 64)
• Loss of education investment for poor countries
  approx 500m per year and total loss to Africa 4
  billion per year.

8
Causes of Brain Drain

• Globalization and trade liberalization Fishing
  in one pool at a disadvantage of developing
  countries e.g.
• Germany 22 Pharmacy Schools for 82m
• Tanzania 1 Pharmacy School for 35m
• Availability of health resources/ facilities
• Low status position of staff e.g. Nurses
• Underutilization of staff potentials e.g
  Pharmacist

9
Addressing Brain Drain (Local)

• Provide training and qualifications specific to
  tasks to be addressed
• Increase pool of health professionals CHW,
  pharmacy assistants, nurse, prescriber e.g. PAT,
  E. Africa
• Raise their status and recognition
• Provide adequate supervision
• Rethink the roles of current health professionals
  e.g. pharmacist to play manager/supervisor role
• Improve access to information and communication
  e.g. video conferencing email, online and CD
  libraries

10
Addressing Brain Drain (Global)

• Institute system of sharing staff
• Twinning of medical institutions or staff
  positions
• Equal time in two institutions/countries
• Mandatory home-country service period
• Increase donor support
• Recruitment and redeployment of health
  professionals
• on research on causes of brain drain and
  development of appropriate policies

11
RATIONAL USEProvider Issues .

• 28th February 2004, Nairobi, Kenya on local FM
  Station
• Announcer Are there any special conditions that
  may
• prevent one from using Viagra?
• Pharmacist Yes, diseases like heart problems.
• That is why one needs a prescription for
  Viagra.
• Announcer Ooh! So you only sell with a
  prescription
• Pharmacist Not really. People want these drugs
  so we
• sell them.
• Announcer And how many tablets make a course?
• Pharmacist They are in threes. But because they
  are so expensive (12 per tab) we sell even
• one tablet.

12
Provider Issues ..What kind of care?

• From GPHF Brochure
• Kenya March 8th 15th 2004, medical camp train
• Treatedgt20,000 people in 5 days
• Reasons for turn out no drugs or cannot afford

13
Provider Issues ..What kind of care?

• Whenever there is a vacuum something will always
  rush to fill it!
• From GFHF Brochure

14
CFW(Kenya) ADDO (Tanzania) ExperienceGetting
closer to the people (CFW Shop)
15
The CFW(Kenya) and ADDO (Tanzania)
experiencesAppropriately trained personnel (CFW)
16
Addressing Provider Issues

• Continuing education e.g. DTC and PRDU courses
  EPN in collaboration with WHO and MSH has
  participated in training of over 150 heath
  professionals over last four years.
• Facilitating non-financial factors providing job
  satisfaction
• Supporting implementation of action plans
  currently inadequately done e.g. EPN only
  supported 3.

17
(No Transcript)
18
Consumer Issues. Problems of perception

• Door-to-door vaccinations have been banned in
  Kano, Zamfara and Niger three predominantly
  Islamic states in Northern Nigeria since last
  October, with critics calling the immunization
  campaign a U.S. plot to spread AIDS or
  infertility among Muslims.
• Shekarau said he believes it is a lesser of two
  evils to sacrifice two, three, four, five, even
  ten children (to polio) than allow hundred of
  thousands or possibly millions of girl-children
  likely to be rendered infertile. The associated
  press Feb 2004
• Our vision not their vision. We need to
  understand factors/forces influencing behaviour.

19
Consumer Issues.. Whats quality to the
consumer?

• Presentation and price important quality factors
• Claims of tablets working better because in
  gold-labeled box or silver foil blister
• Popular notion that the more a tablet costs, the
  better it works
• Consumer definition of quality is not the same as
  ours!!

20
Addressing Consumer Issues(Sexual Health
Exchange 2003/3)

• In our communities we have done workshops with
  people who have never opened a pharmacological
  textbook but most of our people can speak
  eloquently and articulately about the medicines
  that they need, their side-effects and how to
  look after themselves.
• Zackie Achmat

21
Addressing Consumer Issues.. Using untapped
resources Community leaders

• Sexual Health Exchange 2003/3
• Community leader and educator at work (Uganda)

22
Addressing Consumer Issues .. Using untapped
resources Faith leaders

• Islamic Medical Association Uganda worked with
  religious leaders
• 750 religious leaders trained as community
  educators
• Leaders in turn educated communities about PMTCT
  and ART issues through sermons, group talks and
  home visits
• We need to learn to speak in laymans language.

23
Addressing Consumer Issues..Using untapped
resources The Youth

• More than 7,000 mostly young people from local
  schools played Hivyo a treatment game during an
  exhibition in ICASA.
• Need to explore strategies and innovative ways to
  reach the young as future advocates for Improving
  Use of Medicines.
• Courtesy HAI Africa/KCAEM

24
Consumer Issues

• Rephrasing Zackie Achmat
• A critical element to be able to improve use of
  medicines by people will be medicines literacy
  programmes
• Learning from HIV/AIDS experiences
• Investigate scaling up to improve use of all
  drugs
• Develop strategies that focus on different
  strengths within the population

25
(No Transcript)
26
Address Consumer Issues .Harnessing the
peoples power

• Thailands many groups defending and promoting
  access to medicines. The process of people for
  access
• Uganda Access to Essential Medicines Coalition.
• 40 NGOs, CBO and individuals
• Kenya Coalition on Access to Essential Medicines
• Putting Access on the political agenda
• Input in tender for ARVs
• Mass mobilization for public health friendly IP
  bill
• Challenges
• Support for keeping the group going
• Modalities of learning from each other

27
(No Transcript)
28
Information Issues .Unbiased Information ?

• Revealed how drug firms hoodwink medical
  journal ..pharmaceutical giants hire ghost
  writers to produce articles E-drug, Jan 2004
• Patient advocacy groups are not as independent
  as they seem Groups funded by pharmaceutical
  companies are helping lobby the government to
  have new drugs added to the PBS. Sydney Morning
  Herald Dec 2003
• Direct to consumer advertising physician and
  public opinion and potential effects on physician
  patient relationship request for specific
  medication 80.7 Arch Inter, Med. 2004

29
Information Issues .Internet Medicine
(OffshorePharmacy.com)

• WELCOME!
• We believe ordering medication should be as
  simple as ordering anything else on the Net.
  Private, secure, and easy. Choose your
  medication, point, click, order and you're done.
  Your medication is on it's way. No prescription
  required! .. Valium, Viagra, Ultram, Soma,
  Zyban, Prozac, Xanax, Paxil.

30
Addressing Information Issues

• Independent drug information sources
• Establishment of drug information centres
• Training on critical evaluation of information
• Address conflict of interest/ethical issues

31
Summary The Issues for next decade.

• World is a global village
• Research on the impact of global activities on
  access and use and development of appropriate
  policies
• Brain-drain stealing from the poor to give to
  the rich?
• Research on innovative solutions that must
  address both sides of the equation
• Practice makes perfect
• How do we make thinking and practicing RDU the
  norm?
• Improving and learning from examples in the field

32
Summary The Issues for next Decade

• Customer is King and always right?
• Whats important to the consumer/ public? How do
  we bridge the gap?
• What methods/strategies do we use to harness the
  potential in the consumer?
• Internet Its a brave new world and its here!
• What impact on use of medicines?
• How do we use this medium for IUM?
• What strategies for information?

33
THANK YOU

• Eva M. A. Ombaka BSc. Pharm. PhD.Ecumenical
  Pharmaceutical Network P.O. Box 73860Nairobi,
  KENYAEmail epn_at_wananchi.com Website
  www.epnetwork.org