Access to medicines through health systems in low- and middle-income countries

Ozawa, Sachiko; Shankar, Raja; Leopold, Christine; Orubu, Samuel

doi:10.1093/heapol/czz119

Cited by 80 publications

(77 citation statements)

References 10 publications

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“…Our study has revealed that the COVID-19 pandemic has had a range of impacts on the care of patients with NCDs in LMICs by FLHCWs, from constraints on access to care to health effects, in particular, depression and anxiety as noted in other surveys (Ozawa et al, 2019). Despite the challenges, most FLHCWs continue to see patients either in person or remotely, the latter mode is especially common for physicians; pharmacists continue to see patients in-person.…”

Section: Discussionmentioning

confidence: 74%

The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

Bullen

McCormack

Calder

et al. 2021

Prim Health Care Res Dev

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Background: The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs). Aim: To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies. Methods: We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic. Findings: The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients. Conclusions: Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.

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Section: Discussionmentioning

confidence: 74%

The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

Bullen

McCormack

Calder

et al. 2021

Prim Health Care Res Dev

View full text Add to dashboard Cite

show abstract

“…Despite years of effort there are still billions of people in LMICs, and even some in high-income countries who do not have effective access to vaccines and essential medicines that are long out of patent and can be manufactured relatively simply and cheaply. 15 We do not have any reason to expect this to be different for any vaccine or therapy developed as a result of CHIs. We also already see some state actors trying to get preferential early access to vaccines and some not engaging with international organisations and initiatives aimed at ensuring wide, equitable access.…”

Section: Chi Research Has High Social Valuementioning

confidence: 99%

Controlled human infection with SARS-CoV-2 to study COVID-19 vaccines and treatments: bioethics in Utopia

Holm

2020

J Med Ethics

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A number of papers have appeared recently arguing for the conclusion that it is ethically acceptable to infect healthy volunteers with severe acute respiratory syndrome coronavirus 2 as part of research projects aimed at developing COVID-19 vaccines or treatments. This position has also been endorsed in a statement by a working group for the WHO. The papers generally argue that controlled human infection (CHI) is ethically acceptable if (1) the risks to participants are low and therefore acceptable, (2) the scientific quality of the research is high, (3) the research has high social value, (4) participants give full informed consent, and (5) there is fair selection of participants. All five conditions are necessary premises in the overall argument that such research is ethically acceptable. The arguments concerning risk and informed consent have already been critically discussed in the literature. This paper therefore looks specifically at the arguments relating to condition 3 ‘high social value’ and condition 5 ‘fair selection of participants’ and shows that whereas they may be valid, they are not sound. It is highly unlikely that the conditions that are necessary for ethical CHI trials to take place will be fulfilled. Most, if not all, CHI trials will thus be well intentioned but unethical.

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“…Still, the study confirms that by enabling broader representation and perspectives at the national level, the complexity of access becomes apparent, with its priorities, trade-offs, network of global, regional and national stakeholders. This complex system approach is echoed by Ozawa et al (2019) . However, the question remains how this can be best managed.…”

Section: Discussionmentioning

confidence: 99%

The role of government agencies and other actors in influencing access to medicines in three East African countries

Odoch

Dambisya

Peacocke

et al. 2021

Health Policy and Planning

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The WHO Model List of Essential Medicines (MLEM) has since 1977 helped prioritize and ensure availability of medicines especially in low- and middle-income countries. The MLEM consists mainly of generic medicines, though recent trends point towards listing expensive on-patent medicines and increasing global support for medicines against non-communicable diseases. However, the implications of such changes for national essential medicines list (NEML) updates for access to essential medicines has received relatively little attention. This study examined how government agencies and other actors in Kenya, Uganda and Tanzania participate in and influence the NEML update process and subsequent availability of prioritized medicines; and the alignment of these processes to WHO guidance. A mixed study design was used, with qualitative documentary review, key informant interviews and thematic data analysis. Results show that NEML updating processes were similar amongst the three countries and aligned to WHO guidelines, albeit conducted irregularly, with tendency to reprioritization during procurement stages, and were not always accompanied by revision of clinical guidelines. Variations were noted in the inclusion of medicines against cancer and hepatitis C, and the utilization of health technology assessment (HTA). For medicines against diseases with high global engagement, such as HIV/AIDS and TB, national stakeholders had more limited inputs in prioritization and funding. Furthermore, national actors were not influenced by the pharmaceutical industry during the NEML update process, nor were any conflicting agendas identified between health, trade and industrial policies. Hence, the study suggests that more attention should be paid to the combination of HTAs and NEMLs, particularly as countries work towards universal health coverage, in addition to heightened awareness of how global disease-specific initiatives may confound national implementation of the NEML. The study concludes with a call to strengthen country-level policy and procedural coherence around the process of prioritizing and ensuring availability of essential medicines.

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Access to medicines through health systems in low- and middle-income countries

Cited by 80 publications

References 10 publications

The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

The impact of COVID-19 on the care of people living with noncommunicable diseases in low- and middle-income countries: an online survey of physicians and pharmacists in nine countries

Controlled human infection with SARS-CoV-2 to study COVID-19 vaccines and treatments: bioethics in Utopia

The role of government agencies and other actors in influencing access to medicines in three East African countries

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