Drugs in developing countries: inching towards rational policies.

Richards, Tessa

doi:10.1136/bmj.292.6532.1347

Cited by 6 publications

(3 citation statements)

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“…This finding may be in line with other authors (Laing 1991; Mallet et al. 2001; Levison & Laing 2003) who found that prices of medicines in most SSA countries are well above their production costs (Richards 1986; Richard 2004; Ewen & Dey 2007) and that the profits of those in the distribution chain (pharmacists, dispensing doctors, wholesalers and even some governments) are frequently high. The UN report (United Nations 2008) estimates that in the public sector, generic medicines cost on average 250% more than the international reference price and in the private sector, those same medicines cost on average about 650% more than the international reference price.…”

Section: Discussionsupporting

confidence: 89%

Prices of antihypertensive medicines in sub-Saharan Africa and alignment to WHO’s model list of essential medicines

Twagirumukiza

Annemans

Kips

et al. 2010

Tropical Medicine &Amp; International Health

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Summaryobjective To investigate compliance of National Essential Medicines Lists (NEMLs) with the WHO Essential Medicines List (WHO ⁄ EML) in 2007 and to compare prices of antihypertensive drugs in and between 13 sub-Saharan African countries.methodology Data on NEMLs and drug prices were collected from 65 public and 65 private pharmacies (five of each per country). Prices were compared with the International Drug Price Indicator Guide (IDPIG). The cost of drug treatment within a country was calculated using defined daily doses (DDD) and between countries using DDD prices adjusted for purchasing power parity-based gross domestic product per capita.results All surveyed countries had a NEML. However, none of these lists were in complete alignment with the 2007 WHO ⁄ EML, and 38% had not been updated in the last 5 years. Surveyed medicines were cheaper when on the NEMLs; they were also cheaper in public than in private pharmacies. Prices varied greatly per medicine. A large majority of the public prices were higher than those indicated by the IDPIG. Overall, hydrochlorothiazide is the cheapest drug.conclusion There are substantial differences in NEML composition between the 13 countries. The proportion of NEMLs not regularly updated was double the global United Nations estimates. Prices of WHO ⁄ EML-advised drugs differ greatly between drugs and for each drug within and between countries. In general, the use of drugs on the NEML improves financial accessibility, and these drugs should be prescribed preferentially.

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Section: Discussionsupporting

confidence: 89%

Prices of antihypertensive medicines in sub-Saharan Africa and alignment to WHO’s model list of essential medicines

Twagirumukiza

Annemans

Kips

et al. 2010

Tropical Medicine &Amp; International Health

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“…In recent years the WHO has become more active in prescribing policy. A meeting on the rational use of drugs was held in Nairobi in 1985 Richards, 1986). The 100 experts at the meetingdrawn from governments, drug regulatory authorities, from the pharmaceutical industry, and other organisations-invited the WHO to take a leadership role to influence government policy (although without becoming "a supranational manipulator of governments").…”

Section: The Choice Of Anticonvulsant Drugs and Who Initiativesmentioning

confidence: 99%

“…Second, they should set up effective national regulatory authorities. Third, efforts should be made to ensure that drug promotion is ethical and that the education of health workers is improved (see Richards, 1986). The second report of the WHO expert committee (1985) on the use of essential drugs recommended that the antiepileptic drugs in the essential drugs list should consist of diazepam, ethosuximide, phenobarbital, and phenytoin, and that carbamazepine and valproate be included "when the drugs in the main list are known to be ineffective or inappropriate for a given individual, or for use in rare disorders or in exceptional circumstances" (WHO, 1985).…”

Section: The Choice Of Anticonvulsant Drugs and Who Initiativesmentioning

confidence: 99%

Epilepsy in Developing Countries: A Review of Epidemiological, Sociocultural, and Treatment Aspects

1988

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In this report, aspects of epilepsy that differ in developing and in developed countries are reviewed. This is inevitably an incomplete and impressionistic survey, because data on many aspects in developing countries are scarce, and because it is difficult to generalise meaningfully about the enormous diversity of countries and populations that make up the developing world. Epidemiological studies of prevalence and incidence are reviewed with an emphasis on the problems inherent in work in this area in developing countries. Data concerning seizure type, aetiology, and severity of seizures in the Third World are contrasted with those from developed countries. Sociocultural aspects of epilepsy have been poorly studied, and yet are fundamental to effective medical management. The social effects of epilepsy and the local perceptions of cause and of treatment are discussed from work in Africa, Asia, and South America. The principles and success of treatment in the Third World may differ considerably in developing and developed countries. In the Third World, medical manpower is scarce, and epilepsy is managed essentially by primary care resources, without specialised investigations or personnel. The principles of drug therapy may not be understood by patients, and the supply of drugs is often erratic; and these are major reasons for poor compliance with treatment. World Health Organisation (WHO) initiatives have stressed the extensive use of paramedical personnel and of an essential drugs list, but this emphasis may be misdirected, and in practice neither proposal has achieved much success. The recommendation that phenobarbital be extensively used in the Third World, because of its cheapness and efficacy, is also of doubtful merit, as there are well-known and major drawbacks to the widespread use of this drug. Computations of treatment gap figures in three developing countries suggest that between 80-94% of patients with active epilepsy are not receiving anticonvulsant therapy, and cost is only one of a number of reasons for this. The key to improvements in medical treatment lie with a better understanding of the patients' cultural concepts of epilepsy and its treatment, improved drug supply and availability, and efforts to improve education amongst general practitioners and other primary care medical personnel.

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Pharmaceuticals and developing countries: problems and prospects

Jayasuriya

1991

Pharmaceutisch Weekblad Scientific Edition

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Drugs in developing countries: inching towards rational policies.

Cited by 6 publications

References 1 publication

Prices of antihypertensive medicines in sub-Saharan Africa and alignment to WHO’s model list of essential medicines

Prices of antihypertensive medicines in sub-Saharan Africa and alignment to WHO’s model list of essential medicines

Epilepsy in Developing Countries: A Review of Epidemiological, Sociocultural, and Treatment Aspects

Pharmaceuticals and developing countries: problems and prospects

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