Rationing hepatitis C treatment in the context of austerity policies in France and Cameroon: A transnational perspective on the pharmaceuticalization of healthcare systems

Abstract

New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity.

Screening, diagnosis and care cascade for viral hepatitis B and C in Yaoundé, Cameroon: a qualitative study of patients and health providers coping with uncertainty and unbearable costs

“…Our study corroborates the results of other studies in sub-Saharan Africa pointing to serious patient destabilisation associated with HBV diagnosis, inability to pay for medical care and feelings of injustice 11. However, the impact of HBV and HCV on life trajectories have rarely been documented in qualitative studies, which mainly focus on patients’ representations and experiences of HBV infection,11 on obstacles to linkage to care after diagnosis of HBV12 and on access to HCV treatment 10. In line with studies on linkage to care,4 12 we identified large barriers for patients diagnosed with HBV or HCV, mainly at the structural level, including (i) a lack of adequate training of HCP which resulted in frequent misconceptions about transmission, natural history and diagnosis, (ii) a lack of simple, reliable and low-cost diagnostic tests and (iii) a lack of funding allocated to the fight against hepatitis, which resulted in unaffordable user fees for prevention, care and treatment.…”

“…Despite the complex challenges to sub-Saharan HCP, patients and health systems mentioned above, most of these challenges remain dramatically understudied. Comprehensive assessments of the circumstances and experiences of patients and HCP in terms of diagnosis, counselling and care for both diseases are sparse,10–12 especially in countries with poor access to related medical care. In this study, we aimed to document circumstances and perceptions surrounding HBV and HCV screening and counselling, and experiences with regard to access to care and treatment, and the impact these infections have on social and economic trajectories of patients in Yaoundé, the capital city of Cameroon.…”

Politics as an Explanation to the Health Divide in Different Settings: A Comparative Study of England and Ghana

“…Although considerable research has been conducted on politics and health in England to explain how politics is implicated in north-south health inequalities in England, 4 a paucity of research remains on politics and health in Ghana. The approach and rationale adopted in our review is similar to Chabrol et al, 92 who use France and Cameroon to demonstrate the "pharmaceuticalization of health systems" in the context of austerity policies. Such comparisons of distinct settings are useful, as they show the specific contextually situated and historically relevant factors necessary for responding to the challenge of health inequities in different parts of the world.…”

Dr. Ram’s triage

“…Furthermore, global health hierarchically organizes disease categories by their urgency for human economic and physical vitality at a global scale (World Bank 1993). This categorization and prioritization is triage, and though triage in Europe and North America is largely confined to emergency care, austerity policies propagate forms of triage also in nonemergency settings in medical systems there, too (Kentikelenis 2015;Chabrol, David, and Krikorian 2017).…”