When the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was annexed to the Agreement Establishing the World Trade Organisation (WTO) in 1994, it set minimum standards for intellectual property (IP) protection, including protection of patent rights, that must be observed and enforced by all WTO Member States. On the one hand, stringent Intellectual Property protection as seen innovation in the field of science where medical innovation hasled to the creation of live saving vaccines which have reduced prevalence of diseases, ranging from polio to the human Papillomavirus, and invention of antiretroviral medicines which have greatly improved the lives of people living with the Huma Immunodeficiency Virus (HIV). On the other hand, the fulfilment of the obligations under TRIPS has generated a lot of controversy especially as they have been seen as the cause of reduced access to essential medicines in developing countries. / Magister Legum - LLM (Mercantile and Labour Law)

O aumento do consumo de medicamentos pela população idosa brasileira e mundial no século XXI, somado ao envelhecimento populacional e relevante transição epidemiológica, apontam para a necessidade de mais estudos epidemiológicos por serem úteis ao planejamento de intervenções em saúde no âmbito coletivo. Os Estudos de Utilização de Medicamentos representam uma importante estratégia nesse sentido, por permitir a obtenção de informações sobre padrões de prescrição e uso de medicamentos, representando, desta forma, etapa de grande importância das investigações epidemiológicas. Este estudo visa estimar a prevalência e caracterizar o perfil de utilização de medicamentos na população idosa atendida pelas farmácias básicas do município de Uberaba-MG, bem como identificar os fatores mais implicados no acesso a esses medicamentos. Tratou-se de um estudo transversal, pelo qual uma amostra casual de 384 usuários de medicamentos foi entrevistada após a retirada seus medicamentos nas farmácias básicas municipais, entre março e julho de 2015, sendo utilizado um instrumento de coleta de dados, previamente padronizado e aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (CEP-FCFRP-USP). O pesquisador coletou informações sociodemográficas e relativas à saúde dos indivíduos, fotocopiou as prescrições, perguntou sobre o acesso aos medicamentos, e aplicou os testes de Batalla (TB), Med-Take (MT), Morisky-Green (MG) e o Índice da Complexidade da Farmacoterapia (ICFT). A idade média foi de 68,8 anos, sendo 70,0% do sexo feminino, renda per capita média de R$ 862,7, com predomínio de pardos (44,0%), casados (58%), com ensino fundamental incompleto (43,15%); a morbidade de maior prevalência foi a Hipertensão Arterial Sistêmica (71,95%). Dos 384 participantes, 95 (24,7%) afirmaram não recorrer à farmácia básica mais próxima de sua residência e as principais justificativas foram: fácil acesso devido às linhas de ônibus (40%) e consulta na unidade (31,6%). O perfil farmacoepidemiológico apresentou um intervalo de um a dez fármacos utilizados por paciente, com média de três fármacos/paciente; a maior prevalência foi dos medicamentos do aparelho cardiovascular (40,9%); 55,5% realizam automedicação. Conhecimento satisfatório sobre a farmacoterapia foi observado em 49,7% dos participantes; os resultados dos testes TB e MG foram de 13% e 57% de aderentes à farmacoterapia, respectivamente, não havendo correlação linear entre os resultados destes testes. O valor médio do ICFT foi de 7,3, sendo que 32,8% dos participantes possuíam terapias de alta complexidade; este índice apresentou correlação linear negativa em relação ao teste MT. A polifarmácia (uso de seis ou mais princípios ativos) esteve presente em 25,5% dos idosos, a qual não apresentou associação estatística com as variáveis sexo, estado civil, idade, renda per capita e escolaridade. 570 interações medicamentosas potenciais foram verificadas, estando 47,4% dos participantes sujeitos a pelo menos uma interação; 54,7% utilizam medicamentos considerados inapropriados ao idoso. Tais evidências reforçam a necessidade da adoção de estratégias a fim de melhorar a farmacoterapia e a assistência prestada à saúde do paciente idoso. / The increased consumption of medicines by Brazilian elderly population and world in the twenty-first century, coupled with the aging population and relevant epidemiological transition point to the need for more epidemiological studies to be useful to health interventions planning in a community basis. The Drug Use Studies represent an important strategy accordingly, to allow obtaining information on patterns of prescription and use of drugs, representing thus step of great importance of epidemiological investigations. This study aims to estimate the prevalence and characterize the profile of use of drugs in the elderly population served by basic pharmacies in the city of Uberaba-MG, and identify more factors involved in access to these drugs. It was a cross-sectional study, whereby a random sample of 384 users of drugs was interviewed after that it was withdrawing its medicines on the basic pharmacies in the city, between March and July 2015, using a previously standardized and approved data collection instrument by Ethics Committee in Research of the Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (CEP-FCFRP-USP). The researcher collected socio-demographic and health information from individuals, photocopied the prescriptions, asked about access to medicines, and applied the tests of Batalla (TB), Med-Take (MT), Morisky-Green (MG) and the Complexity Index of the Pharmacotherapy (ICFT). The average age was 68.8 years, 70.0% female, average per capita income of R$ 862.7, with a predominance of browns (44.0%), married (58%), with education incomplete elementary (43.15%); the most prevalent morbidity was Arterial Hypertension (71,95%). Of the 384 participants, 95 (24.7%) said they did not resort to basic pharmacy closest to your residence and the main reasons were: easy access due to bus lines (40%) and in consultation Unit (31.6%). The pharmacoepidemiological profile presented a range of one to ten drugs used per patient with average of three drugs/patient; the highest prevalence was among the drugs of the cardiovascular system (40.9%); 55.5% performed self-medication. Satisfactory knowledge on pharmacotherapy was observed in 49.7% of participants; the results of the TB and MG tests were 13% and 57% adherent to the pharmacotherapy, respectively, and there was no linear correlation between the results of these tests. The mean value of ICFT was 7.3, with 32.8% of participants having high complexity; this index presented a negative linear correlation in relation to the MT test. Polypharmacy (use of six or more active principles) was present in 25.5% of the elderly, which did not present statistic association with the variables gender, marital status, age, per capita income and schooling. 570 potential drug interactions were verified, with 47.4% of participants being subject to at least one interaction; 54.7% use drugs considered inappropriate to the elderly. Such evidences reinforce the need to adopt strategies to improve pharmacotherapy and health care for elderly patients.

Made available in DSpace on 2014-06-11T19:24:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-09-04Bitstream added on 2014-06-13T18:52:03Z : No. of bitstreams: 1 carrazza_lc_me_arafcl.pdf: 676852 bytes, checksum: 079c044190870ccb56c82e8ef9eebc47 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O presente trabalho procura investigar inicialmente a questão das patentes, enfatizando a construção do marco regulatório internacional sobre o tema e o debate sobre o patenteamento de medicamentos. Busca-se em seguida caminhar na direção da discussão do licenciamento compulsório de medicamentos como instrumento fundamental de proteção à saúde pública nos países em desenvolvimento (PEDs), procurando tanto explicitar sua inserção no marco regulatório internacional como averiguar sua efetiva utilização. Para tanto, analisar-se-á o tema a partir da inserção da proteção aos direitos de propriedade intelectual nas regras multilaterais de comércio, através do Acordo Trade-Related Aspects of Intellectual Property Rights (TRIPS), de 1995, no âmbito da Organização Mundial do Comércio, no qual todos os países-membros da OMC teriam que reconhecer patentes em todos os campos tecnológicos, inclusive para produtos e processos farmacêuticos. Foi possível observar que, à luz desse novo marco regulatório internacional, os interesses das grandes companhias farmacêuticas e dos países desenvolvidos (notadamente os Estados Unidos da América) – que buscam por meio do monopólio via patentes elevar os retornos econômicos dos investimentos em P&D e limitar a eventual concorrência dos países em desenvolvimento – se contrapõem aos interesses das organizações de defesa dos direitos humanos e dos PEDs, que buscam garantir que medicamentos essenciais estejam disponíveis a preços acessíveis, de modo a permitir a sustentabilidade de programas sociais relacionados à saúde pública. A partir dessa constatação, e considerando a crise global da AIDS e a Declaração de Doha sobre o Acordo TRIPS e a Saúde Pública, de 2001 – que reforçou a importância da licença compulsória - o trabalho se volta para as experiências dos PEDs, especialmente o Brasil, que concederam... / This paper aims initially to investigate the issue of patents emphasizing the construction of the international regulatory framework on the topic, and to debate on the patenting of medicines. From this point, it addresses the discussion of compulsory licensing of patented medicines as a fundamental instrument of public health protection in developing countries, seeking to explicit its inclusion in the international regulatory framework as well as ascertaining its effective usage. Therefore, it will examine the issue from the insertion of the intellectual property rights in the multilateral trade rules through the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement in 1995 of the World Trade Organization, in which all WTO members would have to recognize patents in all technological fields, including pharmaceutical products and processes. It was possible to observe, according to the new international regulatory framework, that the interests of the large pharmaceutical industry (known as big pharma) and developed countries (notably the United States of America) – which seek by patent monopoly to raise the economic returns of investment in R & D and to limit competition from developing countries – oppose the interests of human rights organizations and developing countries, which seek to ensure that essential drugs are available at affordable prices, in order to make sustainable public health policies. After this, and considering the AIDS global crisis and the Doha Declaration on the TRIPS Agreement and Public Health (2001), which emphasized the importance of compulsory license - the paper turns to the experiences of developing countries, especially Brazil, which granted compulsory licensing for access to medicines, mostly antiretroviral. It was possible to conclude that despite the effectiveness results obtained of the usage of compulsory licensing by developing... (Complete abstract click electronic access below)

Orientador: Benedito Rodrigues de Moraes Neto / Banca: Luciana Togeiro de Almeida / Banca: Lia Hasenclever / Resumo: O presente trabalho procura investigar inicialmente a questão das patentes, enfatizando a construção do marco regulatório internacional sobre o tema e o debate sobre o patenteamento de medicamentos. Busca-se em seguida caminhar na direção da discussão do licenciamento compulsório de medicamentos como instrumento fundamental de proteção à saúde pública nos países em desenvolvimento (PEDs), procurando tanto explicitar sua inserção no marco regulatório internacional como averiguar sua efetiva utilização. Para tanto, analisar-se-á o tema a partir da inserção da proteção aos direitos de propriedade intelectual nas regras multilaterais de comércio, através do Acordo Trade-Related Aspects of Intellectual Property Rights (TRIPS), de 1995, no âmbito da Organização Mundial do Comércio, no qual todos os países-membros da OMC teriam que reconhecer patentes em todos os campos tecnológicos, inclusive para produtos e processos farmacêuticos. Foi possível observar que, à luz desse novo marco regulatório internacional, os interesses das grandes companhias farmacêuticas e dos países desenvolvidos (notadamente os Estados Unidos da América) - que buscam por meio do monopólio via patentes elevar os retornos econômicos dos investimentos em P&D e limitar a eventual concorrência dos países em desenvolvimento - se contrapõem aos interesses das organizações de defesa dos direitos humanos e dos PEDs, que buscam garantir que medicamentos essenciais estejam disponíveis a preços acessíveis, de modo a permitir a sustentabilidade de programas sociais relacionados à saúde pública. A partir dessa constatação, e considerando a crise global da AIDS e a Declaração de Doha sobre o Acordo TRIPS e a Saúde Pública, de 2001 - que reforçou a importância da licença compulsória - o trabalho se volta para as experiências dos PEDs, especialmente o Brasil, que concederam... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This paper aims initially to investigate the issue of patents emphasizing the construction of the international regulatory framework on the topic, and to debate on the patenting of medicines. From this point, it addresses the discussion of compulsory licensing of patented medicines as a fundamental instrument of public health protection in developing countries, seeking to explicit its inclusion in the international regulatory framework as well as ascertaining its effective usage. Therefore, it will examine the issue from the insertion of the intellectual property rights in the multilateral trade rules through the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement in 1995 of the World Trade Organization, in which all WTO members would have to recognize patents in all technological fields, including pharmaceutical products and processes. It was possible to observe, according to the new international regulatory framework, that the interests of the large pharmaceutical industry (known as big pharma) and developed countries (notably the United States of America) - which seek by patent monopoly to raise the economic returns of investment in R & D and to limit competition from developing countries - oppose the interests of human rights organizations and developing countries, which seek to ensure that essential drugs are available at affordable prices, in order to make sustainable public health policies. After this, and considering the AIDS global crisis and the Doha Declaration on the TRIPS Agreement and Public Health (2001), which emphasized the importance of compulsory license - the paper turns to the experiences of developing countries, especially Brazil, which granted compulsory licensing for access to medicines, mostly antiretroviral. It was possible to conclude that despite the effectiveness results obtained of the usage of compulsory licensing by developing... (Complete abstract click electronic access below) / Mestre

O aumento do consumo de medicamentos pela população idosa brasileira e mundial no século XXI, somado ao envelhecimento populacional e relevante transição epidemiológica, apontam para a necessidade de mais estudos epidemiológicos por serem úteis ao planejamento de intervenções em saúde no âmbito coletivo. Os Estudos de Utilização de Medicamentos representam uma importante estratégia nesse sentido, por permitir a obtenção de informações sobre padrões de prescrição e uso de medicamentos, representando, desta forma, etapa de grande importância das investigações epidemiológicas. Este estudo visa estimar a prevalência e caracterizar o perfil de utilização de medicamentos na população idosa atendida pelas farmácias básicas do município de Uberaba-MG, bem como identificar os fatores mais implicados no acesso a esses medicamentos. Tratou-se de um estudo transversal, pelo qual uma amostra casual de 384 usuários de medicamentos foi entrevistada após a retirada seus medicamentos nas farmácias básicas municipais, entre março e julho de 2015, sendo utilizado um instrumento de coleta de dados, previamente padronizado e aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (CEP-FCFRP-USP). O pesquisador coletou informações sociodemográficas e relativas à saúde dos indivíduos, fotocopiou as prescrições, perguntou sobre o acesso aos medicamentos, e aplicou os testes de Batalla (TB), Med-Take (MT), Morisky-Green (MG) e o Índice da Complexidade da Farmacoterapia (ICFT). A idade média foi de 68,8 anos, sendo 70,0% do sexo feminino, renda per capita média de R$ 862,7, com predomínio de pardos (44,0%), casados (58%), com ensino fundamental incompleto (43,15%); a morbidade de maior prevalência foi a Hipertensão Arterial Sistêmica (71,95%). Dos 384 participantes, 95 (24,7%) afirmaram não recorrer à farmácia básica mais próxima de sua residência e as principais justificativas foram: fácil acesso devido às linhas de ônibus (40%) e consulta na unidade (31,6%). O perfil farmacoepidemiológico apresentou um intervalo de um a dez fármacos utilizados por paciente, com média de três fármacos/paciente; a maior prevalência foi dos medicamentos do aparelho cardiovascular (40,9%); 55,5% realizam automedicação. Conhecimento satisfatório sobre a farmacoterapia foi observado em 49,7% dos participantes; os resultados dos testes TB e MG foram de 13% e 57% de aderentes à farmacoterapia, respectivamente, não havendo correlação linear entre os resultados destes testes. O valor médio do ICFT foi de 7,3, sendo que 32,8% dos participantes possuíam terapias de alta complexidade; este índice apresentou correlação linear negativa em relação ao teste MT. A polifarmácia (uso de seis ou mais princípios ativos) esteve presente em 25,5% dos idosos, a qual não apresentou associação estatística com as variáveis sexo, estado civil, idade, renda per capita e escolaridade. 570 interações medicamentosas potenciais foram verificadas, estando 47,4% dos participantes sujeitos a pelo menos uma interação; 54,7% utilizam medicamentos considerados inapropriados ao idoso. Tais evidências reforçam a necessidade da adoção de estratégias a fim de melhorar a farmacoterapia e a assistência prestada à saúde do paciente idoso. / The increased consumption of medicines by Brazilian elderly population and world in the twenty-first century, coupled with the aging population and relevant epidemiological transition point to the need for more epidemiological studies to be useful to health interventions planning in a community basis. The Drug Use Studies represent an important strategy accordingly, to allow obtaining information on patterns of prescription and use of drugs, representing thus step of great importance of epidemiological investigations. This study aims to estimate the prevalence and characterize the profile of use of drugs in the elderly population served by basic pharmacies in the city of Uberaba-MG, and identify more factors involved in access to these drugs. It was a cross-sectional study, whereby a random sample of 384 users of drugs was interviewed after that it was withdrawing its medicines on the basic pharmacies in the city, between March and July 2015, using a previously standardized and approved data collection instrument by Ethics Committee in Research of the Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (CEP-FCFRP-USP). The researcher collected socio-demographic and health information from individuals, photocopied the prescriptions, asked about access to medicines, and applied the tests of Batalla (TB), Med-Take (MT), Morisky-Green (MG) and the Complexity Index of the Pharmacotherapy (ICFT). The average age was 68.8 years, 70.0% female, average per capita income of R$ 862.7, with a predominance of browns (44.0%), married (58%), with education incomplete elementary (43.15%); the most prevalent morbidity was Arterial Hypertension (71,95%). Of the 384 participants, 95 (24.7%) said they did not resort to basic pharmacy closest to your residence and the main reasons were: easy access due to bus lines (40%) and in consultation Unit (31.6%). The pharmacoepidemiological profile presented a range of one to ten drugs used per patient with average of three drugs/patient; the highest prevalence was among the drugs of the cardiovascular system (40.9%); 55.5% performed self-medication. Satisfactory knowledge on pharmacotherapy was observed in 49.7% of participants; the results of the TB and MG tests were 13% and 57% adherent to the pharmacotherapy, respectively, and there was no linear correlation between the results of these tests. The mean value of ICFT was 7.3, with 32.8% of participants having high complexity; this index presented a negative linear correlation in relation to the MT test. Polypharmacy (use of six or more active principles) was present in 25.5% of the elderly, which did not present statistic association with the variables gender, marital status, age, per capita income and schooling. 570 potential drug interactions were verified, with 47.4% of participants being subject to at least one interaction; 54.7% use drugs considered inappropriate to the elderly. Such evidences reinforce the need to adopt strategies to improve pharmacotherapy and health care for elderly patients.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-20T17:05:56Z No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / Made available in DSpace on 2017-03-20T17:05:56Z (GMT). No. of bitstreams: 1 Hofer, Ana Paula Barroso [Dissertação, 2015].pdf: 1799140 bytes, checksum: 36e28677babd928285b73b45ed328c2e (MD5) / A lista de medicamentos essenciais é um instrumento de orientação das condutas clínicas e administrativas para medicamentos em determinada organização. Uma lista com medicamentos adequadamente selecionados favorece a sua utilização racional e os demais processos da assistência farmacêutica; sendo a adesão dos médicos prescritores às listas um indicador de sua qualidade. O objetivo do trabalho foi avaliar a adesão dos prescritores à lista de padronização de medicamentos de um hospital terciário do Estado do Rio de Janeiro, através da aplicação de um questionário aos prescritores, além da avaliação de prescrições médicas. O modelo de investigação se caracterizou como descritivo com delineamento transversal, sendo analisadas 1108 prescrições dos pacientes internados e aplicados 31 questionários aos médicos prescritores do hospital de estudo. Foram verificadas características das prescrições médicas e dos prescritores, além de condutas diante dos fatores relacionados à adesão à lista de padronização de medicamentos da instituição. A incidência de medicamentos não padronizados solicitados foi conferida e classificada de acordo com a Anatomical Therapeutic Chemical Classification (ATC) e quanto ao grau de recomendação para utilização em suas principais indicações. O indicador de prescrição médica proposto pela OMS referente à porcentagem de medicamentos prescritos que pertencem à lista de medicamentos essenciais (lista de medicamentos padronizados pela instituição) foi determinado, resultando no valor de 98,25%, referente à taxa de adesão dos prescritores à lista. Entre os medicamentos prescritos ou solicitados não incluídos na lista, aproximadamente 30% fazem parte da classe do sistema cardiovascular, sendo a valsartana, o mais frequente. Os resultados obtidos através da análise das prescrições médicas demonstraram que a adesão à lista ocorre de maneira expressiva, entretanto, foi verificado pelos questionários aplicados que uma grande parte dos médicos desconhece a lista. Desta maneira, a adesão à lista pode ser proveniente do fato do medicamento estar disponível para prescrever, ou ainda, pela grande variedade de itens presentes na lista. Esse desconhecimento da lista de medicamentos por parte dos prescritores parece compartilhado por outras instituições no país, devido a outros hábitos de prescrição, preconceito ou eventualmente pela falta de compromisso dos profissionais / The list of essential drugs is a policy instrument of clinical and administrative managements for drugs in a given organization. A list of properly selected medicines promotes the rational use of them, as well as organizes other pharmaceutical assistance processes. The adherence of prescribers to the lists is an indicator of its quality. The objective of this study was to evaluate the adherence of prescribing the medicine standardization list of a tertiary hospital in the state of Rio de Janeiro, through the analysis of a questionnaire to the prescribers. We also evaluated if the medical prescriptions are compliant with the list of properly selected medicines. It is a descriptive cross-sectional study. We analyzed 1108 prescriptions of patients admitted and applied the questionnaire to 31 medical doctors of the hospital. Were recorded characteristics of medical prescriptions and prescribers factors possibly related to the adherence to the list of properly selected medicines. It was given the incidence of non-standardized medications ordered, classifying them according to the Anatomical Therapeutic Chemical Classification (ATC) and the degree of recommendation for use in its main indications. The indicator, proposed by the WHO, i.e.; the percentage of prescription drugs that belong to the list of medicines essential (list of standardized medicines by the institution) was determined, 98.25% were adherent to the list. Among the medications prescribed or ordered not included in the list, about 30% are part of the cardiovascular system class, and valsartan, the most frequent. The results obtained by analyzing medical prescriptions showed that joining the list occurs more significantly, however, through the questionnaire to the prescribers, we verified that part of them is unaware of the list. Consequently, the adherence to the list is due to the several items available to the prescribers, even if they do not know its existence. The lack of knowledge of the list of drugs by prescribers is observed in other institutions in the country, we believe it was observed due to ancient prescription habits, prejudice or eventually by the lack of commitment of the professionals

Magister Public Health - MPH / Background: A growing concern about possible age-related inequities in health care access has emerged in the increasing debate on the challenges of population ageing and health in sub-Saharan Africa. Older persons may experience systematic exclusion from health services. Viewed as one of the poorest, most marginalized groups in SSA societies, older people are deemed to lack access to even basic, adequate health care. There is an assumption, furthermore, that older persons have less access to required health services than do younger age-groups. This suggests an element of age-related inequity. One possible indicator of age-related inequity may be found through measuring the relative availability of essential medicines for chronic non-communicable diseases (NCD), relative to the availability of medicines for communicable diseases (CD). Aim and objectives: The aim of the study was to compare the availability of essential medicines for NCD and CD in Kenya, as an indicator of age-related inequities in access to health care in Kenya. The three study objectives were as follows, in public and mission facilities in Kenya: 1. To assess the availability of medicines for the following CD: diarrhoea, HIV, malaria, pneumonia and other infections 2. To assess the availability of medicines for the following NCD common in older populations: arthritis, diabetes, glaucoma, gout, heart disease, hypertension and Parkinson’s disease 3. To compare the availability of medicines for CD and NCD and draw conclusions on possible age-related inequities in access. Study design: Using an adapted version of the HAI / WHO methodology, a cross sectional descriptive survey of medicines availability was conducted. HAI and WHO collaboratively developed a standardized and validated methodology for comprehensively measuring medicines availability, as well as prices, affordability and price components. The survey manual, launched in 2003 and revised in 2008, is available to the public. The methodology involves collecting data on the availability and price of medicines found in a sample of health facilities across sectors of interest within national health systems. If the specific medicine, dose and form being surveyed is available on the day of the survey, then the medicine is documented as being available. Methods: Random sampling was carried out in six of Kenya’s eight provinces, targetting ten facilities per province. Data on availability of the targeted medicines was collected by trained data collectors on pilot-tested data collection forms adapted from the standardized WHO / HAI methodology. The list of medicines included sixteen for communicable diseases to treat infections such as diarrhoea, HIV, malaria, and pneumonia and twelve medicines used to treat non-communicable diseases such as diabetes, arthritis, hypertension, gout, glaucoma, stroke and Parkinson’s disease. Availability of medicines was noted by physical observation by a data collector, and calculated as the percentage of facilities where a medicine was found on the day of data collection. The availability of brands and generics was not distinguished and were combined to establish availability of each medicine. Overall availability of all CD and NCD medicines was compared, and within each category between rural and urban areas and between mission and public facilities. The Ministry of Health was informed of the survey and provided the data collectors with an MOH endorsement letter. The names of facilities participating in the study were recorded on the data collection forms, but not reported. No data on individual patients was collected, and no patients were interviewed for this survey. Data were entered into an Excel file and exported to and analyzed with SPSS. Results: A total of 56 facilities were surveyed: 49 in the public sector and 7 in the mission sector, giving a facility response rate of 93%. Thirty facilities were located in rural settings and 26 were in urban settings. More CD medicines were available than medicines for NCD. Of a total of 896 individual observations of CD medicines, 632 (70.5%) were recorded as available on the day of visit, compared to 306 (45.5%) of 672 possible individual observations of NCD medicines. These differences were highly significant statistically (chi-square=98.8, p<0.001). Furthermore, comparison of availability between urban and rural areas showed statistically significant differences for NCD medicines (40.6% vs. 51.3%, p=0.007), but not CD medicines (72.5% vs. 68.3%, p=0.190). There were no significant differences in availability of medicines in mission compared to public facilities. Conclusions: This study reveals the low relative availability of medicines for NCDs in Kenya’s public and mission sector. Medicines for NCDs were less available in rural vs. urban facilities, but there was no rural vs. urban difference in medicines for CDs. While more research should be carried out to understand the reasons behind these findings, immediate attention to the supply and financing of medicines for NCDs is urgently needed. The relatively lower availability of medicines for NCDs than for CDs may be an indicator of age-related inequities in access to health care in Kenya and calls for more investigations on equity and access to health for older people in Kenya.

Master of Public Health - MPH / The World Health Organisation estimates that more than 50% of medicines are inappropriately used globally. The situation is worst in developing countries such as Nigeria, where irrational prescribing practices account for wastage of resources, catastrophic medicines costs and poor access to health services. In 2005, the Social Health Insurance Programme was launched as a financially sustainable model to achieve cost effective and affordable health care services including medicines. This study investigated prescribing practices and availability of medicines in the Social Health Insurance Programme in accredited public sector secondary hospitals in the Federal Capital Territory, Nigeria.Methodology:The study is a descriptive, cross-sectional and retrospective survey of prescriptions of insured outpatients in the Federal Capital Territory, Nigeria. Four hospitals were selected by stratification of thirteen (13) public secondary hospitals in the territory into urban/peri-urban areas, followed by random selection of two hospitals from each stratum.A total of seven hundred and twenty (720) retrospective prescription encounters of insured outpatients were systematically selected from encounters between July 2009 and June 2010 at the selected facilities. Data on prescribing practices and the extent to which prescribed medicines were provided were assessed with the use of modified WHO/INRUD indicators. Descriptive statistics were generated with Epi-info (version 3.4.3) and SPSS (version 17.0)Results: Out of the seven hundred and twenty (720) prescriptions that were assessed analgesics/NSAID, antibiotics, antimalarials and haematinics/vitamins collectively accounted for 67.4% of the medicines prescribed.A comparison of the results with WHO/Derived reference values showed that average number of medicines prescribed per prescription (3.5 ±1, p<0.001) and the rate of antibiotic prescribing (53.7%, p=0.009) were higher than the WHO recommended ranges of (1.6-1.8) and (20.0- 25.4%) respectively.The use of generic names in prescribing (50.9%, p<0.0009) and medicines prescribed from the Essential Medicine List (74.2%, p=0.05) were considerably lower than the standard (100%) However, the rate of injection prescribing (12.49%, p=0.4) was within the recommended range (10.1–17.0%).The study also found that 85.1%, (p=0.001) of prescribed medicines were dispensed, while 93.4% (p=0.256) of essential medicines were dispensed which was lower than the recommended standard (100%). Overall, only 58%,(p<0.0001) of patients had all prescribed medicines completely dispensed and this was significantly lower than the desired standard (100%.) in social health insurance programmes.Conclusions:The findings of this study show trends toward irrational prescribing practices as characterized by poly-pharmacy, overuse of antibiotics, sub-optimal generic prescribing, as well as poor adherence to the use of NHIS-Essential Medicine List. There was sub-optimal provision of prescribed medicines. These are potential threats to the scheme‟s goal of universal access to health care in the year 2015. Pragmatic multi-component interventions are recommended to promote rational prescribing and improve equity in access to essential medicines.

Magister Public Health - MPH / Background: The irrational use of medicines, and increasingly antimicrobials, remains a key health problem in many developing countries including Zambia. Inappropriate, ineffective and inefficient use of medicines is common in health facilities at all levels. There are many factors influencing irrational prescribing and dispensing of antimicrobials including patients, prescribers, dispensers, the supply system (including industry influences), government regulations and medicines information and misinformation. Study aim: The aim of the study was to assess the rational use and availability of antimicrobials at primary level health facilities under the Lusaka district community health office, Zambia. Study design: The study was a cross-sectional descriptive study, with prospective and retrospective components. A standardized research methodology, including tools and indicators, adapted from the World Health Organization, was employed. Study population and sampling: The study population included all the 30 government primary level health facilities (health centres) in Lusaka District, from which 20 primary health facilities were sampled using a combination of purposive and random sampling. Using the WHO standard indicators of rational drug use, this study assessed 800 patient encounters, 520 medicines inventory records, and other baseline data, from 20 health facilities at three different levels under the Lusaka district community health office, Zambia. Data collection: The data collection tools were numbered and labeled. Tool 1: Prescribing Indicator Form was used to collect prescribing data; Tool 2: Patient Care (Pharmacy) Form was used to record dispensing data; Tool 3: Antimicrobial Availability Form for recording data for the availability of the key indicator antimicrobials and their substitutes; Tool 4: Facility Indicator Consolidation Reporting Form was used for consolidating the data collected for each health facility under study; and Tool 5: Facility Medicines Use Indicator Consolidation Form was used for the consolidation of the drug use data for the entire study. Third year Pharmacy Technology students were trained for the data collection process. The patients were first observed from outside the prescriber's room and the dispensing area for consultation and dispensing times respectively, and then they were interviewed to collect the prescribing and dispensing data. The tools were pre-tested. Data analysis: After data checking and consolidation, quantitative data were categorized into continuous numerical variables. Calculations were done manually and using computerized analysis (Epi Info package) and presented as simple frequency and means. Ethics: Ethical clearance for the study was obtained from University of the Western Cape Senate Research Committee. Permission was obtained from the Lusaka Provincial and District health offices, being the authorities that are overseeing the health facilities included in the study. Furthermore, permission was obtained from the health centre in-charges. Consent was obtained from healthcare providers and patients. Key results and discussion: The study found that at the primary level facilities there were more Clinical Officers (55%) than Medical Doctors (25%) and Registered Nurses (20%) in charge of prescribing. The main dispensers were Pharmacy Technologists (85%); there were no Pharmacists available in any of the facilities. A third [259 (32.4 %)] of all the 800 patients in the study were children below 12 years of age. Across the clinics, a mean of 2.94 medicines were prescribed per prescription, with an extremely low rate of prescribing drugs by generic name (36.7%). The proportion of prescriptions including an antibiotic was 36.2 % and 3.4 % included an injectable drug. Linking the antimicrobials and injections to patient diagnoses indicated that many were probably irrational, prescribing decisions. Amoxicillin and metronidazole were by far the most commonly prescribed antimicrobials at 32.0 % and 17.2 % of total antimicrobials, respectively. The essential drugs list was available in 80.0% of facilities and a high percentage of medicines were prescribed from the essential medicines list (81.2%). The overall mean percentage of medicines packages correctly labeled was considerably low at 44.8 %. The average consultation time was short at 4.0 (range 1-8.4) minutes, whereas the dispensing times were equally short and averaged at 116.6 (range 15-360) seconds, with the range of 15 to 360 seconds. The average percentage of first line antimicrobials available at health facilities was 79 %; and the average percentage of second line, substitute, antimicrobials available was 15 %. Conclusion: In line with studies from other settings, this medicines use study found considerable overuse and irrational use of antimicrobials in the primary health care clinics in Lusaka District. Irrational medicine prescribing was common and poor dispensing practices were also seen, resulting in poor use of and adherence to medicines and, consequently, poor therapeutic outcomes. Recommendations: Several recommendations have been formulated. They include: Reinforcing the Drug Therapeutic Committees (DTCs) at the national and the local facility level to help manage medicines use; clarification of prescribers and dispensers roles and responsibilities; development, enforcement or adaption of standard operating procedures (SOPS) for prescribing and dispensing; and improvement of prescribing and dispensing practices through introduction of appropriate education, supervision and audit.

In a well-functioning medicine supply chain management system, procurement forms an integral part that needs to be closely monitored and integrated with other functions. Good procurement practices in the public health sector ensure that good quality efficacious medicines are distributed in the country in the right quantities and at reasonable costs. Pharmaceutical procurement is a major determinant of drug availability and total health costs. It is indicated that medicine expenditure represents the single largest expenditure after salaries and accounts for approximately 20 to 40% of the total healthcare budget, and up to 90% of household budgets in the Sub-Saharan region (MSH, 2012:1). Moreover, effective and efficient public sector procurement systems are essential for the achievement of millennium development goals and the promotion of sustainable development (WHO, 2011:2). The general aim of the study was to evaluate the current status of procurement and supply chain management systems in the public healthcare hospitals in Lesotho. The study set out to understand the policies, guidelines and practices governing medicine procurement in the public hospitals in Lesotho, and also to outline the impact of procurement activities on the overall operation and effectiveness of the healthcare services. A descriptive, cross-sectional study was conducted, focusing on all levels of medicine procurement and supply management systems in all public hospitals in Lesotho. The study period stretched over nine months, from January 2014 to September 2014. The study population was inclusive of 17 public healthcare hospitals in the country and the central medical store (CMS). The findings revealed that all hospitals studied (n=17) perform the functions of selection, procurement, quantification, ordering, inventory management, distribution as well as utilisation. Although an essential medicine list (EML) and standard treatment guidelines (STGs) are available for use, public hospitals do not adhere to the use of EML and STGs for medicine procurement (n=17). Therefore, procurement is not limited to medicines on the EML, it is based on the intensity of healthcare services provided, and public hospitals often request medicines that do not occur on the EML, but are necessary to address the different diseases and public health priorities in respective facilities. According to the Ministry of Health, all public facilities are mandated to procure medicines from the CMS. Public hospitals use their allocated funds for medicine to buy from the CMS, which will, in turn, procure medicines on behalf of the government and distribute to the hospitals as per request, since procurement is pooled at a central level (MOH, 2011:62). However, it was observed that only government facilities (n=11) procure medicines from the CMS only. Facilities that are owned by the Christian health association of Lesotho (CHAL) procure medicines from other places concurrently (n=6). Moreover, CHAL hospitals (n=6) indicated that they are not fully mandated to procure medicines only from the CMS; they can also procure from other agencies based on stock-outs at the CMS, price differences and urgency of obtaining the medicines required. Therefore, procurement practices at government and CHAL hospitals are not similar. The total expenditure on medicines for government hospitals was 7 088 754.50 Maloti and 121 338 713.05 Maloti in the years 2010/2011 and 2011/2012, respectively. The total expenditure for CHAL hospitals was 2 520 590 Maloti and 3 577 360 Maloti in 2010/2011 and 2011/2012, respectively. According to the findings, variance of budget and expenditure for government hospitals were 15 623 446.50 Maloti in 2010/2011 and 9 490 341.22 Maloti in 2011/2012. Variance of the budget and expenditure for CHAL Hospitals were 912 570 million Maloti in 2010/2011 and 922 640 million Maloti in 2011/2012. Most hospitals showed a variance of above 50% in 2010/2011. However, in 2011/2012, a shift pattern was observed indicating an improvement in the utilisation of funds allocated. This shift pattern may indicate a possible improvement in procurement practices, including the quantification and budgeting and commitment to procurement plans. Pharmaceutical management systems require sound policies and a legal framework that will provide a solid foundation for the systems. It is equally important that these policies and regulations are periodically updated to ensure that they address the current health situation in the country and are in line with international standards (MSH, 2012:4). However, some documents are very outdated, and therefore they do not reflect the current health situation in the country as well as procurement trends internationally, and these include national medicine policy, EML and STGs. In conclusion, the medicine procurement system in public hospitals should be strengthened and should incorporate continuous supportive supervision in order to facilitate and encourage adherence to good procurement practices, and therefore the constant availability of good quality, cost-effective essential medicines in the country. / MPharm (Pharmacy Practice), North-West University, Potchefstroom Campus, 2015