Magister Pharmaceuticae - MPharm / Access to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine.

>Magister Scientiae - MSc / Type 2 diabetes mellitus is a progressive disease characterised by defects in insulin secretion, insulin action or both. Proper management of diabetes with appropriate drug and lifestyle interventions, guided by proper glycaemic monitoring has shown improved glycaemic control and a substantial decrease in morbidity associated with complications and mortality. Evidence-based guidelines for the appropriate management of diabetes, suggests the use of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) as monitoring indicators and have set targets levels that indicate appropriate glucose control. In the event of suboptimal control, actions steps to adjust pharmacotherapeutic treatment has been set out. Of the two aforementioned glycaemic monitoring indicators, HbA1c is termed the 'gold standard' as it provides the most comprehensive data i.e. it reflects both fasting and postprandial glucose concentrations over a 3 months period as compared to FPG which only show glucose levels for a few hours. The aim of this study was to describe the use of glycaemic monitoring indicators in patients with type 2 diabetes mellitus, classified as stable, treated at primary health care facilities in the Cape Town Metropolitan Region in South Africa. The study was a descriptive, retrospective and quantitative in design. Data were collected from patient medical records and included glycaemic monitoring tests and results as well as prescribing records for a maximum period of 18 months. The study comprised of 575 participants from five primary health care facilities in the Western Cape Metropole region. All participants had FPG results, while HbA1c results were recorded for 86% of participants at least once. More than 70% of participants with either a FPG or HbA1c result showed suboptimal glucose control i.e. were outside of the target range. In 181 opportunities for intervention in participants with HbA1c results outside target, 113 (62.4%) did not have any therapy adjustments, 19 (10.5%) had the total daily dose increased, 6 (3.3%) had total daily dose decreased, 9 (5.0%) had a step-up in regimen, 5 (2.8%) had a step down in regimen and 29 (16.0%) had a lateral regimen change. In 852 opportunities for intervention in participants with FPG results outside target, 609 (71.5%) did not have any therapy adjustments, 47 (5.5%) had the total daily dose increased, 18 (2.1%) had the total daily dose decreased, 16 (1.9%) had a step-up in regimen, 15 (1.8%) had a step down in regimen and 147 (17.3%) had a lateral change in regimen. This study has demonstrated that in the primary healthcare facilities investigated, FPG was the most often used gycaemic monitoring indicator, glycaemic monitoring of patients mostly show suboptimal glucose control and that opportunities to optimise pharmacotherapy in diabetes management are mostly missed.

Philosophiae Doctor - PhD / Studies on rational medicine use (RMU) have mainly focused on identifying, quantifying, and addressing irrational use without exploring reasons behind this irrational use. In addition, minimal work has been conducted on irrational use of medicines in the context of the growing burden of non-communicable diseases (NCDs). This PhD research examined medicine use in Eswatini, (previously Swaziland) between April 2017 and March 2019, with a focus on prescribing practices linked to specific diagnoses. It further explored factors influencing RMU, which included testing the effects of a short intervention - prescription audit and feedback coupled with small group education - on prescribing practices in health facilities.

O presente estudo avalia a produção pública de medicamentos no Brasil, abordando as possibilidades de avanços no acesso aos medicamentos essenciais. Fundamentou-se na análise bibliográfica e documental. Esta última análise focou os documentos oficiais, originários dos diversos agentes institucionais vinculados à política de medicamentos do país. A Política Nacional de Medicamentos concentrou-se na provisão da assistência farmacêutica e, em especial, no acesso racional aos medicamentos essenciais. A pesquisa, de caráter histórico, destacou analiticamente o desenvolvimento dessa política desde 2003 até o presente. Nesse contexto, privilegiam-se as características universais do atual sistema de saúde no Brasil e o compromisso do Estado nacional em garantir o acesso a esse direito fundamental. Foram também objeto de destaque nesta pesquisa as alternativas de oferta de medicamentos por intermédio da indústria farmacêutica internacional e nacional. O núcleo deste estudo é a análise da produção dos medicamentos pelos laboratórios oficiais, bem como das dificuldades que esses laboratórios enfrentam em função da descontinuidade histórica de políticas voltadas para o fortalecimento de suas atividades. Assim, permite-se afirmar que a produção dos medicamentos essenciais poderia contribuir de forma decisiva para a inclusão da população historicamente excluída das políticas de saúde a partir de estratégias para o seu fortalecimento continuado, definidas pelo Estado brasileiro. / The present thesis has evaluated the medicine production by the State, addressing its possibilities in improving the access to essential medicines. This study has relied on both bibliographical and documental analysis. The latter was focused on official documents from several institutional agencies linked to the countrys pharmaceutical policy. The National Pharmaceutical Policy has been concentrated on the provision of pharmaceutical assistance, especially on the rational access to essential medicines. From an analytical and historical perspective, this research has highlighted the development of such policy from 2003 to the present day. Within this context, the current universal features of the Brazilian National Health System and the responsibility undertaken by the State to provide access to medicines were emphasized. The alternative offers of medicines by both the national and international pharmaceutical industries were also highlighted. The main goal of this thesis was the analysis of pharmaceutical production by the official laboratories as well as the difficulties faced by these laboratories resulting from a lack of continuity in the policies geared at strengthening its activities. Thus, the present work aims to show that essential medicine production might significantly contribute to the inclusion of those historically excluded from the health policies through continued strengthening policies as defined by the State.

O presente estudo avalia a produção pública de medicamentos no Brasil, abordando as possibilidades de avanços no acesso aos medicamentos essenciais. Fundamentou-se na análise bibliográfica e documental. Esta última análise focou os documentos oficiais, originários dos diversos agentes institucionais vinculados à política de medicamentos do país. A Política Nacional de Medicamentos concentrou-se na provisão da assistência farmacêutica e, em especial, no acesso racional aos medicamentos essenciais. A pesquisa, de caráter histórico, destacou analiticamente o desenvolvimento dessa política desde 2003 até o presente. Nesse contexto, privilegiam-se as características universais do atual sistema de saúde no Brasil e o compromisso do Estado nacional em garantir o acesso a esse direito fundamental. Foram também objeto de destaque nesta pesquisa as alternativas de oferta de medicamentos por intermédio da indústria farmacêutica internacional e nacional. O núcleo deste estudo é a análise da produção dos medicamentos pelos laboratórios oficiais, bem como das dificuldades que esses laboratórios enfrentam em função da descontinuidade histórica de políticas voltadas para o fortalecimento de suas atividades. Assim, permite-se afirmar que a produção dos medicamentos essenciais poderia contribuir de forma decisiva para a inclusão da população historicamente excluída das políticas de saúde a partir de estratégias para o seu fortalecimento continuado, definidas pelo Estado brasileiro. / The present thesis has evaluated the medicine production by the State, addressing its possibilities in improving the access to essential medicines. This study has relied on both bibliographical and documental analysis. The latter was focused on official documents from several institutional agencies linked to the countrys pharmaceutical policy. The National Pharmaceutical Policy has been concentrated on the provision of pharmaceutical assistance, especially on the rational access to essential medicines. From an analytical and historical perspective, this research has highlighted the development of such policy from 2003 to the present day. Within this context, the current universal features of the Brazilian National Health System and the responsibility undertaken by the State to provide access to medicines were emphasized. The alternative offers of medicines by both the national and international pharmaceutical industries were also highlighted. The main goal of this thesis was the analysis of pharmaceutical production by the official laboratories as well as the difficulties faced by these laboratories resulting from a lack of continuity in the policies geared at strengthening its activities. Thus, the present work aims to show that essential medicine production might significantly contribute to the inclusion of those historically excluded from the health policies through continued strengthening policies as defined by the State.