Decisions to reform pharmaceutical policy often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a reform that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only one order of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda for one year, has been exported. Future use of the regime appears unlikely. This research aimed to examine the politics underlying the formation of CAMR. Parliamentary committee hearing transcripts from CAMR's legislative development (2004) and from CAMR's legislative review (2007) were analyzed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analyzed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR's final policy design. In 2004, policy debates were dominated by two themes: intellectual property rights and TRIPS compliance. Promoting human rights and the impact of CAMR on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by a greater representation of the interests of potential beneficiary country governments. While the Government attempted to strike a balance between drug affordability and intellectual property protection, it designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.

INTRODUÇÃO:Os medicamentos pertencentes à RENAME têm sua eficácia comprovada são embasados sob critérios técnicos e científicos, e quando prescritos assumem profunda relevância dentro do contexto da saúde pública brasileira, por facilitarem o acesso aos medicamentos.OBJETIVO: Avaliar a associação entre acesso a medicamentos e prescrição segundo a Relação Nacional de Medicamentos Essenciais (RENAME). METODOLOGIA: Foram analisadas cópias de receitas médicas obtidas da pesquisa intitulada Experiência de Acesso da População de Baixa Renda a Medicamentos e Genéricos, Município de São Paulo 2005; para as análises estatísticas, foram utilizados os programas Epi-Info 2000 e OpenEpi. RESULTADOS: A média de medicamentos com receita foi de 2,5 / desvio padrão: 1,5479; o percentual de nenhum acesso e acesso parcial ás prescrições, juntos, foi de 54por cento ; nas Unidades Básicas de Saúde foram realizadas mais da metade das prescrições analisadas; a forma farmacêutica predominante foi comprimidos; cerca de 75por cento dos medicamentos estava presente nas listas de medicamentos essenciais, nacional ou municipal; dos medicamentos prescritos, 78por cento foram obtidos e 41por cento , dos que não estavam prescritos, também foram obtidos. CONCLUSÃO: Do total de medicamentos analisados, 65por cento estavam prescritos segundo a RENAME, e desses, 78por cento , foram obtidos; as Unidades Básicas de Saúde foram responsáveis por fornecer mais da metade das receitas; a quantidade de medicamentos prescritos mostrou-se negativamente correlacionada ao percentual de acesso aos mesmos; as prescrições quando seguem a RENAME têm a chance de acesso entre 4 a 6 vezes maior de se obter os medicamentos / INTRODUCTION: The medicaments belonging to RENAME have their eficiency verified, under technical and cientific criteria and when they are prescribed they become a matter of great concern regarding the Brazilian Publich Health because they facilitate the access to medicaments. OBJECTIVE: Evaluate the association between access to medicaments and prescription according the National List of Essential Medicaments (RENAME). METHODOLOGY : Copies of the medical prescriptions obtained from the research called Experience in Access to medicament and Generic of Low income population, Sao Paulo Municipal Discrict, 2005,and also the Programs Epi-Info 2000 and OpenEpi because of the statistic analysis. RESULTS: The average of medicament with prescription was 2,5 / Standard Deviation: 1.5479, the percentage of no access and partial access together was 54per cent. More than a half of the analysed prescriptions were done at the Health Fundamental Units. Also, among the pharmaceutical kinds, tablets and pills were the dominant ones and around 75per cent of the medicaments were present in the lists of essential medicaments in the country and districs. Among the prescribed medicaments, 78per cent were obtained while 41per cent of the non-prescribed ones were also obtained. CONCLUSION: From a total of the analysed medicaments, 65per cent of them were prescribed observing RENAME, and 78per cent of them were obtained. The Health Fundamental Units were responsible for providing more than a half of the prescriptions. The amount of medicaments involved were negatively correlated to the number of medicaments. The prescriptions that observe RENAME have 4 to 6 times more chances to be successful when it comes to obtaining medicines

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-10-19T16:42:11Z No. of bitstreams: 1 patriciaaparecidabaumgratzdepaula.pdf: 674957 bytes, checksum: 47aead25964f7f8056ae745c65f91f0c (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-10-25T12:23:26Z (GMT) No. of bitstreams: 1 patriciaaparecidabaumgratzdepaula.pdf: 674957 bytes, checksum: 47aead25964f7f8056ae745c65f91f0c (MD5) / Made available in DSpace on 2016-10-25T12:23:26Z (GMT). No. of bitstreams: 1 patriciaaparecidabaumgratzdepaula.pdf: 674957 bytes, checksum: 47aead25964f7f8056ae745c65f91f0c (MD5) Previous issue date: 2008-03-28 / O presente trabalho enfatiza a questão do acesso aos medicamentos visto como direito social assegurado na constituição do Sistema Único de Saúde. Para tanto, abordar-se-á o processo de medicalização vivenciado pela sociedade brasileira contemporânea, bem como, a política nacional de medicamentos e seus entraves. Também irá se buscar a apreensão da categoria acesso aos medicamentos, a partir das dimensões do acesso aos serviços de saúde. Todas estas categorias consideradas indissociáveis na busca pelo acesso universal e eqüinâme aos medicamentos. Nessa perspectiva, a partir da pesquisa qualitativa, foram realizados grupos focais com os usuários das unidades básicas de saúde (UBS) de Juiz de Fora – Minas Gerais, para buscar compreender o entendimento da problemática inerente ao acesso aos medicamentos como direito social, isto é, se esses usuários sentem-se como portadores de direitos ou como privilegiados ao obterem tal acesso. Esse estudo indicou que a maioria dos usuários das UBS não se considera como portadores de direitos, mostrando que o acesso aos medicamentos como direito social garantido constitucionalmente está longe de ser efetivado no cotidiano do serviço público de saúde brasileiro na contemporaneidade. / The present work emphasizes the question of access to medicine as a social right assured by the constitution of Health Public System. For that, it has been approached the process of medicalization experienced by the Brazilian society nowadays, as well as, the national medicines politics and its obstacles. It is also aimed to search for the apprehension of the access category to medicines, from the access dimension to the health services. All these categories considered inseparable in the search for universal and equanimous access to medicines. In this perspective, from the qualitative research, it has been realized foccuss groups with the users of the health basic unities (HBU) from the Juiz de Fora – Minas Gerais, to look forward to comprehend the understanding of the problematic inherent to access to medicines as a social right, that is, if these users feel themselves as porters of rights or as priviledged ones to obtain this access. This study has indicated that the majority of the HBU users do not consider themselves as porters of the rights, showing that access to medicines as a social right assured constitutionally is far from being daily effected in the Brazilian public health service in the contemporaneity.

No description available.

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

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

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Tehcnology: Chiropractic, Durban University of Technology, 2009. / Background: The aim of this study was to determine the knowledge, perception and utilisation of vitamins and minerals, natural medicines and pharmacological agents as adjuncts to Chiropractic practice in South Africa. Method: This study was a population based cross sectional survey utilising a descriptive, quantitative questionnaire study design. The questionnaire was distributed to all practicing qualified Chiropractors (n=388) and masters Chiropractic students (n=102) in South Africa. Results: The results obtained (30.4% response rate), indicated that the majority of the respondents (62.8%) felt qualified to advise patients on vitamins and mineral supplements and had a positive view of the use of vitamins and minerals as part of Chiropractic patient management (86.6%). The majority of the practitioners were aware that topical substances are part of the scope of practice and males were nearly twice as likely as females to use them. The majority thought biopuncture should be available to Chiropractors (82%) and felt that Chiropractors should challenge the legislation to incorporate biopuncture as part of the scope of practice (77.5%). Most respondents agreed with the statement indicating that NSAIDS should be part of Chiropractic scope of practice and 71% of respondents felt that being able to use NSAIDS in non-emergency situations would enhance patient retention. This study revealed that amongst the student population the majority, if allowed, would consider administering pharmacological agents in practice (55.1%). Conclusion: A correlation exists between the perception, knowledge and utilisation of vitamins and minerals, natural medicines and pharmacological agents in the Chiropractic profession with respect to the demographic data and there is a significant difference in opinion between qualified Chiropractors and Chiropractic masters students regarding perception, knowledge and utilisation of these adjuncts to practice.

Advertising on complementary, alternative medicines and over the counter medicines (OTC) published in the printed journals for lay people from the view of Evidence Based Medicine Student: Schirlová. Z Tutor: Matoulková, P. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University in Prague, Czech Republic INTRODUCTION: Advertisements are important means of communicating information to public. The quality of the pharmaceutical advertising has been continuously discused. METHODS: The objective of the study was to assess availability of supporting scientific information for health claims stated in the food supplements and OTC (Over-the- Counter) medicines ads that were published during period September 2012 and June 2013 in the mostly read life style journals for women. For each advertisement, the emphasized claim/-s was compared to available scientific unbiased evidence. The literature search was conducted by using Pubmed database (mainly meta-analysis and randomized clinical trials). Further information was searched in the Scholar Google, Natural Medicines Comprehensive Database (Consumer version) and Micromedex. Different keywords and their appropriate combinations were used to identify relevant information. Frequency analysis was used to assess frequency...

Le droit à la santé est un droit universel des peuples, reconnu internationalement par l’Organisation mondiale de la santé et en France par le code de la santé publique. Mais l’évolution de la démographie et de l’épidémiologie expliquent les volontés de rationalisation des politiques publiques et de maîtrise des coûts des systèmes de santé. L’hôpital, institution multiséculaire, a toujours tenté d’adapter son organisation pour répondre aux besoins sanitaires des populations ; il occupe une place centrale du dispositif de santé et sa pharmacie un rôle clé dans la bonne gestion du médicament, en partenariat avec les services cliniques utilisateurs.La littérature en sciences de gestion présente de précieuses grilles de lecture pour éclairer le fonctionnement de l’hôpital. La théorie socio-économique propose un traitement des dysfonctionnements organisationnels et une approche managériale intégrée. Les théories de la coopération et de la légitimité organisationnelle complètent les concepts académiques mobilisés au service de la reconnaissance et de l’efficience de la pharmacie à usage intérieur de l’hôpital.La recherche des terrains d’observation a été guidée par la posture épistémologique et le choix méthodologique ; la recherche-intervention a favorisé une approche globale du terrain, facilité l’intégration d’autres outils de management et participé à renforcer le processus médico-pharmaceutique à travers diverses actions menées avec les acteurs du service pharmacie, à destination des utilisateurs du médicament. Ce travail a permis la mise en évidence de couples de « coopération-légitimité » permettant de mieux identifier les zones de coopération et de légitimité traditionnelle, fonctionnelle, relationnelle et décisionnelle de la pharmacie hospitalière avec les parties prenantes. / The right to health is a universal right of peoples, internationally acknowledged by the World Health Organization and , in France, by the Code of Public Health. But, the evolution of demography and epidemiology explains the will to rationalize public policies and to master the costs of health systems. Hospitals, centuries old institutions, have always tried to adapt their organizations to meet the health needs of populations ; they occupy central places in health systems and their pharmacies play key roles in the good management of medicines, in partnership with clinical services.The literature of management sciences provides precious reading grids to shed light on the running of hospitals. The socio-economic theory provides a way of dealing with organization misgovernments and an integrated management approach. The theories of cooperation and legitimacy in organizations supplement the academic concepts summoned up in favour of the recognition and the efficiency of pharmacies inside hospitals.The research of fields of observation was guided by an epistemiological posture and a methodogical choice; intervention-research favoured a global approach of those fields, made the integration of other management tools easier and took part in the strengthening of the medico-pharmarceutic process via various actions taken with pharmacy service actors aimed at medicine users.This work provided help to bring to the fore “cooperation-legitimacy” couples and to make possible a better identification of zones of cooperation and legitimacy at the same time traditional, functional, relational and involving decisions as well , in hospital pharmacies with the interested parties.

Magister Legum - LLM / Access to medicines is an essential component of the basic human right to health and a key determinant of the importance attached to the health care system of a country. It essentially entails the availability and acceptability of the essential medicines on the market and the ability of patients to afford such medicines when needed. Globally, countries face access to medicine challenges partly because of patents which undoubtedly accounts for excessive pricing of medicine. As such, efforts have been made to ensure the accessibility of medicines through the Trade-Related Aspect of Intellectual Property Rights (TRIPS) flexibilities of the World Trade Organisation (WTO). Beyond these interventions, it is incumbent on Members of the WTO to domesticate the flexibilities of the TRIPS Agreement before their utilisation because by their very nature, they cannot be self-executed. With an estimated population of 29.6 million, about 310 000 people in Ghana are living with HIV. The country’s health facilities record 40 per cent of outpatient visits each year and about 14 550 per 100 000 of the population are infected with tuberculosis with cancer on the rise. These diseases require medicines which are mostly patented yet Ghana has access to medicine problems despite the existence of a national health insurance system. Ghana has however not fully incorporated the TRIPS flexibilities in its national legislations and therefore unable to fully utilise the flexibilities as an option to access essential medicines. Questions therefore remain as to why and how Ghana can utilise the flexibilities to improve access to medicines. Based on an examination of the WTO’s patent system and legislations of Ghana, this mini- thesis contends that, the extent of incorporation of the flexibilities are inadequate due to the existence of lacunas in the Ghanaian legislations. Furthermore, a comparative assessment with South Africa supports an understanding that conditions are not ripe for full utilisation of all the flexibilities. It further argues that the utilisation of the TRIPS flexibilities by Ghana has been rendered ineffective due to administrative, political, economic and social challenges which adversely affects the full utilisation of the flexibilities incorporated and those yet to be incorporated. It is therefore important that Ghana adopts holistic approaches taking into consideration best practices if the TRIPS flexibilities must be effectively utilised. This mini-thesis concludes that, the TRIPS flexibilities are necessary for accessing essential medicines in Ghana to promote the right to health and that a review of Ghana’s current legislations to fully incorporate the TRIPS flexibilities and addressing other non-legal challenges are the required linchpin for effective utilisation of the TRIPS flexibilities.