Access to essential medicines: in Pakistan identifying policy research and concerns

The fundamental importance of ensuring access to medicines, particularly for the poor, is reflected in MDG 8 however remains poor in many low and middle income countries (LMICs). Country specific evidence on access to medicines is weak in LMICs and research has rarely been from an integrated health systems perspective. This study used an evidence based approach to identify key priority concerns and emerging research questions related to access to medicines in Pakistan. WHO’s Access to Medicine Framework was used as the conceptual basis for data collection on rational usage, affordability, financing and health systems. Methods involved a systematic desk review, in-depth stakeholder interviews and a consensus building Roundtable exercise. In Pakistan there has been considerable work in terms of medicines related policy acts and operative guidelines. However considerable gaps exist between policy and practice and between medicine policies and health systems strategies. Average number of medications prescribed is higher than other LMICs and prescription practices frequently do not follow standard recommended therapies from specialists down to general practitioners. There is a widely entrenched private informal sector and shadow pharmacies which remains largely unregulated. Spending on drugs is mainly borne by households, accounts for 63% of total spending on drugs in Pakistan as compared to only 18% in OECD countries and can lead to catastrophic household expenditure. Medicine therapy for chronic care is particularly unaffordable even with use of low cost generics. Within the public sector, availability of essential generics is extremely low at 3.3% as compared to 29-54% in LMICs. Public sector spending on drugs is far below the minimum $2 per capita indicated for LMICs and existing spending faces issues of questionable adherence to EDL, low quality drugs and outdated logistics management systems. Contracting out the management of BHUs has resulted in better medicine availability. There is serious shortage of trained manpower pharmacists across private and public sector with 0.9 pharmacist / 100000 population in Pakistan far below recommended ratio of 1 pharmacist per 2000 population. Drug regulation also requires with registration of excessive number of drugs, wide quality variation in quality and pricing, and frequent instances of spurious drugs and black marketing. Chronic shortage of low prices essential medicines is a long standing issue linked to disincentive to production due to low pricing and flat price control. The above policy concerns raise need for research in key areas. First, there is need for surveys on continuous surveillance of policy impact on availability, price and affordability of medicines; mapping of private informal sector and shadow pharmacies; and consumer health seeking preferences. Second, collation is required of best practice lessons on registration, pricing, market vigilance and enhancement of rational drug use. Third, operation research pilots in key areas such as alternative health financing mechanisms involving commodity voucher, GP contracting, pre-payment schemes, equity funds for increasing drug availability and affordability; scientific improvement of logistics management system in public sector; and introducing community participation in accountability mechanisms. Pharmaceutical policy and research needs to be centrally placed within larger health systems related initiatives. It needs to be accompanied by sustained dialogue and interaction between multiple stakeholders including private sector. Adequate steps also need to be taken to ensure a continuous culture of research feeding into evidence based policie

Rational prescription & use: a snapshot of the evidence from Pakistan and emerging concerns

Introduction: Irrational drug use remains globally common and there is a lack of country level synthesis for strategizing policy actions in Pakistan. Methodology: We conducted a scoping review of available peer reviewed and grey literature on prescribing patterns and drug dispensing in Pakistan to identify emerging concerns. Results: There is excessive drug use in Pakistan compared to the average for LMICs with inappropriate prescribing, high use of injections and antibiotics, choice of more expensive drugs, inadequate dispensing and weak community pharmacy. Policy concerns include excessive drug registration, poor enforcement of essential drug lists and standard management protocols, open access of industry to health providers, and lack of private sector regulation. Conclusion and Policy Recommendations: Review of evidence demonstrates deviance from rational use in the areas of medicine prescription, dispensing and self-medication, and low impact of existing policy measures. Quality of research needs to be improved focusing on standardized national surveys, consumer related formative research, and interventional research. Rational drug use is a neglected area in Pakistan requiring policy measures at multiple levels of health system and continued and simultaneous investment in standardized researc

Prevention of non-communicable diseases in Pakistan: an integrated partnership-based model

Development and implementation of non-communicable disease (NCD) prevention polices in the developing countries is a multidimensional challenge. This article highlights the evolution of a strategic approach in Pakistan. The model is evidence-based and encompasses a concerted and integrated approach to NCDs. It has been modelled to impact a set of indicators through the combination of a range of actions capitalizing on the strengths of a public-private partnership. The paper highlights the merits and limitations of this approach. The experience outlines a number of clear imperatives for fostering an enabling environment for integrated NCD prevention public health models, which involve roles played by a range of stakeholders. It also highlights the value that such partnership arrangements bring in facilitating the mission and mandates of ministries of health, international agencies with global health mandates, and the non-profit private sector. The experience is of relevance to developing countries that have NCD programs running and those that need to develop them. It provides an empirical basis for enhancing the performance of the health system by fostering partnerships within integrated evidence-based models and permits an analysis of health systems models built on shared responsibility for the purpose of providing sustainable health outcomes

Parallel NGO networks for HIV control: risks and opportunities for NGO contracting.

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy measures that facilitate in bringing NGOs groups to a shared understanding of health issues and responses

The formation of copper oxide nanorods in the presence of various surfactant micelles

Copper oxide nanorods with average diameters and lengths of ca. 8 nm and 400 nm, respectively, have been prepared by a simple onestep solid-state reaction in the presence of various surfactant micelles. The effect of three different surfactants viz., SDS, CTAB and Triton X-100 and their critical micellar concentration (CMC) on the formation of nanorods has been studied using XRD, TEM, DSC and XPS techniques. It is found that the formation of the nanorods in the presence of SDS micelles is better with higher thermal stability and possessing lower binding energy with regard to Cu2p peak

NGOs and government partnership for health systems strengthening: A qualitative study presenting viewpoints of government, NGOs and donors in Pakistan

<p>Abstract</p> <p>Background</p> <p>Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized.</p> <p>Methods</p> <p>A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives and donor community about the role and position of NGOs in health systems strengthening in Pakistan's context. Analysis of the data was done manually to generate nodes, sub-nodes and themes.</p> <p>Results</p> <p>Since many years, international and local non-governmental organizations (NGOs) have endeavored to fill the gaps in health service delivery, research and advocacy. NGOs have relatively performed better and achieved the results because of the flexible planning and the ability to design population based projects on health education, health promotion, social marketing, community development and advocacy. This paper captures the need and the opportunity of public private partnership in Pakistan and presents a framework for a meaningful engagement of the government and the private and nonprofit NGOs.</p> <p>Conclusion</p> <p>Involving the NGOs for health system strengthening may eventually contribute to create a healthcare system reflecting an increased efficiency, more equity and good governance in the wake of the Millennium Development Goals. Nevertheless, few questions need to be answered and pre-requisites have to be fulfilled before moving on.</p

Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan

Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers\u27 perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi.METHOD: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived.Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers\u27 improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area.CONCLUSION: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods

Myths and fallacies about male contraceptive methods: a qualitative study amongst married youth in slums of Karachi, Pakistan

Pakistan presently has one of the largest cohorts of young people in its history, with around 36 million people between the ages of 15 and 24 years. One of the main reasons for high population growth in Pakistan is almost stagnant contraceptive prevalence rate of 30% nationallyand 17.4% amongst youth. The study was conducted to explore the perceptions regarding myths and fallacies related to male contraceptive methods among married youth aged 18-24 year in Karachi, Pakistan. Qualitative exploratory study design was adopted and a total of eight Focus Group Discussions (FGDs) were conducted. Study was conducted in two Union Councils of Korangi Town in the squatter settlement of Karachi, Pakistan from July to September 2010. Thematic analysis was done manually. General, physical, sexual, psychological, socio-cultural and religious were the common categories which lead to myths and fallacies related to condoms use and vasectomy among the married youth. The foremost myth amongst male and female youth was that use of both condoms and vasectomy cause impotence in males. Additionally, condoms were thought to cause infections, backache and headache in males. Some youth of the area think that vasectomy is meant for prisoners only. In conclusion our findings suggest that the potential reasons behind low use of male contraceptive methods among youth of squatter settlement of Karachi were myths and fallacies about male contraceptive methods. There are some important policy implications like counseling of the couple through peers and well trained family planning service providers to address these myths and misconceptions from the minds of youth