Balancing Medicine Prices and Business Sustainability: Analyses of Pharmacy Costs, Revenues and Profit Shed Light on Retail Medicine Mark-Ups in Rural Kyrgyzstan

BACKGROUND: Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. METHODS. We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). RESULTS: Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. CONCLUSION: Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals. Health systems researchers must document the positive and negative financial experiences of pharmacy initiatives to inform future projects and advance access to medicines goals.United States Agency for International Development through the Child and Family Applied Research Project at the Boston University School of Public Healt

Two Bioeconomic Studies on Haddock Culture: Live Feed and Juvenile Production

The State of Maine is reliant upon its natural resources. Wild catches of marine finfish, especially ground fish such as cod and haddock, are declining. In addition, several new restrictions have been placed on the culture of Atlantic salmon due to its listing under the Endangered Species Act. These issues serve as an impetus to explore the development of alternative species for cold-water marine aquaculture. This research focuses on early haddock culture. The two areas where haddock culture varies from production of other species are the need for live feeds and proximity to seawater. Unlike salmon, haddock spend their entire life in seawater. Due to their small size at hatching, haddock must be fed rotifers and Artemia (live feeds). These factors distinguish the rearing of haddock from salmon. The objective of this research was to develop an ex-ante estimate of the cost of producing juvenile haddock. A static budget was developed and then the stochastic factors affecting production were identified and quantified. The model was re-estimated using Monte Carlo simulation techniques to account for the uncertainty and risk of the stochastic factors. Risk efficient technology choices were identified from the simulation. This was accomplished by dividing the thesis into two distinct papers: live feed production and juvenile production. Different strategies of rearing the live feed organisms were analyzed. It was found that using yeast was more cost effective than using green water for enrichment. A breakeven analysis was done to analyze the relationship between the increased risk of a rotifer crash and the decreased cost of continuously rearing systems. The third area of live feeds production that was considered was the unpredictability of Artemia cyst prices. It was found that a doubling of Artemia cyst prices lead to a 5% increase in the total live feeds cost. The second portion of the thesis looks at juvenile feeding technologies. Biological literature suggests that a reduction in the number of days juvenile haddock are fed live feeds will reduce the total costs of production. Including both the biological risk of mortality and the cost of producing live feeds, it was found that reducing the number of days on live feeds did not lead to a reduction in total costs. Overall, it was found that juvenile haddock could be produced at under $1.60, 85% of the time. Reducing the number of days on live feeds did not result in a decline of total costs. The final step of the research involved sensitivity and policy analysis to determine where future research is needed. The price of Artemia cysts, the interest rate, and an increase to two production cycles per year were analyzed to determine the impact on per-fish costs. The largest cost reduction was seen when production increased to two cycles per year. This cost reduction is due to the large capital costs associated with the system

A lifeline to treatment: the role of Indian generic manufacturers in supplying antiretroviral medicines to developing countries

<p>Abstract</p> <p>Background</p> <p>Indian manufacturers of generic antiretroviral (ARV) medicines facilitated the rapid scale up of HIV/AIDS treatment in developing countries though provision of low-priced, quality-assured medicines. The legal framework in India that facilitated such production, however, is changing with implementation of the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights, and intellectual property measures being discussed in regional and bilateral free trade agreement negotiations. Reliable quantitative estimates of the Indian role in generic global ARV supply are needed to understand potential impacts of such measures on HIV/AIDS treatment in developing countries.</p> <p>Methods</p> <p>We utilized transactional data containing 17,646 donor-funded purchases of ARV tablets made by 115 low- and middle-income countries from 2003 to 2008 to measure market share, purchase trends and prices of Indian-produced generic ARVs compared with those of non-Indian generic and brand ARVs.</p> <p>Results</p> <p>Indian generic manufacturers dominate the ARV market, accounting for more than 80% of annual purchase volumes. Among paediatric ARV and adult nucleoside and non-nucleoside reverse transcriptase inhibitor markets, Indian-produced generics accounted for 91% and 89% of 2008 global purchase volumes, respectively. From 2003 to 2008, the number of Indian generic manufactures supplying ARVs increased from four to 10 while the number of Indian-manufactured generic products increased from 14 to 53. Ninety-six of 100 countries purchased Indian generic ARVs in 2008, including high HIV-burden sub-Saharan African countries. Indian-produced generic ARVs used in first-line regimens were consistently and considerably less expensive than non-Indian generic and innovator ARVs. Key ARVs newly recommended by the World Health Organization are three to four times more expensive than older regimens.</p> <p>Conclusions</p> <p>Indian generic producers supply the majority of ARVs in developing countries. Future scale up using newly recommended ARVs will likely be hampered until Indian generic producers can provide the dramatic price reductions and improved formulations observed in the past. Rather than agreeing to inappropriate intellectual property obligations through free trade agreements, India and its trade partners - plus international organizations, donors, civil society and pharmaceutical manufacturers - should ensure that there is sufficient policy space for Indian pharmaceutical manufacturers to continue their central role in supplying developing countries with low-priced, quality-assured generic medicines.</p

PENGARUH LIKUIDITAS, PROFITABILITAS DAN KEBIJAKAN DIVIDEN TERHADAP NILAI PERUSAHAAN PADA PERUSAHAAN MANUFAKTUR SEKTOR TEKSTIL DAN GARMEN YANG TERDAFTAR DI BURSA EFEK INDONESIA PERIODE 2018 – 2020

Penelitian ini bertujuan untuk menguji pengaruh likuiditas, profitabilitas dan kebijakan dividen terhadap nilai perusahaan. Penelitian ini dilakukan pada perusahaan manufaktur sektor tekstil dan garmen yang terdaftar di Bursa efek Indonesia periode 2018 - 2020. Penelitian ini menggunakan pendekatan kuantitatif, jenis data yang digunakan yaitu data sekunder. Data yang diperoleh dapat diakses melalui website www.idx.co.iddengan pengambilan sampel menggunakan pendekatan purposive sampling dan menggunakan teknik analisis regresi linier berganda yang dibantu dengan menggunakan program SPSS yang meliputi uji asumsi klasik serta uji parsial (uji t) dengan taraf nyata (α) 5%. Hasil penelitian ini menunjukan bahwa likuiditas dan profitabilitas secara parsial berpengaruh positif dan signifikan terhadap nilai perusahaan. Dan hasil penelitian kebijakan dividen menunjukan bahwa secara parsial berpengaruh positif dan tidak signifikan terhadap nilai perusahaan

The Role of DSN-MUI Fatwa in Indonesian Sharia Banking Development Flows in the Industrial Revolution 4.0

The development of Islamic banking in recent years has experienced a very significant increase. This happens because it uses the principles of Sharia (Islamic law) and gets support from the government to accelerate Sharia banking activities. One form of support to improve the development of Islamic banking is the issuance of Law No. 21 of 2008 concerning Islamic Banking. An important authority in the dynamics of Sharia banking regulation is the National Sharia Council-Indonesian Ulema Council (DSN-MUI). This institution is an authoritative source in overseeing the obedience of Sharia banking industry players to comply with Sharia rules. The purpose of this study is to analyze the fatwa issued by the DSN-MUI on the development of Islamic financial institutions (LKS) in Indonesia, especially the Islamic banking sector. This study uses a qualitative method with a literature study approach. Findings: the results of this study conclude that the position of the DSN-MUI fatwa does not yet have a significant role in the development of Islamic bank products and services. This is because the fatwa acts only as a complement to Islamic bank products and services. In addition, the fatwa is a legal requirement for the Islamic banking sector in the context of Sharia compliance. The DSN-MUI fatwa is issued after the products and services have been published, not with a discussion mechanism first

Aktivitas keagamaan persatuan mahasiswa patani di Indonesia Kota Palangka Raya Kalimantan Tengah

Aktivitas Keagamaan merupakan segala aktivitas dalam kehidupan yang didasarkan pada nilai-nilai agama, yang diyakini agar tidak terjadi kekacauan di dalam kehidupan sehari-hari. Perkembangan dalam pelaksanaan kegiatan keagamaan dan kegiatan apa saja yang dilakukan. sehingga persoalan yang akan dikaji pada penelitian ini adalah 1) Bagaimana aktivitas keagamaan persatuan mahasiswa Thailand di Kota Palangka Raya Kalimantan Tengah? 2) Bentuk aktivitas keagamaan apa saja yang dilakukan oleh persatuan mahasiswa Thailand di Kota Palangka Raya Kalimantan Tengah? Adapun tujuan penelitian ini pertama, mendeskripsikan aktivitas keagamaan persatuan mahasiswa Thailand di Kota Palangka Raya Kalimantan Tengah. Kedua, mengetahui bentuk aktivitas keagamaan apa saja yang dilakukan oleh persatuan mahasiswa Thailand di Kota Palangka Raya Kalimantan Tengah. Penelitian ini menggunakan metode penelitian kualitatif. Pengumpulan data menggunakan teknik observasi, wawancara, dan dokumentasi. Hasil dari penelitian ini adalah: 1) Aktivitas keagamaan persatuan mahasiswa Thailand di Kota Palangka Raya Kalimantan Tengah mengadakan dengan bertahab melalui program kerja diawali dengan mengadakan rapat bersama seperti aktivitas mingguan, bulanan, dan tahunan. Adapun aktivitas mingguan adalah setiap malam rabu, malam jumat, dan malam sabtu. bergantian atau berroling dalam memapar materi kepada teman. Adapun aktivitas bulanan adalah gotong royong dilakukan setiap akhir bulan. Adapun aktivitas tahunan adalah mengadakan kegiatan asyura, peringatan israj&miraj, maulid Nabi, baca yasin bersama pada malam nisfu syaban dan silaturahmi rumah keluarga pada hari raya idul fitri&adha kegiatan tersebut selalu melakukan oleh mahasiswa Thailand pada waktu yang tertentu. 2) Bentuk aktivitas keagamaan yang dilakukan oleh persatuan mahsiswa Thailand di Kota Palangka Raya Kalimantan Tengah yaitu belajar tajwid, ceramah, khutbah, puisi, pidato, memfasih juz Amma, sholat berjamaah, yasinan, puasa sunah, sedekah, bedah buku, gotong royong, asyura pada bulan muharram, israj miraj, maulid Nabi dan silaturahmi pada hari lebaran. ABSTRACT Religious activities are all activities in life that are based on religious values, which are believed to prevent chaos in everyday life. Progress in carrying out religious activities and what activities are carried out. So that the issues to be examined in this study are 1) What is the religious activity of Thai student associations in the city of Palangka Raya, Central Kalimantan? 2) What forms of religious activities are carried out by the Thai student union in the City of Palangka Raya in Central Kalimantan? The purpose of this study is first, to describe the religious activities of Thai student unions in the City of Palangka Raya, Central Kalimantan. Secondly, knowing what forms of religious activity are carried out by Thai student unions in the City of Palangka Raya, Central Kalimantan. This study used qualitative research methods. Data collection uses observation, interview, and documentation techniques. The results of this study are: 1) The religious activity of Thai student unions in the City of Palangka Raya, Central Kalimantan, held by working through a work program beginning with holding joint meetings such as weekly, monthly and annual activities. The weekly activity is every night Wednesday, Friday night, and Saturday night. alternating or surfing in exposing material to friends. The monthly activities are mutual cooperation carried out at the end of each month. The annual activity is to hold Ashura activities, commemoration of Israj & Miraj, Maulid Nabi, read yasin together on the night of Nisfu Syaban and the gathering of family homes on Eid al-Fitr & there are always activities carried out by Thai students at certain times. 2) Forms of religious activity carried out by Thai student union in Palangka Raya City, Central Kalimantan, namely learning recitation, lectures, sermons, poetry, speeches, giving juz Amma, congregational prayer, yasinan, sunnah fasting, almsgiving, book review, mutual cooperation, ashura in the month of muharram, israj miraj, maulid Nabi and friendship on the day of Eid

Sustainable Procurement in Australia: Quantity Surveyors' Perception on Life Cycle Costing

Life cycle costing (LCC) has long been recognised as one of the essential techniques for sustainable development. Over the past decades, the use of LCC in the industry has been restricted and building stakeholders are blaming each other for its limited application. The research aims to investigate quantity surveyors'perception towards LCC implementation in Australia by specifically examining their general awareness and application of LCC; determining the key obstacles hindering LCC implementation; and identifying the key enablers for LCC implementation. An online survey of 24 quantity surveying professionals was undertaken. The overall results indicate that quantity surveying professionals do have basic knowledge of LCC and appreciate its benefits. However, the results suggest that clients and architects are the key culprits for hindering the implementation of LCC by placing greater emphasis on initial costs and design over strategic value of an asset. For wider application, it is suggested that government and professional bodies play a vital role to enforcing and promoting the future use of LCC. In conclusion, the research informs building stakeholders the key issues in LCC implementation and adds to the existing body of knowledge on LCC application for future research to be undertaken