First conference on consumer adverse reaction reporting
* David Finer is a medical writer and was Chairperson of the Conference.
The First International Conference on Consumer Reports on Medicines was held in Sigtuna, Sweden, from 29 September - 1 October 2000, with some 70 participants from 35 countries. The Conference sought to call attention to the experiences of consumers as a crucial, untapped force in pharmacovigilance, beneficial for drug safety, but also in terms of consumer empowerment in its own right.
Direct consumer reporting of adverse drug events is indeed credible but also controversial in some camps. Yet it is the only system based on the end-users themselves.
The Conference was organized by the Swedish organization KILEN (Consumer Institute for Medicines and Health) in cooperation with the Dag Hammarskjöld Foundation, Health Action International, People’s Health Assembly 2000, the Uppsala Monitoring Centre, the Swedish Consumers’ Association, and the Sigtuna Foundation. Participants included experts from the medical and pharmaceutical professions, drug regulatory authorities, the consumer movement and WHO.
Presentations of existing consumer reporting systems/initiatives were made by representatives from Australia, the Netherlands, Sweden, Switzerland and the UK.
A consensus report from the Conference states that general reasons for considering consumer reports on medicines relate to the need to promote principles of equity, therapeutic advances, accountability and responsiveness. Also, existing physician-based systems have serious deficiencies, which might to some extent be compensated for by the establishment of consumer reporting. Foremost among these limitations are the small proportion of practising physicians (often less than 5%) who contribute data. Input from existing systems relates primarily to new drugs, despite the fact that new problems can emerge with older drugs even after decades of use.
Consumers give more complete picture
Delegates heard that benefits of consumer reporting of adverse drug effects include an earlier accumulation of signals, covering a wider spectrum of organ systems and adverse events. Consumers provide more informative, vivid and complete accounts of unwanted experiences and situations, about which physicians are not informed and so cannot report, such as self-treatment with over-the-counter drugs or herbals.
With so many excellent reasons for direct consumer reporting, why, one might ask, is it not already established? It is because in most countries, consumer reports are simply not eligible for inclusion in the existing physician-based systems, and because consumers lack power and knowledge.
The Conference recommended that, prior to wide-scale implementation, consumer reporting on medicines system/s should be piloted in regions or with patient groups, and handled by an independent body at arm’s length from government and industry. In aggregated form, reports should be made available to all interested parties, including the mass media. The data would also be related to the current data from the 59 national physician-based schemes in the Uppsala Monitoring Centre (a WHO Collaborating Centre for International Drug Monitoring). Appropriate arrangements should be made to enable hospitalised patients as well as participants in clinical drug trials to file reports.
Expert analysis needed
The principle of the subject’s freedom to report should be laid down in Guidelines for Good Clinical Practice accepted by the European Commission and in clinical trial protocols, subject to approval by ethics committees and analogous bodies. Confidentiality agreements concluded between an industrial sponsor and a clinical investigator should never be allowed to impede reporting of adverse effects by participants. Provided there is proper feedback and careful expert analysis of reports, it will not necessarily be more difficult to eliminate mischievous, misleading or ambiguous reports than has been the case in professional-based systems.
A system of consumer reporting on medicines might be supported from public funds, drug licensing fees or research organizations, including the European Union. Its value will depend to some part on enlisting support from existing systems, allaying unjustified concerns and countering possible misunderstandings.
Delegates warned that while developing consumer empowerment, one must also seek to counter potentially harmful influences, such as current efforts to extend Direct-to-Consumer-Advertising of prescription drugs from New Zealand and the USA to the rest of the world.
Further Conference information can be found on the Web at: www.kilen.org
A world of difference: grim statistics on maternal health in developing countries
A woman living in Africa has a lifetime risk of dying from complications related to pregnancy 200 times greater than a woman living in a wealthy industrialised country, according to research findings reviewed in the WHO Bulletin*.
* Bulletin of the World Health Organization, May 2000 (available on the Web at: http://www.who.int/bulletin/). For subscription details contact: World Health Organization, Marketing and Dissemination, CH 1211 Geneva 27, Switzerland.
WHO data show that of the more than 500,000 maternal deaths every year, over 99% are in developing countries and less than 1% in the industrialised world. The main causes of these deaths are unsafe abortion, haemorrhage, infections, high blood pressure and obstructed labour. A quarter to a third of all deaths of women of reproductive age are the result of complications of pregnancy or childbirth.
“The poor fare far worse than the rest of society on all reproductive health outcome indicators. But poverty is not an insurmountable barrier to health when there is a high level commitment to investing in health,” a Bulletin article states. “Gender-based discrimination is an important determinant of poor reproductive health. Women suffer the major burden of sexual and reproductive ill-health because they also suffer discrimination in access to basic needs, health services and the exercise of human rights.” Another Bulletin article reviews data suggesting that making abortion safer could save the lives of many thousands of women a year.
Hopefully a trouble-free pregnancy for this woman in Haiti. But women in the developing world have an unacceptably high risk of dying from pregnancy-related complications
Photo: WHO/PAHO/A Waak
Doctors revise ethical guidelines on medical research
The World Medical Association General Assembly has sent a strong signal to all involved in medical research that rich populations should not exploit poor populations by testing on them new treatments from which they will never benefit. The Assembly held in Edinburgh, Scotland, in October 2000, approved a revised Declaration of Helsinki. Initially drawn up in 1964, the Declaration has since become the most widely accepted guidance worldwide on medical research involving human participants. Commenting on the changes, Dr Anders Milton, chairman of the Association, said: “Research should not be carried out in countries in development just because it is cheaper and the laws are more lax. The same ethical rules should apply wherever research is being conducted”.
The new Declaration emphasises in much clearer terms than ever before the duty that doctors owe to participants in medical research. It says that freely given informed consent, preferably in writing, should be obtained from all participants. People who cannot give informed consent should be included in research only under exceptional conditions.
Strengthening participants’ rights
The Declaration specifies that doctors participating in research have an obligation to declare any financial or other potential conflict of interest. Research is justified only if the populations to be studied stand to benefit. The Declaration states that every patient entered into a study should have access to the best treatment identified by that study once it is completed. Furthermore, testing of any new treatment should be done against the best current method, where that exists, and not against a placebo. This would mean that people in developing countries would at least get access to the best current treatment if they agree to take part in research into new treatments.
The revised Declaration of Helsinki will be distributed to WHO, national bioethics commissions, patients’ representatives groups and other relevant stakeholders. The full text is on the World Medical Association’s Web site: www.wma.net
Source: BMJ 2000;321:913
New course targets better community drug use
At a time when the majority of medicines are purchased directly by consumers without prescription, community education is vital, and a new course is setting out to meet the needs of those with a critical role to play in this much neglected area. Just how neglected was shown by a WHO global survey on public education in rational drug use1, which revealed a shortage of expertise, support and funds for this type of work, in spite of its public health and economic benefits.
Developed by WHO’s Department of Essential Drugs and Medicines Policy and the University of Amsterdam, in collaboration with experts world wide, the course, Promoting Rational Drug Use in the Community, was held for the first time in October 2000 in Bangkok. Enthusiastic participants learned how to effectively identify and prioritise community drug use problems; choose and develop appropriate intervention strategies and communication channels; pretest materials; evaluate impact; and fundraise and network for support and sustainability.
Anyone who came looking for “quick fixes” would have been disappointed. Participants learned that interventions must take into account the social and economic context in which health and medicine-seeking behaviour take place, and be developed with community input. The course emphasises that change is usually incremental. So programme objectives may start with awareness training, move on to knowledge acquisition, and then finally on to behavioural change.
Twenty-five participants, from 14 countries, valued the help given to identify clear objectives, based on realistic expectations of impact on future work.
The skills and experiences of everyone on this highly participatory course proved a major resource. Teaching methods were group activities, field work, presentations and discussions. Participants spent the final two days preparing a detailed plan of action to tackle an important community drug use problem in their home country. They also took home a set of session materials and a small core communications library. But from their comments it was evident that course members were leaving Thailand with much more. As one participant put it, “I realise that in my professional life I have only been looking at half of the picture...”. Another said the course would “help me use scarce resources to implement the most appropriate/feasible and needed interventions.” And for a third it was “a great experience, well planned and well organized”.
After such initial success the course is set to become a regular event, with the next one being held in Entebbe, Uganda, from 11 - 24 November 2001.
WHO. Public education in rational drug use: a global survey. EDM Research Series No.24. Geneva: World Health Organization; 1997. WHO/DAP/97.5.
Next Promoting Rational Drug Use in the Community Course
If you would like to know more about the course in Entebbe, Uganda, from 11 - 24 November 2001, please complete and return this form. Alternatively, further details and an application form can be printed out directly from the EDM web-page at: http://www.who.int/medicines/organization/par/secondcourse.html. Course fees are US$ 2,950, which covers tuition, course materials and accommodation. The deadline for receipt of applications is 1 October 2001.
Full postal address ________________________________________________
Tel _________________ Fax ________________________________________
Please return to the address below:
University of Amsterdam
Faculty of Social and Behavioural Sciences
Attn. Dr Ria Reis
Oudezijds Achterburgwal 185
1012 DK Amsterdam
Tel: +31 20 525 4779
Fax: +31 20 525 3010
Creating a message that counts - participants working on a poster during the course
Photo: S.Sanders, Mahidol University, Bangkok
WHO’s Emergency Library Kits
Library Kits containing essential documents related to public health in emergencies are now available from WHO. Intended to provide technical guidance to field-operating agencies, the Kit includes 120 documents - guidelines and reference manuals produced by WHO, other UN organizations and external publishers. The contents will be updated regularly.
Packed in a metal trunk that converts into a bookcase, the Emergency Library Kit costs approximately US$ 1,320, plus transport charges.
For further information contact: World Health Organization, Department of Emergency and Humanitarian Action, 1211 Geneva 27, Switzerland.
Welcome new HIV/AIDS resource for francophone Africa
A new HIV/AIDS information network for Central and West Africa has been launched - the first network of this type in French. Known as SAFCO (SIDA en Afrique du Centre et de l’Ouest), it will encourage discussion and the electronic exchange of information on HIV/AIDS-related issues. The service is particularly welcome because there is a scarcity of such information and technical material in French in Africa, the continent hardest hit by the virus.
As well as information exchange, SAFCO aims to: strengthen advocacy efforts; improve information about current projects; promote prevention measures; reinforce access to care and treatment; disseminate the results of international conferences and support their implementation.
SAFCO, with over 700 members, is a UNAIDS supported initiative. One of its main strengths is that it is a public cross-sectoral and inter-community information forum. It has input from both the “grassroots” - concerned individuals, government representatives, NGOs, educators, investigators, practitioners and others - and from national and international institutions.
Joining the SAFCO network is free of charge, just send a message to: email@example.com
WHO list of comparator products
Multisource (generic) drugs need to meet the same quality, safety and efficacy standards as the original brand name or innovator product. WHO has now published a list of globally recognised comparator products, to help regulators identify the product against which bioequivalence and interchangeability of generic versions can be assessed.
The list includes 147 drugs from the WHO Model List for which a comparator product has already been identified. It names the manufacturer who is the innovator, and the national market where that manufacturer considers that the product meets the best safety, quality, efficacy and labelling standards. A second list gives the remaining essential drugs for which a comparator product has yet to be selected.
The information is available in WHO Drug Information Volume 13, No. 3, 1999.
APUA’s small grants programme
The Alliance for Prudent Use of Antibiotics (APUA) has initiated a small grants programme, which provides chapters with seed money of US$ 1,500 for projects designed to curb antibiotic resistance and to promote the rational use of these drugs.
APUA’s national chapters form a global network of health care practitioners and scientific groups working to control antimicrobial resistance. They provide information and tailor the Alliance’s message to local customs and medical practices, and the small grants programme is intended to encourage these efforts. Projects submitted for grants are evaluated according to their objectives, collaborative components and management plans. To date grants are helping to support research and education in seven developing and transitional countries.
For further information contact: The Alliance for Prudent Use of Antibiotics, P.O. Box 1372, Boston MA 021171372, USA. E-mail: firstname.lastname@example.org
Leading organizations’ new guidelines on ethics
At a time of increased focus on ethical issues in the pharmaceutical sector, UNAIDS and the European Medicines Evaluation Agency are among many organizations producing their own guidelines.
UNAIDS and vaccine research
In the case of the Joint United Nations Programme on HIV/AIDS (UNAIDS) the ethical guidelines cover HIV vaccine research for those giving trial AIDS vaccines. It is widely thought that developing such a vaccine offers the best hope of controlling the AIDS epidemic, especially in developing countries. But experts say it will be a lengthy and complex process, because of the scientific and ethical challenges involved in clinical trials among human volunteers.
The guidance document, which addresses some of these ethical challenges, took over two years to draw up. It was based on a series of consultations organized by UNAIDS and which involved representatives from 33 countries. The meetings took place in Brazil, Thailand and Uganda (countries that are participating in HIV vaccine trials) as well as in Geneva and Washington. They involved lawyers, activists, NGOs, people living with HIV/AIDS, social scientists, ethicists, epidemiologists, health policy specialists, and agencies and institutions involved in vaccine development.
There was consensus on most, but not all, issues. The most contentious area was the level of treatment that should be offered to participants in vaccine trials who become infected with HIV, not through the trials (vaccines cannot cause HIV infection) but through eventual behavioural exposure. According to the UNAIDS document, “Care and treatment should be provided, with the ideal being to provide the best proven therapy, and the minimum to provide the highest level of care attainable in the host country” under the circumstances in which the trial is conducted.
The AIDS virus. Development of a vaccine is considered to be the best hope of controlling the AIDS epidemic. Guidelines are now in place to address the complex ethical issues involved in testing such a vaccine
Photo: WHO/Institut Pasteur/C. Dauget
With resources in industrialised and developing countries so different, however, not every country can expect to provide the same level of care.
The document contains 18 “guidance points” reflecting a number of issues, including:
• international ethical responsibility to support vaccine trials;
• the obligation to provide an effective vaccine to populations where trials are conducted and to other populations in need;
• the need to strengthen ethical review capacity in developing countries;
• the importance of social and behavioural aspects of testing, and future use of an HIV vaccine.
The guidelines identify responsibilities for the “sponsors” of vaccine trials. In modern vaccine development programmes, sponsors are not usually a single pharmaceutical company. Instead, there tend to be multiple sponsors, with one or more corporations, one or more national governments, and one or more international agencies.
The guidelines highlight the importance of involving communities early in the design, development, implementation and distribution of results of HIV vaccine research. They are designed as a framework to enable communities to decide what is appropriate for them.
Agency acts to ensure integrity, independence, transparency
The European Medicines Evaluation Agency is to have a code of conduct giving specific guidance on conflicts of interest, gifts and confidentiality.
The Code applies to management board, scientific committee and working party members, European experts listed by the Agency, all Agency staff and by analogy all visiting staff. Three categories of interest are listed: financial interests, work carried out for the pharmaceutical industry in the previous five years, and other links, such as grants for study or research, or fellowships endowed by industry in the previous five years.
Anyone with direct interests in the pharmaceutical industry has to end them to remain with the Agency. If there are indirect interests they must be neutralised, for example by preventing someone from taking part in certain tasks.
In general staff have to discourage gifts of anything more than token value which can be shared openly with colleagues. Any gifts of a personal nature must be returned, and staff must not use items with pharmaceutical company logos at work.
The Code states that invitations to predominantly leisure events cannot be accepted, and at meetings or on missions staff should normally pay for their own meals. Invitations from individual pharmaceutical companies, suppliers, etc. should not be accepted. In addition no payment may be accepted for speeches, lectures or publications directly related to Agency activities. Permission to speak at conferences will be refused “if networking or gaining influence must be assumed to be the major objective of the organizer”. Invitations from congresses or meetings organized by pharmaceutical companies are unacceptable.
Africa’s strategy on traditional medicine
The Strategy for Traditional Medicine for the African Region (2000 - 2001) is being developed by the WHO Regional Office for Africa. Its aim is to assist Member States to integrate traditional medicine into health systems and services, and to promote appropriate and rational use. In December 1999, WHO held a consultative meeting on the Strategy, which brought together 23 experts from 15 countries for three days of intensive debate in Harare, Zimbabwe.
Combatting priority diseases
Participants recommended that action plans be developed to implement the Strategy at regional and national levels, so that by 2020 traditional medicine will be an integrated component of the minimum health care package in African countries. Much discussion focused on ensuring the protection of the intellectual property rights of indigenous knowledge in traditional medicine, and the cultivation and conservation of native medicinal plants. Delegates asked WHO to provide technical and financial support for developing traditional medicinal products to combat priority diseases, such as malaria, hypertension, diabetes and HIV/AIDS-related conditions.
Closing the meeting the WHO Regional Director for Africa, Dr Ebrahim Samba, said he wanted to see the continued use of African herbal plants and traditional medicines to treat diseases. He hoped that such traditional medicinal products would eventually be exported, after clinical trials have proved their efficacy and safety. Dr Samba stressed the economic importance this could have for Africans.
As a follow-up to the December consultative meeting, WHO’s Regional Office for Africa organized the African Forum on the role of traditional medicine in health systems, in Harare in February 2000. Over 100 participants from throughout the region held wide ranging discussions, reviewed current and needed research on these medicines, and identified local production issues. Recommendations from the meeting included: ensuring adequate legal and regulatory frameworks to promote traditional medicines; establishing or strengthening traditional medicine practitioners’ associations; and increasing collaboration among healers, scientists and doctors.
HAI-Lights has become the first HAI-Europe publication de signed to be read and used electronically. All of the information included in the newsletter’s August 2000 double issue appears in easy to find links shown on the cover page. HAI-Europe has been working towards a Web-based version of the regional newsletter for some time, due to members’ demand for faster information and more accessible material.
It is planned to link the newsletter’s content to a Web site search function so that articles on various issues can be retrieved quickly and easily.
Access the August issue of HAI-Lights at: http://www.haiweb.org/pubs/hailights/aug2000/
The entire newsletter is also available in a downloadable text format. You can choose Word for either PC or Mac to read or print out the issue’s complete contents or a specific section.
French set to curb drug spending
The French Government has warned that the rate of growth of pharmaceutical spending is still far too high, and that it is deciding which products will have price or reimbursement cuts, or be removed from the list of reimbursable products.
Speaking at a press conference in May 2000, Labour and Solidarity Minister, Martine Aubry, said that health care expenditure was still rising strongly, particularly in the pharmaceutical sector, which increased by 6.3% in 1999. While projections for 2000 are for a cut of 0.7% this is far higher than the target set by Government of 2%. Addressing the Social Security Accounts Commission shortly before her press conference, Ms Aubry said that it was “absolutely necessary” to bring pharmaceutical expenditure into line with Government targets.
An elderly patient in France, where the Government is acting to reduce rising pharmaceutical expenditure
Photo: WHO/E. Schwab
She singled out “unjustifiable prescribing”, saying that some products were quickly capturing a sizeable share of the market more because of what she termed “aggressive commercial policies towards doctors than because they are advances in public health”. “Information arrives in doctors’ surgeries from pharmaceutical companies and only from them” she continued. “ I am not criticising the industry. It does its job, which is to sell and sell even more. But she said that she did not want doctors to be “left alone to face the industry”. The Government intends to supply doctors with independent information on the correct use of medicines. While encouraged by increasing generic substitution, Ms Aubry said that she wanted to see more generic products on the market soon.
The French pharmaceutical industry association, SNIP, has criticised the Government’s target of a 2% increase in pharmaceutical spending in 2000. The Government cost-containment initiatives (prescribing guidelines, computerization of doctors’ surgeries, the encouragement of generics and reimbursement review) were necessary, SNIP stated, but had failed to bring spending into line with the 2% limit.
Source: Scrip, No.2543, 26 May 2000.
Indian training course highlights pharmacists’ evolving role
A group of community and hospital pharmacists and pharmacy students from the Bengal area benefited from a break in routine when in September 1999 they spent two days looking at broader issues affecting their profession. Twenty-six participants held wide-ranging discussions on subjects including their changing role, the structure of the country’s pharmaceutical industry and the patent situation. Run jointly by the Community Development Medicinal Unit, Calcutta, and the Indian Pharmaceutical Association, Bengal Branch, the training course, Good Community Pharmacy Practice, was so successful that it is planned to repeat it every year.
Upgrading knowledge and skills
In the varied programme, a session on formulations marketed in India although banned by the Government generated animated debate. So too did the topic of clinical waste management - an area new to many of the participants. The second day began with a discussion on how best to respond to symptoms of common ailments, followed by tips on improving drug dispensing, and medical stores management.
Although maybe not of immediate relevance to the job description of most participants, two sessions provided plenty of food for thought. One was on the scientific principles of pharmaceutical inventory management. The other covered the structure of the pharmaceutical industry in India, recent changes in national drug policy and the Indian patents scenario.
For further information contact: Community Development Medicinal Unit, 47/1B Garcha Road, Calcutta-700 019, West Bengal, India, or see: http://education.vsnl.com/cdmudocu/CDMUHome.htm
Participants engrossed by a demonstration of special dosage forms
A World Health Report with a difference
The World Health Report 2000 - Health Systems: Improving Performance1 is an expert analysis of the increasingly important influence of health systems in people’s daily lives. In recent decades, health systems have contributed enormously to better health for most of the global population.
But they have the potential to achieve further improvements, especially for the poor. As Dr Brundtland, WHO’s Director-General, comments in her introduction to the Report, “The poor are treated with less respect, given less choice of service providers and offered lower-quality amenities. In trying to buy health from their own pockets, they pay and become poorer.”
To date very little has been done to unravel the complex factors that explain good or bad performance by individual health systems. Given equal resources, why do some succeed where others fail? Is performance simply driven by the laws of supply and demand, or does another logic apply? Why is dissatisfaction with services so widespread, even in wealthy countries offering the latest interventions? If systems need improvement, what tools exist to measure performance and outcomes?
These are some of the questions that the Report addresses, as it presents the results of the first ever analysis of the world’s health systems. It provides an index of performance based on three fundamental goals: improving the level and distribution of health, enhancing the responsiveness of the system to the legitimate expectations of the population, and assuring fair financial contributions.
As the Report argues, good performance depends critically on the delivery of high-quality services. But health systems must also protect citizens from the financial risks of illness and meet their expectations with dignified care. The publication shows how the achievement of these goals depends on the ability of each system to carry out four main functions: service provision, resource generation, financing and stewardship. Chapters devoted to each function offer new conceptual insights and practical advice on how to assess performance and achieve improvements with available resources.
The analysis revealed a number of problems common to many countries. Among them are that:
• many health ministries focus on the public sector and often disregard the frequently much larger private sector health care;
• in many countries, some if not most physicians work simultaneously for the public sector and in private practice. This means that the public sector ends up subsidising unofficial private practice;
• many governments fail to prevent a “black market” in health, where widespread corruption, bribery, “moonlighting” and other illegal practices flourish. The black markets, which themselves are caused by malfunctioning health systems, and health workers’ low incomes, further undermine those systems;
• many health ministries fail to enforce regulations that they themselves have created or are supposed to implement in the public interest.
The Report aims to stimulate debate about better ways of measuring health system performance and overcoming such problems. By shedding new light on what makes systems behave in certain ways, WHO also hopes to help policy-makers understand the many complex issues involved, weigh their options and make wise choices.
1. WHO. The world health report 2000 - health systems: improving performance. Geneva: World Health Organization; 2000. Available from: Marketing and Dissemination, World Health Organization, 1211 Geneva 27, Switzerland. Price: Sw.fr.15/US$ 13.50, and in developing countries Sw.fr.10.50. The full report is available on the Web at: http://www.who.int/home/reports.html
Celebrating the Chinese version of the Monitor
The Essential Drugs Division of China’s State Drug Administration has seen its hard work rewarded as the first two issues of the Monitor in Chinese have rolled off the printing presses, to an enthusiastic reception.
Ten thousand copies of each issue have been printed and distributed, free of charge, to Government departments, medical institutes and experts in the pharmaceutical sector. While these first issues contain a selection of key articles from recent editions, future copies will reproduce the text of the most recent Monitor.
New public health channel piloted in Africa
WorldSpace Foundation and SATELLIFE have announced a new health service that will provide a steady stream of material to assist medical professionals in Africa in the diagnosis, prevention and treatment of prevalent diseases. The service, called the Public Health Channel, aims to overcome the barriers of poverty, geography and unreliable communications infrastructures, to help stop the rise of diseases such as malaria, tuberculosis and HIV/AIDS.
“The ability to widely disseminate information about the treatment and prevention of HIV/AIDS and other diseases is the reason the WorldSpace system was created,” says Gracia Hillman, WorldSpace Foundation President.
“The goal of SATELLIFE’s information services is to connect the health practitioner in the developing world with a range of high-quality information resources in a cost-effective manner, by making use of the most affordable, efficient and appropriate technology”, states SATELLIFE Executive Director, Holly Ladd. “The Public Health Channel will employ the technology of the WorldSpace system to exponentially increase the amount of information health practitioners throughout Africa can access - information that most health practitioners in the United States and Europe take for granted.”
The Public Health Channel will be launched in four countries: Ethiopia, Kenya, Uganda and Zimbabwe. After an initial test period, the project will expand to other African countries, as funding becomes available. WorldSpace receivers will be placed in hospitals, medical schools, medical libraries, health clinics, health ministries and research settings.
WorldSpace receivers provide crystal clear digital audio channels, and can also serve as a modem, downloading text-based material and dynamic images from the AfriStar satellite directly to computers. TheWorldSpace system transcends the difficulties of unreliable telephone systems at a fraction of the cost of most Internet-based projects.
WorldSpace Foundation works with NGOs and other humanitarian groups to bring life-saving information to people who are disadvantaged by poverty, rural location and the digital divide.
SATELLIFE is an international not-for-profit humanitarian organization. Its mission is to improve health by improving connections between professionals in the field, through electronic communications and information exchange in the areas of public health, medicine and the environment. Particular emphasis is on areas of the world where poor communications, economic conditions or natural disasters limit access.
SATELLIFE produces two e-mail publications, HealthNet News and HealthNet News - AIDS, which feature materials from 21 journals, including the British Medical Journal, Lancet and East African Medical Journal.
SATELLIFE also operates and maintains several global electronic discussion groups on subjects relevant to developing countries. (See Netscan page 32 for more information on SATELLIFE’s services).
WorldSpace Foundation is a non profit organization created in 1997. Based in Washington DC, USA, its work encompasses Africa, Asia-Pacific, Latin America and the Caribbean. It has 5% of the channel capacity of the three WorldSpace Corporation satellites for non commercial social development and distance learning programming.
Drug donations problem in Venezuela
Months after devastating floods and landslides left up to 30,000 people dead or missing and 200,000 homeless, the Bolivarian Republic of Venezuela was being inundated again by a flood of unusable medical aid. Harrowing television pictures of the disaster in December 1999 in the coastal states of Vargas and Falcon, near Caracas, sparked a massive humanitarian response, and tonnes of medicines arrived from around the world.
However, health workers helping the victims say that huge quantities of medical aid remain stockpiled in warehouses, and up to 70% will have to be incinerated. A report by the Government’s Pharmacological Production Service says many products cannot be used because they are out of date, unnecessary, have been partially used, or have no Spanish labelling. As a result, the Government has already had to spend at least 10m bolivars (approximately US$ 16,000) to hire extrastaff and increase working hours simply to classify what has been received.
Dr Francisco Griffin, Director-General of the Production Service, said he thought some companies had deliberately sent expired products, considered as toxic waste, to evade the cost of having to deal with them themselves. In 1996 WHO published interagency guidelines on drug donations1 in response to increasing reports of such problems being caused by inappropriate donations.
However, Dr Griffin accepted that the Service had not anticipated such a massive international response to the landslides. When the disorganized nature of the donations and the “titanic work” required to sort through them became clear, advertisements were belatedly posted on the Web sites of international organizations asking only for specifically requested products.*
* There are signs that countries are beginning to speak out, to avoid receiving unnecessary drugs when faced with disasters. For example, Mozambique required all donations to be consistent with WHO’s Interagency guidelines when areas of the country were flooded in February and March 2000.
Source: BMJ 2000;320:1491.
Calm waters on Lake Maracaibo for this auxiliary health worker doing her rounds, but floods in Venezuela in 1999 caused massive devastation
Photo: WHO/P. Almsay
1. WHO. Interagency guidelines for drug donations. Geneva: World Health Organization; 1996. (Second edition published 1999).
Update on drug donations
A study carried out by Community Initiatives Support Services International has investigated the benefits and problems of donated drugs at 24 mission health facilities in Kenya and Tanzania between 1997 and 1998. It found that:
• On average health facilities received four deliveries of donated drugs per year.
• Approximately a quarter of all donated drugs had a shelf-life of less than one year.
• A quarter of donated drugs were antibiotics.
• Three-quarters of the health facilities had sent a list of drugs required to the donor, but only half received drugs from that list.
• When donated drugs were not requested by the health facility it was more likely that good drug donation practices were not adhered to.
• While nurses were the most likely health workers to be in charge of pharmacies and of selecting, prescribing and dispensing drugs, donors usually decided the quantity of each drug to send.
Researchers concluded that:
• Donated drugs are more appropriate when the recipient, not the donor, decides which drugs are sent.
• As nurses play a central role in drug donations they must understand the principles of good donation practices.
• There is still a need to promote the essential drugs concept and use of essential drugs lists by both donors and recipients.
For further information on the study contact: Dr Eva Ombaka, The Pharmaceutical Programme, World Council of Churches/Community Initiatives Support Services International, P.O. Box 73860, Nairobi, Kenya. Source: Practical Pharmacy, No. 14, 1999.
Oxfam campaigns to lower drug prices
Oxfam, the international development agency, is launching a campaign on access to medicines, with a focus on the issue of affordability. Oxfam has drawn on its programme experience and local research to produce a number of reports looking at the determinants of drug prices, and at policies that can bring them down. It is paying particular attention to the influence of World Trade Organization intellectual property rules and to the policies of the pharmaceutical industry, and makes policy recommendations to the main actors.
The British-based organization is seeking to raise public awareness on the issues as part of a broader international campaign to make the world trading system work more to the advantage of poor communities and poor countries. Oxfam has humanitarian and development programmes in over 70 low-income countries. It is also a prominent NGO advocate on international economic development issues, including trade and debt.
For more information visit Oxfam’s Web site at: www.oxfam.org.uk or e-mail: <email@example.com>. Alternatively, write to George Tarvit, Campaign Department, Oxfam, 274 Banbury Road, Oxford, OX2 7DZ, UK.