Drug use by consumers is also influenced by factors at the international level including:
Global trade regulation and access to drugs
Globalization and the international regulation of trade have important consequences for health policy. Concerns about the consequences of globalization and international trade agreements and what were described as the ‘non-level playing field’ on which they were developed, were first raised at the 1996 World Health Assembly. The lack of financial access to patented HIV/AIDS medicines in developing countries and alliances between health and development groups in both developed and developing countries have brought these issues to the forefront of national and global agendas.
The World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) obliges all WTO Member States to provide 20 years of patent protection for medicines. Industrialized countries should have implemented TRIPS by 1996, developing countries had to introduce national regulation on intellectual property by the year 2000 and least developed countries have until 2016 to do so. The 2001 meeting of the World Trade Organization in Doha acknowledged that access to medicines should have primacy over commercial interests (see Médecins Sans Frontières, 2003).
Over the past decade there has been a shift in donor support away from vertical programmes, such as essential drugs programmes, and towards health reform and sector-wide approaches. Health reform policies affect local-level implementation of essential drugs programmes. They generally promote collaboration with the private sector, the introduction of user fees and decentralization of health care decision-making, including pharmaceutical procurement and supply.
There have been several recent efforts to mobilize resources in order to increase access to specific, greatly needed medicines and vaccines in developing countries. Examples of this trend include the Global Alliance for Vaccines and Immunisation (GAVI), the Medicines for Malaria Venture public-private partnership to enhance malaria drug supply and the Global Fund for HIV, TB and Malaria. These initiatives can potentially increase access in developing countries to urgently needed medical technologies.
An interagency committee including a wide range of NGOs and UN agencies has published the second edition of Guidelines for Drug Donations (WHO/EDM/PAR/99.4) which aim to ensure appropriate supply and rational use of donated medicines.
Global consumer advocacy
As is the case at the national level, consumer advocacy at the global level is vital for rational drug use. Consumer organizations operating in the global arena lobby for rational medicines policies within the formulation of world health policies. They monitor the adoption and implementation of international agreements. Such groups also publicize inappropriate or harmful activities carried out by the pharmaceutical industry. The global advocacy movement also supports national organizations in their campaigns for structural change and rational drug use.
The Internet is a very important source of information on health and medicines for people who can access it. It also serves as a tool for advocacy and networking. However, its lack of borders and regulation also makes it a popular way to promote drugs on industry-sponsored web sites and sites containing material on specific health conditions. WHO has published guidelines to help consumers (and health workers) find reliable information on the Internet (WHO, 1999).
Table 1 overleaf gives an overview of the main factors influencing drug use by consumers, according to their level of influence. You can add factors to this list based on local discussions and your own analysis of what influences consumers’ drug use in your own country.
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Table 1. Main factors influencing drug use by consumers
LEVEL OF INFLUENCE
• Perceived need for drugs
• Ideas about efficacy and safety
• Uncertainty resulting in poly-pharmacy
• Division of drug consumption roles
• Cost of medicines
• Literacy levels
• The power of medicines
• Drug use culture
• Drug supply system
• Information channels
• Extent to which health workers are consulted
• Quality of health worker prescribing
• Quality of the consultation
• Quality dispensing
• Regular supply
• Cost of medicines
• Implementation of essential drugs policy
• Drug promotion
• Financing and reimbursement
• Consumer advocacy
• The media
• Public education
• Health consequences of global trade agreements
• Donor support for essential drugs programmes
• Global consumer advocacy
• The Internet
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