(2012; 268 pages)
Skin diseases may often be forgotten by policy makers, but not by patients. Many adults and children suffer from common disorders such as pyoderma, scabies, acne, dermatophytosis, skin warts and pediculosis capitis leading to much discomfort, medical expenses and loss of schooldays.
In industrialized countries effective and convenient treatments are easily available, and are usually reimbursed by health insurance. In low- and middle income countries (LMICs) and especially for the poorer segments of the population, the situation is different. Many patients first try their luck with the local store or the traditional healer, and only visit a clinic or hospital when the disease has progressed to an advanced stage. And when the diagnosis is finally made the patient, or the parent, often receives a written prescription to buy the treatment in a private pharmacy.
In LMICs up to three quarters of medical expenses are paid out of pocket. Poor households in LMICs spent up to 9.5% of their household expenditure on medicines, compared to 3.5% by the poor in high-income countries. Surveys from over fifty LMICs have shown that, on average, more than half of essential medicines are out of stock in public sector facilities, forcing patients to the private sector where brand preferences lead to prices which are 3-5 times higher than those of simple generic products. This picture is especially relevant for dermatological diseases, for which many facilities cannot afford to supply all patients with ready-made dermatological ointments and creams.
This book is the very welcome second revised edition of a publication that has stood the test of time. It brings the cost-effective treatment of common skin diseases within reach of all general physicians, clinical officers and nurses in rural clinics and district hospitals. The book also offers very practical guidance to pharmacists and pharmacy technicians in larger hospitals to prepare simple dermatological formulations at very low cost.
From an industrial development point of view, domestic production of skin preparations is a good start for building self-reliance in medicine manufacturing. Small-scale production of skin preparations does not require much capital investment, and the products can be adapted to local preferences and labeling. This business case is much easier to make than for manufacture of tablets and injections which require much more capital investment and technical sophistication, and which face immense global competition from large-scale production from countries like India and China.
The approach of this book is also very much in line with WHO’s concept of essential medicines: a limited range of carefully selected essential medicines leads to better treatment and lower costs. The book is especially recommended for use by publicly funded or faith-based not-for-profit health care services – in other words, in situations where the health care provider wants to make an honest effort to supply the patients with cheap and cost-effective treatment.
Hans V. Hogerzeil, MD, PhD, DSc, FRCP Edin
Professor of Global Health, University of Groningen, the Netherlands
Former Director of Essential Medicines and Pharmaceutical Policies, WHO, Geneva