Drugs are important in delivering effective health intervention. Over the past 50 years, there are many drugs available for the prevention of the disease such as polio and measles, for treating viral and bacterial infection such as Zidovudine (antiretroviral drugs for the treatment of HIV) and TB drugs, for the treatment of chronic diseases such as CVD, depression and diabetes, as well as for the palliative care. Some issues must be taken into account when we are considering about the delivery of appropriate drugs for those who need them.
Financial issues include funding for basic research and commercial development, defining and protecting intellectual property rights, and assuring affordability. Basically, basic research and commercial development of the drugs can be found mostly in the developed countries. The main problem for this is the drugs produced by these developed countries are mostly focussed on their disease burden. This is proven by the fact that out of 1, 325 new medicines available between 1975 and 1997, only 11 drugs were specifically developed for tropical disease such as TB and malaria. Some international measures have been initiated since past decade such as Doctors Without Borders’ Drugs for Neglected Disease, public research into developing vaccines for malaria and new therapies for drug-resistant TB.
Other than that, assuring affordability of the drugs is also important in financial issues. This is because, if the drug is too expensive, it cannot be purchased by the patient, so the effective health care intervention cannot be achieved. One of the solutions for this problem is the use of the essential drug list that is listed by WHO. Basically there are 320 essential drugs in 559 formulations in WHO guidelines. Essential drugs are important because it focuses on the least expensive alternative in order to treat the categories of diseases that are prioritized. Essential drugs list varies among countries. According to WHO, essential medicines are those that satisfy the priority health care need of the population. The criteria for the essential medicines include the availability of the medicines in sufficient amount, affordable, in appropriate dosage form and assured quality.
b. Logistical issues
Logistical issues include procurement, storage and distribution. Procurement process mainly focus on three things; the quality of the drugs, the price and the reliability of the supplier. This process follows strict tender in which the lowest price is not the main indicator for primary selection. In this kind of tender, the bidders are required to send info related to companies reliability, production quality, financial stability, and their past performance. The price of the drugs would be decreased with time. This is because of several factors such as when the patent protection expires, when the compulsory licensing is enacted, and in the conditions in which there is public pressure, collective negotiation or international advocacy. After the drugs are purchased, it is important to transport the drugs properly in order to maintain the quality of the drugs and prevent damage of the drugs. The drugs must be stored properly.
c. Clinical issues
Clinical issues here concern about the appropriate prescription practices and adherence to the regimen prescribed. There are two main problems related to the failures in drug therapy; the failure of the patient to comply the correct dosage and the duration of the drug therapy; the wrong prescription by medical staffs. Some of the medical staffs tend to prescribe the drug unnecessarily. Both of the factors above have devastating effect on the effectiveness of health care intervention because it can accelerate the emergence of drug resistant microorganism such as the case of TB. The emergence of drug resistant microorganism could really cause major negative impact on middle and low-income countries because this problem occurs mostly in the countries mentioned above but not the developed countries. Most of the basic research as stated somewhere in this topic, is carried out in the high-income countries.
d. Incentives issues
Basically, these issues are related to the drug research, development and marketing that affect the involvement of pharmaceutical companies, private health care providers, pharmacies, and publicly financed or managed health services.
References:
1. Jamison, D.T., Breman, J.G., et al. 2006. Priorities in Health. World Bank, Washington, DC.
2. Who Health Organization. 2010. Essential Medicines. [online accessed on Nov 3 2010]
Tidak ada komentar:
Posting Komentar