Assistência Farmacêutica em Moçambique: a ajuda externa na provisão pública de medicamentos / Pharmaceutical Services in Mozambique: foreign aid in public provision of medicines

Resumo Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.

Abstract This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.

Vector control services: malaria supply chain management in facilities standard operations manual

Use of malaria medicines is essential and critical in our response to the malaria situation in Guyana. It is part of the final link between patients and health services. Availability of malaria medicines and diagnostic supplies can only be realized by improving the opportunity to manage these commodities in an efficient manner. For these reasons, this manual will address all aspects of the pharmaceutical management cycle. The manual provides basic information for the successful operation of the supply chain for Malaria Medicines and Supplies. The intention is to use this manual for training and orientation of health workers in best practices of the drug management cycle, in pursuit of securing performance improvements to the malaria program.

Health workers perceptions on chloroquine and sulfadoxine/sulfalene-pyrimethamine monotherapies: implications for the change to combination therapy of artemether/lumefantrine in Tanzania

Objective: To describe; from health workers (HWs) perspectives; the potential and actual barriers to the implementation of the first change of policy from chloroquine (CQ) to Sulfadoxine / Sulfalane - Pyrimewthamine (SP) in preparation for the second change of policy to Artemisinin based Combination Therapies (ACTs). Methods: A descriptive cross-sectional survey of HWs using questionnaire interviews was carried out in public and private health facilities in Songea Urban district. The interview concerned awareness and knowledge on the commonly used antimalarial drugs as given in the new policy; focusing on SP use and the associated side effects as well as perceptions on the potency and safety of SP versus CQ and the perceived alternative antimalarial drugs to non-response or reaction to SP. Results: Awareness on the new policy was very high; 91.4 of HWs were aware that SP was the new drug. Although the majority of HWs (81.9) reported using the new policy as soon as it was out; a significant percentage (76.2) reported continued use of SP (P-value 0.001). SP was perceived to have a low potency in that it was slow in fever clearance. A significant percentage (65.7) of HWs reported a history of problems with SP use namely headaches and skin reactions. Quinine (QN) was significantly frequently mentioned as the perceived alternative drug to CQ (61.1) and non-response (56.6) or reaction (54.1) to SP. Conclusion: Findings show that SP was generally not preferred by HWs; and they continued to use CQ despite the evidence that it was no longer effective indicating that. HWs tend to maintain perceptions based on their experiences with drugs currently in use. Pertinent information; education and behaviour change communication strategies related to the change from SP to ACT should focus on the fact that the previous drug is no longer effective so as to induce consistent use of the new drug

The role of private drug vendors as malaria treatment providers in selected malaria endemic areas of Sri Lanka.

BACKGROUND AND OBJECTIVES: The involvement of private drug vendors in malaria treatment is particularly high in developing countries and understanding their practices and knowledge about antimalarials and malaria treatment will aid in devising strategies to increase the correct use of antimalarials and improve adherence to the government's malaria drug policy. Results of a study on the knowledge and practices of the private drug vendors conducted in seven districts in Sri Lanka, mostly in malarious areas are presented. METHODS: Data on awareness of government's malaria drug policy, practice of issuing antimalarials, knowledge about malaria and antimalarial drugs were collected from the drug vendors using pre-tested questionnaire in vernacular language. Data were statistically analysed using Stata 8.2. Chi-square test was carried out for individual explanatory variables and a logistic regression model was applied taking all response variables as binary outcome. RESULTS: Vendors' knowledge on antimalarials was poor with 58% of the vendors being unaware of the government malaria drug policy in the country. Also, the advice provided to customers buying antimalarials was limited. However, the majority of the private vendors emphasised that they were aware of the importance of case confirmation before treatment as stressed in the national policy. Although, the vendors did not have a high awareness of national drug policies they were only found selling chloroquine and primaquine as recommended by the Ministry of Health. INTERPRETATION AND CONCLUSION: In recent years Sri Lanka, as a whole, has experienced very little malaria. The reduction in demand for antimalarials due to low incidence levels may have influenced the knowledge and awareness on antimalarials and government drug policies. However, since low levels of malaria do not guarantee that epidemics will not occur, attempts to educate private drug vendors as a part of an organised control programmes are of major importance.

Drug Resistance to AIDS; Tuberculosis and Malaria in the African Region

With just 10of the world population; sub-Saharan Africa has the highest burden of HIV/AIDS; tuberculosis and malaria in the world. Both access to and adequate utilization of eff ective treatment with quality-assured medicines are crucial for reducing the disease burden. However; eff orts to improve access to treatment are hampered by the development of HIV; TB and malaria drug resistance. This is a result of genetic mutations and is a major threat to control of HIV/AIDS; TB and malaria. HIV drug resistance can be minimized by good antiretroviral treatment (ART) programmes; removal of barriers to continuous access to ART and reduction of HIVtransmission. Recent surveys conducted at antenatal clinics in several countries in the African Region estimated that HIV resistance to all drug classes is less than 5. A global HIV drug resistance network established in 2001 supports countries in capacity building and guidance on standard procedures for monitoring HIV drug resistance. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are principally a result of inadequate or poorly administered treatment regimens. The new WHO Stop TB Strategy launched in 2006 identifies management of MDR-TB as a core component of TB control. The magnitude of MDR-TB in the African Region is still unknown. In 2007; 27 countries notifi ed MDR-TB cases; and six reported at least one case of XDR-TB. Following widespread resistance to chloroquine and sulphadoxine-pyrimethamine all malaria-endemic countries except two in the Region have changed the treatment policy to artemisinin-based combination therapy (ACT). The main method of monitoring antimalarial drug resistance is through therapeutic efficacy testing. Todate there has been no confi rmed resistance to ACTs in the African Region. Given the emergence and spread of resistance to HIV; TB and malaria drugs; the purpose of this paper is to describe the issues and challenges and propose a way forward with regard to the prevention and control of such resistance