Suicide in developing countries (2): risk factors.

PubMed

Vijayakumar, Lakshmi; John, Sujit; Pirkis, Jane; Whiteford, Harvey

2005-01-01

The majority of studies on risk factors for suicide have been conducted in developed countries, and less work has been done to systematically profile risk factors in developing countries. The current paper presents a selective review of sociodemographic, clinical, and environmental/situational risk factors in developing countries. Taken together, the evidence suggests that the profiles of risk factors in developing countries demonstrate some differences from those in developed countries. In some developing countries, at least, being female, living in a rural area, and holding religious beliefs that sanction suicide may be of more relevance to suicide risk than these factors are in developed countries. Conversely, being single or having a history of mental illness may be of less relevance. Risk factors that appear to be universal include youth or old age, low socioeconomic standing, substance use, and previous suicide attempts. Recent stressful life events play a role in both developing and developed countries, although their nature may differ (e.g., social change may have more of an influence in the former). Likewise, access to means heightens risk in both, but the specific means may vary (e.g., access to pesticides is of more relevance in developing countries). These findings have clear implications for suicide prevention, suggesting that preventive efforts that have shown promise in developed countries may need to be tailored differently to address the risk factor profile of developing countries.

A Conceptual Framework of Mapping Access to Health Care across EU Countries: The Patient Access Initiative.

PubMed

Souliotis, Kyriakos; Hasardzhiev, Stanimir; Agapidaki, Eirini

Research evidence suggests that access to health care is the key influential factor for improved population health outcomes and health care system sustainability. Although the importance of addressing barriers in access to health care across European countries is well documented, little has been done to improve the situation. This is due to different definitions, approaches and policies, and partly due to persisting disparities in access within and between European countries. To bridge this gap, the Patient Access Partnership (PACT) developed (a) the '5As' definition of access, which details the five critical elements (adequacy, accessibility, affordability, appropriateness, and availability) of access to health care, (b) a multi-stakeholders' approach for mapping access, and (c) a 13-item questionnaire based on the 5As definition in an effort to address these obstacles and to identify best practices. These tools are expected to contribute effectively to addressing access barriers in practice, by suggesting a common framework and facilitating the exchange of knowledge and expertise, in order to improve access to health care between and within European countries. © 2016 S. Karger AG, Basel.

Socio-Economic and Health Access Determinants of Breast and Cervical Cancer Screening in Low-Income Countries: Analysis of the World Health Survey

PubMed Central

Akinyemiju, Tomi F.

2012-01-01

Background Breast and Cervical cancer are the two most common cancers among women in developing countries. Regular screening is the most effective way of ensuring that these cancers are detected at early stages; however few studies have assessed factors that predict cancer screening in developing countries. Purpose To assess the influence of household socio-economic status (SES), healthcare access and country level characteristics on breast and cervical cancer screening among women in developing countries. Methods Women ages 18–69 years (cervical cancer screening) and 40–69 years (breast cancer screening) from 15 developing countries who participated in the 2003 World Health Survey provided data for this study. Household SES and healthcare access was assessed based on self-reported survey responses. SAS survey procedures (SAS, Version 9.2) were used to assess determinants of breast and cervical cancer screening in separate models. Results 4.1% of women ages 18–69 years had received cervical cancer screening in the past three years, while only 2.2% of women ages 40–69 years had received breast cancer screening in the past 5 years in developing countries. Cancer screening rates varied by country; cervical cancer screening ranged from 1.1% in Bangladesh to 57.6% in Congo and breast cancer screening ranged from 0% in Mali to 26% in Congo. Significant determinants of cancer screening were household SES, rural residence, country health expenditure (as a percent of GDP) as well as healthcare access. Discussion A lot more needs to be done to improve screening rates for breast and cervical cancer in developing countries, such as increasing health expenditure (especially in rural areas), applying the increased funds towards the provision of more, better educated health providers as well as improved infrastructure. PMID:23155413

Global access to infertility care in developing countries: a case of human rights, equity and social justice.

PubMed

Ombelet, W

2011-01-01

According to WHO data more than 180 million couples in developing countries suffer from primary or secondary infertility. The social stigma of childlessness still leads to isolation and abandonment in many developing countries. Differences between the developed and developing world are emerging because of the different availability in infertility care and different socio-cultural value surrounding procreation and childlessness. Although reproductive health education and prevention of infertility are number one priorities, the need for accessible diagnostic procedures and new reproductive technologies (ART) is very high. The success and sustainability of ART in resource-poor settings will depend to a large extend on our ability to optimise these techniques in terms of availability, affordability and effectiveness. Accessible infertility treatment can only be successfully introduced in developing countries if socio-cultural and economic prerequisites are fulfilled and governments can be persuaded to support their introduction. We have to liaise with the relevant authorities to discuss the strengthening of infertility services, at the core of which lies the integration of infertility, contraceptive and maternal health services within public health care structures. After a fascinating period of more than 30 years of IVF, only a small part of the world population benefits from these new technologies. Time has come to give equitable access to effective and safe infertility care in resource-poor countries as well.

Sea-change or change challenge? Health information access in developing countries: The U.S. National Library of Medicine experience.

PubMed

Royall, J; Lyon, B

2011-09-01

Health professionals in developing countries want access to information to help them make changes in health care and contribute to medical research. However, they face challenges of technology limitations, lack of training, and, on the village level, culture and language. This report focuses on the U.S. National Library of Medicine experience with access: for the international medical/scientific community to health information which has been published by researchers in developing countries; for scientists and clinicians in developing countries to their own literature and to that of their colleagues around the world; for medical librarians who are a critical conduit for students, faculty, researchers, and, increasingly, the general public; and for the front line workers at the health center in the village at the end of the line. The fundamental question of whether or not information communication technology can make a difference in access and subsequently in health is illustrated by an anecdote regarding an early intervention in Africa in 1992. From that point, we examine programs to improve access involving malaria researchers, medical journal editors, librarians, and medical students working with local health center staff in the village. Although access is a reality, the positive change in health that the information technology intervention might produce often remains a mirage. Information and technology are not static elements in the equation for better access. They must function together, creating a dialectic in which they transform and inform one another and those whom their combination touches.

Tracking progress towards global drinking water and sanitation targets: A within and among country analysis.

PubMed

Fuller, James A; Goldstick, Jason; Bartram, Jamie; Eisenberg, Joseph N S

2016-01-15

Global access to safe drinking water and sanitation has improved dramatically during the Millennium Development Goal (MDG) period. However, there is substantial heterogeneity in progress between countries and inequality within countries. We assessed countries' temporal patterns in access to drinking water and sanitation using publicly available data. We then classified countries using non-linear modeling techniques as having one of the following trajectories: 100% coverage, linear growth, linear decline, no change, saturation, acceleration, deceleration, negative acceleration, or negative deceleration. We further assessed the degree to which temporal profiles follow a sigmoidal pattern and how these patterns might vary within a given country between rural and urban settings. Among countries with more than 10 data points, between 15% and 38% showed a non-linear trajectory, depending on the indicator. Overall, countries' progress followed a sigmoidal trend, but some countries are making better progress and some worse progress than would be expected. We highlight several countries that are not on track to meet the MDG for water or sanitation, but whose access is accelerating, suggesting better performance during the coming years. Conversely, we also highlight several countries that have made sufficient progress to meet the MDG target, but in which access is decelerating. Patterns were heterogeneous and non-linearity was common. Characterization of these heterogeneous patterns will help policy makers allocate resources more effectively. For example, policy makers can identify countries that could make use of additional resources or might be in need of additional institutional capacity development to properly manage resources; this will be essential to meet the forthcoming Sustainable Development Goals. Copyright © 2015 Elsevier B.V. All rights reserved.

Building a widespread public health education system for developing countries in Africa.

PubMed

Wiesner, Martin; Pfeifer, Daniel

2013-01-01

Many developing countries struggle to move their health care system into the information age. Millions of people in Africa do not have any access to online resources to satisfy their need for adequate individual health information. Access to high quality content available in public spots could have an immense impact on people's daily life. Our browser-based health education application might help to provide a better understanding of diseases for people in developing countries. We encourage other researchers to adopt our vision for a widespread public health education system in Africa.

Promoting Access to Finance by Empowering Consumers--Financial Literacy in Developing Countries

ERIC Educational Resources Information Center

Kefela, Ghirmai T.

2010-01-01

This paper is an effort to establish the financial sector in developing countries to promote financial literacy of their customers. This could have access to finance and savings, which in turn support livelihoods, economic growth, sound financial systems, and participate in the economy. The main objectives of this paper is to enhance a bank's…

Lighting up the World The first global application of the open source, spatial electrification toolkit (ONSSET)

NASA Astrophysics Data System (ADS)

Mentis, Dimitrios; Howells, Mark; Rogner, Holger; Korkovelos, Alexandros; Siyal, Shahid; Broad, Oliver; Zepeda, Eduardo; Bazilian, Morgan

2016-04-01

In September 2015, the international community has adopted a new set of targets, following and expanding on the millennium development goals (MDGs), the Sustainable Development Goals (SDGs). Ensuring access to affordable, reliable, sustainable and modern energy for all is one of the 17 set goals that each country should work towards realizing. According to the latest Global Tracking Framework, 15% of the global population live without access to electricity. The majority of those (87%) reside in rural areas. Countries can reach universal access through various electrification options, depending on different levels of energy intensity and local characteristics of the studied areas, such as renewable resources availability, spatially differentiated costs of diesel-fuelled electricity generation, distance from power network and major cities, population density and others, data which are usually inadequate in national databases. This general paucity of reliable energy-related information in developing countries calls for the utilization of geospatial data. This paper presents a Geographic Information Systems (GIS) based electrification analysis for all countries that have not yet reached full access to electricity (Sub-Saharan Africa, Developing Asia, Latin America and Middle East). The cost optimal mix of electrification options ranges from grid extensions to mini-grid and stand-alone applications and is identified for all relevant countries. It is illustrated how this mix is influenced by scrolling through various electrification levels and different oil prices. Such an analysis helps direct donors and investors and inform multinational actions with regards to investments related to energy access.

Cancer control in developing countries: using health data and health services research to measure and improve access, quality and efficiency

PubMed Central

2010-01-01

Background Cancer is a rapidly increasing problem in developing countries. Access, quality and efficiency of cancer services in developing countries must be understood to advance effective cancer control programs. Health services research can provide insights into these areas. Discussion This article provides an overview of oncology health services in developing countries. We use selected examples from peer-reviewed literature in health services research and relevant publicly available documents. In spite of significant limitations in the available data, it is clear there are substantial barriers to access to cancer control in developing countries. This includes prevention, early detection, diagnosis/treatment and palliation. There are also substantial limitations in the quality of cancer control and a great need to improve economic efficiency. We describe how the application of health data may assist in optimizing (1) Structure: strengthening planning, collaboration, transparency, research development, education and capacity building. (2) Process: enabling follow-up, knowledge translation, patient safety and quality assurance. (3) Outcome: facilitating evaluation, monitoring and improvement of national cancer control efforts. There is currently limited data and capacity to use this data in developing countries for these purposes. Summary There is an urgent need to improve health services for cancer control in developing countries. Current resources and much-needed investments must be optimally managed. To achieve this, we would recommend investment in four key priorities: (1) Capacity building in oncology health services research, policy and planning relevant to developing countries. (2) Development of high-quality health data sources. (3) More oncology-related economic evaluations in developing countries. (4) Exploration of high-quality models of cancer control in developing countries. Meeting these needs will require national, regional and international collaboration as well as political leadership. Horizontal integration with programs for other diseases will be important. PMID:20942937

Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need

PubMed Central

Hanssens, Lise; Vyncke, Veerle; De Maeseneer, Jan; Willems, Sara

2017-01-01

Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC) system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013) and the Primary Healthcare Activity Monitor for Europe (2010). The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country’s PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce) as this can influence inequity in unmet need. PMID:28046051

'Time is costly': modelling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa.

PubMed

Ventelou, Bruno; Moatti, Jean-Paul; Videau, Yann; Kazatchkine, Michel

2008-01-02

Macroeconomic policy requirements may limit the capacity of national and international policy-makers to allocate sufficient resources for scaling-up access to HIV care and treatment in developing countries. An endogenous growth model, which takes into account the evolution of society's human capital, was used to assess the macroeconomic impact of policies aimed at scaling-up access to HIV/AIDS treatment in six African countries (Angola, Benin, Cameroon, Central African Republic, Ivory Coast and Zimbabwe). The model results showed that scaling-up access to treatment in the affected population would limit gross domestic product losses due to AIDS although differently from country to country. In our simulated scenarios of access to antiretroviral therapy, only 10.3% of the AIDS shock is counterbalanced in Zimbabwe, against 85.2% in Angola and even 100.0% in Benin (a total recovery). For four out of the six countries (Angola, Benin, Cameroon, Ivory Coast), the macro-economic gains of scaling-up would become potentially superior to its associated costs in 2010. Despite the variability of HIV prevalence rates between countries, macro-economic estimates strongly suggest that a massive investment in scaling-up access to HIV treatment may efficiently counteract the detrimental long-term impact of the HIV pandemic on economic growth, to the extent that the AIDS shock has not already driven the economy beyond an irreversible 'no-development epidemiological trap'.

Evaluation of spatial accessibility to primary healthcare using GIS

NASA Astrophysics Data System (ADS)

Jamtsho, S.; Corner, R. J.

2014-11-01

Primary health care is considered to be one of the most important aspects of the health care system in any country, which directly helps in improving the health of the population. Potential spatial accessibility is a very important component of the primary health care system. One technique for studying spatial accessibility is by computing a gravity-based measure within a geographic information system (GIS) framework. In this study, straight-line distances between the associated population clusters and the health facilities and the provider-to-population ratio were used to compute the spatial accessibility of the population clusters for the whole country. Bhutan has been chosen as the case study area because it is quite easy to acquire and process data for the whole country due to its small size and population. The spatial accessibility measure of the 203 sub-districts shows noticeable disparities in health care accessibility in this country with about only 19 sub-districts achieving good health accessibility ranking. This study also examines a number of different health accessibility policy scenarios which can assist in identifying the most effective health policy from amongst many probable planning scenarios. Such a health accessibility measuring system can be incorporated into an existing spatial health system in developing countries to facilitate the proper planning and equitable distribution of health resources.

A review of abortion laws in Western-European countries. A cross-national comparison of legal developments between 1960 and 2010.

PubMed

Levels, Mark; Sluiter, Roderick; Need, Ariana

2014-10-01

The extent to which women have had access to legal abortions has changed dramatically in Western-Europe between 1960 and 2010. In most countries, abortion laws developed from completely banning abortion to allowing its availability on request. Both the timing and the substance of the various legal developments differed dramatically between countries. Existing comparative studies on abortion laws in Western-European countries lack detail, usually focus either on first-trimester abortions or second trimester abortions, cover a limited time-span and are sometimes inconsistent with one another. Combining information from various primary and secondary sources, we show how and when the conditions for legally obtaining abortion during the entire gestation period in 20 major Western-European countries have changed between 1960 and 2010. We also construct a cross-nationally comparable classification of procedural barriers that limit abortion access. Our cross-national comparison shows that Western-Europe witnessed a general trend towards decreased restrictiveness of abortion laws. However, legal approaches to regulating abortion are highly different in detail. Abortion access remains limited, sometimes even in countries where abortion is legally available without restrictions relating to reasons. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Supporting Clean Energy Development in Swaziland

DOE Office of Scientific and Technical Information (OSTI.GOV)

2016-04-01

Swaziland, a country largely dependent on regional fossil fuel imports to meet power needs, is vulnerable to supply changes and price shocks. To address this challenge, the country's National Energy Policy and Implementation Strategy prioritizes actions to enhance energy independence through scaling up renewable energy and energy efficiency. With approximately 70 percent of the country lacking electricity, Swaziland is also strongly committed to expanding energy access to support key economic and social development goals. Within this context, energy security and energy access are two foundational objectives for clean energy development in Swaziland. The partnership between the Swaziland Energy Regulatory Authoritymore » and the Clean Energy Solutions Center led to concrete outcomes to support clean energy development in Swaziland. Improving renewable energy project licensing processes will enable Swaziland to achieve key national objectives to expand clean energy access and transition to greater energy independence.« less

Access to biologicals in Crohn’s disease in ten European countries

PubMed Central

Péntek, Márta; Lakatos, Peter L; Oorsprong, Talitha; Gulácsi, László; Pavlova, Milena; Groot, Wim; Rencz, Fanni; Brodszky, Valentin; Baji, Petra; Crohn’s Disease Research Group

2017-01-01

AIM To analyze access (availability, affordability and acceptability) to biologicals for Crohn’s disease (CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development. METHODS A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product (GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated. RESULTS At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries (France, Germany, Latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, Poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden (13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary (87%-124%) and Romania (141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita (0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with CD on biologicals per 100000 population and the availability and affordability was also strong (-0.75, -0.69 respectively). CONCLUSION Substantial inequalities in access to biologicals were largely associated with GDP. To explain differences in access among countries with similar development needs further research on acceptance. PMID:28974896

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries.

PubMed

Gammie, Todd; Lu, Christine Y; Babar, Zaheer Ud-Din

2015-01-01

To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country's legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country's pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases.

The Economic Impact of Community College Capacity Development in Developing Countries: A Longitudinal Analysis

ERIC Educational Resources Information Center

Tyndorf, Darryl M., Jr.; Glass, Chris R.

2017-01-01

Developing countries have significantly expanded efforts to import more flexible short-cycle institutions based on the United States community college model. The U.S. community college model addresses human capital needs of the labor market in developing countries by increasing access to an affordable education. However, there is limited research…

Dissemination of Information in Developing Countries: The Personal Computer and beyond

ERIC Educational Resources Information Center

Wong, Wai-Man

2005-01-01

With the blooming of information in digital format, dissemination of information is becoming a big challenge for developing countries. It is not only due to the limited provision of personal computers--in addition, the technological infrastructure and the ability to access information are also becoming major concerns in developing countries. This…

Cyberspace, Distance Learning, and Higher Education in Developing Countries: Old and Emergent Issues of Access, Pedagogy, and Knowledge Production. International Studies in Sociology and Social Anthropology, 94

ERIC Educational Resources Information Center

Assie-Lumumba, N'Dri T., Ed.

2004-01-01

Amidst the euphoria about the new frontiers of technology sometimes perceived as a panacea for expansion of higher education in developing countries, there is a need to analyze persistent and new grounds of unequal opportunity for access, learning, and the production of knowledge. This volume addresses fundamental questions about the educational…

Gene co-ops and the biotrade: translating genetic resource rights into sustainable development.

PubMed

Reid, W V

1996-04-01

The 1992 Convention on Biological Diversity marks a basic change in the international status of genetic resources. Prior to the Convention, these resources were considered to be the "heritage of mankind.' Although the intent of this open access regime was to ensure the widespread availability of genetic resources for agriculture and industry, commercial use of the resources provided no additional economic incentive for conservation by source countries. The Biodiversity Convention corrects this policy failure by establishing that states have sovereign rights over their genetic resources, thereby enabling market incentives to complement various multilateral mechanisms that might directly fund biodiversity conservation. A number of obstacles face countries that are translating this broad right to regulate access into specific policies, laws, and regulations designed to meet conservation and development objectives. A review of these obstacles and of trends in technological development suggest that nations and developing country institutions should take a set of actions to develop access legislation and Material Transfer Agreements, establish biodiversity "cooperatives' and intermediary institutions to facilitate information exchange, develop minimum standards for access legislation, and require that prior informed consent of local communities be obtained by all biodiversity collectors.

Improving Global Access to New Vaccines: Intellectual Property, Technology Transfer, and Regulatory Pathways

PubMed Central

2014-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers. PMID:25211753

Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways.

PubMed

Crager, Sara Eve

2014-11-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

[Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways].

PubMed

Crager, Sara Eve

2015-01-01

The 2012 World Health Assembly Global Vaccine Action Plan called for global access to new vaccines within 5 years of licensure. Current approaches have proven insufficient to achieve sustainable vaccine pricing within such a timeline. Paralleling the successful strategy of generic competition to bring down drug prices, a clear consensus is emerging that market entry of multiple suppliers is a critical factor in expeditiously bringing down prices of new vaccines. In this context, key target objectives for improving access to new vaccines include overcoming intellectual property obstacles, streamlining regulatory pathways for biosimilar vaccines, and reducing market entry timelines for developing-country vaccine manufacturers by transfer of technology and know-how. I propose an intellectual property, technology, and know-how bank as a new approach to facilitate widespread access to new vaccines in low- and middle-income countries by efficient transfer of patented vaccine technologies to multiple developing-country vaccine manufacturers.

Comparison of legislation concerning people with disability and heritage environment in Malaysia and developed countries

NASA Astrophysics Data System (ADS)

Marsin, J. M.; Ariffin, S. I.; Shahminan, R. N. R.

2014-02-01

Heritage towns and buildings are invaluable cultural assets of a nation, and are extremely useful in manifesting place identity, and crucial in promoting tourism. These places of cultural significance should be made accessible to everyone including people with mobility or sensory impairments, the elderly, parents with small children and those who are temporarily disabled due to injury or illness. By creating a accessible heritage environment not only can you cater towards the increasing population of disabled people, but you could increase the number of cultural properties as resources of a nation through 'accessible tourism'. However the differences in implementation of barrier-free tourism for historic buildings and places are rather large between developed and developing countries such as Malaysia. This paper serves as preliminary study on accessibility of heritage environment in Malaysia. First, review of some related definitions, perception toward disability, and background studies in disability movement will be discussed to achieve better understanding of the increasing population of disabled people and how it would affect the development of infrastructure in the built environment. Second, it will look into existing legislation concerning heritage conservation and legislation on provision of access for the disabled in Malaysia and other developing countries. Finally, this paper seeks to find gaps between these legislations and conclude with some recommendations.

Managing the effect of TRIPS on availability of priority vaccines.

PubMed Central

Milstien, Julie; Kaddar, Miloud

2006-01-01

The stated purpose of intellectual property protection is to stimulate innovation. The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires all Members of the World Trade Organization (WTO) to enact national laws conferring minimum standards of intellectual property protection by certain deadlines. Critics of the Agreement fear that such action is inconsistent with ensuring access to medicines in the developing world. A WHO convened meeting on intellectual property rights and vaccines in developing countries, on which this paper is based, found no evidence that TRIPS has stimulated innovation in developing market vaccine development (where markets are weak) or that protection of intellectual property rights has had a negative effect on access to vaccines. However, access to future vaccines in the developing world could be threatened by compliance with TRIPS. The management of such threats requires adherence of all countries to the Doha Declaration on TRIPS, and the protections guaranteed by the Agreement itself, vigilance on TRIPS-plus elements of free trade agreements, developing frameworks for licensing and technology transfer, and promoting innovative vaccine development in developing countries. The role of international organizations in defining best practices, dissemination of information, and monitoring TRIPS impact will be crucial to ensuring optimal access to priority new vaccines for the developing world. PMID:16710544

Drinking water and sanitation: progress in 73 countries in relation to socioeconomic indicators.

PubMed

Luh, Jeanne; Bartram, Jamie

2016-02-01

To assess progress in the provision of drinking water and sanitation in relation to national socioeconomic indicators. We used household survey data for 73 countries - collected between 2000 and 2012 - to calculate linear rates of change in population access to improved drinking water (n = 67) and/or sanitation (n = 61). To enable comparison of progress between countries with different initial levels of access, the calculated rates of change were normalized to fall between -1 and 1. In regression analyses, we investigated associations between the normalized rates of change in population access and national socioeconomic indicators: gross national income per capita, government effectiveness, official development assistance, freshwater resources, education, poverty, Gini coefficient, child mortality and the human development index. The normalized rates of change indicated that most of the investigated countries were making progress towards achieving universal access to improved drinking water and sanitation. However, only about a third showed a level of progress that was at least half the maximum achievable level. The normalized rates of change did not appear to be correlated with any of the national indicators that we investigated. In many countries, the progress being made towards universal access to improved drinking water and sanitation is falling well short of the maximum achievable level. Progress does not appear to be correlated with a country's social and economic characteristics. The between-country variations observed in such progress may be linked to variations in government policies and in the institutional commitment and capacity needed to execute such policies effectively.

[Emergency room services utilization in the province of Reggio Emilia: a comparison between immigrants and Italians].

PubMed

Bonvicini, Laura; Broccoli, Serena; D'Angelo, Stefania; Candela, Silvia

2011-01-01

The aim of the study is to compare Italian and immigrant accesses to Emergency Room (ER) Services in the province of Reggio Emilia, with particular attention to time differences and to potentially inappropriate accesses. the database of ER accesses in the province of Reggio Emilia was analyzed for the years 2007- 2010. In the analysis of the resident population all autochthonous citizens and all immigrants from Developed Countries were considered Italians, while citizens from Developing Countries were Immigrants. Temporary Immigrants were those immigrants with residence and citizenship in a Developing Country. A descriptive analysis was conducted using demographic variables related to patients (age, gender, citizenship and residence) and variables related to access (admission emergency codes, cause of admission, hour, day of the week, month and discharge modality). Standardized access Ratios (SRs) were calculated for the resident population, together with 95%Confidence Intervals (95% CI). The SRs were calculated separately for children and for adults. In the years 2007-2010, 562,658 accesses to ER were recorded for Italians, 95,300 accesses for Immigrants and 6,800 for the Temporary Immigrants. Access rates for resident Immigrants were higher than Italian ones. In 2010, the SR for men was 1.24 (95%CI 1.22-1.27) while for women it was 1.18 (95%CI 1.15-1.27). Considering only non-urgent accesses, the SRs were even higher (SR men=1.65, 95% CI 1.58-1.72, women=1.43, 95% CI 1.36-1.50). Similar findings were observed in children. Immigrants access the ER services more than Italians do.They also show more non-urgent accesses in comparison with Italians. This finding is consistent with results of studies conducted in other European countries and it underlines the necessity to reorganize primary care in order to better meet immigrants' needs.

Driving a decade of change: HIV/AIDS, patents and access to medicines for all

PubMed Central

2011-01-01

Since 2000, access to antiretroviral drugs to treat HIV infection has dramatically increased to reach more than five million people in developing countries. Essential to this achievement was the dramatic reduction in antiretroviral prices, a result of global political mobilization that cleared the way for competitive production of generic versions of widely patented medicines. Global trade rules agreed upon in 1994 required many developing countries to begin offering patents on medicines for the first time. Government and civil society reaction to expected increases in drug prices precipitated a series of events challenging these rules, culminating in the 2001 World Trade Organization's Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights and Public Health. The Declaration affirmed that patent rules should be interpreted and implemented to protect public health and to promote access to medicines for all. Since Doha, more than 60 low- and middle-income countries have procured generic versions of patented medicines on a large scale. Despite these changes, however, a "treatment timebomb" awaits. First, increasing numbers of people need access to newer antiretrovirals, but treatment costs are rising since new ARVs are likely to be more widely patented in developing countries. Second, policy space to produce or import generic versions of patented medicines is shrinking in some developing countries. Third, funding for medicines is falling far short of needs. Expanded use of the existing flexibilities in patent law and new models to address the second wave of the access to medicines crisis are required. One promising new mechanism is the UNITAID-supported Medicines Patent Pool, which seeks to facilitate access to patents to enable competitive generic medicines production and the development of improved products. Such innovative approaches are possible today due to the previous decade of AIDS activism. However, the Pool is just one of a broad set of policies needed to ensure access to medicines for all; other key measures include sufficient and reliable financing, research and development of new products targeted for use in resource-poor settings, and use of patent law flexibilities. Governments must live up to their obligations to protect access to medicines as a fundamental component of the human right to health. PMID:21439089

Hemodialysis in Asia

PubMed Central

Prasad, Narayan; Jha, Vivekanand

2015-01-01

Background Asia is the largest, most populous and most heterogeneous continent in the world. The number of patients with end-stage renal disease is growing rapidly in Asia. Summary A fully informed report on the status of dialysis therapies including hemodialysis (HD) is limited by the lack of systematic registries. Available data suggest remarkable heterogeneities, with some countries like Taiwan, Japan and Korea exhibiting well-established HD systems, high prevalence and universal access to all patients, while low- and low-middle income countries are unable to provide HD to eligible patients because of high cost and poor healthcare systems. Many Asian countries have unregulated dialysis units, with poor standards of delivery, quality control and outcome reporting. This leads to high mortality due to preventable complications like infections. Modeling data suggest that at least 2.9 million people need dialysis in Asia, which represents a gap in availability of dialysis to the tune of −66%. The population is projected to grow rapidly in the coming years. Several countries are expanding access to HD. Innovative modifications in dialysis practice are being made to optimize outcomes. It is important to develop robust systems of documentation and outcome reporting to evaluate the effects of such changes. HD needs to develop in conjunction with effective preventive programs and improvement of health systems. Key Messages The practice of HD in Asia is growing and evolving. Rapid expansion will improve the currently dismal access to care for large sections of the population. Quality issues need to be addressed if the full benefit of this therapy is to reach the population. Developed countries of Asia can provide substantial messages to developing economies. HD programs must develop in conjunction with prevention efforts. Facts from East and West (1) While developed Western and Asian countries provide end-stage renal disease patients full access to HD, healthcare systems from South and South-East Asia can offer access to HD only to a limited fraction of the patients in need. Even though the annual costs of HD are much lower in less developed countries (for instance 30 times lower in India compared to the US), patients often cannot afford costs not covered by health insurance. (2) The recommended dialysis pattern in the West is at least three sessions weekly with high-flux dialyzers. Studies from Shanghai and Taiwan might however indicate a benefit of twice versus thrice weekly sessions. In less developed Asian countries, a twice weekly pattern is common, sometimes with dialyzer reuse and inadequate water treatment. A majority of patients decrease session frequency or discontinue the program due to financial constraint. (3) As convective therapies are gaining popularity in Europe, penetration in Asia is low and limited by costs. (4) In Asian countries, in particular in the South and South-East, hepatitis and tuberculosis infections in HD patients are higher than in the West and substantially increase mortality. (5) Progress has recently been made in countries like Thailand and Brunei to provide universal HD access to all patients in need. Nevertheless, well-trained personnel, reliable registries and better patient follow-up would improve outcomes in low-income Asian countries. PMID:27536677

Building Capacity for Assessment in PISA for Development Countries. PISA for Development Brief 14

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

This article explains how the Program for International Student Initiative for Development (PISA-D) initiative aims to make PISA more accessible to middle- and low-income countries. A key component of PISA-D is building capacity in the participating countries for managing large-scale student learning assessments and using the results to support…

Housing Quality and Access to Material and Learning Resources within the Home Environment in Developing Countries

ERIC Educational Resources Information Center

Bradley, Robert H.; Putnick, Diane L.

2012-01-01

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were…

Differences and inequalities in relation to access to renal replacement therapy in the BRICS countries.

PubMed

Ferraz, Fábio Humberto Ribeiro Paes; Rodrigues, Cibele Isaac Saad; Gatto, Giuseppe Cesare; Sá, Natan Monsores de

2017-07-01

End-stage renal disease (ESRD) is an important public health problem, especially in developing countries due to the high level of economic resources needed to maintain patients in the different programs that make up renal replacement therapy (RRT). To analyze the differences and inequalities involved in access to RRT in the BRICS countries (Brazil, Russian Federation, India, China and South Africa). This is an applied, descriptive, cross-sectional, quantitative and qualitative study, with documentary analysis and a literature review. The sources of data were from national censuses and scientific publications regarding access to RRT in the BRICS countries. There is unequal access to RRT in all the BRICS countries, as well as the absence of information regarding dialysis and transplants (India), the absence of effective legislation to inhibit the trafficking of organs (India and South Africa) and the use of deceased prisoners as donors for renal transplants (China). The construction of mechanisms to promote the sharing of benefits and solidarity in the field of international cooperation in the area of renal health involves the recognition of bioethical issues related to access to RRT in the BRICS countries.

Education and the Knowledge Military

DTIC Science & Technology

2010-04-01

residents emigrated from developing countries with undeveloped education systems and work in service related fields. They come to America for various...Cooperation and Development Countries (OECD) in a 2006 international assessment. 5 An increasingly diverse country , demographics are particularly important...seaboard of a country is one of its frontiers” and the easier the access to this frontier through deep water ports the greater the ability to

Promoting space research and applications in developing countries through small satellite missions

NASA Astrophysics Data System (ADS)

Sweeting, M.

The high vantage-point of space offers very direct and tangible benefits to developing countries when carefully focused upon their real and particular communications and Earth observation needs. However, until recently, access to space has been effectively restricted to only those countries prepared to invest enormous sums in complex facilities and expensive satellites and launchers: this has placed individual participation in space beyond the sensible grasp of developing countries. However, during the last decade, highly capable and yet inexpensive small satellites have been developed which provide an opportunity for developing countries realistically to acquire and operate their own independent space assets - customized to their particular national needs. Over the last 22 years, the Surrey Space Centre has pioneered, developed and launched 23 nano-micro-minisatellite missions, and has worked in partnership with 12 developing countries to enable them to take their first independent steps into space. Surrey has developed a comprehensive and in-depth space technology know-how transfer and 'hands-on' training programme that uses a collaborative project comprising the design, construction, launch and operation of a microsatellite to acquire an indigenous space capability and create the nucleus of a national space agency and space industry. Using low cost small satellite projects as a focus, developing countries are able to initiate a long term, affordable and sustainable national space programme specifically tailored to their requirements, that is able to access the benefits derived from Earth observation for land use and national security; improved communications services; catalyzing scientific research and indigenous high-technology supporting industries. Perhaps even more important is the long-term benefit to the country provided by stimulating educational and career opportunities for your scientists and engineers and retaining them inside the country rather the all-too-familiar 'brain-drain' seeking employment overseas. The most successful countries have secured their initial investment in acquiring space know-how by following through with the formation of a national space agency or organization to provide a stable nucleus for supporting long-term space activities. Particularly suited to developing countries, Surrey has co-ordinated the first international constellation of small satellites for Earth Observation - the Disaster Monitoring Constellation (DMC). Four enhanced microsatellites have been launched in 2002 & 2003 built collaboratively by Surrey and Algeria, Nigeria, Turkey and UK which now provide daily images of anywhere in the world for disaster management and monitoring other dynamic phenomena such as land use and urban development. The same model of international partnership will be used in follow-on constellations with different sensors (IR, SAR, hyper-spectral) to meet national needs in a sustainable way. In a similar manner whereby the Personal Computer enabled developing countries access to modern information technologies on an affordable budget, small satellites are enabling these same countries to access space within sensible and sustainable expenditures for the direct benefit of their populations.

Massive open online courses: a resource for health education in developing countries.

PubMed

Liyanagunawardena, Tharindu R; Aboshady, Omar A

2017-01-01

Developing countries are suffering from increasing burdens presented by both non-communicable and emerging infectious diseases. Health education is an important step to fight against these mostly preventable diseases. E-learning has been shown to be one of the tools that address some of the training challenges experienced in developing countries by supporting efficient content delivery, decreasing costs and increasing access. Massive open online courses (MOOCs) are a recent innovative presentation of online learning that have attracted millions of learners from all over the world. In this commentary, we propose MOOCs as a potential tool to offer a tremendous opportunity to fulfil the unmet training needs of the health sector in developing countries in two complementary ways: as a resource for training healthcare professionals; and as a resource for the general public. Potential barriers to accessing MOOCs and possible solutions are also discussed.

Water and sanitation issues for persons with disabilities in low- and middle-income countries: a literature review and discussion of implications for global health and international development.

PubMed

Groce, N; Bailey, N; Lang, R; Trani, J F; Kett, M

2011-12-01

The critical importance of unrestricted access to clean drinking water and basic sanitation for all is highlighted in Millennium Development Goal 7, which calls for the reduction by half of the proportion of people without such access by 2015. Unfortunately, little attention has been paid to the needs of such access for the one billion people living with a disability worldwide, despite the fact that the right to equal access for all international development initiatives is guaranteed in the new United Nations Convention on the Rights of Persons with Disabilities. In this paper, we review what is currently known about access to water and sanitation for persons with disabilities in low- and middle-income countries from the perspective of both international development and global health, and identify existing gaps in research, practice and policy that are of pressing concern if the water and sanitation needs of this large - and largely overlooked - population are to be addressed.

Political, cultural and economic foundations of primary care in Europe.

PubMed

Kringos, Dionne S; Boerma, Wienke G W; van der Zee, Jouke; Groenewegen, Peter P

2013-12-01

This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country. Copyright © 2013 Elsevier Ltd. All rights reserved.

Energy access and living standards: some observations on recent trends

NASA Astrophysics Data System (ADS)

Rao, Narasimha D.; Pachauri, Shonali

2017-02-01

A subset of Sustainable Development Goals pertains to improving people’s living standards at home. These include the provision of access to electricity, clean cooking energy, improved water and sanitation. We examine historical progress in energy access in relation to other living standards. We assess regional patterns in the pace of progress and relative priority accorded to these different services. Countries in sub-Saharan Africa would have to undergo unprecedented rates of improvement in energy access in order to achieve the goal of universal electrification by 2030. World over, access to clean cooking fuels and sanitation facilities consistently lag improved water and electricity access by a large margin. These two deprivations are more concentrated among poor countries, and poor people in middle income countries. They are also correlated to health risks faced disproportionately by women. However, some Asian countries have been able to achieve faster progress in electrification at lower income levels compared to industrialized countries’ earlier efforts. These examples offer hope that future efforts need not be constrained by historical rates of progress.

Equity in access to maternal and child health services in five developing countries: what works.

PubMed

Talukder, M D Noorunnabi; Rob, Ubaidur

2010-01-01

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.

Are transnational tobacco companies' market access strategies linked to economic development models? A case study of South Korea.

PubMed

Lee, Sungkyu; Holden, Chris; Lee, Kelley

2013-01-01

Transnational tobacco companies (TTCs) have used varied strategies to access previously closed markets. Using TTCs' efforts to enter the South Korean market from the late 1980s as a case study, this article asks whether there are common patterns in these strategies that relate to the broader economic development models adopted by targeted countries. An analytical review of the existing literature on TTCs' efforts to access emerging markets was conducted to develop hypotheses relating TTCs' strategies to countries' economic development models. A case study of Korea was then undertaken based on analysis of internal tobacco industry documents. Findings were consistent with the hypothesis that TTCs' strategies in Korea were linked to Korea's export-oriented economic development model and its hostile attitude towards foreign investment. A fuller understanding of TTCs' strategies for expansion globally can be derived by locating them within the economic development models of specific countries or regions. Of foremost importance is the need for governments to carefully balance economic and public health policies when considering liberalisation.

Innovative Approaches to Increase Access to Medicines in Developing Countries

PubMed Central

Stevens, Hilde; Huys, Isabelle

2017-01-01

Access to essential medicines is problematic for one third of all persons worldwide. The price of many medicines (i.e., drugs, vaccines, and diagnostics) is unaffordable to the majority of the population in need, especially in least-developed countries, but also increasingly in middle-income countries. Several innovative approaches, based on partnerships, intellectual property, and pricing, are used to stimulate innovation, promote healthcare delivery, and reduce global health disparities. No single approach suffices, and therefore stakeholders need to further engage in partnerships promoting knowledge and technology transfer in assuring essential medicines to be manufactured, authorized, and distributed in low- and middle-income countries (LMICs) in an effort of making them available at affordable and acceptable conditions. PMID:29270407

Providing preimplantation genetic diagnosis in the United Kingdom, The Netherlands and Germany: a comparative in-depth analysis of health-care access.

PubMed

Aarden, Erik; Van Hoyweghen, Ine; Vos, Rein; Horstman, Klasien

2009-07-01

In recent years, preimplantation genetic diagnosis (PGD) has developed into a routine diagnostic procedure in health care. Although during this process, several initiatives have been employed to regulate the procedure, access to PGD may be hampered by the diversity in health-care arrangements or therapeutic cultures in different countries. This article demonstrates how PGD provision practices depend on much more than regulation alone, by providing an in-depth comparative analysis of the provision of PGD in Britain, the Netherlands and Germany. In analysing regulation, organization, selection of indications, and mechanisms and criteria for reimbursement, differences between these countries can be identified. This is important, since differences in PGD provision can have enormous consequences for the access of individual patients in different countries. Somewhat paradoxically, this article concludes that even though differences in access do have serious consequences, they also serve the establishment of PGD. Developing access to PGD in national 'therapeutic cultures' can contribute to making PGD routine health care in a way that may not be achievable by harmonizing regulation.

Drinking water and sanitation: progress in 73 countries in relation to socioeconomic indicators

PubMed Central

Bartram, Jamie

2016-01-01

Abstract Objective To assess progress in the provision of drinking water and sanitation in relation to national socioeconomic indicators. Methods We used household survey data for 73 countries – collected between 2000 and 2012 – to calculate linear rates of change in population access to improved drinking water (n = 67) and/or sanitation (n = 61). To enable comparison of progress between countries with different initial levels of access, the calculated rates of change were normalized to fall between –1 and 1. In regression analyses, we investigated associations between the normalized rates of change in population access and national socioeconomic indicators: gross national income per capita, government effectiveness, official development assistance, freshwater resources, education, poverty, Gini coefficient, child mortality and the human development index. Findings The normalized rates of change indicated that most of the investigated countries were making progress towards achieving universal access to improved drinking water and sanitation. However, only about a third showed a level of progress that was at least half the maximum achievable level. The normalized rates of change did not appear to be correlated with any of the national indicators that we investigated. Conclusion In many countries, the progress being made towards universal access to improved drinking water and sanitation is falling well short of the maximum achievable level. Progress does not appear to be correlated with a country’s social and economic characteristics. The between-country variations observed in such progress may be linked to variations in government policies and in the institutional commitment and capacity needed to execute such policies effectively. PMID:26957676

Protecting HIV information in countries scaling up HIV services: a baseline study.

PubMed

Beck, Eduard J; Mandalia, Sundhiya; Harling, Guy; Santas, Xenophon M; Mosure, Debra; Delay, Paul R

2011-02-06

Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.

Poverty and stroke in India: a time to act.

PubMed

Pandian, Jeyaraj D; Srikanth, Velandai; Read, Stephen J; Thrift, Amanda G

2007-11-01

In developed countries, the predominant health problems are those lifestyle-related illnesses associated with increased wealth. In contrast, diseases occurring in developing countries can largely be attributed to poverty, poor healthcare infrastructure, and limited access to care. However, many developing countries such as India have undergone economic and demographic growth in recent years resulting in a transition from diseases caused by poverty toward chronic, noncommunicable, lifestyle-related diseases. Despite this recent rapid economic growth, a large proportion of the Indian population lives in poverty. Although risk factors for stroke in urban Indian populations are similar to developed nations, it is likely that they may be quite different among those afflicted by poverty. Furthermore, treatment options for stroke are fewer in developing countries like India. Well-organized stroke services and emergency transport services are lacking, many treatments are unaffordable, and sociocultural factors may influence access to medical care for many stroke victims. Most stroke centers are currently in the private sector and establishing such centers in the public sector will require enormous capital investment. Given the limited resources available for hospital treatments, it would be logical to place a greater emphasis on effective populationwide interventions to control or reduce exposure to leading stroke risk factors. There also needs to be a concerted effort to ensure access to stroke care programs that are tailored to suit Indian communities and are accessible to the large majority of the population, namely the poor.

Improving Access to Essential Medicines: How Health Concerns can be Prioritised in the Global Governance System

PubMed Central

Sridhar, Devi

2008-01-01

This paper discusses the politics of access to essential medicines and identifies ‘space’ in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact. These include developing country coalitions and citizens in developed countries though participation in civil society organisations. These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been so powerful due to the assistance of the media as well as the decision to compromise with pharmaceutical companies and their host countries. To improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication and collaboration. PMID:19461853

The SciELO Open Access: A Gold Way from the South

ERIC Educational Resources Information Center

Packer, Abel L.

2009-01-01

Open access has long emphasized access to scholarly materials. However, open access can also mean access to the means of producing visible and recognized journals. This issue is particularly important in developing and emergent countries. The SciELO (Scientific Electronic Library On-line) project, first started in Brazil and, shortly afterward, in…

Education and Development: Dynamics of Access, Equity, and Social Justice in Nigeria

ERIC Educational Resources Information Center

Oghenekohwo, Jonathan E.; Torunarigha, Young D.

2018-01-01

Widening access to education as social justice is basic in any discourse on educational investment, growth and development in developing country such as Nigeria. Presently, there is disconnect between educational development expectations and public policy frameworks designed to drive the united nations sustainable development goals (SDGs) in 2030…

Access to Orphan Drugs: A Comprehensive Review of Legislations, Regulations and Policies in 35 Countries

PubMed Central

Gammie, Todd

2015-01-01

Objective To review existing regulations and policies utilised by countries to enable patient access to orphan drugs. Methods A review of the literature (1998 to 2014) was performed to identify relevant, peer-reviewed articles. Using content analysis, we synthesised regulations and policies for access to orphan drugs by type and by country. Results Fifty seven articles and 35 countries were included in this review. Six broad categories of regulation and policy instruments were identified: national orphan drug policies, orphan drug designation, marketing authorization, incentives, marketing exclusivity, and pricing and reimbursement. The availability of orphan drugs depends on individual country’s legislation and regulations including national orphan drug policies, orphan drug designation, marketing authorization, marketing exclusivity and incentives such as tax credits to ensure research, development and marketing. The majority of countries (27/35) had in place orphan drug legislation. Access to orphan drugs depends on individual country’s pricing and reimbursement policies, which varied widely between countries. High prices and insufficient evidence often limit orphan drugs from meeting the traditional health technology assessment criteria, especially cost-effectiveness, which may influence access. Conclusions Overall many countries have implemented a combination of legislations, regulations and policies for orphan drugs in the last two decades. While these may enable the availability and access to orphan drugs, there are critical differences between countries in terms of range and types of legislations, regulations and policies implemented. Importantly, China and India, two of the largest countries by population size, both lack national legislation for orphan medicines and rare diseases, which could have substantial negative impacts on their patient populations with rare diseases. PMID:26451948

Essential Medicine Utilization and Situation in Selected Ten Developing Countries: A Compendious Audit

PubMed Central

Haque, Mainul

2017-01-01

Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries. PMID:28852629

The introduction of new vaccines into developing countries. IV: Global Access Strategies.

PubMed

Mahoney, Richard T; Krattiger, Anatole; Clemens, John D; Curtiss, Roy

2007-05-16

This paper offers a framework for managing a comprehensive Global Access Strategy for new vaccines in developing countries. It is aimed at strengthening the ability of public-sector entities to reach their goals. The Bill and Melinda Gates Foundation and The Rockefeller Foundation have been leaders in stimulating the creation of new organizations - public/private product development partnerships (PDPs) - that seek to accelerate vaccine development and distribution to meet the health needs of the world's poor. Case studies of two of these PDPs - the Salmonella Anti-pneumococcal Vaccine Program and the Pediatric Dengue Vaccine Initiative - examine development of such strategies. Relying on the application of innovation theory, the strategy leads to the identification of six Components of Innovation which cover all aspects of the vaccine innovation process. Appropriately modified, the proposed framework can be applied to the development and introduction of other products in developing countries including drugs, and nutritional and agricultural products.

Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors.

PubMed

Scheil-Adlung, Xenia; Behrendt, Thorsten; Wong, Lorraine

2015-08-31

Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development. The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas. In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps. Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Large scale land acquisitions and REDD+: a synthesis of conflicts and opportunities

NASA Astrophysics Data System (ADS)

Carter, Sarah; Manceur, Ameur M.; Seppelt, Ralf; Hermans-Neumann, Kathleen; Herold, Martin; Verchot, Lou

2017-03-01

Large scale land acquisitions (LSLA), and Reducing Emissions from Deforestation and forest Degradation (REDD+) are both land based phenomena which when occurring in the same area, can compete with each other for land. A quantitative analysis of country characteristics revealed that land available for agriculture, accessibility, and political stability are key explanatory factors for a country being targeted for LSLA. Surprisingly LSLA occur in countries with lower accessibility. Countries with good land availability, poor accessibility and political stability may become future targets if they do not already have LSLA. Countries which high levels of agriculture-driven deforestation and LSLA, should develop interventions which reduce forest loss driven either directly or indirectly by LSLA as part of their REDD+ strategies. Both host country and investor-side policies have been identified which could be used more widely to reduce conflicts between LSLA and REDD+. Findings from this research highlight the need for and can inform the development of national and international policies on land acquisitions including green acquisitions such as REDD+. Land management must be considered with all its objectives—including food security, biodiversity conservation, and climate change mitigation—in a coherent strategy which engages relevant stakeholders. This is not currently occurring and might be a key ingredient to achieve the targets under the Sustainable Development Goals 2 and 15 and 16 (related to food security and sustainable agriculture and the protection of forests) among others.

Rating maternal and neonatal health services in developing countries.

PubMed Central

Bulatao, Rodolfo A.; Ross, John A.

2002-01-01

OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution. PMID:12378290

Improving access of associated states to advanced concepts in medical telematics--a day before the accession to EU.

PubMed

Duplaga, Mariusz; Leszczuk, Mikolaj; Zielinski, Krzysztof

2006-01-01

Central and Eastern Europe countries (CEEC) undertook considerable efforts to include themselves in the main research and development activities in the area of health telematics in Europe. Countries of this region demonstrate diversified environments of economy transformation and health care systems status. The transition phase to market economy brings essential risks to the healthcare system performance. It seems that efforts of developing e-health environment in CEEC could be substantially accelerated by extended co-operation with partners from current member states of the European Union. The PRO-ACCESS project was initiated in the late phase of fifth Framework Programme as supporting action. It focused on the transfer of current concepts in medical telematics to countries remaining in the pre-accession phase. The process of dissemination of up-to-date approaches to e-health environment development is carried out by the Krakow Centre of Telemedicine and is supported by leading health telematics centres in Europe. To accelerate the dissemination activities the network of co-operating centres in CEEC was established. The strategy employed within the PRO-ACCESS project is supposed to yield "critical mass" necessary for facilitating the e-health development in this region of Europe. The activities employed to reach this objective included publishing activities, events and trainings as well as intake of solutions from supporting centres.

Digital Divide as It Affects the Development of E-Commerce in Nigeria: A Qualitative Research Study

ERIC Educational Resources Information Center

Omorogbe, Cyril Amadin Matthew

2012-01-01

Several studies have shown that information and communications technology (ICT) is important in economic and business development. The advent and rapid development of ICT have not helped in bridging the technological gap between developing countries and advanced countries. In fact, there is an Internet access gap between developed and developing…

An integrated approach to scale up the market penetration of low carbon technologies in developing countries and water scarce regions

NASA Astrophysics Data System (ADS)

Thompson, Michelle Angela

Water scarcity is a global challenge that stifles social and economic growth. There is a growing concern to examine the water-energy nexus to understand the importance of applying energy and water interactions to technology. In developing countries there are many communities that live off-grid in remote region with no access to electricity or clean water. Additionally, there are developed countries that are located in regions with electricity but no access to clean water. Recent developments in renewable energy technology and energy policies have greatly reduced the costs of renewable energy making them more attractive and affordable. The purpose of this dissertation is to evaluate the main barriers to deploying renewables to non-Organization for Economic Co-operation and Development (non-OECD) countries and member countries of the Organization for Economic Co-operation and Development (OECD). This dissertation examines the potential of renewable desalination technology systems across emerging countries. The findings of this research can serve as the basis for investors interested in entering this market. The combined chapters seek to address potential problems regarding the costs, methods, and tools required for the implementation of the appropriate water purification technologies for off-grid, community scale infrastructures.

Challenges and gaps for energy planning models in the developing-world context

NASA Astrophysics Data System (ADS)

Debnath, Kumar Biswajit; Mourshed, Monjur

2018-03-01

Energy planning models (EPMs) support multi-criteria assessments of the impact of energy policies on the economy and environment. Most EPMs originated in developed countries and are primarily aimed at reducing greenhouse gas emissions while enhancing energy security. In contrast, most, if not all, developing countries are predominantly concerned with increasing energy access. Here, we review thirty-four widely used EPMs to investigate their applicability to developing countries and find an absence of consideration of the objectives, challenges, and nuances of the developing context. Key deficiencies arise from the lack of deliberation of the low energy demand resulting from lack of access and availability of supply. Other inadequacies include the lack of consideration of socio-economic nuances such as the prevalence of corruption and resulting cost inflation, the methods for adequately addressing the shortcomings in data quality, availability and adequacy, and the effects of climate change. We argue for further research on characterization and modelling of suppressed demand, climate change impacts, and socio-political feedback in developing countries, and the development of contextual EPMs.

South East Asia, Differing Socioeconomic Factors, Differing Access to Radiotherapy: The Philippines, a Microcosm.

PubMed

Calaguas, Miriam Joy C; Gubat, Johannes A

2017-04-01

The accessibility of radiotherapy in Southeast Asia, a region characterized by diversity in both economy and culture, differ widely among its member countries. In most countries, access is not universal and is generally limited by radiotherapy resources and the health-seeking behavior of patients. This in turn relates to the current health policy in place, the practice of radiation oncology, and cultural factors such as religion and family dynamics. Although it is clear that radiotherapy access parallel economic development, it is also affected by different social factors that work to facilitate or impede its improvement. These factors are herein described in relation to the Philippine situation, where there is wide economic disparity, multiple subcultures, and logistical impediments to improving radiotherapy access, reminiscent of the Southeast Asian region. In the face of increasing cancer burden, it becomes increasingly important to improve services and develop new and efficient approaches taking different cultural factors into consideration. Through regional and international cooperation, solutions to the common and complex problem of inequity in radiotherapy access may be developed. Copyright © 2017. Published by Elsevier Inc.

Noncommunicable diseases among urban refugees and asylum-seekers in developing countries: a neglected health care need

PubMed Central

2014-01-01

With the increasing trend in refugee urbanisation, growing numbers of refugees are diagnosed with chronic noncommunicable diseases (NCDs). However, with few exceptions, the local and international communities prioritise communicable diseases. The aim of this study is to review the literature to determine the prevalence and distribution of chronic NCDs among urban refugees living in developing countries, to report refugee access to health care for NCDs and to compare the prevalence of NCDs among urban refugees with the prevalence in their home countries. Major search engines and refugee agency websites were systematically searched between June and July 2012 for articles and reports on NCD prevalence among urban refugees. Most studies were conducted in the Middle East and indicated a high prevalence of NCDs among urban refugees in this region, but in general, the prevalence varied by refugees’ region or country of origin. Hypertension, musculoskeletal disease, diabetes and chronic respiratory disease were the major diseases observed. In general, most urban refugees in developing countries have adequate access to primary health care services. Further investigations are needed to document the burden of NCDs among urban refugees and to identify their need for health care in developing countries. PMID:24708876

Limited electricity access in health facilities of sub-Saharan Africa: a systematic review of data on electricity access, sources, and reliability

PubMed Central

Adair-Rohani, Heather; Zukor, Karen; Bonjour, Sophie; Wilburn, Susan; Kuesel, Annette C; Hebert, Ryan; Fletcher, Elaine R

2013-01-01

ABSTRACT Background: Access to electricity is critical to health care delivery and to the overarching goal of universal health coverage. Data on electricity access in health care facilities are rarely collected and have never been reported systematically in a multi-country study. We conducted a systematic review of available national data on electricity access in health care facilities in sub-Saharan Africa. Methods: We identified publicly-available data from nationally representative facility surveys through a systematic review of articles in PubMed, as well as through websites of development agencies, ministries of health, and national statistics bureaus. To be included in our analysis, data sets had to be collected in or after 2000, be nationally representative of a sub-Saharan African country, cover both public and private health facilities, and include a clear definition of electricity access. Results: We identified 13 health facility surveys from 11 sub-Saharan African countries that met our inclusion criteria. On average, 26% of health facilities in the surveyed countries reported no access to electricity. Only 28% of health care facilities, on average, had reliable electricity among the 8 countries reporting data. Among 9 countries, an average of 7% of facilities relied solely on a generator. Electricity access in health care facilities increased by 1.5% annually in Kenya between 2004 and 2010, and by 4% annually in Rwanda between 2001 and 2007. Conclusions: Energy access for health care facilities in sub-Saharan African countries varies considerably. An urgent need exists to improve the geographic coverage, quality, and frequency of data collection on energy access in health care facilities. Standardized tools should be used to collect data on all sources of power and supply reliability. The United Nations Secretary-General's “Sustainable Energy for All” initiative provides an opportunity to comprehensively monitor energy access in health care facilities. Such evidence about electricity needs and gaps would optimize use of limited resources, which can help to strengthen health systems. PMID:25276537

Early childhood development: impact of national human development, family poverty, parenting practices and access to early childhood education.

PubMed

Tran, T D; Luchters, S; Fisher, J

2017-05-01

This study was to describe and quantify the relationships among family poverty, parents' caregiving practices, access to education and the development of children living in low- and middle-income countries (LAMIC). We conducted a secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys (MICS). Early childhood development was assessed in four domains: language-cognitive, physical, socio-emotional and approaches to learning. Countries were classified into three groups on the basis of the Human Development Index (HDI). Overall, data from 97 731 children aged 36 to 59 months from 35 LAMIC were included in the after analyses. The mean child development scale score was 4.93 out of a maximum score of 10 (95%CI 4.90 to 4.97) in low-HDI countries and 7.08 (95%CI 7.05 to 7.12) in high-HDI countries. Family poverty was associated with lower child development scores in all countries. The total indirect effect of family poverty on child development score via attending early childhood education, care for the child at home and use of harsh punishments at home was -0.13 SD (77.8% of the total effect) in low-HDI countries, -0.09 SD (23.8% of the total effect) in medium-HDI countries and -0.02 SD (6.9% of the total effect) in high-HDI countries. Children in the most disadvantaged position in their societies and children living in low-HDI countries are at the greatest risk of failing to reach their developmental potential. Optimizing care for child development at home is essential to reduce the adverse effects of poverty on children's early development and subsequent life. © 2016 John Wiley & Sons Ltd.

Bayesian networks modelling in support to cross cutting analysis of water supply and sanitation in developing countries

NASA Astrophysics Data System (ADS)

Dondeynaz, C.; López Puga, J.; Carmona Moreno, C.

2013-02-01

Despite the efforts made towards the millennium goals targets during the last decade, access to improved water supply or basic sanitation remains still not accessible for millions of people across the world. This paper proposes a set of models that use 25 key variables from the WatSan4Dev dataset and country profiles involving Water Supply and Sanitation (Dondeynaz et al., 2012). This paper proposes the use of Bayesian Network modelling methods because adapted to the management of non-normal distribution, and integrate a qualitative approach for data analysis. They also offer the advantage to integrate preliminary knowledge into the probabilistic models. The statistical performance of the proposed models ranges between 80 and 95% which is very satisfactory taking into account the strong heterogeneity of variables. Probabilistic scenarios run from the models allow a quantification of the relationships between human development, external support, governance aspects, economic activities and Water Supply and Sanitation (WSS) access. According to models proposed in this paper, a strong poverty reduction will induce an increment of the WSS access equal to 75-76% through: (1) the organisation of on-going urbanisation process to avoid slums development; and, (2) the improvement of health care for instance for children. On one side, improving governance, such as institutional efficiency, capacities to make and apply rules or control of corruption will also have a positive impact on WSS sustainable development. The first condition for an increment of the WSS access remains of course an improvement of the economic development with an increment of household income. Moreover, a significant country environmental commitment associated with civil society freedom of expression constitutes a favourable environment for sustainable WSS services delivery. Intensive agriculture through irrigation practises also appears as a mean for sustainable WSS thanks to multi-uses and complementarities. Strong and structured agriculture sector facilitates rural development in areas where WSS access often steps behind compared to urban areas1. External financial support, named Official Development Aid (ODA), plays a role in WSS improvement but comes last in the sensitivity analyses of models. This aid supports first poor countries at 47%, and is associated to governance aspects: (1) political stability and (2) country environmental commitment and civil society degree of freedom. These governance aspects constitute a good framework for aid implementation in recipient countries. Modelling is run with the five groups of countries as defined in Dondeynaz et al. (2012). Models for profile 4 (essential external support) and profile 5 (primary material consumption) are specifically detailed and analysed in this paper. For countries in profile 4, to fight against water scarcity and desertification pressure should be the priority. However, for countries in profile 5, efforts should first concentrate on political stability consolidation while supporting economic activity diversification. Nevertheless, for both profiles, reduction of poverty should remain the first priority as previously indicated. 1 JMP statistics, 2004 http://www.wssinfo.org/data-estimates/table/

Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

PubMed Central

2014-01-01

Background Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries. Methods This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons’ National Accreditation Program for Breast Centers as well as our local guideline. Results Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients. Conclusions These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support. PMID:24650245

Improving access to surgery in a developing country: experience from a surgical collaboration in Sierra Leone.

PubMed

Kushner, Adam L; Kamara, Thaim B; Groen, Reinou S; Fadlu-Deen, Betsy D; Doah, Kisito S; Kingham, T Peter

2010-01-01

Although surgery is increasingly recognized as an essential component of primary health care, there has been little documentation of surgical programs in low- and middle-income countries. Surgeons OverSeas (SOS) is a New York-based organization with a mission to save lives in developing countries by improving surgical care. This article highlights the surgical program in Sierra Leone as a possible model to improve access to surgery. An SOS team conducted a needs assessment of surgical capacity in Sierra Leone in February 2008. Interventions were then developed and programs were implemented. A follow-up assessment was conducted in December 2009, which included interviews of key Sierra Leone hospital personnel and a review of operating room log books. Based on an initial needs assessment, a program was developed that included training, salary support, and the provision of surgical supplies and equipment. Two 3-day workshops were conducted for a total of 44 health workers, salary support given to over 100 staff, and 2 containers of supplies and equipment were donated. Access to surgery, as measured by the number of major operations at Connaught Hospital, increased from 460 cases in 2007 to 768 cases in 2009. The SOS program in Sierra Leone highlights a method for improving access to surgery that incorporates an initial needs assessment with minimal external support and local staff collaboration. The program functions as a catalyst by providing training, salary support, and supplies. The beneficial results of the program can then be used to advocate for additional resources for surgery from policy makers. This model could be beneficial in other resource-poor countries in which improved access to surgery is desired. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

New strategies for providing hormonal contraception in developing countries.

PubMed

Townsend, John W; Sitruk-Ware, Regine; Williams, Katherine; Askew, Ian; Brill, Klaus

2011-05-01

Even with progress in increasing access to effective contraception over the past decades, and the growing range of contraceptive methods available on the market, women in developing countries continue to report an unmet need for family planning. This constraint continues to challenge reproductive health policies and programs, while the momentum of population growth and the young age structure in developing countries leads to larger numbers of potential contraceptive users and increasing global demand in contraceptive markets. Of late, there is a renewed focus on increasing access to long-acting hormonal methods to effectively meet this need, establishing and effectively implementing new service delivery strategies. A number of processes have profoundly affected the procurement and use of hormonal contraceptive methods in developing countries: a supportive policy environment, evidence-based practices and an increasing diversity of delivery strategies play a significant part in increasing number of contraceptive users and the demand for hormonal contraception. Copyright © 2011 Elsevier Inc. All rights reserved.

Type 2 diabetes self-management education programs in high and low mortality developing countries: a systematic review.

PubMed

Dube, Loveness; Van den Broucke, Stephan; Housiaux, Marie; Dhoore, William; Rendall-Mkosi, Kirstie

2015-02-01

Although self-management education is a key factor in the care for diabetes patients, its implementation in developing countries is not well documented. This systematic review considers the published literature on diabetes self-management education in high and low mortality developing countries. The aim is to provide a state of the art of current practices and assess program outcomes, cultural sensitivity, and accessibility to low literate patients. The Cochrane Library, PubMed, MEDLINE, PsycInfo, and PsycArticles databases were searched for peer-reviewed articles on type 2 diabetes published in English between 2009 and 2013. The World Bank and WHO burden of disease criteria were applied to distinguish between developing countries with high and low mortality. Information was extracted using a validated checklist. Three reviews and 23 primary studies were identified, 18 of which were from low mortality developing countries. Studies from high mortality countries were mostly quasi-experimental, those from low mortality countries experimental. Interventions were generally effective on behavior change and patients' glycemic control in the short term (≤9 months). While 57% of the studies mentioned cultural tailoring of interventions, only 17% reported on training of providers, and 39% were designed to be accessible for people with low literacy. The limited studies available suggest that diabetes self-management education programs in developing countries are effective in the short term but must be tailored to conform to the cultural aspects of the target population. © 2014 The Author(s).

Improving the availability and accessibility of opioids for the treatment of pain: the International Pain Policy Fellowship.

PubMed

Bosnjak, Snezana; Maurer, Martha A; Ryan, Karen M; Leon, Marta X; Madiye, Gabriel

2011-08-01

Opioid analgesics are simultaneously indispensable medicines for the treatment of moderate to severe pain and are harmful when abused. The challenge for governments is to balance the obligation to prevent diversion, trafficking, and abuse of opioids with the equally important obligation to ensure their availability and accessibility for the relief of pain and suffering. Over the last 30 years, significant progress has been made toward improving access to opioids as measured by increasing global medical opioid consumption. However, this progress is marked by ongoing large disparities among countries, with most increases in medical opioid consumption attributed to high-income countries, not low- and middle-income countries (LMICs). The International Pain Policy Fellowship (IPPF) was developed by the Pain & Policy Studies Group, with the central goal of developing national leaders from LMICs and empowering them to improve availability and accessibility of opioids for the treatment of pain. To date, two classes of fellows have been selected, representing 17 fellows from 15 countries. Progress achieved by the leadership of three fellows from Sierra Leone, Colombia, and Serbia is highlighted in this paper. The fellows from each country were successful at initiating collaboration with relevant governmental bodies, national authorities, and professional societies, which resulted in a new supply of oral opioids in Sierra Leone and Serbia, and improvements in the distribution of already available opioids in Colombia. All fellows were instrumental in facilitating evaluation of national policy. The IPPF program empowers fellows with the necessary knowledge, skills, and guidance to improve the availability and accessibility of opioids for the treatment of pain.

Harnessing information and communication technologies to leverage scarce resources for cancer education, research and practice in developing countries

PubMed Central

Andela, Valentine B

2006-01-01

In developing countries, low levels of awareness, cost and organizational constraints on access to specialized care contribute to inadequate patient help-seeking behavior. As much as 95% of cancer patients in developing countries are diagnosed at late to end stage disease. Consequently, treatment outcome is dismally poor and a vicious cycle sets in, with public mystification of cancer and the admonishment of cancer medicine as a futile effort, all, to the further detriment of patient help-seeking behavior and treatment engagement. The situation spirals down, when the practice of cancer medicine is not gratifying to the medical practitioner and does not appeal as a medical specialty to those in training. The future of cancer medicine in developing countries thus hinges on the demystification of cancer through positive information, coupled to an effective organization that allows for the optimal use of available resources, facilitates access to specialized care and promotes the flow of knowledge and technology amongst various stakeholders. This paper strives to make a cogent argument and highlight the capital importance of information and communication technologies in organizing and leveraging scarce resources for cancer education, research and practice in developing countries. PMID:16390555

Equity, Institutional Diversity and Regional Development: A Cross-Country Comparison

ERIC Educational Resources Information Center

Pinheiro, Rómulo; Charles, David; Jones, Glen A.

2016-01-01

This paper investigates historical and current developments regarding governmental policies aimed at enhancing spatial equity (access) or decentralisation of higher education provision in three countries--Australia, Canada and Norway. We then shed light on the links or interrelations between policy objectives and initiatives and institutional…

Equity of access to maternal health interventions in Brazil and Colombia: a retrospective study.

PubMed

De La Torre, Amaila; Nikoloski, Zlatko; Mossialos, Elias

2018-04-11

Reducing maternal mortality is a top priority in Latin American countries. Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development. Using data from the Demographic Health Survey, this study quantified and compared, by means of concentration indices, the socioeconomic-related inequity in access to four key maternal health interventions in Brazil and Colombia. Decomposition analysis of the concentration index was used for two indicators - skilled attendance at birth and postnatal care in Brazil. Coverage levels of the four key maternal health interventions were similar in the two countries. More specifically, we found that coverage of some of the interventions (e.g. ante-natal care and skilled birth assistance) was higher than 90% in both countries. Nevertheless, the concentration index analysis pointed to significant pro-rich inequities in access in all four key interventions in both countries. Interestingly, the analysis showed that Colombia fared slightly better than Brazil in terms of equity in access of the interventions studied. Finally, the decomposition analysis for the presence of a skilled attendant at birth and postnatal care in Brazil underlined the significance of regional disparities, wealth inequalities, inequalities in access to private hospitals, and inequalities in access to private health insurance. There are persistent pro-rich inequities in access to four maternal health interventions in both Brazil and Colombia. The decomposition analysis conducted on Brazilian data suggests the existence of disparities in system capacity and quality of care between the private and the public health services, resulting in inequities of access to maternal health services.

A Framework for Sustainable Energy Development beyond the Grid: Meeting the Needs of Rural and Remote Populations

ERIC Educational Resources Information Center

Agbemabiese, Lawrence

2009-01-01

Advances in energy access in developing countries over the past 25 years have been remarkable with more than 1 billion unserved people gaining access to electricity and modern fuels. However, as impressive as this may sound, large gaps remain: 1.6 billion people still lack access to electricity and another 2.5 billion continue to rely on…

A review of accessibility of administrative healthcare databases in the Asia-Pacific region.

PubMed

Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

2015-01-01

We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3-6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted based on requirements by data custodians. Compared with previous research, this study describes the landscape of databases in the selected countries with more granularity using an assessment tool developed for this purpose. A high number of databases were identified but most had restricted access, preventing their potential use to support research. We hope that this study helps to improve the understanding of the AHDB landscape, increase data sharing and database research in Asia-Pacific countries.

Essays on Education Programs in Developing Countries

ERIC Educational Resources Information Center

He, Fang

2010-01-01

This dissertation evaluates programs seeking to address educational access and quality in developing countries. Chapter 1 examines the impact of two school feeding programs on enrollment in Sri Lanka. Chapter 2 assesses the relative productivity of several modes of implementing an Indian English education curriculum in India. Finally, chapter 3…

Learning Profiles and the "Skills Gap" in Four Developing Countries: A Comparative Analysis of Schooling and Skills Development

ERIC Educational Resources Information Center

Rolleston, Caine

2014-01-01

Educational access in developing countries has improved significantly in recent years, but less evidence is available on learning and learning progress in comparative perspective. This paper employs data from Young Lives to examine levels and trends in cognitive skill development and the links to enrolment in school across the four study countries…

Essential drugs in the new international economic environment.

PubMed Central

Velásquez, G.; Boulet, P.

1999-01-01

Recent global developments in the regulation of trade and intellectual property rights threaten to hinder the access of populations in developing countries to essential drugs. The authors argue for state intervention in the health and pharmaceutical markets in order to guarantee equitable access to these products. PMID:10212525

Teachers' Helpers: Experimental Evidence from Costa Rica on Computers for English Language Learning

ERIC Educational Resources Information Center

Humpage, Sarah; Álvarez-Marinelli, Horacio

2014-01-01

Computers have taken an increasingly prominent role in education around the world in recent years in developed and developing countries alike. As developing country governments have turned their focus from increasing enrollment to improving the quality of education in their schools, many have made access to computers a key component to their…

Access and Equity in Higher Education in Antigua and Barbuda

ERIC Educational Resources Information Center

Hewlett-Thomas, Elsie

2009-01-01

Across the international higher education spectrum access represents a significant issue. The literature is replete with analyses of access in various higher education systems. Low and inequitable patterns of participation in higher education are particularly prominent in developing countries. This dissertation is a case study of the higher…

The role of gender inequities in women’s access to reproductive health care: a population-level study of Namibia, Kenya, Nepal, and India

PubMed Central

Namasivayam, Amrita; Osuorah, Donatus C; Syed, Rahman; Antai, Diddy

2012-01-01

Background: The role of gender inequities in explaining women’s access to reproductive health care was examined in four countries (two sub-Saharan African and two South Asian countries). The extent of gender inequities varies across and within countries, and is rooted in the different cultural practices and gender norms within these different countries, and differences in the status and autonomy of women. Methods: Demographic and Health Survey data from women aged 15–49 years within these countries were analyzed with multivariate logistic regression analysis to examine the role of multidimensional characteristics of gender inequities, operationalized as access to skilled antenatal care, tetanus toxoid injection during pregnancy, and access to skilled antenatal care. Results: Significant associations were found between several dimensions of gender inequities (with the exception of decision-making autonomy) and reported use of maternal reproductive health care services. Several pathways of influence between the outcome and exposure variables were also identified. Conclusion: Dimensions of gender inequities (with the exception of decision-making autonomy) differentially influenced woman’s use of reproductive health care services, thus highlighting the urgent need for concerted and sustained efforts to change these harmful traditional values if several of these countries are to meet Millennium Development Goal-5. PMID:22927766

The World Health Channel: an innovation for health and development.

PubMed

McConnell, Harry; Haile-Mariam, Tenagne; Rangarajan, S

2004-01-01

The issues of the digital divide and of accessing health information in areas of greatest need has been addressed by many. It has been a key component of the discussion of the World Summit for the Information Society and also the focus of an important new initiative, the Global Review for Health Information. Only approximately 1 in 700 people in Africa have internet access compared to a rate worldwide of approximately 10%. Access to essential health information and knowledge management for health care has been deemed a priority for the development of health systems and for the care of patients in areas with limited resources, prompting recent efforts by international organisations and by both governmental and non-governmental agencies (see Godlee et al, 2004 and McConnell, 2004). Health care in developing countries can be limited by many different resources: lack of health care workers with sufficient training, lack of diagnostic equipment, lack of treatment facilities or essential pharmaceuticals; and lack of education or expertise in many relevant areas. Much of the health care done in developing countries is by local lay persons or practitioners or by volunteers working with a variety of NGOs. These volunteers are often very dedicated young people with a vision of health-for-all that is often frustrated in the limited time they are able to spend in these areas and further constrained by meager resources (including availability of appropriate information). The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. Futhermore, there are often many NGOs working simultaneously on similar projects in the same region without knowledge of each other's activities. Often this occurs simply because a lack of communication exists between organisations, resulting in unnecessary duplication of effort. The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. The health care worker in developing countries is frequently faced with a paucity of information appropriate to the clinical situations on hand as well as a lack of locally available expertise. The lack of access to health care and other vital resources is one factor in the much lower (by approximately 1/3) life expectancy in the least developed countries campared to industrialised nations. In many developing countries there is only one doctor for 5-10,00 people, compared to a ratio of 1:200 in many developed countries. Textbooks, if they exist, may be 10-20 years out of date and are often directed more at the needs of developed countries. There is thus a growing need for wider availability of training and information on health care in developing countries and support for health care workers. There is also a need for increased communication and collaboration between governmental and non-governmental organisations working in international health to share education, resources and to coordinate efforts in areas supporting improved health care delivery. In recognition of this, the Institute for Sustainable Health Education and Development (www.ished.org) is launching the World Health Channel (WHC) in the spring of 2005 in collaboration with WorldSpace. This will allow access to critical health information in developing countries and place the emphasis on issues important for clinical care for front line health workers in these areas.

Technology innovation for infectious diseases in the developing world.

PubMed

So, Anthony D; Ruiz-Esparza, Quentin

2012-10-25

Enabling innovation and access to health technologies remains a key strategy in combating infectious diseases in low- and middle-income countries (LMICs). However, a gulf between paying markets and the endemicity of such diseases has contributed to the dearth of R&D in meeting these public health needs. While the pharmaceutical industry views emerging economies as potential new markets, most of the world's poorest bottom billion now reside in middle-income countries--a fact that has complicated tiered access arrangements. However, product development partnerships--particularly those involving academic institutions and small firms--find commercial opportunities in pursuing even neglected diseases; and a growing pharmaceutical sector in BRICS countries offers hope for an indigenous base of innovation. Such innovation will be shaped by 1) access to building blocks of knowledge; 2) strategic use of intellectual property and innovative financing to meet public health goals; 3) collaborative norms of open innovation; and 4) alternative business models, some with a double bottom line. Facing such resource constraints, LMICs are poised to develop a new, more resource-effective model of innovation that holds exciting promise in meeting the needs of global health.

Distance learning--an educational tool for developing countries.

PubMed

Dobson, M B

2000-01-01

Many anaesthetists in small hospitals and developing countries have poor access to educational materials. The use of electronic means of publication and distribution, combined with the concepts of distance learning, can lead to better levels of knowledge and clinical practice. A project based on these principles has been set up in Zimbabwe, and is proving helpful to both trainers and trainees. All District Hospitals have been visited, and trainees in them identified. A survey has been completed to identify the subject areas in which training is most necessary. Trainees have been provided with reference materials on CD-ROM which they can access by computer (each hospital has a computer). Specialist anaesthesiologists in the country are producing interactive tutorials which can be sent out by e-mail to every hospital, and these are backed up by a programme of regular visits, seminars and clinical teaching. The programme is proving helpful to both trainees and tutors, and has the potential to be used in the future in other developing countries.

[Introduction of vaccination against human papillomavirus in developing countries: update and perspectives].

PubMed

Hessel, L

2009-08-01

Cervical cancer and other diseases related to human papillomavirus (HPV) represent a global public health problem. Safe and effective vaccines are now available and already used in many industrialized countries. Immunization offers the best hope for protecting the population against a disease that is the second most deadly cancer in the developing world and the first most deadly in Africa. The World Health Organization currently recommends introduction of HVP vaccination in developing countries. Widespread vaccination could be beneficial in numerous domains other than primary prevention of cervical cancer. Efforts to overcome the numerous obstacles and speed up implementation of HVP vaccination programs are now underway in many areas ranging from related scientific issues such as epidemiology and clinical research to administrative concerns such as healthcare economics, vaccination guidelines, public acceptation, program funding, and universal access. Vaccine manufacturers have committed themselves to working in partnership with national and international organizations to ensure access to HPV vaccine for all countries regardless of economic level, Although numerous issues must be resolved to optimize the use of HPV vaccines and ensure synergistic integration of vaccination, screening and treatment, current initiatives and efforts should allow introduction of HPV vaccination in developing countries in a not too distant future.

Prospects for Vascular Access Education in Developing Countries: Current Situation in Cambodia.

PubMed

Naganuma, Toshihide; Takemoto, Yoshiaki

2017-01-01

We report our activities training doctors on vascular access procedures at International University (IU) Hospital in Cambodia through a program facilitated by Ubiquitous Blood Purification International, a nonprofit organization that provides medical support to developing countries in the field of dialysis medicine. Six doctors from Japan have been involved in the education of medical personnel at IU, and we have collectively visited Cambodia about 15 times from 2010 to 2016. In these visits, we have performed many operations, including 42 for arteriovenous fistula, 1 arteriovenous graft, and 1 percutaneous transluminal angioplasty. Stable development and management of vascular access is increasingly required in Cambodia due to increased use of dialysis therapy, and training of doctors in this technique is urgently required. However, we have encountered several difficulties that need to be addressed, including (1) the situation of personnel receiving this training, (2) problems with facilities, including medical equipment and drugs, (3) financial limitations, and (4) problems with management of vascular access. © 2017 S. Karger AG, Basel.

Innovative farmers and regulatory gatekeepers: Genetically modified crops regulation and adoption in developing countries

PubMed Central

Sinebo, Woldeyesus; Maredia, Karim

2016-01-01

ABSTRACT The regulation of genetically modified (GM) crops is a topical issue in agriculture and environment over the past 2 decades. The objective of this paper is to recount regulatory and adoption practices in some developing countries that have successfully adopted GM crops so that aspiring countries may draw useful lessons and best practices for their biosafatey regulatory regimes. The first 11 mega-GM crops growing countries each with an area of more than one million hectares in 2014 were examined. Only five out of the 11 countries had smooth and orderly adoption of these crops as per the regulatory requirement of each country. In the remaining 6 countries (all developing countries), GM crops were either introduced across borders without official authorization, released prior to regulatory approval or unapproved seeds were sold along with the approved ones in violation to the existing regulations. Rapid expansion of transgenic crops over the past 2 decades in the developing world was a result of an intense desire by farmers to adopt these crops irrespective of regulatory roadblocks. Lack of workable biosafety regulatory system and political will to support GM crops encouraged unauthorized access to GM crop varieties. In certain cases, unregulated access in turn appeared to result in the adoption of substandard or spurious technology which undermined performance and productivity. An optimal interaction among the national agricultural innovation systems, biosafety regulatory bodies, biotech companies and high level policy makers is vital in making a workable regulated progress in the adoption of GM crops. Factoring forgone opportunities to farmers to benefit from GM crops arising from overregulation into biosafety risk analysis and decision making is suggested. Building functional biosafety regulatory systems that balances the needs of farmers to access and utilize the GM technology with the regulatory imperatives to ensure adequate safety to the environment and human health is recommended. PMID:26954893

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

PubMed Central

McBain, Ryan; Norton, Daniel J.; Morris, Jodi; Yasamy, M. Taghi; Betancourt, Theresa S.

2012-01-01

Background Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. Methods and Findings This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Conclusions Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors' Summary PMID:22303288

International Schools for Young Astronomers Teaching for Astronomy Development: two programmes of the International Astronomical Union

NASA Astrophysics Data System (ADS)

Gerbaldi, Michèle; DeGreve, Jean-Pierre; Guinan, Edward

2011-06-01

This text outlines the main features of two educational programmes of the International Astronomical Union (IAU): the International Schools for Young Astronomers (ISYA) and the Teaching for Astronomy Development programme (TAD), developed since 1967. The main goal of the International Schools for Young Astronomers (ISYA) is to support astronomy (education and research) in developing countries in organizing a 3-week School for students with typically M.Sc. degrees. The context in which the ISYA were developed changed drastically during the last decade. From a time when access to large telescopes was difficult and mainly organized on a nation-basis, nowadays the archives of astronomical data have accumulated at the same time that many major telescope become accessible, and they are accessible from everywhere, the concept of virtual observatory reinforcing this access. A second programme of the IAU, Teaching for Astronomy Development (TAD), partially based on a School, but also of shorter duration (typically one week) has a complementary objective. It is dedicated to assist countries that have little or no astronomical activity, but that wish to enhance their astronomy education. The fast development of the TAD programme over the past years is emphasized.

Framing access to medicines in developing countries: an analysis of media coverage of Canada's Access to Medicines Regime.

PubMed

Esmail, Laura C; Phillips, Kaye; Kuek, Victoria; Cosio, Andrea Perez; Kohler, Jillian Clare

2010-01-04

In September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process. We conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives. The most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media. Media framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the legislation. Using the media to engage the public in more in-depth exploration of the policy issues at stake may contribute to a more informed policy development process. The media can be an effective channel for those stakeholders with a weaker voice in policy deliberations to raise public attention to particular issues; however, the political and institutional context must be taken into account as it may outweigh media framing effects.

Health inequalities by gradients of access to water and sanitation between countries in the Americas, 1990 and 2010.

PubMed

Mújica, Oscar J; Haeberer, Mariana; Teague, Jordan; Santos-Burgoa, Carlos; Galvão, Luiz Augusto Cassanha

2015-11-01

To explore distributional inequality of key health outcomes as determined by access coverage to water and sanitation (WS) between countries in the Region of the Americas. An ecological study was designed to explore the magnitude and change-over-time of standard gap and gradient metrics of environmental inequalities in health at the country level in 1990 and 2010 among the 35 countries of the Americas. Access to drinking water and access to improved sanitation facilities were selected as equity stratifiers. Five dependent variables were: total and healthy life expectancies at birth, and infant, under-5, and maternal mortality. Access to WS correlated with survival and mortality, and strong gradients were seen in both 1990 and 2010. Higher WS access corresponded to higher life expectancy and healthy life expectancy and lower infant, under-5, and maternal mortality risks. Burden of life lost was unequally distributed, steadily concentrated among the most environmentally disadvantaged, who carried up to twice the burden than they would if WS were fairly distributed. Population averages in life expectancy and specific mortality improved, but whereas absolute inequalities decreased, relative inequalities remained mostly invariant. Even with the Region on track to meet MDG 7 on water and sanitation, large environmental gradients and health inequities among countries remain hidden by Regional averages. As the post-2015 development agenda unfolds, policies and actions focused on health equity-mainly on the most socially and environmentally deprived-will be needed in order to secure the right for universal access to water and sanitation.

Medicine procurement and the use of flexibilities in the Agreement on Trade-Related Aspects of Intellectual Property Rights, 2001-2016.

PubMed

't Hoen, Ellen Fm; Veraldi, Jacquelyn; Toebes, Brigit; Hogerzeil, Hans V

2018-03-01

Millions of people, particularly in low- and middle-income countries, lack access to effective pharmaceuticals, often because they are unaffordable. The 2001 Ministerial Conference of the World Trade Organization (WTO) adopted the Doha Declaration on the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement and Public Health. The declaration recognized the implications of intellectual property rights for both new medicine development and the price of medicines. The declaration outlined measures, known as TRIPS flexibilities, that WTO Members can take to ensure access to medicines for all. These measures include compulsory licensing of medicines patents and the least-developed countries pharmaceutical transition measure. The aim of this study was to document the use of TRIPS flexibilities to access lower-priced generic medicines between 2001 and 2016. Overall, 176 instances of the possible use of TRIPS flexibilities by 89 countries were identified: 100 (56.8%) involved compulsory licences or public noncommercial use licences and 40 (22.7%) involved the least-developed countries pharmaceutical transition measure. The remainder were: 1 case of parallel importation; 3 research exceptions; and 32 non-patent-related measures. Of the 176 instances, 152 (86.4%) were implemented. They covered products for treating 14 different diseases. However, 137 (77.8%) concerned medicines for human immunodeficiency virus infection and acquired immune deficiency syndrome or related diseases. The use of TRIPS flexibilities was found to be more frequent than is commonly assumed. Given the problems faced by countries today in procuring high-priced, patented medicines, the practical, legal pathway provided by TRIPS flexibilities for accessing lower-cost generic equivalents is increasingly important.

Medicine procurement and the use of flexibilities in the Agreement on Trade-Related Aspects of Intellectual Property Rights, 2001–2016

PubMed Central

Veraldi, Jacquelyn; Toebes, Brigit; Hogerzeil, Hans V

2018-01-01

Abstract Millions of people, particularly in low- and middle-income countries, lack access to effective pharmaceuticals, often because they are unaffordable. The 2001 Ministerial Conference of the World Trade Organization (WTO) adopted the Doha Declaration on the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement and Public Health. The declaration recognized the implications of intellectual property rights for both new medicine development and the price of medicines. The declaration outlined measures, known as TRIPS flexibilities, that WTO Members can take to ensure access to medicines for all. These measures include compulsory licensing of medicines patents and the least-developed countries pharmaceutical transition measure. The aim of this study was to document the use of TRIPS flexibilities to access lower-priced generic medicines between 2001 and 2016. Overall, 176 instances of the possible use of TRIPS flexibilities by 89 countries were identified: 100 (56.8%) involved compulsory licences or public noncommercial use licences and 40 (22.7%) involved the least-developed countries pharmaceutical transition measure. The remainder were: 1 case of parallel importation; 3 research exceptions; and 32 non-patent-related measures. Of the 176 instances, 152 (86.4%) were implemented. They covered products for treating 14 different diseases. However, 137 (77.8%) concerned medicines for human immunodeficiency virus infection and acquired immune deficiency syndrome or related diseases. The use of TRIPS flexibilities was found to be more frequent than is commonly assumed. Given the problems faced by countries today in procuring high-priced, patented medicines, the practical, legal pathway provided by TRIPS flexibilities for accessing lower-cost generic equivalents is increasingly important. PMID:29531417

An exploration of multilevel modeling for estimating access to drinking-water and sanitation.

PubMed

Wolf, Jennyfer; Bonjour, Sophie; Prüss-Ustün, Annette

2013-03-01

Monitoring progress towards the targets for access to safe drinking-water and sanitation under the Millennium Development Goals (MDG) requires reliable estimates and indicators. We analyzed trends and reviewed current indicators used for those targets. We developed continuous time series for 1990 to 2015 for access to improved drinking-water sources and improved sanitation facilities by country using multilevel modeling (MLM). We show that MLM is a reliable and transparent tool with many advantages over alternative approaches to estimate access to facilities. Using current indicators, the MDG target for water would be met, but the target for sanitation missed considerably. The number of people without access to such services is still increasing in certain regions. Striking differences persist between urban and rural areas. Consideration of water quality and different classification of shared sanitation facilities would, however, alter estimates considerably. To achieve improved monitoring we propose: (1) considering the use of MLM as an alternative for estimating access to safe drinking-water and sanitation; (2) completing regular assessments of water quality and supporting the development of national regulatory frameworks as part of capacity development; (3) evaluating health impacts of shared sanitation; (4) using a more equitable presentation of countries' performances in providing improved services.

Understanding history, philanthropy and the role of WHO in provision of assistive technologies for hearing loss.

PubMed

Chadha, Shelly; Moussy, Francis; Friede, Martin Howell

2014-09-01

Philanthropy continues to play an important role in provision of hearing devices and is often the only alternative for the majority of those in need of these devices. While this leads to improved access to services it may also create unsustainable service delivery models. Over the past decade, World Health Organization (WHO) has been making consistent efforts towards promoting accessibility and affordability of high-quality hearing devices, especially in Low- and Middle-Income Countries (LMIC). WHO developed and updated the "Guidelines for Hearing Aids and Services in Developing Countries", in 2004. In 2006, WHO supported the establishment of "World Wide (WW) Hearing", to promote hearing aid access across the globe. In the past year, WHO has renewed these efforts. As the first step and following a consultation on promoting access to hearing devices, WHO has developed a preferred product profile in order to facilitate the development and access of appropriate and affordable hearing aids for developing countries. The Convention on the Rights of Persons with Disabilities (article 32), calls for international collaboration to promote access to assistive technology including hearing devices. A coordinated global effort is required to promote availability and affordability of high-quality hearing devices. Such an undertaking requires the cooperation of all stakeholders: WHO, Member States, Non-Governmental Organizations (NGOs), philanthropists, manufacturers and users, to fulfill the international obligation and bring about a change in the quality of life of millions of people with hearing loss. Development of preferred product profile for hearing aids in LMICs can improve development and provision of high-quality, affordable hearing devices. Investment made by the recipients, such as partial financial contribution towards the cost of device or through purchase of ear mould or batteries, leads to a greater sense of responsibility towards the device and its maintenance. Low level of awareness about hearing loss and the potential benefits of hearing aids contribute to the underutilization of hearing aids.

Increasing skilled birth attendance through midwifery workforce management.

PubMed

Rosskam, Ellen; Pariyo, George; Hounton, Sennen; Aiga, Hirotsugu

2013-01-01

Policy makers and development partners struggle to help find solutions to the high rates of maternal and newborn mortality in many low and middle income countries. Increasing access to midwives and health workers skilled in midwifery can help to alleviate the situation. We aim to contribute to the debate on strategies to increase access to skilled birth attendance by sharing our views, illustrated with as yet unpublished case stories that were recognized with Awards of Excellence at the Second Global Forum on Human Resources for Health, 2011, held in Bangkok, Thailand. The correlation between access to skilled birth attendance and the density of midwives, nurses and doctors has been well established in the literature. How to cost-effectively scale up skilled birth attendance in low and middle income countries, however, remains a matter of debate. This article is based on a review of success stories in midwifery workforce management and innovations in increasing population access to midwives and other health workers skilled in midwifery. We draw on case stories from three low resource settings: Bangladesh, Sri Lanka and Nigeria. Addressing the problem of access to skilled birth attendance, some countries are making good progress towards achieving Millennium Development Goals 4 and 5. Unshakeable political will and financial commitment are fundamental. Copyright © 2012 John Wiley & Sons, Ltd.

Teachers' Perceptions of STEM Education and Its Impact on Students' Math Self-Efficacy

NASA Astrophysics Data System (ADS)

Reyes-Elizondo, Alejandra

New technologies and their benefits have become the norm, while past technologies are often overlooked. In the developed world, it is easily assumed that everyone has access to electricity, yet more than 1 billion people worldwide still live without it today. Electricity impacts all aspects of life: education, health, economy, and income, to name a few. This paper seeks to understand the relationship between having access to electricity and health outcomes, focusing on maternal mortality; mortality for those under 5 years of age; and mortality from non-communicable diseases, in 84 low and lower-middle income countries. Analyzing 84 countries using data from 1996 to 2014, this paper aims to understand how electricity impacts particular health outcomes. The key findings show that while having access to electricity is significantly associated with a reduction in maternal mortality and mortality for those under 5, it is not significantly associated with mortality from non-communicable diseases. These results indicate that enhancing access to electricity is merely a vessel towards improving health outcomes, but is not a magic policy in its own right. From a policy perspective, these findings imply that increasing access to electricity does not negate efforts towards improving the provision of health care alongside climate friendly and sustainable ways of electricity generation in developing countries.

Evidence-based healthcare in developing countries.

PubMed

Pearson, Alan; Jordan, Zoe

2010-06-01

Developing countries have limited resources, so it is particularly important to invest in healthcare that works. The case for evidence-based practice has long been made in the West. However, poor access to information makes this endeavour near impossible for health professionals working with vulnerable communities in low-income economies. This paper provides a call to action to create an evidence base for health professionals in developing countries and identify appropriate strategies for the dissemination of this information in realistic and meaningful ways.

Household Water Treatments in Developing Countries

ERIC Educational Resources Information Center

Smieja, Joanne A.

2011-01-01

Household water treatments (HWT) can help provide clean water to millions of people worldwide who do not have access to safe water. This article describes four common HWT used in developing countries and the pertinent chemistry involved. The intent of this article is to inform both high school and college chemical educators and chemistry students…

World Inequality: Social and Economic Data for Selected Developing Countries.

ERIC Educational Resources Information Center

Social Education, 1998

1998-01-01

Presents a chart of socioeconomic data for 38 developing countries and the United States. Includes statistics on GNP per capita, percent of people living on less than one dollar a day, under-age-5 mortality rate, percent of population without access to safe water, and total adult-literacy rate. (DSK)

How can a policy foster local pharmaceutical production and still protect public health? Lessons from the health-industry complex in Brazil.

PubMed

da Fonseca, Elize Massard

2018-04-01

The global health community is increasingly advocating for the local production of pharmaceuticals in developing countries as a way to promote technology transfer, capacity building and improve access to medicines. However, efforts to advance drug manufacturing in these countries revive an old dilemma of fostering technological development versus granting access to social services, such as healthcare. This paper explores the case of Brazil, a country that has developed large-scale health-inspired industrial policies, but is, yet, little understood. Brazil's experience suggests that progressive healthcare bureaucrats can create innovative practices for technology and knowledge transfers. It also demonstrates that highly competitive pharmaceutical firms can collaborate with each other, if a government provides them the right incentives. Reforming regulatory policies is crucial for guaranteeing high-quality products in developing countries, but governments must play a crucial role in supporting local firms to adapt to these regulations. These findings send a strong message to global health policymakers and practitioners on the conditions to create a suitable environment for local production of medical products.

Education for Agriculture and Rural Development in Low-Income Countries: Implications of the Digital Divide.

ERIC Educational Resources Information Center

Gasperini, Lavinia; Mclean, Scott

The "digital divide" refers to inequitable access to information and communication technologies (ICTs) between wealthy and poor countries and between privileged and underprivileged social groups within all countries. This presentation outlines global parameters of the digital divide, discusses the use of ICTs in education in…

Singaporean Parents' Views of Their Young Children's Access and Use of Technological Devices

ERIC Educational Resources Information Center

Ebbeck, Marjory; Yim, Hoi Yin Bonnie; Chan, Yvonne; Goh, Mandy

2016-01-01

Debates continue about the access young children have to technological devices, given the increasingly accessible and available technology in most developed countries. Concerns have been expressed by parents/caregivers and researchers, and questions have been raised about possible risks and benefits of these devices on young children who, in some…

Migrants' access to healthcare services within the European Union: a content analysis of policy documents in Ireland, Portugal and Spain.

PubMed

Ledoux, Céline; Pilot, Eva; Diaz, Esperanza; Krafft, Thomas

2018-06-15

The current migration flow into Europe is leading to a growing ethnically diverse population in many European countries. Now more than ever, those populations have different healthcare needs, languages, traditions, and previous level of care. This higher level of diversity is likely to increase health inequalities that might challenge healthcare systems if not addressed. In this context, this study aims at reviewing the policy framework for migrants' access to healthcare in Spain, Portugal and Ireland, countries with a long history of immigration, to identify lessons to be learned for policies on migrants' health. A content analysis of official policy documents was undertaken and the conceptual framework developed by Mladowsky was adapted to classify the actions indicated in the policies. The content analysis revealed that the policy aim for all three analysed countries is the improvement of the health status of the immigrant population based on equity and equality principles. The main strategies are the adaptation of services through actions targeting patients and providers, such as the implementation of cultural mediators and trainings for health professionals. The three countries propose a great range of policies aiming at improving access to healthcare services for immigrants that can inspire other European countries currently welcoming refugees. Developing inclusive policies, however does not necessarily mean they will be implemented or felt on the ground. Inclusive policies are indeed under threat due to the economic and social crises and due to the respective nationalistic attitudes towards integration. The European Union is challenged to take a more proactive leadership and ensure that countries effectively implement inclusive actions to improve migrant's access to health services.

A panel analysis of the strategic association between information and communication technology and public health delivery.

PubMed

Wu, Sarah Jinhui; Raghupathi, Wullianallur

2012-10-22

In this exploratory research, we use panel data analysis to examine the correlation between Information and Communication Technology (ICTs) and public health delivery at the country level. The goal of this exploratory research is to examine the strategic association over time between ICTs and country-level public health. Using data from the World Development Indicators, we construct a panel data set of countries of five different income levels and look closely at the period from 2000 to 2008. The panel data analysis allows us to explore this dynamic relationship under the control for unobserved country-specific effects by using a fixed-effects estimation method. In particular,, we examine the association of five ICT factors with five public health indicators: adolescent fertility rate, child immunization coverage, tuberculosis case detected, life expectancy, and adult mortality rate. First, overall ICTs' factors substantially improve a country's public health delivery on the top of wealth effect. Second, among all the ICTs' factors, accessibility is the only one that is associated with improvements in all aspects of public health delivery, while the contributions from the usage, quality, and applications are negligible. ICTs' accessibility factor is associated with a considerable extension to life expectancy and reduced adult mortality rate. Third, all entity-specific factors are significant in each model, indicating that countries' economic development level does influence their public health delivery. Our results indicate that ICT accessibility has a strong association with effective delivery of public health. There are others, but the key strategic applications are eHealth and mHealth. The findings of this study will help government officials and public health policy makers to formulate strategic decisions regarding the best ICT investments and deployment. For example, the study shows that providing accessibility should be a critical focus.

Slow-sand water filter: Design, implementation, accessibility and sustainability in developing countries

PubMed Central

Clark, Peter A.; Pinedo, Catalina Arango; Fadus, Matthew; Capuzzi, Stephen

2012-01-01

Summary The need for clean water has risen exponentially over the globe. Millions of people are affected daily by a lack of clean water, especially women and children, as much of their day is dedicated to collecting water. The global water crisis not only has severe medical implications, but social, political, and economic consequences as well. The Institute of Catholic Bioethics at Saint Joseph’s University has recognized this, and has designed a slow-sand water filter that is accessible, cost-effective, and sustainable. Through the implementation of the Institute’s slow-sand water filter and the utilization of microfinancing services, developing countries will not only have access to clean, drinkable water, but will also have the opportunity to break out of a devastating cycle of poverty. PMID:22739748

Generic medicines policies in the Asia Pacific region: ways forward.

PubMed

Nguyen, Tuan A; Hassali, Mohamed A A; McLachlan, Andrew

2013-01-01

Generic medicines are a key strategy used by governments and third-party payers to contain medicines costs and improve the access to essential medicines. This strategy represents an important opportunity provided by the global intellectual property regimes to discover and develop copies of original products marketed by innovator companies once the patent protection term is over. While there is an extensive experience regarding generic medicines policies in developed countries, this evidence may not translate to developing countries. The generic medicines policies workshop at the Asia Pacific Conference on National Medicines Policies 2012 provided an important opportunity to discuss and document country-specific initiatives for improving access to and the rational of use of generic medicines in the Asia Pacific region. Based on the identified barriers and enablers to implementation of generic medicines policies in the region, a set of future action plans and recommendations has been made.

Brain drain from developing countries: how can brain drain be converted into wisdom gain?

PubMed Central

Dodani, Sunita; LaPorte, Ronald E

2005-01-01

Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. Why do talented people leave their countries and go abroad? What are the consequences of such migrations especially on the educational sector? What policies can be adopted to stem such movements from developing countries to developed countries? This article seeks to raise questions, identify key issues and provide solutions which would enable immigrant health professionals to share their knowledge, skills and innovative capacities and thereby enhancing the economic development of their countries. PMID:16260795

Exploring Situational Factors Shaping Access in a Laptop Program for Socially Disadvantaged Children in India: A Case Study

ERIC Educational Resources Information Center

Padmanabhan, Poornima; Wise, Alyssa Friend

2012-01-01

Low-cost laptop programs attempt to address gaps in access to computers in developing countries. However, the translation of computing access from intention to actuality is mediated by many situational factors. This research presents a case study of how access to a set of laptops donated to a school for socially disadvantaged children in India was…

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries.

PubMed

Moon, Suerie; Jambert, Elodie; Childs, Michelle; von Schoen-Angerer, Tido

2011-10-12

Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.

A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries

PubMed Central

2011-01-01

Background Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines. Discussion We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term. Summary To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices. PMID:21992405

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015.

PubMed

2017-07-15

National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Rethinking health sector procurement as developmental linkages in East Africa.

PubMed

Mackintosh, Maureen; Tibandebage, Paula; Karimi Njeru, Mercy; Kariuki Kungu, Joan; Israel, Caroline; Mujinja, Phares G M

2018-03-01

Health care forms a large economic sector in all countries, and procurement of medicines and other essential commodities necessarily creates economic linkages between a country's health sector and local and international industrial development. These procurement processes may be positive or negative in their effects on populations' access to appropriate treatment and on local industrial development, yet procurement in low and middle income countries (LMICs) remains under-studied: generally analysed, when addressed at all, as a public sector technical and organisational challenge rather than a social and economic element of health system governance shaping its links to the wider economy. This article uses fieldwork in Tanzania and Kenya in 2012-15 to analyse procurement of essential medicines and supplies as a governance process for the health system and its industrial links, drawing on aspects of global value chain theory. We describe procurement work processes as experienced by front line staff in public, faith-based and private sectors, linking these experiences to wholesale funding sources and purchasing practices, and examining their implications for medicines access and for local industrial development within these East African countries. We show that in a context of poor access to reliable medicines, extensive reliance on private medicines purchase, and increasing globalisation of procurement systems, domestic linkages between health and industrial sectors have been weakened, especially in Tanzania. We argue in consequence for a more developmental perspective on health sector procurement design, including closer policy attention to strengthening vertical and horizontal relational working within local health-industry value chains, in the interests of both wider access to treatment and improved industrial development in Africa. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Canada and access to medicines in developing countries: intellectual property rights first.

PubMed

Lexchin, Joel

2013-09-03

Canadian reports have recommended that health as a human right must be Canada's overarching global commitment and that the primacy of human rights should be prioritized over other elements of international law including international trade and investment law as it applies to access to pharmaceuticals. This paper uses a series of case reports to examine Canada's commitment to this goal. Specifically it examines cases where improved access has been in conflict with increased intellectual property rights. The 6 cases are: Canada's position when 39 pharmaceutical companies took South Africa to court in 1998 over its legislation to allow parallel importation of patented medicines and to regulate the price of medications; the stance that Canada took in the negotiations around the Doha Declaration in 2001; the passage of Canada's Access to Medicines Regime in 2004 and subsequent attempts to amend the legislation in 2011 and 2012; Canada's involvement in the final declaration at the United Nations High-Level meeting on non-communicable diseases in 2012; Canada's views about the terms in the Anti-Counterfeiting Trade Agreement as expressed in 2009; and Canada's 2013 position on the extension of the exemption for least developed countries from having to comply with the terms of the Trade Related Aspects of Intellectual Property Rights Agreement. In the first case Canada was neutral but in the remaining 5 cases Canada prioritized intellectual property rights over access. This position is consistent with how Canada has acted around domestic issues involving intellectual property rights for pharmaceutical products. Canada has supported strengthened rights despite the fact that their touted benefits have not been realized either domestically or in developing countries. As a result Canada has failed in its humanitarian duty to protect the human right to health in the form of safe and low cost medicines for the people in developing countries.

Canada and access to medicines in developing countries: intellectual property rights first

PubMed Central

2013-01-01

Canadian reports have recommended that health as a human right must be Canada’s overarching global commitment and that the primacy of human rights should be prioritized over other elements of international law including international trade and investment law as it applies to access to pharmaceuticals. This paper uses a series of case reports to examine Canada’s commitment to this goal. Specifically it examines cases where improved access has been in conflict with increased intellectual property rights. The 6 cases are: Canada’s position when 39 pharmaceutical companies took South Africa to court in 1998 over its legislation to allow parallel importation of patented medicines and to regulate the price of medications; the stance that Canada took in the negotiations around the Doha Declaration in 2001; the passage of Canada’s Access to Medicines Regime in 2004 and subsequent attempts to amend the legislation in 2011 and 2012; Canada’s involvement in the final declaration at the United Nations High-Level meeting on non-communicable diseases in 2012; Canada’s views about the terms in the Anti-Counterfeiting Trade Agreement as expressed in 2009; and Canada’s 2013 position on the extension of the exemption for least developed countries from having to comply with the terms of the Trade Related Aspects of Intellectual Property Rights Agreement. In the first case Canada was neutral but in the remaining 5 cases Canada prioritized intellectual property rights over access. This position is consistent with how Canada has acted around domestic issues involving intellectual property rights for pharmaceutical products. Canada has supported strengthened rights despite the fact that their touted benefits have not been realized either domestically or in developing countries. As a result Canada has failed in its humanitarian duty to protect the human right to health in the form of safe and low cost medicines for the people in developing countries. PMID:24007595

Bayesian networks modelling in support to cross-cutting analysis of water supply and sanitation in developing countries

NASA Astrophysics Data System (ADS)

Dondeynaz, C.; López Puga, J.; Carmona Moreno, C.

2013-09-01

Despite the efforts made towards the Millennium Development Goals targets during the last decade, improved access to water supply or basic sanitation still remains unavailable for millions of people across the world. This paper proposes a set of models that use 25 key variables and country profiles from the WatSan4Dev data set involving water supply and sanitation (Dondeynaz et al., 2012). This paper suggests the use of Bayesian network modelling methods because they are more easily adapted to deal with non-normal distributions, and integrate a qualitative approach for data analysis. They also offer the advantage of integrating preliminary knowledge into the probabilistic models. The statistical performance of the proposed models ranges between 20 and 5% error rates, which are very satisfactory taking into account the strong heterogeneity of variables. Probabilistic scenarios run from the models allow an assessment of the relationships between human development, external support, governance aspects, economic activities and water supply and sanitation (WSS) access. According to models proposed in this paper, gaining a strong poverty reduction will require the WSS access to reach 75-76% through: (1) the management of ongoing urbanisation processes to avoid slums development; and (2) the improvement of health care, for instance for children. Improving governance, such as institutional efficiency, capacities to make and apply rules, or control of corruption is positively associated with WSS sustainable development. The first condition for an increment of the HDP (human development and poverty) remains of course an improvement of the economic conditions with higher household incomes. Moreover, a significant country commitment to the environment, associated with civil society freedom of expression constitutes a favourable setting for sustainable WSS services delivery. Intensive agriculture using irrigation practises also appears as a mean for sustainable WSS thanks to multi-uses and complementarities. With a WSS sector organised at national level, irrigation practices can support the structuring and efficiency of the agriculture sector. It may then induce rural development in areas where WSS access often is set back compared to urban areas1. External financial support, called Official Development Assistance (ODA CI), plays a role in WSS improvement but comes last in the sensitivity analyses of models. An overall 47% of the Official Development Assistance goes first to poor countries, and is associated to governance aspects: (1) political stability and (2) country commitment to the environment and civil society degree of freedom. These governance aspects constitute a good framework for aid implementation in recipient countries. Modelling is run with the five groups of countries as defined in Dondeynaz et al. (2012). Models for profile 4 (essential external support) and profile 5 (primary material consumption) are specifically detailed and analysed in this paper. For countries in profile 4, fighting against water scarcity and progressing desertification should be the priority. However, for countries in profile 5, efforts should first concentrate on consolidation of political stability while supporting diversification of the economic activities. Nevertheless, for both profiles, reduction of poverty should remain the first priority as previously indicated. 1 JMP statistics, 2004 http://www.wssinfo.org/data-estimates/table/, last access: 22 July 2013.

A review of accessibility of administrative healthcare databases in the Asia-Pacific region

PubMed Central

Milea, Dominique; Azmi, Soraya; Reginald, Praveen; Verpillat, Patrice; Francois, Clement

2015-01-01

Objective We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia. Methods The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases. Results Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3–6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted based on requirements by data custodians. Conclusions Compared with previous research, this study describes the landscape of databases in the selected countries with more granularity using an assessment tool developed for this purpose. A high number of databases were identified but most had restricted access, preventing their potential use to support research. We hope that this study helps to improve the understanding of the AHDB landscape, increase data sharing and database research in Asia-Pacific countries. PMID:27123180

Poverty & health: criticality of public financing.

PubMed

Duggal, Ravi

2007-10-01

Countries with universal or near universal access to healthcare have health financing mechanisms which are single-payer systems in which either a single autonomous public agency or a few coordinated agencies pool resources to finance healthcare. This contributes to both equity in healthcare as well as to low levels of poverty in these countries. It is only in countries like India and a number of developing countries, which still rely mostly on out-of-pocket payments, where universal access to healthcare is elusive. In such countries those who have the capacity to buy healthcare from the market most often get healthcare without having to pay for it directly because they are either covered by social insurance or buy private insurance. In contrast, a large majority of the population, who suffers a hand-to-mouth existence, is forced to make direct payments, often with a heavy burden of debt, to access healthcare from the market because public provision is grossly inadequate or non existent. Thus, the absence of adequate public health investment not only results in poor health outcomes but it also leads to escalation of poverty. This article critically reviews the linkages of poverty with healthcare financing using evidence from national surveys and concludes that public financing is critical to good access to healthcare for the poor and its inadequacy is closely associated with poverty levels in the country.

Confronting Challenges to the Liberal Arts Curriculum: Perspectives of Developing and Transitional Countries

ERIC Educational Resources Information Center

Peterson, Patti McGill

2012-01-01

Comparative research on higher education in developing and transitional countries is often focused on such issues as access, finance, student mobility and the impact of globalization, but there has been little attention to curriculum and the forces that shape it. Confronting Challenges to the Liberal Arts Curriculum fills an important gap in the…

"I Like the People I Work with. Maybe I'll Get to Meet Them in Person One Day": Teaching and Learning Practice Development with Transnational Teaching Teams

ERIC Educational Resources Information Center

Keevers, Lynne; Lefoe, Geraldine; Leask, Betty; Sultan, Fauziah K. P. Dawood; Ganesharatnam, Sumitha; Loh, Vincent; Lim, Jane See Yin

2014-01-01

Significant changes have occurred in the international education landscape driven by the need for access to higher education in developing countries. One response to this situation has been the provision of higher education in the developing country via partnership arrangements with overseas institutions. Rapid growth in transnational programmes…

Changing Social Institutions to Improve the Status of Women in Developing Countries. OECD Development Centre Policy Brief No. 27

ERIC Educational Resources Information Center

Jutting, Johannes: Morrisson, Christian

2005-01-01

One of the long-standing priorities of the international community is to reduce gender disparity in developing countries. Yet, the overall picture is still gloomy: women continue to be excluded from access to resources and employment and are denied basic human rights. This Policy Brief explains why progress has been so minimal and what should be…

The Impact of Social Institutions on the Economic Role of Women in Developing Countries. OECD Development Centre Working Paper No. 234

ERIC Educational Resources Information Center

Morrisson, Christian; Jutting, Johannes

2004-01-01

Donor agencies and policy makers tend to agree that increased access of women to education, health, credit, formal legal rights and employment opportunities, in conjunction with economic growth, will substantially improve the socio-economic role of women in developing countries. This paper challenges that view. It argues that these measures might…

Solid fuel use is associated with anemia in children.

PubMed

Accinelli, Roberto A; Leon-Abarca, Juan A

2017-10-01

Over 3 billion people use solid fuels as a means of energy and heating source, and ~ 50% of households burn them in inefficient, poorly ventilated stoves. In 2010, ~ 43% of the 640 million preschool children in 220 countries suffered from a certain degree of anemia, with iron deficiency as the main cause in developed countries whereas its causes remained multifactorial in the undeveloped group. In this study, we explore the relations of country-wide variables that might affect the people's health status (from socioeconomic status to more specific variables such as water access). We found independent relationship between solid fuel use and anemia in children under five years old (p < 0.0001), taking into account the prevalence of anemia in pregnant woman and the access to improved water sources. Countries in which the population uses solid fuel the most have over three times higher anemia rates in children than countries with the lowest prevalence of solid fuels use. There is still a complex relationship between solid fuels use and anemia, as reflected in its worldwide significance (p < 0.05) controlled for measles immunization, tobacco consumption, anemia in pregnant mothers, girl's primary education, life expectancy and improved water access but not (p > 0.05) when weighing for sanitation access or income per capita. Copyright © 2017 Elsevier Inc. All rights reserved.

Access to infertility care in the developing world: the family promotion gap.

PubMed

Asemota, Obehi A; Klatsky, Peter

2015-01-01

Infertility in resource-poor settings is an overlooked global health problem. Although scarce health care resources must be deployed thoughtfully, prioritization of resources may be different for recipient and donor countries, the latter of whom focus on maternal health care, prevention, and family planning. For women and couples with involuntary childlessness, the negative psychosocial, sociocultural, and economic consequences in low-income countries are severe, possibly more so than in most Western societies. Despite the local importance of infertility, few resources are committed to help advance infertility care in regions like sub-Saharan Africa. The worldwide prevalence of infertility is remarkably similar across low-, middle-, and high-income countries. The World Health Organization (WHO) recognizes infertility as a global health problem and established universal access to reproductive health care as one of the United Nation's Millennium Developmental Goals for 2015. Currently, access to infertility care is varied and is usually only attainable by the very wealthy in low-income countries. We provide an overview on the current state of access to infertility care in low-income countries such as in sub-Saharan Africa and a rationale for providing comprehensive reproductive care and possible solutions for providing cost-effective infertility services in these settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Access and barriers to health care delivery in Arab countries: a review.

PubMed

Kronfol, N M

2012-12-01

This paper reviews some of the main obstacles encountered by the population (or rather by different social groups) in accessing health services in Arab countries. These obstacles can be social and cultural, administrative and organizational or financial and may impact on gender and ethnic groups to different degrees. Governments are urged to address the health inequalities that result from these obstacles and promote equity, solidarity and fairness through social policies that enhance social and national development.

The Global Opioid Policy Initiative: a wealth of information, but what is next?

PubMed

Scholten, Willem

2014-03-01

Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. Data from the project will be an important resource for those who advocate for improved access to opioid analgesics. Yet, like so often, many more aspects of inadequate opioid analgesic consumption require exploration and reporting, including legislative barriers. The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.

Maternal and child health project in Nigeria.

PubMed

Okafor, Chinyelu B

2003-12-01

Maternal deaths in developing countries are rooted in womens powerlessness and their unequal access to employment, finance, education, basic health care, and other resources. Nigeria is Africa's most populous country, and it is an oil producing country, but Nigeria has one of the worst maternal mortality rates in Africa. These deaths were linked to deficiencies in access to health care including poor quality of health services, socio-cultural factors, and access issues related to the poor status of women. To address these problems, a participatory approach was used to bring Christian women from various denominations in Eastern Nigeria together. With technical assistance from a research unit in a university in Eastern Nigeria, the women were able to implement a Safe Motherhood project starting from needs assessment to program evaluation. Lessons learned from this program approach are discussed.

Development of OA Abroad and Its Inspirations

ERIC Educational Resources Information Center

Bi, Jing

2010-01-01

This study introduces the concept and characteristics of open access (OA), analyses the status quo and development of OA in foreign countries, and discusses its inspiration to its future development in China.

Turkey as an Emerging Energy Hub

DTIC Science & Technology

2010-06-01

respecting environment concerns.”27 It has two dimensions; one of them is the view of the importing country, the other the view of the exporting ...country. For an importing country (consumer), energy security refers primarily to access to the sources and security of supplies,28 for an exporting ...production is insufficient for the country’s needs. Turkey is a developing country and needs energy to sustain its economic growth . To sustain that

The International Year of Astronomy 2009 (IYA2009): Making Astronomy Accessible to Differently-Abled Individuals

NASA Astrophysics Data System (ADS)

Venner, L.

2008-12-01

The US Goal for the IYA2009 is: To offer an engaging astronomy experience to every person in the country, nurture existing partnerships, and build new connections to sustain public interest. NASAís commitment to the IYA2009 US goal is demonstrated by their support of accessible programming and materials developed to reach every person in the country including differently-abled individuals. The members of NASAís Jet Propulsion Laboratory Solar System Ambassador Program have been utilizing these accessible programs and materials in schools and science centers in addition to offering accessible star parties to the public. This paper will present some of the materials and techniques used by Ambassadors to bring astronomy to every person. Accessible programming will ensure that the next generation of explorers will include diverse individuals from all walks of life.

Volunteered Geographic Information (vgi) and Environmental Monitoring, a New Approach in Developing Countries

NASA Astrophysics Data System (ADS)

Manouchehri, M.; Kiavarz Moghaddam, M.

2017-09-01

Increasing world population and unprecedented expansion of urbanization in the world has caused many environmental problems. The relationship between man and the environment is bidirectional one that have great short-term and long-term impacts on the cities and regions. The best way to deal with it is the participation of the people themselves. The use of new technologies has now become one of the most important methods for monitoring the environment that can increase the participation of citizens, improving environmental problems to provide the cheapest and the most accessible form. Developing countries such as Iran, which faces enormous environmental problems are suitable for the development of technological methods of monitoring. Large population and citizens' participation feasibility using VGI can have a positive effect on developing countries. Finally, by using F-VGI that ensures the validity and accuracy of data we can access an appropriate platform that leads us to suitable model for environment monitoring in the form of the application.

A simple and low-cost Internet-based teleconsultation system that could effectively solve the health care access problems in underserved areas of developing countries.

PubMed

Kuntalp, Mehmet; Akar, Orkun

2004-08-01

In many developing countries including Turkey, telemedicine systems are not in wide use due to the high cost and complexity of the required technology. Lack of these systems however has serious implications on patients who live in rural areas. The objective of this paper is to present a simple and economically affordable alternative to the current systems that would allow experts to easily access the medical data of their remote patients over the Internet. The system is developed in client-server architecture with a user-friendly graphical interface and various services are implemented as dynamic web pages based on PHP. The other key features of the system are its powerful security features and platform independency. An academic prototype is implemented and presented to the evaluation of a group of physicians. The results reveal that the system could find acceptance from the medical community and it could be an effective means of providing quality health care in developing countries.

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries.

PubMed

Bain, Rob E S; Gundry, Stephen W; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-03-01

To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement.

Technology innovation for infectious diseases in the developing world

PubMed Central

2012-01-01

Enabling innovation and access to health technologies remains a key strategy in combating infectious diseases in low- and middle-income countries (LMICs). However, a gulf between paying markets and the endemicity of such diseases has contributed to the dearth of R&D in meeting these public health needs. While the pharmaceutical industry views emerging economies as potential new markets, most of the world’s poorest bottom billion now reside in middle-income countries--a fact that has complicated tiered access arrangements. However, product development partnerships--particularly those involving academic institutions and small firms--find commercial opportunities in pursuing even neglected diseases; and a growing pharmaceutical sector in BRICS countries offers hope for an indigenous base of innovation. Such innovation will be shaped by 1) access to building blocks of knowledge; 2) strategic use of intellectual property and innovative financing to meet public health goals; 3) collaborative norms of open innovation; and 4) alternative business models, some with a double bottom line. Facing such resource constraints, LMICs are poised to develop a new, more resource-effective model of innovation that holds exciting promise in meeting the needs of global health. PMID:23849080

Patents and access to drugs in developing countries: an ethical analysis.

PubMed

Sterckx, Sigrid

2004-05-01

More than a third of the world's population has no access to essential drugs. More than half of this group of people live in the poorest regions of Africa and Asia. Several factors determine the accessibility of drugs in developing countries. Hardly any medicines for tropical diseases are being developed, but even existing drugs are often not available to the patients who need them. One of the important determinants of access to drugs is the working of the patent system. This paper first maps out some facts about the global patent regime that has emerged as a consequence of the conclusion of the WTO-TRIPs Agreement in 1994. Attempts to construct a moral justification of the patent system have been based on three grounds: natural rights, distributive justice, and utilitarian arguments. This paper examines to what extent and on which grounds drug patents can be justified. The final section looks at the so-called 'Doha Declaration on the TRIPs Agreement and Public Health', which was adopted by the WTO Ministerial Conference two years ago, recognising the primacy of public health over the interests of patent proprietors.

Feasibility of standardized injury surveillance and reporting: a comparison of data from four Asian nations.

PubMed

Nakahara, S; Jayatilleke, A U; Ichikawa, M; Marasinghe, A; Kimura, A; Yoshida, K

2008-04-01

To address the increasing number of injuries in developing countries, the World Health Organization (WHO) encourages the establishment of hospital-based surveillance systems and systematic data collection. Although a computerized system is preferable in terms of efficiency, many developing countries have difficulty accessing the appropriate resources. To assess the possibility of comparing and sharing data among countries, and then to discuss the possibility of establishing an international data management system through the internet. A point-by-point comparison of data directories from injury surveillance systems in Thailand, Cambodia, Sri Lanka, and Japan was conducted using guidelines published by WHO as the standard. Thailand, Cambodia, and Sri Lanka used data items that are comparable to each other and to WHO guidelines, with few, readily amenable, differences. The Japanese system used quite different data items. Data comparability suggests the feasibility of a global data management system that can store data from various countries. Such a system, if made accessible over the internet, would benefit resource-constrained countries by providing them with a ready-made framework to implement a surveillance system at low cost.

Are transnational tobacco companies’ market access strategies linked to economic development models? A case study of South Korea

PubMed Central

Lee, Sungkyu; Holden, Chris; Lee, Kelley

2013-01-01

Transnational tobacco companies (TTCs) have used varied strategies to access previously closed markets. Using TTCs’ efforts to enter the South Korean market from the late 1980s as a case study, this article asks whether there are common patterns in these strategies that relate to the broader economic development models adopted by targeted countries. An analytical review of the existing literature on TTCs’ efforts to access emerging markets was conducted to develop hypotheses relating TTCs’ strategies to countries’ economic development models. A case study of Korea was then undertaken based on analysis of internal tobacco industry documents. Findings were consistent with the hypothesis that TTCs’ strategies in Korea were linked to Korea’s export-oriented economic development model and its hostile attitude toward foreign investment. A fuller understanding of TTCs’ strategies for expansion globally can be derived by locating them within the economic development models of specific countries or regions. Of foremost importance is the need for governments to carefully balance economic and public health policies when considering liberalisation. PMID:23327486

The Role and Tasks of Education in the Politic of Evolution of the Modern World (with Especial Regard to the Developing Countries).

ERIC Educational Resources Information Center

Podoski, Kazimierz

This paper, one of several on the theme of economy and culture in the politics of nation building, was written for the Ninth World Congress of the International Political Science Association. The author's aim is to indicate the role of modern education policy in the world's socio-economic development, especially in developing countries. Access to…

Cancer initiatives in developing countries.

PubMed

Mellstedt, H

2006-06-01

The coming decades will bring dramatic increases in morbidity and mortality from cancer in the developing world. The burden of cancer is increasing globally, with an expected 20 million new cases per year in 2020, half of which will be in low- and middle-income countries. Despite an already overwhelming burden of health problems, developing countries must somehow address this cancer pandemic and their alarming share of cancer illness. Many large-scale and innovative worldwide initiatives have been launched in the fight against cancer. These programs represent colossal efforts to expand resources for health education among people and healthcare workers in developing countries and to increase awareness of cancer prevention. Many novel evidence-based and culturally-relevant programs are being implemented for screening and early prevention of common cancers. Several key initiatives are supporting clinical research, guideline development, oncology training, and appropriate technology transfer, such as access to electronic medical literature. Treatment programs are expanding access and quality of radiologic and pharmacologic therapies for cancer. These initiatives represent an unprecedented level of and cooperation among international agencies, governmental and nongovernmental organizations, international foundations, scientific societies, local institutions, and industry. This review examines the scope of need in response to the increasing burden of cancer in the developing world and major initiatives that have been created to respond to these needs.

SUSTAINABLE WATER DEVELOPMENT PROGRAM FOR RURAL NIGERIA

EPA Science Inventory

Rural areas of Sub-Saharan Africa face the most acute water supply challenges in the world. Nigeria, the most populous African country, has considerable populations without basic access to safe drinking water, with over 50% of the country lacking coverage. The village of Adu A...

Securing Gender Equality through a Nexus of Energy Policy Performance and Relative Political Performance

NASA Astrophysics Data System (ADS)

Perkins-Ozuagiemhe, Andrea Christen

This dissertation presents what is believed to be the first empirical study that measures the effect of increasing access to modern household energy sources upon advancing gender equality within developing countries. As a powerful and fundamental public infrastructural socio-economic building block, improved access to modern energy in developing countries delivers the necessary economic ingredient of time as a major component of household production and consumption and captures the interdependence between market and household economies. Thus, because it has been empirically proven that men and women differ in their utilization of household energy with women spending more time engaged in non-market household labor than men, improving access to modern household energy in developing countries, especially in rural areas, theoretically would disproportionately affect women's lives. Essentially, the element of "time" not only extends the day for women to use towards more economically and educationally productive activities, but also lessens the burden of domestic chores from women with technological advancements in more time-efficient household appliances and cleaner modern energy sources. This dissertation introduces gender differentiation in a model in the form of a gender relative status composite measure comparing socio-economic achievements in secondary education, life expectancy, and labor force participation rates by varying degree of demographic transition, thereby, measuring the effect of improved access to modern household energy upon overall gender equality. Fixed effects panel regressions employing a Driscoll-Kraay non-parametric covariance matrix, and estimated and interpreted adjusted predictions and marginal effects of the two-way interaction between a country's available access to residential electric power (kWh per capita) and the level of relative political performance against predicted values of gender relative status are employed. The models confirm that, in fact, that women are not impacted equally by energy policy preferences as men and that women in developing countries benefit from increased access to modern household energy. Thus, gender-differentiated energy usage illustrates why treating population as a homogenous group fails to capture how energy policy preferences and energy policy performance can affect different subgroups of population in terms of individual choices and how those differences can affect an overall economic growth and development. Fundamental theoretical implications emerge from this dissertation's empirical findings. First, improving gender equality through technological advancements in household electricity facilitates the progress of demographic transition in terms of reducing fertility rates. Time altering effects of increased access and use of household electricity modify intra-household relations by diminishing differing roles between men and women. When women gain greater autonomy facilitated by increasing time via access to modern household electricity for more economically and educationally productive activities, fertility rates and child births tend to decrease by altering choice in family size with increased investments in children. The effect that the reduction in fertility generated by increased gender equality has upon demographic transition is that it alters the change in age structure in a developing country by decreasing youth dependency ratios generating the demographic dividend. Gender equality-generated fertility reductions may also facilitate the return to human capital by lessening the burden of non-SNA work and activities including reducing child care, increasing female labor force participation rates.

Assessing the usefulness of the water poverty index by applying it to a special case: Can one be water poor with high levels of access?

NASA Astrophysics Data System (ADS)

Komnenic, V.; Ahlers, R.; Zaag, P. van der

Using indices and indicators in assessment of progress of a developing country has two sides. Such indicators offer an easy-to-understand shorthand/synopsis of issues vital for a country’s development. The other side of the coin, however, is that this synopsis may be distorted due to incorrect data or inapplicability of an index or an indicator to a specific case. This paper assesses the applicability of Water Poverty Index for the countries riparian to the Sava sub-basin, a tributary to the Danube river basin and presents the results of its application. At the same time, the paper discusses the concept of water poverty and the appropriateness of its use in the case of Sava River Basin countries by differentiating the economic poverty in some of those countries from sufficient access to and use of water resources in all of them.

Including Disabled Children in Learning: Challenges in Developing Countries. CREATE Pathways to Access. Research Monograph No. 36

ERIC Educational Resources Information Center

Croft, Alison

2010-01-01

This is an exploratory study suggesting ways of analysing challenges for developing countries in the move to greater inclusion of disabled children and young people in learning. The paper focuses on pedagogical challenges to realising more inclusive education. Pedagogy encompasses not only the practice of teaching and learning, but also the ideas…

Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals.

PubMed

Tangcharoensathien, Viroj; Mills, Anne; Palu, Toomas

2015-04-29

The Sustainable Development Goals (SDGs), to be committed to by Heads of State at the upcoming 2015 United Nations General Assembly, have set much higher and more ambitious health-related goals and targets than did the Millennium Development Goals (MDGs). The main challenge among MDG off-track countries is the failure to provide and sustain financial access to quality services by communities, especially the poor. Universal health coverage (UHC), one of the SDG health targets indispensable to achieving an improved level and distribution of health, requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access. Given the trend of increased fiscal capacity in most developing countries, aiming at long-term progress toward UHC is feasible, if there is political commitment and if focused, effective policies are in place. Trends in high income countries, including an aging population which increases demand for health workers, continue to trigger international migration of health personnel from low and middle income countries. The inspirational SDGs must be matched with redoubled government efforts to strengthen health delivery systems, produce and retain more and relevant health workers, and progressively realize UHC.

Framing access to medicines in developing countries: an analysis of media coverage of Canada's Access to Medicines Regime

PubMed Central

2010-01-01

Background In September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process. Methods We conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives. Results The most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media. Conclusions Media framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the legislation. Using the media to engage the public in more in-depth exploration of the policy issues at stake may contribute to a more informed policy development process. The media can be an effective channel for those stakeholders with a weaker voice in policy deliberations to raise public attention to particular issues; however, the political and institutional context must be taken into account as it may outweigh media framing effects. PMID:20044940

Issues of environmental compliance in developing countries.

PubMed

Singh, S; Rajamani, S

2003-01-01

Environmental laws define the scarcity of environmental resources as they affect the factor endowment of a country and therefore its position in the international division of labour. There is now also a general agreement that applying the "polluter pays" principle should solve environmental problems. As the burden of abatement increases, as measured by the ratio of abatement expenditure to sales, there is definitely an incentive for firms to either invest in cleaner technology or more efficient abatement technology. There is also evidence that taxes and charges, designed to internalise externalities, can actually affect trade. It is interesting to know if the developing countries face particular market access problems in the face of stringent environmental standards and regulations. While it is true that stringent measures impose market access restrictions and cause limitations on competitiveness, this is much more widely felt by the developing countries because of lack of infrastructure and monitoring facilities, limited technology choices, inadequate access to environment-friendly raw materials, lack of complete information, presence of small-scale exporters and emergence of environmental standards in sectors of export interest to developing countries. The small and medium enterprises often divert sales either to the domestic market or to external markets where environmental requirements are less stringent, in order to save on their costs. In developing countries, 80% of the tanning industry is comprised of small and medium enterprises (SMEs) processing raw to semi-finished leather, usually less than 2 tons per day. In Europe and other developed countries the SMEs in the leather sector have vanished due to strict environmental legislation and this will likely occur in developing countries also. The environmental legislation has not always been practical, either because the laws are too ambitious or unrealistic in certain parameters, or because they have lacked effective instrumentation and institutional support. Some environmental regulations have not succeeded as they do not match the technical requirements and economic reality of the country or region, or because they do not take the institutional capabilities of the society that has to implement them into consideration. For the survival and sustenance of the SMEs in the leather industry, it may be a viable alternative to carry out the tanning process in a decentralized fashion such that the raw to semi-finished process is carried out in the large scale sector while the semi-finished to finished process could either be reserved or open to competition as per the countries' requirements. But the issue of concern is whether it is fair that the raw to semi-finished tanning process, containing 70% of the pollution discharge should be undertaken by developing countries alone, especially if it is at the cost of their survival! However, the game analysed in the paper reveals that tanning units in developing countries would prefer to comply with the regulations and stay in the industry, the alternatives being to collude or to compete!

Sustainability issues in rural water supply in Asia.

PubMed

1998-03-01

This article identifies some sustainability issues in management of water supplies in rural Asia. The International Drinking Water Supply and Sanitation Decade was 1981-90. At present, less than 50% of the rural population in several Asian countries have access to safe water, and even less have access to adequate sanitation. Access does not ensure quality of services or supplies. Data on coverage is inadequate and does not take into account water quality, hours of service, reliability of supplies, distance to the source, and community use patterns. It is difficult to improve access to the poor. There is no single uniform strategy that works for all parts of a country. Countries need to promote community management that has strategic vision and appropriate priorities. Local management is constrained by centralized authority, the orientation of sector agencies, and staff with weak managerial, financial, technical, and communications skills. Many countries lack resources to maintain water delivery infrastructures and to prevent deterioration of services. There is a need to develop low cost appropriate technologies, management requirements, health education, community participation, mobilization of women, and synergistic, nonsequential development. Demand for water and sanitation is driven by survival and privacy issues. Rural water supply programs should view water as an economic and social good. Water management is effective when decisions are made locally. Local governments need to be strengthened in order to be able to perform demand management, select institutional options, and to take care of the unserviced.

Accessing Parental Perspectives to Inform the Development of Parent Training in Autism in South-Eastern Europe

ERIC Educational Resources Information Center

Preece, David; Symeou, Loizos; Stošic, Jasmina; Troshanska, Jasmina; Mavrou, Katerina; Theodorou, Eleni; Frey Škrinjar, Jasmina

2017-01-01

Parent training has been shown to be an important means of supporting families living with autism--but such services are not universally accessible. A multinational project funded by the European Commission has been developed in order to establish such parent training in three south-eastern European countries. To ensure that the training was…

An intellectual property sharing initiative in agricultural biotechnology: development of broadly accessible technologies for plant transformation.

PubMed

Chi-Ham, Cecilia L; Boettiger, Sara; Figueroa-Balderas, Rosa; Bird, Sara; Geoola, Josef N; Zamora, Pablo; Alandete-Saez, Monica; Bennett, Alan B

2012-06-01

The Public Intellectual Property Resource for Agriculture (PIPRA) was founded in 2004 by the Rockefeller Foundation in response to concerns that public investments in agricultural biotechnology benefiting developing countries were facing delays, high transaction costs and lack of access to important technologies due to intellectual property right (IPR) issues. From its inception, PIPRA has worked broadly to support a wide range of research in the public sector, in specialty and minor acreage crops as well as crops important to food security in developing countries. In this paper, we review PIPRA's work, discussing the failures, successes, and lessons learned during its years of operation. To address public sector's limited freedom-to-operate, or legal access to third-party rights, in the area of plant transformation, we describe PIPRA's patent 'pool' approach to develop open-access technologies for plant transformation which consolidate patent and tangible property rights in marker-free vector systems. The plant transformation system has been licensed and deployed for both commercial and humanitarian applications in the United States (US) and Africa, respectively. © 2012 The Authors. Plant Biotechnology Journal © 2012 Society for Experimental Biology, Association of Applied Biologists and Blackwell Publishing Ltd.

Growing vegetables in developing countries for local urban populations and export markets: problems confronting small-scale producers.

PubMed

Dinham, Barbara

2003-05-01

Vegetables attract high applications of pesticides, and farmers in developing countries use many acutely toxic insecticides to control pests on these crops. With the liberalisation of agricultural markets in developing countries, the number of small-scale farmers growing vegetables for both domestic and export markets is increasing. Demand for supplies of year-round and exotic fruit and vegetables has grown in industrialised countries, but with rising quality standards and traceability requirements it is difficult for small-scale farmers to benefit from this lucrative non-traditional agricultural export trade. The demand is high for vegetables in the expanding cities in developing countries, and farmers in peri-urban areas, or rural areas with good access to the cities, are in a position to find a growing market for their produce. Poor storage facilities will often mean that farmers are forced to sell at peak times when prices are low. Farmers rarely have access to training in pesticide use, and have only limited or no access to advice on the complicated management of pesticides. The Food and Agriculture Organisation of the UN is concerned about high levels of poor quality and adulterated pesticides on sale in developing countries. Surveys repeatedly show that without training, farmers are unable to make good crop decisions: recognition of pests and their predators is generally low, leading to decisions to spray to kill any insect; knowledge of product selection, application rates and timing is poor; different products are often combined in the belief that the effect will be greater; re-entry periods after spraying and essential harvest intervals are not known; and without knowledge of alternatives, farmers will often assume that the only solution to pest problems is to spray more frequently. From a consumer's point of view, few developing countries are able to monitor pesticide residues, particularly for produce grown for home consumption: most countries do not have laboratories for even simple residue testing. Changes in European Maximum Residue Limits means that export crops will be rejected if they contain residues at the Limit of Detection of pesticides not registered in Europe. Season-long field level training in Integrated Pest Management can help farmers to become better decision-makers, and to greatly reduce pesticide use while reducing risks to their own health and environment, producing safer products for consumers, maintaining yields, and increasing incomes.

Access in Community College Policy: An Examination of the Social and Political Space Afforded Disabled Students in California Community College Policies

ERIC Educational Resources Information Center

Hoggatt, Michael J.

2017-01-01

Access to education has long been seen as a fundamental element of a developed country. Specifically, the relative availability and access to education by various constituent groups has been identified as an essential metric in educational evaluation. Yet, individuals with disabilities have been identified as being underrepresented within…

Barcelona 2002: law, ethics, and human rights. Using the law to improve access to treatments.

PubMed

Elliott, Richard; Parmar, Sharan; Divan, Vivek; Berger, Jonathan

2002-12-01

The XIII International AIDS Conference in Durban, South Africa in July 2000 focused worldwide attention on the problem of accessing treatments in developing countries. In the interim, thanks to the work of activists - from demonstrations to court cases, and from acts of public courage by people living with HIV/AIDS to ongoing lobbying of politicians and trade negotiators - some very significant developments have occurred. But the reality is that the vast majority of people living with HIV/AIDS still lack access to affordable, quality medicines. This article, a summary of a paper presented at "Putting Third First: Vaccines, Access to Treatments and the Law," a satellite meeting held at Barcelona on 5 July 2002 and organized by the Canadian HIV/AIDS Legal Network, the AIDS Law Project, South Africa, and the Lawyers Collective HIV/AIDS Unit, India, explores three approaches for improving access. In the first part, Richard Elliott provides an overview of the state of the right to health as embodied in international human rights law; comments on the experience to date in litigating claims to the right to health; and identifies potential strategies activists can adopt to advance recognition of the right to health. In the second part, Sharan Parmar and Vivek Divan describe price-control and drug-financing mechanisms used by industrialized countries to increase the affordability of medicines; and discuss how some of these mechanisms could be adapted for use in developing countries. Finally, Jonathan Berger describes the use of litigation in the courts by the Treatment Action Campaign in South Africa.

Essential Medicines: An Indian Perspective

PubMed Central

Maiti, Rituparna; Bhatia, Vikas; Padhy, Biswa Mohan; Hota, Debasish

2015-01-01

The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world's poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers. PMID:26435594

Identification of Challenges to the Availability and Accessibility of Opioids in Twelve European Countries: Conclusions from Two ATOME Six-Country Workshops.

PubMed

Linge-Dahl, Lisa; Vranken, Marjolein; Juenger, Saskia; North, Kate; Scholten, Willem; Payne, Sheila; Radbruch, Lukas

2015-12-01

Access to many controlled medicines is inadequate in a number of European countries. This leads to deficits in the treatment of moderate to severe pain as well as in opioid agonist therapy. The study objective was to elaborate the reasons for this inadequacy. The work plan of the Access to Opioid Medication in Europe (ATOME) project included two six-country workshops. These workshops comprised a national situational analysis, drafting tailor-made recommendations for improvement and developing action plans for their implementation. In total, 84 representatives of the national Ministries of Health, national controlled substances authorities, experts representing regulatory and law enforcement authorities, leading health care professionals, and patient representatives from 13 European countries participated in either one of the workshops. The delegates used breakout sessions to identify key common challenges. Content analysis was used for the evaluation of protocols and field notes. A number of challenges to opioid accessibility in the countries was identified in the domains of knowledge and educational, regulatory, legislative, as well as public awareness and training barriers that limit opioid prescription. In addition, short validity of prescriptions and bureaucratic practices resulting in overregulation impeded availability of some essential medicines. Stigmatization and criminalisation of people who use drugs remained the major impediment to increasing opioid agonist program coverage. The challenges identified during outcomes of the workshops were used as the basis for subsequent dissemination and implementation activities in the ATOME project, and in some countries the workshop proceedings already served as a stepping-stone for the first changes in regulations and legislation.

Coping with increasing water and land resources limitation for meeting world's food needs: the role of virtual water and virtual land trade

NASA Astrophysics Data System (ADS)

Soriano, Barbara; Garrido, Alberto; Novo, Paula

2013-04-01

Increasing pressure to expand agriculture production is giving rise to renewed interest to obtain access to land and water resources in the world. Water footprint evaluations show the importance of green water in global food trade and production. Green water and land are almost inseparable resources. In this work we analyse the role of foreign direct investment and cooperation programmes from developed countries in developing counties, focusing on virtual water trade and associated resources. We develop econometric models with the aim to explain observed trends in virtual water exports from developing countries as explained by the inverse flow of investments and cooperation programmes. We analyse the main 19 emerging food exporters, from Africa, Asia and America, using 15 years of data. Results show that land per capita availability and foreign direct investments explain observed flows of virtual water exports. However, there is no causality with these and flows cooperation investments. Our analysis sheds light on the underlying forces explaining the phenomenon of land grab, which is the appropriation of land access in developing countries by food-importers.

What predicts the quality of advanced cancer care in Latin America? A look at five countries: Argentina, Brazil, Cuba, Mexico, and Peru.

PubMed

Torres Vigil, Isabel; Aday, Lu Ann; De Lima, Liliana; Cleeland, Charles S

2007-09-01

Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations (P<0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta=0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries.

Preparing the Future--Women, Literacy and Development. The Impact of Female Literacy on Human Development and the Participation of Literate Women in Change. ActionAid Development Report No. 4.

ERIC Educational Resources Information Center

Bown, Lalage

The outcomes of 43 project case studies and a country case study (Nepal) were examined to identify the impact of adult women's literacy. A look at women's situation in developing countries showed that women had multifarious roles, long working hours, and less access to education than males. The case studies revealed the following social effects of…

Current status of HIV treatment in Asia and the Pacific region.

PubMed

Phuphuakrat, Angsana; Kiertiburanakul, Sasisopin; Sungkanuparph, Somnuek

2014-07-01

Asia and the Pacific represent a diverse group of nations facing HIV epidemic profiles of differing severity. Compared to other parts of the world, the burden of HIV disease is high in this region because of its large populations. At the end of 2011, 5million people were living with HIV in Asia and the Pacific. This accounted for 15% of people living with HIV worldwide. The prevalence of people living with HIV, as well as access to HIV treatment and care, varies widely between countries. Differences between high-income economies and the rest of the continent are remarkable. Many high-income countries provide antiretroviral therapy (ART) to their citizens. Middle- and low-income countries have rapid ART scale-up and are dependent on international funding. This may compromise the sustainability of ART availability. In addition, lack of access to second- and third-line therapy remains a problem in many countries. The global goal of achieving universal access to ART by 2015 requires mainly low- and middle-income countries to be targeted. Regional policy should be developed in order to identify new infections in key populations, to start earlier treatment, to retain patients in care and to maintain funding.

Organization and startup of The Gambia's new community-based medical programme.

PubMed

Chávez, José A; Suárez, Lázaro V; Del Rosario, Odalis; Hechavarría, Suiberto; Quiñones, Judith

2012-01-01

The shortage of health professionals in developing countries and especially in their poorest regions imperils the vision of health for all. New training policies and strategies are needed urgently to address these shortages. The Gambia's new Community-Based Medical Programme is one such strategy. KEYWORDS Medical education, access to health care, healthcare disparities, health manpower, rural health, developing countries, The Gambia.

Girls' Access to Education in a Developing Country

NASA Astrophysics Data System (ADS)

Geissinger, Helen

1997-09-01

Papua New Guinea is a developing country which gained its independence from Australia in 1975. Many of its educational structures inherited from the time of the early missions and the colonial administration influence the practices of today. Women have not advanced in the new country as far as was prophesied in the early 1970s leading up to Independence. Although the current poor economic conditions have some effect on women's advancement, the difficulties they face in even obtaining a basic education form one of the major factors which hinder their progress. This paper describes a number of the barriers which prevent girls from accessing education at every level, from gaining enrolment in the first year of school to positioning themselves for university entry. Distance education provides one of the few "second chances" that young Papua New Guineans can gain, provided they can afford the fees and engage with the somewhat independent study required for success.

[Essential medicines and the TRIPS Agreement: collision between the right to health and intellectual property rights].

PubMed

Allard Soto, Raúl

2015-03-01

The strengthening of pharmaceutical patent protection globally puts strains on access to essential medicines. According to the present paper, this process has led to the collision of the intellectual property rights adopted in the World Trade Organization (WTO) Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and the right to health stated in the International Covenant on Economic, Social and Cultural Rights (ICESCR). Several controversies disputed in the WTO illustrate the confrontation between countries with a powerful pharmaceutical industry and the interests of developing countries. It is concluded that the TRIPS-plus rules subscribed to by developing countries in free trade agreements which give the pharmaceutical patent holder more rights than those stipulated in the original TRIPS Agreement are incompatible with the obligations to provide access to essential medicines under the right to health of the ICESCR.

Availability of alcohol: Location, time and ease of purchase in high- and middle-income countries: Data from the International Alcohol Control study.

PubMed

Gray-Phillip, Gaile; Huckle, Taisia; Callinan, Sarah; Parry, Charles D H; Chaiyasong, Surasak; Cuong, Pham Viet; Mackintosh, Anne-Marie; Meier, Petra; Kazantseva, Elena; Piazza, Marina; Parker, Karl; Casswell, Sally

2018-03-26

Cross-country studies on alcohol purchasing and access are rare. We examined where and when people access alcohol to understand patterns of availability across a range of middle- and high-income countries. Surveys of drinkers in the International Alcohol Control study in high-income countries (Australia, England, Scotland, New Zealand and St Kitts and Nevis) and middle-income countries (Mongolia, South Africa, Peru, Thailand and Vietnam) were analysed. Measures were: location of purchase from on-premise and take-away outlets, proportion of alcohol consumed on-premise versus take-away outlets, hours of purchase, access among underage drinkers and time to access alcohol. On-premise purchasing was prevalent in the high-income countries. However, the vast majority of alcohol consumed in all countries, except St Kitts and Nevis (high-income), was take-away. Percentages of drinkers purchasing from different types of on-premise and take-away outlets varied between countries. Late purchasing was common in Peru and less common in Thailand and Vietnam. Alcohol was easily accessed by drinkers in all countries, including underage drinkers in the middle-income countries. In nine out of 10 countries the vast majority of alcohol consumed was take-away. Alcohol was readily available and relatively easy for underage drinkers to access, particularly in the middle-income countries. Research is needed to assess the harms associated with take-away consumption including late at night. Attention is needed to address the easy access by underage drinkers in the middle-income countries which has been less of a focus than in high-income countries. © 2018 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries

PubMed Central

Bain, Rob ES; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-01-01

Abstract Objective To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Methods Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Findings Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. Conclusion The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement. PMID:22461718

Economic impacts of policies affecting crop biotechnology and trade.

PubMed

Anderson, Kym

2010-11-30

Agricultural biotechnologies, and especially transgenic crops, have the potential to boost food security in developing countries by offering higher incomes for farmers and lower priced and better quality food for consumers. That potential is being heavily compromised, however, because the European Union and some other countries have implemented strict regulatory systems to govern their production and consumption of genetically modified (GM) food and feed crops, and to prevent imports of foods and feedstuffs that do not meet these strict standards. This paper analyses empirically the potential economic effects of adopting transgenic crops in Asia and Sub-Saharan Africa. It does so using a multi-country, multi-product model of the global economy. The results suggest the economic welfare gains from crop biotechnology adoption are potentially very large, and that those benefits are diminished only very slightly by the presence of the European Union's restriction on imports of GM foods. That is, if developing countries retain bans on GM crop production in an attempt to maintain access to EU markets for non-GM products, the loss to their food consumers as well as to farmers in those developing countries is huge relative to the slight loss that could be incurred from not retaining EU market access. Copyright © 2010 Elsevier B.V. All rights reserved.

Infertility in public health: the case of Norway

PubMed Central

Sundby, J.

2010-01-01

Infertility is a health issue that demonstrates how unequal access to health care is at a global level. In the poorer segments of the world, and in poor parts of wealthy societies, access is often minimal or non-existent. Public and lay attitudes to modern infertility treatment have been heavily debated alongside development of methods. I have looked at the changes in the public discourse in modern media, legislation, politics, and among professionals. The paper seeks to present and discuss some of these changes as they have evolved in one of the countries that have had one of the more strict laws regulating access to treatment, namely Norway. It is a country that nevertheless offers treatment in the public health system. The paper also tries to connect this discussion to the difficulties faced in every attempt to expand infertility services to the developing world. PMID:25013709

The (political) economics of antiretroviral treatment in developing countries.

PubMed

Nattrass, Nicoli J

2008-12-01

Despite unprecedented international mobilisation to support universal provision of highly active antiretroviral therapy (HAART), national governments continue to play the key role in determining access to treatment. Whereas some AIDS-affected countries have performed as well as or better than expected given their level of development, institutional characteristics and demographic challenges (e.g. Thailand and Brazil), others (notably South Africa) have not. This article argues that the 'economics' of antiretroviral drug delivery is at heart a political-economy of access to treatment. It depends on commitment on the part of national governments to negotiate with pharmaceutical companies over patented antiretroviral drug prices, on their policy towards compulsory licensing, and on the approach they adopt to delivering HAART. Civil society has an important role to play in encouraging governments to become, and remain, committed to taking action to ensure sustainable and widespread access to HAART.

Generalized System of Preferences: Background and Renewal Debate

DTIC Science & Technology

2006-09-26

Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Stakeholders’ Concerns...States, the European Union and 11 other industrialized countries — Australia, Belarus, Bulgaria, Canada, Japan, New Zealand, Norway, Switzerland , and...GSP is to provide certain goods originating in developing countries with preferential market access (usually in the form of lower tariff rates or duty

Investing in Youth: Brazil

ERIC Educational Resources Information Center

OECD Publishing, 2014

2014-01-01

The series Investing in Youth builds on the expertise of the Organisation for Economic Cooperation and Development (OECD) on youth employment, social support and skills. It covers both OECD countries and countries in the process of accession to the OECD, as well as some emerging economies. This report provides a detailed diagnosis of the youth…

NREL: International Activities - Country Programs

Science.gov Websites

for use of mini-grid quality assurance and design standards and advising on mini-grid business models communities of practice and technical collaboration across countries on mini-grid development, modeling and interconnection standards and procedures, and with strengthening mini-grids and energy access programs. NREL is

Investing in Youth: Latvia

ERIC Educational Resources Information Center

OECD Publishing, 2015

2015-01-01

The series Investing in Youth builds on the expertise of the Organisation for Economic Cooperation and Development (OECD) on youth employment, social support and skills. It covers both OECD countries and countries in the process of accession to the OECD, as well as some emerging economies. This report provides a detailed diagnosis of the youth…

Your Country 1 & 2!

ERIC Educational Resources Information Center

Kohnke, Lucas

2011-01-01

This article describes two lesson plans based on the theme: "Your Country," developed using Gilly Salmon's 5 step model in creating e-tivities. The lesson plan model contains five steps that include: (1) Access and motivation where learners will gain experience in using technology, relevant and authentic tasks which will provide explicit…

People with Profound and Multiple Intellectual Disabilities Using Symbols to Control a Computer: Exploration of User Engagement and Supporter Facilitation

ERIC Educational Resources Information Center

Bunning, Karen; Kwiatkowska, Gosia; Weldin, Nick

2012-01-01

Computer usage features in everyday life for the majority of people in developed countries. Access is a problem for many users with intellectual disability. Action-research was conducted to develop and explore the potential of specially adapted, computer readable symbols for choosing and accessing media on a computer. Five people with profound and…

ICTs and Educational Development: The Utilization of Mobile Phones in Distance Education in Nigeria

ERIC Educational Resources Information Center

Kabir, Fatima Shehu; Kadage, Abdullahi Tukur

2017-01-01

The demand for education in Africa has been on the increase. Thus, there is the need to identify more affordable ways of improving access to learning. For many decades, Open and Distance Education mediated by ICTs has been used to improve access to education. But in developing countries ICTS have been full of challenges of cost, and lack of…

Combined optimization model for sustainable energization strategy

NASA Astrophysics Data System (ADS)

Abtew, Mohammed Seid

Access to energy is a foundation to establish a positive impact on multiple aspects of human development. Both developed and developing countries have a common concern of achieving a sustainable energy supply to fuel economic growth and improve the quality of life with minimal environmental impacts. The Least Developing Countries (LDCs), however, have different economic, social, and energy systems. Prevalence of power outage, lack of access to electricity, structural dissimilarity between rural and urban regions, and traditional fuel dominance for cooking and the resultant health and environmental hazards are some of the distinguishing characteristics of these nations. Most energy planning models have been designed for developed countries' socio-economic demographics and have missed the opportunity to address special features of the poor countries. An improved mixed-integer programming energy-source optimization model is developed to address limitations associated with using current energy optimization models for LDCs, tackle development of the sustainable energization strategies, and ensure diversification and risk management provisions in the selected energy mix. The Model predicted a shift from traditional fuels reliant and weather vulnerable energy source mix to a least cost and reliable modern clean energy sources portfolio, a climb on the energy ladder, and scored multifaceted economic, social, and environmental benefits. At the same time, it represented a transition strategy that evolves to increasingly cleaner energy technologies with growth as opposed to an expensive solution that leapfrogs immediately to the cleanest possible, overreaching technologies.

Is Equal Access to Higher Education in South Asia and Sub-Saharan Africa Achievable by 2030?

ERIC Educational Resources Information Center

Ilie, Sonia; Rose, Pauline

2016-01-01

Higher education is back in the spotlight, with post-2015 sustainable development goals emphasising equality of access. In this paper, we highlight the long distance still to travel to achieve the goal of equal access to higher education for all, with a focus on poorer countries which tend to have lower levels of enrolment in higher education.…

The Baltic Republics and Language Ideological Debates Surrounding European Union Accession

ERIC Educational Resources Information Center

Hogan-Brun, Gabrielle

2005-01-01

This paper describes the impact of European Union accession negotiations on language ideological debates regarding minority (language) and citizenship rights in the Baltic Republics. It explores issues pertaining to the transferability of standards developed for established democracies in the West to the situation of democratising countries in…

Access to Elementary Education in India. Country Analytical Review

ERIC Educational Resources Information Center

Govinda, R.; Bandyopadhyay, Madhumita

2008-01-01

This analytical review aims at exploring trends in educational access and delineating different groups, which are vulnerable to exclusion from educational opportunities at the elementary stage. This review has drawn references from series of analytical papers developed on different themes i.e. regional disparity in education, social equity and…

Preparing Daughters: The Context of Rurality on Mothers' Role in Contraception

ERIC Educational Resources Information Center

Noone, Joanne; Young, Heather M.

2009-01-01

Context: The United States continues to have the highest rate of adolescent childbearing among developed countries. Lack of access and disadvantage contribute to this problem, which disproportionately impacts rural women. Given the increased difficulty rural young women face regarding contraceptive access, parental communication and support play…

Social Equity and Access to a Philippine STEM School

ERIC Educational Resources Information Center

Talaue, Frederick Toralballa

2014-01-01

Like most developing countries in the world, there is a huge gap in opportunities to access quality science education between students from the high- and low-socioeconomic strata of Philippine society. In establishing its own science, technology, engineering, and mathematics (STEM) high school, despite limited public funding in 1964, the…

New Image Qualities in Education: A Comparative Study

ERIC Educational Resources Information Center

Çankaya, Ibrahim

2018-01-01

The aim of this study is to compare Turkish and European Union Countries Educations in terms of the new image qualities such as data like access to online education, digital access, foreign languages learnt per pupil, research & development investments, human resources employed in science and technology, the study opportunities offered to…

Working to improve the management of sarcoma patients across Europe: a policy checklist.

PubMed

Kasper, Bernd; Lecointe-Artzner, Estelle; Wait, Suzanne; Boldon, Shannon; Wilson, Roger; Gronchi, Alessandro; Valverde, Claudia; Eriksson, Mikael; Dumont, Sarah; Drove, Nora; Kanli, Athanasia; Wartenberg, Markus

2018-04-16

The Sarcoma Policy Checklist was created by a multidisciplinary expert group to provide policymakers with priority areas to improve care for sarcoma patients. This paper draws on this research, by looking more closely at how France, Germany, Italy, Spain, Sweden and the United Kingdom are addressing each of these priority areas. It aims to highlight key gaps in research, policy and practice, as well as ongoing initiatives that may impact the future care of sarcoma patients in different European countries. A pragmatic review of the published and web-based literature was undertaken. Telephone interviews were conducted in each country with clinical and patient experts to substantiate findings. Research findings were discussed within the expert group and developed into five core policy recommendations. The five identified priority areas were: the development of designated and accredited centres of reference; more professional training; multidisciplinary care; greater incentives for research and innovation; and more rapid access to effective treatments. Most of the countries studied have ongoing initiatives addressing many of these priorities; however, many are in early stages of development, or require additional funding and resources. Gaps in access to quality care are particularly concerning in many of Europe's lower-resourced countries. Equitable access to information, clinical trials, innovative treatments and quality specialist care should be available to all sarcoma patients. Achieving this across Europe will require close collaboration between all stakeholders at both the national and European level.

Disparities in Under-Five Child Injury Mortality between Developing and Developed Countries: 1990-2013.

PubMed

Huang, Yun; Wu, Yue; Schwebel, David C; Zhou, Liang; Hu, Guoqing

2016-07-07

Using estimates from the 2013 Global Burden of Disease (GBD) study, we update evidence on disparities in under-five child injury mortality between developing and developed countries from 1990 to 2013. Mortality rates were accessed through the online visualization tool by the GBD study 2013 group. We calculated percent change in child injury mortality rates between 1990 and 2013. Data analysis was conducted separately for <1 year and 1-4 years to specify age differences in rate changes. Between 1990 and 2013, over 3-fold mortality gaps were observed between developing countries and developed countries for both age groups in the study time period. Similar decreases in injury rates were observed for developed and developing countries (<1 year: -50% vs. -50% respectively; 1-4 years: -56% vs. -58%). Differences in injury mortality changes during 1990-2013 between developing and developed nations varied with injury cause. There were greater reductions in mortality from transport injury, falls, poisoning, adverse effects of medical treatment, exposure to forces of nature, and collective violence and legal intervention in developed countries, whereas there were larger decreases in mortality from drowning, exposure to mechanical forces, and animal contact in developing countries. Country-specific analysis showed large variations across countries for both injury mortality and changes in injury mortality between 1990 and 2013. Sustained higher child injury mortality during 1990-2013 for developing countries merits the attention of the global injury prevention community. Countries that have high injury mortality can benefit from the success of other countries.

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

PubMed Central

Williamson, Lisa M; Parkes, Alison; Wight, Daniel; Petticrew, Mark; Hart, Graham J

2009-01-01

Background Improving the reproductive health of young women in developing countries requires access to safe and effective methods of fertility control, but most rely on traditional rather than modern contraceptives such as condoms or oral/injectable hormonal methods. We conducted a systematic review of qualitative research to examine the limits to modern contraceptive use identified by young women in developing countries. Focusing on qualitative research allows the assessment of complex processes often missed in quantitative analyses. Methods Literature searches of 23 databases, including Medline, Embase and POPLINE®, were conducted. Literature from 1970–2006 concerning the 11–24 years age group was included. Studies were critically appraised and meta-ethnography was used to synthesise the data. Results Of the 12 studies which met the inclusion criteria, seven met the quality criteria and are included in the synthesis (six from sub-Saharan Africa; one from South-East Asia). Sample sizes ranged from 16 to 149 young women (age range 13–19 years). Four of the studies were urban based, one was rural, one semi-rural, and one mixed (predominantly rural). Use of hormonal methods was limited by lack of knowledge, obstacles to access and concern over side effects, especially fear of infertility. Although often more accessible, and sometimes more attractive than hormonal methods, condom use was limited by association with disease and promiscuity, together with greater male control. As a result young women often relied on traditional methods or abortion. Although the review was limited to five countries and conditions are not homogenous for all young women in all developing countries, the overarching themes were common across different settings and contexts, supporting the potential transferability of interventions to improve reproductive health. Conclusion Increasing modern contraceptive method use requires community-wide, multifaceted interventions and the combined provision of information, life skills, support and access to youth-friendly services. Interventions should aim to counter negative perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention should be exploited, despite the challenges involved. PMID:19228420

Public health and epidemiology journals published in Brazil and other Portuguese speaking countries

PubMed Central

Barreto, Mauricio L; Barata, Rita Barradas

2008-01-01

It is well known that papers written in languages other than English have a great risk of being ignored simply because these languages are not accessible to the international scientific community. The objective of this paper is to facilitate the access to the public health and epidemiology literature available in Portuguese speaking countries. It was found that it is particularly concentrated in Brazil, with some few examples in Portugal and none in other Portuguese speaking countries. This literature is predominantly written in Portuguese, but also in other languages such as English or Spanish. The paper describes the several journals, as well as the bibliographic databases that index these journals and how to access them. Most journals provide open-access with direct links in the indexing databases. The importance of this scientific production for the development of epidemiology as a scientific discipline and as a basic discipline for public health practice is discussed. To marginalize these publications has implications for a more balanced knowledge and understanding of the health problems and their determinants at a world-wide level. PMID:18826592

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Innovative Medical Technology, Health Technology Assessment, and Health Policy: The Case of Remote Patient Monitoring of Cardiac Implantable Electronic Devices in South Korea.

PubMed

Lee, Sang-Soo; Salole, Eugene

2017-01-01

In many developed countries with universal coverage healthcare systems, payers require new medical technologies to be assessed as safe, effective, and cost-effective through health technology assessment (HTA) before approval for reimbursement coverage and market access. However, in some cases, HTA is not the sole criterion for decision-making and other factors override the evidence. Remote patient monitoring (RPM) for cardiac implantable electronic devices, a novel technology recognized as safe, effective, and cost-effective, and the standard of care in many countries, is prohibited in South Korea. This peculiar situation is apparently due to deficiencies in healthcare policy and the delivery system and also to poor engagement between stakeholders. We propose that a higher level of engagement and trust between stakeholders needs to be developed, and healthcare providers should be involved in the early development of health policy, so that unnecessary barriers to access to useful medical technology are corrected, thereby allowing Koreans to enjoy the benefits available in other developed countries.

HIV among women in developing countries.

PubMed

Decarlo, P

1999-01-01

In South Africa, a pregnant woman infected with HIV took zidovudine to protect her fetus, but the child later developed HIV because the woman was not told about breast milk transmission. Women in developing countries have been hit hard by the AIDS epidemic because social inequalities that make it impossible for them to negotiate for safer sex or even to choose their sexual partners. In most developing countries, the only treatment women have access to is the zidovudine that is available only during their participation in clinical trials on prenatal transmission. Activists have expressed concern over programs that attempt to save the lives of babies with no regard for their mothers or other women. Women with HIV need access to health care, to information, and to counselors who can help them make choices. Women must be able to assess whether to risk breast feeding or attempt costly bottle feeding, which may lead to higher levels of infant mortality from bacteria in contaminated water. Women must also be educated so that they can protect their sexual health. In some settings, the topics of sex and sexuality still must be introduced into public discourse. Strong prevention programs are reducing HIV-infection rates among young women in parts of Tanzania, among pregnant women and prostitutes in Dakar, among prostitutes in Thailand and Nepal, and among street children in Brazil. Effective programs must consider AIDS a social issue and address education, equality, and information access.

Household food access and child malnutrition: results from the eight-country MAL-ED study.

PubMed

Psaki, Stephanie; Bhutta, Zulfiqar A; Ahmed, Tahmeed; Ahmed, Shamsir; Bessong, Pascal; Islam, Munirul; John, Sushil; Kosek, Margaret; Lima, Aldo; Nesamvuni, Cebisa; Shrestha, Prakash; Svensen, Erling; McGrath, Monica; Richard, Stephanie; Seidman, Jessica; Caulfield, Laura; Miller, Mark; Checkley, William

2012-12-13

Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites. We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites. Average age of study children was 41 months. Mean food access insecurity score (range: 0-27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17). Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition.

Household food access and child malnutrition: results from the eight-country MAL-ED study

PubMed Central

2012-01-01

Background Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites. Methods We administered a socioeconomic survey to 800 households in research sites in eight countries, including a recently validated nine-item food access insecurity questionnaire, and obtained anthropometric measurements from children aged 24 to 60 months. We used multivariable regression models to assess the relationship between household food access insecurity and anthropometry in children, and we assessed the invariance of that relationship across country sites. Results Average age of study children was 41 months. Mean food access insecurity score (range: 0–27) was 5.8, and varied from 2.4 in Nepal to 8.3 in Pakistan. Across sites, the prevalence of stunting (42%) was much higher than the prevalence of wasting (6%). In pooled regression analyses, a 10-point increase in food access insecurity score was associated with a 0.20 SD decrease in height-for-age Z score (95% CI 0.05 to 0.34 SD; p = 0.008). A likelihood ratio test for heterogeneity revealed that this relationship was consistent across countries (p = 0.17). Conclusions Our study provides evidence of the validity of using a simple household food access insecurity score to investigate the etiology of childhood growth faltering across diverse geographic settings. Such a measure could be used to direct interventions by identifying children at risk of illness and death related to malnutrition. PMID:23237098

Cancer Care and Control as a Human Right: Recognizing Global Oncology as an Academic Field.

PubMed

Eniu, Alexandru E; Martei, Yehoda M; Trimble, Edward L; Shulman, Lawrence N

2017-01-01

The global burden of cancer incidence and mortality is on the rise. There are major differences in cancer fatality rates due to profound disparities in the burden and resource allocation for cancer care and control in developed compared with developing countries. The right to cancer care and control should be a human right accessible to all patients with cancer, regardless of geographic or economic region, to avoid unnecessary deaths and suffering from cancer. National cancer planning should include an integrated approach that incorporates a continuum of education, prevention, cancer diagnostics, treatment, survivorship, and palliative care. Global oncology as an academic field should offer the knowledge and skills needed to efficiently assess situations and work on solutions, in close partnership. We need medical oncologists, surgical oncologists, pediatric oncologists, gynecologic oncologists, radiologists, and pathologists trained to think about well-tailored resource-stratified solutions to cancer care in the developing world. Moreover, the multidisciplinary fundamental team approach needed to treat most neoplastic diseases requires coordinated investment in several areas. Current innovative approaches have relied on partnerships between academic institutions in developed countries and local governments and ministries of health in developing countries to provide the expertise needed to implement effective cancer control programs. Global oncology is a viable and necessary field that needs to be emphasized because of its critical role in proposing not only solutions in developing countries, but also solutions that can be applied to similar challenges of access to cancer care and control faced by underserved populations in developed countries.

The role of energy systems on hydropower in Turkey

NASA Astrophysics Data System (ADS)

Yuksel, Ibrahim; Arman, Hasan; Halil Demirel, Ibrahim

2017-11-01

Over the last two decades, global electricity production has more than doubled and electricity demand is rising rapidly around the world as economic development spreads to emerging economies. Not only has electricity demand increased significantly, it is the fastest growing end-use of energy. Therefore, technical, economic and environmental benefits of hydroelectric power make it an important contributor to the future world energy mix, particularly in the developing countries. On the other hand, the hydropower industry is closely linked to both water management and renewable energy production, and so has a unique role to play in contributing to sustainable development in a world where billions of people lack access to safe drinking water and adequate energy supplies. In addition to, approximately 1.6 billion people have no access to electricity and about 1.1 billion are without adequate water supply. However, resources for hydropower development are widely spread around the world. Potential exists in about 150 countries, and about 70% of the economically feasible potential remains to be developed-mostly in developing countries where the needs are most urgent. This paper deals with renewable energy systems and the role of hydropower in Turkey.

Legal barriers in accessing opioid medicines: results of the ATOME quick scan of national legislation of eastern European countries.

PubMed

Vranken, Marjolein J M; Mantel-Teeuwisse, Aukje K; Jünger, Saskia; Radbruch, Lukas; Lisman, John; Scholten, Willem; Payne, Sheila; Lynch, Tom; Schutjens, Marie-Hélène D B

2014-12-01

Overregulation of controlled medicines is one of the factors contributing to limited access to opioid medicines. The purpose of this study was to identify legal barriers to access to opioid medicines in 12 Eastern European countries participating in the Access to Opioid Medication in Europa project, using a quick scan method. A quick scan method to identify legal barriers was developed focusing on eight different categories of barriers. Key experts in 12 European countries were requested to send relevant legislation. Legislation was quick scanned using World Health Organization guidelines. Overly restrictive provisions and provisions that contain stigmatizing language and incorrect definitions were identified. The selected provisions were scored into two categories: 1) barrier and 2) uncertain, and reviewed by two authors. A barrier was recorded if both authors agreed the selected provision to be a barrier (Category 1). National legislation was obtained from 11 of 12 countries. All 11 countries showed legal barriers in the areas of prescribing (most frequently observed barrier). Ten countries showed barriers in the areas of dispensing and showed stigmatizing language and incorrect use of definitions in their legislation. Most barriers were identified in the legislation of Bulgaria, Greece, Lithuania, Serbia, and Slovenia. The Cypriot legislation showed the fewest total number of barriers. The selected countries have in common as main barriers prescribing and dispensing restrictions, the use of stigmatizing language, and incorrect use of definitions. The practical impact of these barriers identified using a quick scan method needs to be validated by other means. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Living with systemic lupus erythematosus in the developing world.

PubMed

Phuti, A; Schneider, M; Tikly, M; Hodkinson, B

2018-03-26

Most of our understanding of SLE and its negative impact originates from developed countries. This review aims to collate existing literature on Health-Related Quality of Life (HRQoL) in SLE patients living in developing countries to identify the gaps for the focus of future research. A narrative literature review was compiled using selected MeSH terms to search EBSCOHOST for articles published between January 1975 and February 2018 pertaining to HRQoL in SLE patients in developing countries. 31 studies from 11 countries were included for analysis. Only one longitudinal, one randomized controlled trial (RCT), one qualitative study, and two intervention studies were found. High disease activity and organ damage were associated with poor functional ability, mental health and low socio-economic status (SES). Poor SES is a recurring theme in developing countries, and worsens all SLE outcomes by reducing access to healthcare, mental, social and emotional support systems. In developing countries, SLE has a globally negative impact on patients' HRQoL, similar to that seen in developed countries. There is an urgent need for more HRQoL studies, and in particular, longitudinal, qualitative and interventional studies in these countries to investigate unmet needs, and to explore novel strategies to improve patient outcomes.

Does Land Degradation Increase Poverty in Developing Countries?

PubMed Central

2016-01-01

Land degradation is a global problem that particularly impacts the poor rural inhabitants of low and middle-income countries. We improve upon existing literature by estimating the extent of rural populations in 2000 and 2010 globally on degrading and improving agricultural land, taking into account the role of market access, and analyzing the resulting impacts on poverty. Using a variety of spatially referenced datasets, we estimate that 1.33 billion people worldwide in 2000 were located on degrading agricultural land (DAL), of which 1.26 billion were in developing countries. Almost all the world’s 200 million people on remote DAL were in developing countries, which is about 6% of their rural population. There were also 1.54 billion rural people on improving agricultural land (IAL), with 1.34 billion in developing countries. We find that a lower share of people in 2000 on DAL, or a higher share on IAL, lowers significantly how much overall economic growth reduces poverty from 2000 to 2012 across 83 developing countries. As the population on DAL and IAL in developing countries grew by 13% and 15% respectively from 2000 to 2010, these changing spatial distributions of rural populations could impact significantly future poverty in developing countries. PMID:27167738

Mapping actions to improve access to medicines for mental disorders in low and middle income countries.

PubMed

Barbui, C; Dua, T; Kolappa, K; Saraceno, B; Saxena, S

2017-10-01

In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013-2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use. Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines. A 4 × 4 framework mapping actions as a function of the four components of access - selection, availability, affordability and appropriate use - and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines. Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries

PubMed Central

Frenz, Patricia; Grabenhenrich, Linus; Keil, Thomas; Tinnemann, Peter

2016-01-01

Abstract Objective To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. Methods We obtained data on 16 631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. Findings The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. Conclusion No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care. PMID:27034521

Gender and access to education in Asia

NASA Astrophysics Data System (ADS)

Jayaweera, Swarna

1987-12-01

Attention has been focused in recent years by international agencies and national governments in Asia on the need to extend educational opportunity and to universalize at least the first level of education. The resource constraints of economically developing societies have militated against reaching these goals. Statistics of gender-based enrolment at all three levels of education show that equal access of women to education even at the first level is an almost illusory goal for six countries in South Asia. Gender disparities in educational participation are seen to be minimal in other countries except in vocational education. It is argued that while economic difficulties are a major constraint to educational opportunity, patriarchal social structures have also operated as a significant barrier in economically disadvantaged countries.

Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries.

PubMed

Broda, Anja; Bieber, Anja; Meyer, Gabriele; Hopper, Louise; Joyce, Rachael; Irving, Kate; Zanetti, Orazio; Portolani, Elisa; Kerpershoek, Liselot; Verhey, Frans; Vugt, Marjolein de; Wolfs, Claire; Eriksen, Siren; Røsvik, Janne; Marques, Maria J; Gonçalves-Pereira, Manuel; Sjölund, Britt-Marie; Woods, Bob; Jelley, Hannah; Orrell, Martin; Stephan, Astrid

2017-08-03

As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

Changing global essential medicines norms to improve access to AIDS treatment: lessons from Brazil.

PubMed

Nunn, A; Fonseca, E Da; Gruskin, S

2009-01-01

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.

Sewage Management Changes in the North-eastern Poland After Accession to the European Union

NASA Astrophysics Data System (ADS)

Skarżyński, Szymon; Bartkowska, Izabela

2018-02-01

Poland's accession to the European Union contributed to the infrastructure development of the whole country. One of the elements of the modernized infrastructure is the sewage network and facilities on this network, as well as facilities for waste water treatment and disposal of sludge. A wide stream of funds flowing to the country, and consequently also to the north-eastern polish voivodeships (Podlaskie, Warmian-Masurian, Lublin), allowed modernization, organize, and sometimes to build a new sewage management of this part of the country. The main factors and parameters that allow us to evaluate the development of the sewage management in north-eastern Poland are included: percentage of population using sewage treatment plants, number of municipal sewage plants with the division of their type, number of industrial plants, number of septic tanks, amount of sewage purified in a year, amount of sludge produced in the year, design capacity of sewage treatment plant, size of plant in population equivalent (PE). From a number of investments in the field of wastewater management carried out in the discussed area in the period after Poland's accession to the European Union, 9 investments were considered the most important, 3 from each of the voivodeships.

Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya

PubMed Central

Cheptinga, Philip; Rusyniak, Daniel E.

2015-01-01

Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya. PMID:25780757

Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya.

PubMed

House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E

2015-01-01

Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

Investing in Youth: Lithuania

ERIC Educational Resources Information Center

OECD Publishing, 2016

2016-01-01

The series Investing in Youth builds on the expertise of the Organisation for Economic Cooperation and Development (OECD) on youth employment, social support and skills. It covers both OECD countries and countries in the process of accession to the OECD, as well as some emerging economies. The present report on Lithuania is the fourth of a new…

Tensions in a Nepali Telecenter: An Ethnographic Look at Progress Using Activity Theory

ERIC Educational Resources Information Center

Lee, Jeffrey Chih-Yih

2010-01-01

Developing countries such as Nepal struggle to keep up technologically. While advances make it possible for average Nepalis to access mobile phones, computers, and digital cameras, barriers impede access. As with other governments (Huerta & Rodrigo, 2007; Mokhtarian & Meenakshisun, 2002), Nepal responded in 2004 with telecenters to push…

Public Internet Access Points (PIAPs) and Their Social Impact: A Case Study from Turkey

ERIC Educational Resources Information Center

Afacan, Gulgun; Er, Erkan; Arifoglu, Ali

2013-01-01

Building public Internet access points (PIAPs) is a significant contribution of governments towards achieving an information society. While many developing countries are investing great amounts to establish PIAPs today, people may not use PIAPs effectively. Yet, the successful implementation of PIAPs is the result of citizens' acceptance to use…

Policy without politics: the limits of social engineering.

PubMed

Navarro, Vicente

2003-01-01

The extent of coverage provided by a country's health services is directly related to the level of development of that country's democratic process (and its power relations). The United States is the only developed country whose government does not guarantee access to health care for its citizens. It is also the developed country with the least representative and most insufficient democratic institutions, owing to the constitutional framework of the political system, the privatization of the electoral process, and the enormous power of corporate interests in both the media and the political process. As international experience shows, without a strong labor-based movement willing to be radical in its protests, a universal health care program will never be accepted by the US establishment.

Access to Higher Education in the European Community: Synthesis Report (Volume 1) and Country Reports (Volume 2).

ERIC Educational Resources Information Center

de Jonge, J. F. M.; And Others

This report examines, country by country, the present state of student access to higher education institutions in the Member States of the European Community (EC), as well as the elements which affect access directly and the elements which can potentially have an effect on access. Volume 1 of the report gives an overview of the methods of data…

Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level.

PubMed

O'Connell, Thomas S; Bedford, K Juliet A; Thiede, Michael; McIntyre, Di

2015-06-09

A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.

Environmental Impact of Tourism and Air Transport on the Sustainable Development of Small Island Developing States

DOT National Transportation Integrated Search

1999-01-01

The United Nations General Assembly recognized that many small island developing countries were confronted with compelling factors such as their smallness in size, susceptibility and vulnerability to natural disasters, remoteness of access and geogra...

Determinants of access to health care for depression in 49 countries: A multilevel analysis.

PubMed

Araya, Ricardo; Zitko, Pedro; Markkula, Niina; Rai, Dheeraj; Jones, Kelvyn

2018-07-01

The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income. Copyright © 2018 Elsevier B.V. All rights reserved.

Patterns of citations of open access and non-open access conservation biology journal papers and book chapters.

PubMed

Calver, Michael C; Bradley, J Stuart

2010-06-01

Open access (OA) publishing, whereby authors, their institutions, or their granting bodies pay or provide a repository through which peer-reviewed work is available online for free, is championed as a model to increase the number of citations per paper and disseminate results widely, especially to researchers in developing countries. We compared the number of citations of OA and non-OA papers in six journals and four books published since 2000 to test whether OA increases number of citations overall and increases citations made by authors in developing countries. After controlling for type of paper (e.g., review or research paper), length of paper, authors' citation profiles, number of authors per paper, and whether the author or the publisher released the paper in OA, OA had no statistically significant influence on the overall number of citations per journal paper. Journal papers were cited more frequently if the authors had published highly cited papers previously, were members of large teams of authors, or published relatively long papers, but papers were not cited more frequently if they were published in an OA source. Nevertheless, author-archived OA book chapters accrued up to eight times more citations than chapters in the same book that were not available through OA, perhaps because there is no online abstracting service for book chapters. There was also little evidence that journal papers or book chapters published in OA received more citations from authors in developing countries relative to those journal papers or book chapters not published in OA. For scholarly publications in conservation biology, only book chapters had an OA citation advantage, and OA did not increase the number of citations papers or chapters received from authors in developing countries.

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.

PubMed

Rechel, Bernd; Džakula, Aleksandar; Duran, Antonio; Fattore, Giovanni; Edwards, Nigel; Grignon, Michel; Haas, Marion; Habicht, Triin; Marchildon, Gregory P; Moreno, Antonio; Ricciardi, Walter; Vaughan, Louella; Smith, Tina Anderson

2016-07-01

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Repository on maternal child health: health portal to improve access to information on maternal child health in India.

PubMed

Khanna, Rajesh; Karikalan, N; Mishra, Anil Kumar; Agarwal, Anchal; Bhattacharya, Madhulekha; Das, Jayanta K

2013-01-02

Quality and essential health information is considered one of the most cost-effective interventions to improve health for a developing country. Healthcare portals have revolutionalized access to health information and knowledge using the Internet and related technologies, but their usage is far from satisfactory in India. This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country. The portal 'Repository on Maternal Child Health' was developed using an open source content management system and standardized processes were followed for collection, selection, categorization and presentation of resource materials. Its usage is evaluated using key performance indicators obtained from Google Analytics, and quality assessed using a standardized checklist of knowledge management. The results are discussed in relation to improving quality and access to health information. The portal was launched in July 2010 and provides free access to full-text of 900 resource materials categorized under specific topics and themes. During the subsequent 18 months, 52,798 visits were registered from 174 countries across the world, and more than three-fourth visits were from India alone. Nearly 44,000 unique visitors visited the website and spent an average time of 4 minutes 26 seconds. The overall bounce rate was 27.6%. An increase in the number of unique visitors was found to be significantly associated with an increase in the average time on site (p-value 0.01), increase in the web traffic through search engines (p-value 0.00), and decrease in the bounce rate (p-value 0.03). There was a high degree of agreement between the two experts regarding quality assessment carried out under the three domains of knowledge access, knowledge creation and knowledge transfer (Kappa statistic 0.72). Efficient management of health information is imperative for informed decision making, and digital repositories have now-a-days become the preferred source of information management. The growing popularity of the portal indicates the potential of such initiatives in improving access to quality and essential health information in India. There is a need to develop similar mechanisms for other health domains and interlink them to facilitate access to a variety of health information from a single platform.

Repository on maternal child health: Health portal to improve access to information on maternal child health in India

PubMed Central

2013-01-01

Background Quality and essential health information is considered one of the most cost-effective interventions to improve health for a developing country. Healthcare portals have revolutionalized access to health information and knowledge using the Internet and related technologies, but their usage is far from satisfactory in India. This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country. Methods The portal ‘Repository on Maternal Child Health’ was developed using an open source content management system and standardized processes were followed for collection, selection, categorization and presentation of resource materials. Its usage is evaluated using key performance indicators obtained from Google Analytics, and quality assessed using a standardized checklist of knowledge management. The results are discussed in relation to improving quality and access to health information. Results The portal was launched in July 2010 and provides free access to full-text of 900 resource materials categorized under specific topics and themes. During the subsequent 18 months, 52,798 visits were registered from 174 countries across the world, and more than three-fourth visits were from India alone. Nearly 44,000 unique visitors visited the website and spent an average time of 4 minutes 26 seconds. The overall bounce rate was 27.6%. An increase in the number of unique visitors was found to be significantly associated with an increase in the average time on site (p-value 0.01), increase in the web traffic through search engines (p-value 0.00), and decrease in the bounce rate (p-value 0.03). There was a high degree of agreement between the two experts regarding quality assessment carried out under the three domains of knowledge access, knowledge creation and knowledge transfer (Kappa statistic 0.72). Conclusions Efficient management of health information is imperative for informed decision making, and digital repositories have now-a-days become the preferred source of information management. The growing popularity of the portal indicates the potential of such initiatives in improving access to quality and essential health information in India. There is a need to develop similar mechanisms for other health domains and interlink them to facilitate access to a variety of health information from a single platform. PMID:23281735

[Poor, propertyless and pregnant: classification of women's status by country].

PubMed

1988-12-01

A new study called "Poor, propertyless, and pregnant" that classified the condition of women in 99 countries found women in Sweden, Finland, and the US to enjoy the best legal and social conditions and the greatest degree of equality with men. The worst discrimination against women occurred in Bangladesh, Mali, Afghanistan, North Yemen, Pakistan, Nigeria, and Saudi Arabia. Women do not have complete equality with men in any country. But over 60% of the world's female population lives in countries where extensive poverty and sexual discrimination have created conditions of deprivation. One of the principal mechanisms that negatively influences the condition of women is early procreation; early and frequent childbirth obliterates women's chances for education and paid employment. Feminization of poverty is becoming universal, largely because a growing proportion of households are headed by women with dependent children. In developed and developing countries alike, working women with families work a double day. Although the struggle for legal and social equality for women takes different forms in different countries, certain basic measures can be applied by all governments. Reforms are needed to give women access to more remunerative jobs, equal property rights, and access to credit. Greater investments are needed in reproductive health and in education and training for women. Governments, employers, and husbands should recognize the social value of childbirth and child rearing. The study is divided into 5 sections, each of which has 4 series of data, so that each country is evaluated on 20 variables. The 5 sections are health, nuptiality and children, education, economic participation, and social equality. In most developed countries women live an average of 7 years longer than men, but in developing countries the difference is only 2 years. Complications of pregnancy and childbirth cause the deaths of over 500,000 women each year and affect another 5 million, mostly in developing countries. The condition and welfare of women are tightly linked to 3 factors: age at marriage, beginning of procreation, and capacity to regulate and space pregnancies. Women's status is also influenced by whether they are married and their rights to divorce. In developing countries about 45% of women are illiterate, compared to 25% of men. The salaries of women do not equal those of men in any country. Only Finland and Sweden have been unreservedly committed to providing equal political rights and legal protection against sexual discrimination.

Electronic theses and dissertations: a review of this valuable resource for nurse scholars worldwide.

PubMed

Goodfellow, L M

2009-06-01

A worldwide repository of electronic theses and dissertations (ETDs) could provide worldwide access to the most up-to-date research generated by masters and doctoral students. Until that international repository is established, it is possible to access some of these valuable knowledge resources. ETDs provide a technologically advanced medium with endless multimedia capabilities that far exceed the print and bound copies of theses and dissertations housed traditionally in individual university libraries. CURRENT USE: A growing trend exists for universities worldwide to require graduate students to submit theses or dissertations as electronic documents. However, nurse scholars underutilize ETDs, as evidenced by perusing bibliographic citation lists in many of the research journals. ETDs can be searched for and retrieved through several digital resources such as the Networked Digital Library of Theses and Dissertations (http://www.ndltd.org), ProQuest Dissertations and Theses (http://www.umi.com), the Australasian Digital Theses Program (http://adt.caul.edu.au/) and through individual university web sites and online catalogues. An international repository of ETDs benefits the community of nurse scholars in many ways. The ability to access recent graduate students' research electronically from anywhere in the world is advantageous. For scholars residing in developing countries, access to these ETDs may prove to be even more valuable. In some cases, ETDs are not available for worldwide access and can only be accessed through the university library from which the student graduated. Public access to university library ETD collections is not always permitted. Nurse scholars from both developing and developed countries could benefit from ETDs.

A review of formal institutions affecting water supply and access in Botswana

NASA Astrophysics Data System (ADS)

Mogomotsi, Patricia K.; Mogomotsi, Goemeone E. J.; Matlhola, Dimpho M.

2018-06-01

Over the years, many countries across the world have increasingly experienced the collapse of their ecosystems, leading to an elevated increase on the demand for freshwater resources. Botswana is not an exception. The problem of disrupted potable water supply is widespread across the country. However, the physical shortage of water in the country is arguably coupled by lack of effective and efficient water supply and management institutions and water infrastructure. Most of the research on water scarcity in Botswana is mostly inclined towards physical water scarcity, while little is investigated on how the design of institutions for water management in developing countries leads to water scarcity. Furthermore, the premises of most research is neoclassical economics ideas, thereby offering solutions as developing and/or reforming water markets and water pricing mechanisms, among other findings. This paper analyses potable water supply and access in Botswana within a new institutional economics paradigm. The study examines key features of water institutions in Botswana on how they affect water supply and access, applying new institutional economics fundamentals. The study extensively uses various secondary data sources including weather and climate reports, policy documents, maps and charts and survey data, among others. The paper argues that to achieve effective water allocation in Botswana, there is a need to balance social and environmental water resource needs through water policies and other statutory enactments, as well as the crafting of practical management strategies. The country, therefore, requires not only a swift institutional transformation in the water sector, but also needs practical governance structure necessary for implementing integrated water resources management and driving water resources towards sustainability.

Access to safe abortion: progress and challenges since the 1994 International Conference on Population and Development (ICPD).

PubMed

Shah, Iqbal H; Åhman, Elisabeth; Ortayli, Nuriye

2014-12-01

The 1994 International Conference on Population and Development (ICPD) viewed access to safe abortion as imperative for public health. Globally, the number of induced abortions (safe and unsafe) per 1000 women aged 15-44 years declined from 35 in 1995 to 28 in 2008. The number of deaths due to unsafe abortion declined from 69,000 in 1990 to 47,000 in 2008, as safe and effective methods of abortion, including manual vacuum aspiration and medical abortion, became more widely available. During the same period, there was a slight increase in the number of countries where abortion is permitted on request, and 70 countries made grounds for abortion more liberal. Since ICPD, the decline in unsafe abortion was slower than that in safe abortion, and unsafe-abortion-related mortality continued to be a problem. Nearly all unsafe abortions and mortality occur in developing countries. While more must be done to ensure universal access to safe, acceptable and affordable contraception to reduce the need for abortion, this need will always exist. Information on grounds for safe abortion should be made widely available for women to access services to which they are legally entitled to. As recommended by ICPD, quality postabortion care including contraception counseling and provision should be available to all women, regardless of the legal grounds for abortion. The paper provides the evidence on unsafe abortion, a reproductive health issue that is entirely preventable but has been largely neglected or tarnished by emotional and contentious debates. Copyright © 2014 Elsevier Inc. All rights reserved.

Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity.

PubMed

Ovnat Tamir, Sharon; Shemesh, Shay; Oron, Yahav; Marom, Tal

2017-05-01

Acute otitis media (AOM) is a common childhood disease, with an enormous economic and healthcare-related burden. Guidelines and consensus papers for AOM diagnosis and management were published in many countries. Our objective was to study the differences and similarities between these protocols in developing and developed countries. The keywords: 'acute otitis media' AND 'children' AND ['treatment' or 'management'] AND ['guideline' or 'consensus'] were used in various electronic databases between 1 January 1989 through 31 December 2015. Overall, 99 sources from 62 countries were retrieved: 53 from 22 developed countries, and 46 from 40 developing countries. Representative guidelines from America (the USA, Argentina), Europe (Italy, Moldova), Africa (South Africa, Tanzania, Ethiopia), Asia (Japan, Afghanistan, Sri Lanka),and Oceania (South Australia, Fiji) were compared. Paediatric societies publish guidelines in most developed countries; in developing countries, the Ministry of Health usually initiates guideline formulation. Most guidelines use the same diagnostic criteria and offer watchful waiting in mild-moderate scenarios. Amoxicillin is the suggested first-line antibiotic, whereas options for second-line and third-line therapies vary. Duration of therapy varies and is usually age dependent: 5-7 days for children <2 years and 10 days for children >2 years in developed countries, while duration and age groups vary greatly in developing countries. Reduction of AOM risk factors is encouraged in developed countries, but rarely in developing countries. Guidelines for AOM from developing and developed countries are similar in many aspects, with variation in specific recommendations, due to local epidemiology and healthcare accessibility. Formulation of regional guidelines may help reduce AOM burden. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

An analysis of perceived access to health care in Europe: How universal is universal coverage?

PubMed

Cylus, Jonathan; Papanicolas, Irene

2015-09-01

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N=51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals' perceptions of access and important barriers to accessing health care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Towards Age-Friendly Hospitals in Developing Countries: A Case Study in Iran

PubMed Central

Ahmadi, Ahmad; Seyedin, Hesam; Fadaye-Vatan, Reza

2015-01-01

Background: Developing countries such as Iran are experiencing a growth in the elderly population. This is a challenge for healthcare providers and their families. This study investigated the extent in which hospitals at Tehran meet the criteria of age-friendly hospitals. Methods: In this descriptive study, using convenience sampling, 26 hospitals were selected in Tehran, the capital city of Iran. The instrument was a checklist included 50 items in the three dimensions of information and training of service providers, management systems in health care centers, physical environment and accessibility of hospitals. Results: Most hospitals were in a good condition regarding physical environment and access to public transportation, but in a poor condition for special healthcare programs for the elderly, teaching principles of geriatrics and gerontology, interaction of medical staff, physicians and nurses with senior patients and systems of priority for them. Conclusion: Due to the growing elderly population, it is necessary for health policymakers, especially in developing countries, to consider seriously the issue of elderly healthcare and their need for special outpatient and inpatient services. PMID:26000245

Anaesthesia and global health initiatives for children in a low-resource environment.

PubMed

Hodges, Sarah C

2016-06-01

As the United Nations moves from Millennium Development Goals to Sustainable Development Goals, we find ourselves with the opportunity to influence the priority of global health initiatives. Previously, the global health community has failed to recognise the importance of access to safe, affordable surgery and developing the necessary specialities that support it as most of the funding focus had been on primary healthcare and infectious diseases. Now the WHO is publishing guidelines to safe surgery and the Lancet Commission on Global Surgery has been launched. However, this is only the start; anaesthesia remains a forgotten speciality within the world of public and global health and there are still challenges in escalating surgery in low and middle-income countries to an acceptable level that is affordable and timely. Although there is increased world interest in safe surgery and anaesthesia this has not yet been translated into a mandate that will compel countries to invest in improving levels of infrastructure, accessibility, manpower, and safety. A general anaesthetic remains a dangerous event in a child's life in resource-limited countries.

The Somalia Country Case Study. Mid-Decade Review of Progress towards Education for All.

ERIC Educational Resources Information Center

Bennaars, Gerard A.; Seif, Huda A.; Mwangi, Doris

In 1995, the International Consultative Forum on Education for All commissioned case studies in developing countries as part of a mid-decade review of progress in expanding access to basic education. This paper examines the situation in Somalia, where civil war has completely destroyed the infrastructure of education. Part 1 summarizes Somalia's…

Results for Learning Report 2012: Fostering Evidence-Based Dialogue to Monitor Access and Quality in Education

ERIC Educational Resources Information Center

Cortese, Lauren; Crouch, Luis; Pinto, Nancy; Salgado, Vania; Schmidt, Caroline; Soman, Kouassi; Thiam, Mamadou; Chaluda, Ania; Omoeva, Carina

2012-01-01

The Global Partnership for Education (GPE) works with low-income countries around the world to help them provide basic education of good quality to all of their children. Countries develop education sector plans that set clear targets and commitments; their partners including donors, multilateral agencies, civil society and the private sector…

Learners' Access to Tools and Experience with Technology at the University of the South Pacific: Readiness for E-Learning

ERIC Educational Resources Information Center

Raturi, Shikha; Hogan, Robert; Thaman, Konai Helu

2011-01-01

Technology in higher education has become exceedingly popular and useful; however, a digital divide generally applies to the use of technology in education in many developing countries. The Pacific Island countries differ in their technological capacities and infrastructure, with the Fijian capital Suva being most technologically and…

Advancing Migrant Access to Health Services in Europe (AMASE): Protocol for a Cross-sectional Study.

PubMed

Fakoya, Ibidun; Álvarez-Del Arco, Débora; Monge, Susana; Copas, Andrew J; Gennotte, Anne-Francoise; Volny-Anne, Alain; Göpel, Siri; Touloumi, Giota; Prins, Maria; Barros, Henrique; Staehelin, Cornelia; Del Amo, Julia; Burns, Fiona M

2016-05-16

Migrants form a substantial proportion of the population affected by the human immunodeficiency virus (HIV) epidemic in Europe, yet HIV prevention for this population is hindered by poor understanding of access to care and of postmigration transmission dynamics. We present the design and methods of the advancing Migrant Access to health Services in Europe (aMASE) study, the first European cross-cultural study focused on multiple migrant populations. It aims to identify the structural, cultural, and financial barriers to HIV prevention, diagnosis, and treatment and to determine the likely country of HIV acquisition in HIV-positive migrant populations. We delivered 2 cross-sectional electronic surveys across 10 countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Switzerland, and United Kingdom). A clinic survey aimed to recruit up to 2000 HIV-positive patients from 57 HIV clinics in 9 countries. A unique study number linked anonymized questionnaire data to clinical records data (viral loads, CD4 cell counts, viral clades, etc). This questionnaire was developed by expert panel consensus and cognitively tested, and a pilot study was carried out in 2 countries. A Web-based community survey (n=1000) reached those living with HIV but not currently accessing HIV clinics, as well as HIV-negative migrants. It was developed in close collaboration with a community advisory group (CAG) made up of representatives from community organizations in 9 of the participating countries. The CAG played a key role in data collection by promoting the survey to higher-risk migrant groups (sub-Saharan Africans, Latin Americans, men who have sex with men, and people who inject drugs). The questionnaires have considerable content overlap, allowing for comparison. Questions cover ethnicity, migration, immigration status, HIV testing and treatment, health-seeking behavior, sexual risk, and drug use. The electronic questionnaires, which were available in 15 languages, allowed for complex routing, preventing respondents from answering irrelevant questions. In total, we recruited 2249 participants from 57 HIV clinics as part of the clinic survey and retrieved 1637 complete responses as part of the community survey. The findings will provide much-needed information for improving HIV prevention interventions and access to services for migrant communities.

Chronic kidney disease hotspots in developing countries in South Asia.

PubMed

Abraham, Georgi; Varughese, Santosh; Thandavan, Thiagarajan; Iyengar, Arpana; Fernando, Edwin; Naqvi, S A Jaffar; Sheriff, Rezvi; Ur-Rashid, Harun; Gopalakrishnan, Natarajan; Kafle, Rishi Kumar

2016-02-01

In many developing countries in the South Asian region, screening for chronic diseases in the community has shown a widely varying prevalence. However, certain geographical regions have shown a high prevalence of chronic kidney disease (CKD) of unknown etiology. This predominantly affects the young and middle-aged population with a lower socioeconomic status. Here, we describe the hotspots of CKD of undiagnosed etiology in South Asian countries including the North, Central and Eastern provinces of Sri Lanka and the coastal region of the state of Andhra Pradesh in India. Screening of these populations has revealed cases of CKD in various stages. Race has also been shown to be a factor, with a much lower prevalence of CKD in whites compared to Asians, which could be related to the known influence of ethnicity on CKD development as well as environmental factors. The difference between developed and developing nations is most stark in the realm of healthcare, which translates into CKD hotspots in many regions of South Asian countries. Additionally, the burden of CKD stage G5 remains unknown due to the lack of registry reports, poor access to healthcare and lack of an organized chronic disease management program. The population receiving various forms of renal replacement therapy has dramatically increased in the last decade due to better access to point of care, despite the disproportionate increase in nephrology manpower. In this article we will discuss the nephrology care provided in various countries in South Asia, including India, Bangladesh, Pakistan, Nepal, Bhutan, Sri Lanka and Afghanistan.

Differences in the Digital Home Lives of Young People in New Zealand

ERIC Educational Resources Information Center

Hartnett, Maggie

2017-01-01

Digital technology is changing every aspect of life from how we communicate to the way we learn. International trends would suggest that digital access is becoming increasingly widespread in developed countries. But general trends may hide the fact that some households still do not have access to the internet for a variety of reasons. Differences…

The Economic Crisis and Other Challenges in Accessing Science and Technological Information in Asia.

ERIC Educational Resources Information Center

Stueart, Robert D.

This paper discusses access to scientific and technical information in Asia. The first section considers the economic crisis, including the growth in information service as a major indicator of the success or failure of the economies of developing countries. Libraries' response to the economic crisis is addressed in the second section, including…

Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil

PubMed Central

Nunn, A.; Fonseca, E. Da; Gruskin, S.

2009-01-01

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today. PMID:19333805

Canada's implementation of the Paragraph 6 Decision: is it sustainable public policy?

PubMed Central

Cohen-Kohler, Jillian C; Esmail, Laura C; Cosio, Andre Perez

2007-01-01

Background Following the Implementation of Paragraph 6 of the Doha Declaration on TRIPS and Public Health, Canada was among the first countries globally to amend its patent law, which resulted in Canada's Access to Medicines Regime (CAMR). CAMR allows the production and export of generic drugs to developing countries without the requisite manufacturing capacity to undertake a domestic compulsory license. CAMR has been the subject of much criticism lodged at its inability to ensure fast access to urgent medicines for least developing and developing countries in need. Only recently did the Canadian government grant Apotex the compulsory licenses required under CAMR to produce and export antiretroviral therapy to Rwanda's population. Methods The objective of this research is to investigate whether the CAMR can feasibly achieve its humanitarian objectives given the political interests embedded in the crafting of the legislation. We used a political economy framework to analyze the effect of varied institutions, political processes, and economic interests on public policy outcomes. In-depth, semi-structured interviews were conducted with nineteen key stakeholders from government, civil society and industry. Qualitative data analysis was performed using open-coding for themes, analyzing by stakeholder group. Results CAMR is removed from the realities of developing countries and the pharmaceutical market. The legislation needs to include commercial incentives to galvanize the generic drug industry to make use of this legislation. CAMR assumes that developing country governments have the requisite knowledge and human resource capacity to make use of the regime, which is not the case. The legislation does not offer sufficient incentives for countries to turn to Canada when needed drugs may be procured cheaply from countries such as India. In the long term, developing and least developing countries seek sustainable solutions to meet the health needs of their population, including developing their own capacity and local industries. Conclusion CAMR is symbolically meaningful but in practice, limited. The Rwanda case will be noteworthy in terms of the future of the legislation. To meet its intended international health objectives, this legislation needs to be better informed of developing country needs and global pharmaceutical market imperatives. Finally, we contend that serious public policy change cannot strike a balance between all vested interests. Above all, any feasible policy that aims to facilitate compulsory licensing must prioritize public health over trade or economic interests. PMID:18062821

Can developing countries leapfrog the centralized electrification paradigm?

DOE PAGES

Levin, Todd; Thomas, Valerie M.

2016-02-04

Due to the rapidly decreasing costs of small renewable electricity generation systems, centralized power systems are no longer a necessary condition of universal access to modern energy services. Developing countries, where centralized electricity infrastructures are less developed, may be able to adopt these new technologies more quickly. We first review the costs of grid extension and distributed solar home systems (SHSs) as reported by a number of different studies. We then present a general analytic framework for analyzing the choice between extending the grid and implementing distributed solar home systems. Drawing upon reported grid expansion cost data for three specificmore » regions, we demonstrate this framework by determining the electricity consumption levels at which the costs of provision through centralized and decentralized approaches are equivalent in these regions. We then calculate SHS capital costs that are necessary for these technologies provide each of five tiers of energy access, as defined by the United Nations Sustainable Energy for All initiative. Our results suggest that solar home systems can play an important role in achieving universal access to basic energy services. The extent of this role depends on three primary factors: SHS costs, grid expansion costs, and centralized generation costs. Given current technology costs, centralized systems will still be required to enable higher levels of consumption; however, cost reduction trends have the potential to disrupt this paradigm. Furthermore, by looking ahead rather than replicating older infrastructure styles, developing countries can leapfrog to a more distributed electricity service model.« less

Selecting an appropriate strategy to make quality 7.1 % chlorhexidine digluconate accessible for umbilical cord care.

PubMed

Metzler, Mutsumi; Coffey, Patricia S

2016-01-01

Achieving increased access to medicines in low- and middle-income countries is a complex issue that requires a holistic approach. Choosing an appropriate manufacturing strategy that can ensure a sustainable supply of these medicines is an essential component of that approach. The Chlorhexidine Working Group, a consortium of more than 25 international organizations, donors, and manufacturers led by PATH, has been working to increase access to 7.1 % chlorhexidine digluconate for umbilical cord care in low- and middle-income countries to reduce neonatal mortality due to infection. The working group initially considered two strategies for manufacture of this commodity: (1) production and global distribution by a multinational company; and (2) production and regional distribution by locally owned companies or subsidiaries of multinational companies based in low- and middle-income countries. Local production may be beneficial to public health and economic development in these countries, yet capability and capacity of pharmaceutical manufacturers, regulatory and legal provisions, and market factors must be carefully assessed and addressed to ensure that local production is the correct strategy and that it contributes to improved access to the medicine. To date, this effort to implement a local production strategy has resulted in successful registration of 7.1 % chlorhexidine digluconate for umbilical cord care by manufacturers in Bangladesh, Kenya, Nepal, and Nigeria. Additionally, the product is now available in domestic and export markets.

Factors influencing global antiretroviral procurement prices.

PubMed

Wirtz, Veronika J; Forsythe, Steven; Valencia-Mendoza, Atanacio; Bautista-Arredondo, Sergio

2009-11-18

Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this.

Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study.

PubMed

Van Beek, Karen; Woitha, Kathrin; Ahmed, Nisar; Menten, Johan; Jaspers, Birgit; Engels, Yvonne; Ahmedzai, Sam H; Vissers, Kris; Hasselaar, Jeroen

2013-07-17

According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the inventory. Comparative analysis of country specific information was performed afterwards. In all countries palliative care regulations and policies existed (either in laws, royal decrees, or national policies). An explicit right to palliative care was mentioned in the Belgium, French and German law. In addition, access to palliative care was mentioned by all countries, varying from explicit regulations to policy intentions in national plans. Also, all countries had a national policy on palliative care, although sometimes mainly related to national cancer plans. Differences existed in policy regarding palliative care leave, advance directives, national funding, palliative care training, research, opioids and the role of volunteers. Although all included European countries have policies on palliative care, countries largely differ in the presence of legislation and regulations on palliative care as well as the included topics. European healthcare policy recommendations should support palliative care access across Europe.

Should non-citizens have access to publicly funded health care?: a study of public attitudes and their affecting factors.

PubMed

Sun, L-Y; Lee, E-W; Zahra, A; Park, J-H

2015-09-01

To analyse public attitudes towards access for non-citizens to publicly funded health care and to assess the factors that affect such attitudes. Cross-sectional study. Data from 29 countries were used for a multilevel regression, and data from four countries (United States, Sweden, Philippines, and Korea) were used for a linear regression. The data were collected from the International Social Survey Program (ISSP), the World Bank, the Organization for Economic Cooperation and Development (OECD), and the United Nations. The dependent variable was considered to be agreement for non-citizen access to publicly funded health care. The independent variables included: the gross national income (GNI), the gross national income coefficient (GINI), sex, age, education, household income, employment, health insurance, self-related health status, chronic illness, percent having insurance, percent having public insurance, percent employed, percent migrants, percent of health expenditure of the total gross domestic product (GDP), and percent of social expenditure of the total GDP. Egalitarianism for education policy (EEP), egalitarianism for health policy (EHP), and willingness to contribute to an egalitarian health policy (WCHP) were also examined. In the countries surveyed, more than half of the citizens agreed that non-citizens should have access to publicly funded health care. Agreement with that statement had a negative trend with respect to the GNI. The percent having public insurance and WCHP had a significantly positive association with agreement while the percent of those with insurance had a negative relationship. In the USA, household income, EHP, and WCHP were positively associated with agreement, while females were inversely associated with agreement. In Sweden, having health insurance had an inverse association to agreement while females, postsecondary education, health insurance coverage, and WCHP were positively associated with agreement. In the Philippines, household income, EEP, and EHP had significant negative associations with agreement while WCHP had a positive relationship. In Korea, household income and self-rated health status were positively associated with agreement, while postsecondary education had a negative association. Public attitudes towards allowing non-citizens to have access to publicly funded health care present high levels of variation, even among developed countries or countries with similar GDPs. The specific socio-economic conditions within a country and an individual's own social, demographic, and economic background can have different effects on the individual's attitudes towards non-citizens. On a global level, coverage of public health insurance plays an important role for enhancing the public's positive attitudes towards non-citizens' access to publicly funded health care. On a national level, health care policies tailored toward non-citizens based on the specific situation of each country and region are necessary. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016.

PubMed

2018-06-02

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations. Bill & Melinda Gates Foundation. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

A European late starter: lessons from the history of reform in Irish health care.

PubMed

Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

NCCN Frameworks for Resource Stratification of NCCN Guidelines: Adult Cancer Pain and Palliative Care.

PubMed

Swarm, Robert A; Dans, Maria

2018-05-01

The NCCN Framework aims to provide adapted guidelines for low- and middle-resource countries to improve the experience of patients with cancer. In particular, the NCCN Frameworks for Adult Cancer Pain and Palliative Care and were designed to help expand access to pain management and palliative care for patients in low-resource countries. The NCCN Framework is one of several tools that can improve cancer care in the developing world. The NCCN Harmonized Guidelines for Sub-Saharan Africa, a collaborative effort between NCCN, American Cancer Society, Clinton Health Access Initiative, and African Cancer Coalition, was developed to harmonize NCCN recommendations with local guidelines across Africa and to make best use of available services and resources. Copyright © 2018 by the National Comprehensive Cancer Network.

Sources of Free and Open Source Spatial Data for Natural Disasters and Principles for Use in Developing Country Contexts

NASA Astrophysics Data System (ADS)

Taylor, Faith E.; Malamud, Bruce D.; Millington, James D. A.

2016-04-01

Access to reliable spatial and quantitative datasets (e.g., infrastructure maps, historical observations, environmental variables) at regional and site specific scales can be a limiting factor for understanding hazards and risks in developing country settings. Here we present a 'living database' of >75 freely available data sources relevant to hazard and risk in Africa (and more globally). Data sources include national scientific foundations, non-governmental bodies, crowd-sourced efforts, academic projects, special interest groups and others. The database is available at http://tinyurl.com/africa-datasets and is continually being updated, particularly in the context of broader natural hazards research we are doing in the context of Malawi and Kenya. For each data source, we review the spatiotemporal resolution and extent and make our own assessments of reliability and usability of datasets. Although such freely available datasets are sometimes presented as a panacea to improving our understanding of hazards and risk in developing countries, there are both pitfalls and opportunities unique to using this type of freely available data. These include factors such as resolution, homogeneity, uncertainty, access to metadata and training for usage. Based on our experience, use in the field and grey/peer-review literature, we present a suggested set of guidelines for using these free and open source data in developing country contexts.

Compulsory licensing of patented pharmaceutical inventions: evaluating the options

PubMed Central

Reichman, Jerome H.

2010-01-01

In this Comment, the author traces the relevant legislative history pertaining to compulsory licensing of patented pharmaceuticals from the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement of 1994 to the 2003 waiver to, and later proposed amendment of, article 31, which enables poor countries to obtain needed medicines from other countries that possess manufacturing capacity. The Comment then evaluates recent, controversial uses of the relevant legislative machinery as viewed from different critical perspectives. The Comment shows how developing countries seeking access to essential medicines can collaborate in ways that would avoid undermining incentives to innovation and other social costs attributed to compulsory licensing. It ends by defending the legality of recent measures taken to promote public health in developing countries, and by reminding developed countries that unilateral retaliation against such measures is demonstratably illegal under WTO foundational law and jurisprudence. PMID:19493070

Soalr cooking in developing countries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stone, L.

1994-11-01

Solar cooking must overcome a number of obstacles to realize its potential to improve the lives of women in developing countries. Unlike historical interest in solar cooking, current interest derives from vital environmental and human needs. Deforestation and reliance on wood for cooking lead to many hardships, especially for women, and women in developing countries need access to technology and funding. If the woman builds the oven herself, it notonly makes her more willing to use it but the process empower her with new knowledge and kills. The physical design of the oven must be adapted to local conditions andmore » materials for the oven should be inexpensive and locally available.« less

South Africa's protracted struggle for equal distribution and equitable access - still not there.

PubMed

van Rensburg, Hendrik C J

2014-05-08

The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa's transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce.Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows.

Health equity and migrants in the Greater Mekong Subregion

PubMed Central

McMichael, Celia; Healy, Judith

2017-01-01

ABSTRACT Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers – and irregular migrants in particular – face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems. PMID:28452652

Use of microcomputers in health and social service applications in developing nations.

PubMed

Bertrand, W E

1987-01-01

The microcomputer is creating something of a revolution in many developing nations where historically there has been a lack of access to computer power at all levels of the health sector. For the first time, practitioners and researchers, often trained in computer techniques for developing countries, have access through microcomputers to data and information manipulation in their local workplace. While the history of microcomputers in such settings is short, this article presents early evidence from several countries which indicates the usefulness of various applications. The majority of the applications reported in the literature from clinical and research laboratories is made up of national data base systems and special studies of morbidity and mortality. Secondary applications, including assistance in biographical searches and word and graphics processing, are also reviewed in this article. A summary of the most utilized microcomputer hardware configurations completes the review.

Which benefits and limits derive from ESA membership for European Countries owning ;medium-sized; space agencies?

NASA Astrophysics Data System (ADS)

Petroni, Giorgio; Bigliardi, Barbara; Galati, Francesco; Petroni, Alberto

2018-01-01

This study investigates the benefits and limits deriving from membership with ESA of six medium-sized space agencies in terms of strengthening and development (or not) of space technologies, as well as their contribution to the growth of productive activities and to the increase of services for citizens. This research contributes to the more general issue of the usefulness of space activities, not only for scientific or military-political purposes but also for economic and social development. Results show that, on the one hand, the membership with ESA has allowed smaller Countries to access space programs, to develop advanced technologies and to support the growth of their firms in some significant markets, but, on the other hand, the membership has also limited the access to space to few companies, without encouraging the broad dissemination of technological knowledge.

A review of promoting access to medicines in China - problems and recommendations.

PubMed

Sun, Jing; Hu, Cecile Jia; Stuntz, Mark; Hogerzeil, Hans; Liu, Yuanli

2018-02-20

Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China. Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China. Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE) and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP). With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed. The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are facing. To further promote access to medicines, China should speed up the re-assessment of the quality and efficacy of domestically produced generic medicines; coordinate various reforms of price determination, insurance payments, and procurement policies; address medicine shortages through comprehensive policies and legislation; establish specific mechanisms to achieve sustainable equitable access to expensive essential medicines with health technology assessment as a tool to ensure that policy and priority setting are created in a coherent and evidence-based way.

The diversity of regulation and public financing of IVF in Europe and its impact on utilization.

PubMed

Berg Brigham, K; Cadier, B; Chevreul, K

2013-03-01

How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems? Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries' policies became more restrictive. Europe is a world leader in the development and utilization of IVF, yet surveillance reveals significant differences in uptake among countries which have adopted different approaches to the regulation and and public financing of IVF. A descriptive and comparative analysis of legal restrictions on access to IVF in 13 of the EU15 countries that affirmatively regulate and publicly finance IVF. Using 2009 data from the European Society of Human Reproduction and Embryology study of regulatory frameworks in Europe and additional legislative research, we examined and described restrictions on access to IVF in terms of general eligibility, public financing and the scope of available services. Multiple correspondence analysis was used to identify patterns of regulation and groups of countries with similar regulatory patterns and to explore the effects on utilization of IVF, using data from the most recent European and international IVF monitoring reports. Regulations based on social characteristics of treatment seekers who are not applicable to other medical treatments, including relationship status and sexual orientation, appear to have the greatest impact on utilization. Countries with the most generous public financing schemes tend to restrict access to covered IVF to a greater degree. However, no link could be established between IVF utilization and the manner in which coverage was regulated or the level of public financing. Owing to the lack of data regarding the actual level of public versus private financing of IVF it is impossible to draw conclusions regarding equity of access. Moreover, the regulatory and utilization data were not completely temporally matched in what can be a quickly changing regulatory landscape. Whether motivated by cost, eligility restrictions or the availability of particular services, cross-border treatment seeking is driven by regulatory policies, underscoring the extra-territorial implications of in-country political decisions regarding access to IVF. There was no funding source for this study. The authors have no conflicts of interest to declare.

Access and use of human tissues from the developing world: ethical challenges and a way forward using a tissue trust

PubMed Central

2011-01-01

Background Scientists engaged in global health research are increasingly faced with barriers to access and use of human tissues from the developing world communities where much of their research is targeted. In part, the problem can be traced to distrust of researchers from affluent countries, given the history of 'scientific-imperialism' and 'biocolonialism' reflected in past well publicized cases of exploitation of research participants from low to middle income countries. Discussion To a considerable extent, the failure to adequately engage host communities, the opacity of informed consent, and the lack of fair benefit-sharing have played a significant role in eroding trust. These ethical considerations are central to biomedical research in low to middle income countries and failure to attend to them can inadvertently contribute to exploitation and erode trust. A 'tissue trust' may be a plausible means for enabling access to human tissues for research in a manner that is responsive to the ethical challenges considered. Summary Preventing exploitation and restoring trust while simultaneously promoting global health research calls for innovative approaches to human tissues research. A tissue trust can reduce the risk of exploitation and promote host capacity as a key benefit. PMID:21266076

Educational Access in Ghana. Country Policy Brief

ERIC Educational Resources Information Center

Akyeampong, K.; Djangmah, J.; Oduro, A.; Seidu, A.; Hunt, F.

2008-01-01

This Policy Brief describes and explains patterns of access to schools in Ghana. It outlines policy and legislation on access to education and provides an analysis of access, vulnerability and exclusion. It is based on findings from the Country Analytic Report on Access to Basic Education in Ghana (Akyeampong et al, 2007) [ED508809] which can be…

Educational Access in South Africa. Country Policy Brief

ERIC Educational Resources Information Center

Motala, S.; Dieltens, V.; Carrim, N.; Kgobe, P.; Moyo, G.; Rembe, S.

2008-01-01

This Policy Brief describes and explains patterns of access to schools in South Africa. It outlines policy and legislation on access to education and provides a statistical analysis of access, vulnerability and exclusion. It is based on findings from the Country Analytic Review on Educational Access in South Africa (Motala et al, 2007) [ED508808]…

Trends in cancer mortality in the European Union and accession countries, 1980-2000.

PubMed

Levi, F; Lucchini, F; Negri, E; Zatonski, W; Boyle, P; La Vecchia, C

2004-09-01

Cancer mortality rates and trends over the period 1980-2000 for accession countries to the European Union (EU) in May 2004, which include a total of 75 million inhabitants, were abstracted from the World Health Organization (WHO) database, together with, for comparative purposes, those of the current EU. Total cancer mortality for men was 166/100,000 in the EU, but ranged between 195 (Lithuania) and 269/100,000 (Hungary) in central and eastern European accession countries. This excess related to most cancer sites, including lung and other tobacco-related neoplasms, but also stomach, intestines and liver, and a few neoplasms amenable to treatment, such as testis, Hodgkin's disease and leukaemias. Overall cancer mortality for women was 95/100,000 in the EU, and ranged between 100 and 110/100,000 in several central and eastern European countries, and up to 120/100,000 in the Czech Republic and 138/100,000 in Hungary. The latter two countries had a substantial excess in female mortality for lung cancer, but also for several other sites. Furthermore, for stomach and especially (cervix) uteri, female rates were substantially higher in central and eastern European accession countries. Over the last two decades, trends in mortality were systematically less favourable in accession countries than in the EU. Most of the unfavourable patterns and trends in cancer mortality in accession countries are due to recognised, and hence potentially avoidable, causes of cancer, including tobacco, alcohol, dietary habits, pollution and hepatitis B, plus inadequate screening, diagnosis and treatment. Consequently, the application of available knowledge on cancer prevention, diagnosis and treatment may substantially reduce the disadvantage now registered in the cancer mortality of central and eastern European accession countries.

URSA MAIOR: a One Liter Nanosatellite Bus for Low Cost Access to Space

NASA Astrophysics Data System (ADS)

Santoni, F.

One of the main limitations in the access to space for developing countries is the economical effort typically required by space missions. Secondly, space activity is a field of very high technology, requiring technical skills, education and practice, at a level which is seldom reached by developing countries. Interventions aimed to facilitate access to space for developing countries should be focussed primarily on the missions allowing access to space at reasonable cost. Moreover, perhaps more importantly, they should emphasize conducting the mission design, construction, ground testing and operation in orbit as an open activity, accessible to developing countries personnel, in order to set up an education process, which is not just selling a product ready satellite. Universities could have a very important role in this activity. Many Universities around the world have designed, built and launched small satellites. Università di Roma "La Sapienza" set up a program for the construction of small satellites in an academic environment, involving directly the students in the design, construction, ground testing and operation in orbit. The first satellite built in the framework of this program, UNISAT, was successfully launched in September 2000. The second, UNISAT-2, initially scheduled for launch in 2001, has been delayed by the launch provider to late 2002. These two satellites, based on a modular design, emphasizing ease of construction and assembly, weight roughly 10 kg. The realization of these satellites was made possible within the regular financing given to university research programs, keeping down cost by the use of commercial off the shelf components instead of space rated ones. The microsatellite experience at Università di Roma "La Sapienza", is going further with the development of a new nanosatellite bus, URSA MAIOR (Università di Roma "la SApienza" Micro Autonomous Imager in ORbit), aiming at cutting down cost and possibly improving performance. The whole satellite has a volume of one liter and a target weight of one kilogram. It can support small scientific missions, such as Earth imaging, and, potentially, small communications payloads. All the on-board components are commercial off the shelf, including solar panels, completely assembled in the University laboratories. Commercial Li-Ion batteries are the energy storage device. Three axis attitude stabilization is provided by a bias momentum wheel, with magnetic coils for active nutation damping and pointing control. Academic personnel and students are involved in the whole process of the nanosatellite design, construction and ground test. All the phases of the projects are open to the participation of the students, contributing ideas and solution to the technical problems, under the supervision of the academic staff. All the subsystems and components are designed to be assembled in a normally equipped electronics laboratory, without any potentially harmful materials or operations. For example the Li-Ion battery pack have been assembled following a procedure, primarily focussed on ease of integration and assembly by not experienced people, such as students, in a normally equipped University electronics laboratory. Packing materials were selected with no special requirements in terms of toxicity control, potential harmful operations, environmental cleanliness, or expensive curing machines. The space education experience made at Università di Roam "La Sapienza", with all the phases of the space program opened to students, realizing small satellites with small economical budgets seems to be a useful tool to give access to space to developing countries. These could have a piece of hardware in space at reachable costs, realizing small earth imaging or communication missions, and at the same time could obtain space education through hands-on experience, filling, at least in part, the technological gap. The paper describes the nanosatellite bus URSA MAIOR in some detail, showing how it could be exploited as useful tool to give developing countries access to space, as well as space education.

Investing in Youth: Tunisia. "Strengthening the Employability of Youth during the Transition to a Green Economy"

ERIC Educational Resources Information Center

OECD Publishing, 2015

2015-01-01

The series Investing in Youth builds on the expertise of the Organisation for Economic Cooperation and Development (OECD) on youth employment, social support and skills. It covers both OECD countries and countries in the process of accession to the OECD, as well as some emerging economies. This report provides a detailed diagnosis of the youth…

Nurse-midwifery in rural Pakistan.

PubMed

Woods, A B

1991-01-01

Pakistan is a relatively new nation of predominantly Islamic influence. Like many developing countries, it is plagued by extensive communicable diseases, malnutrition, inadequate sewage systems, and illiteracy. Religious beliefs and cultural influences impact heavily on access to health care and on maternal-child health outcomes. This paper examines the major maternal-child health problems encountered, as well as implications for midwifery practice in an Islamic country.

Promoting equity to achieve maternal and child health.

PubMed

Thomsen, Sarah; Hoa, Dinh Thi Phuong; Målqvist, Mats; Sanneving, Linda; Saxena, Deepak; Tana, Susilowati; Yuan, Beibei; Byass, Peter

2011-11-01

Maternal and child mortality rates, the targets for two of the eight Millennium Development Goals, remain unacceptably high in many countries. Some countries have made significant advances in reducing deaths in pregnancy, childbirth, and childhood at the national level. However, on a sub-national basis most countries show wide disparities in health indices which are not necessarily reflected in national figures. This is a sign of inequitable access to and provision of health services. Yet there has been little attention to health equity in relation to the Millennium Development Goals. Instead, countries have focused on achieving national targets. This has led to an emphasis on utilitarian, as opposed to universalist, approaches to public health, which we discuss here. We recommend a policy of "proportionate universalism". In this approach, universal health care and a universal social policy are the ultimate goal, but in the interim actions are carried out with intensities proportionate to disadvantage. We also briefly describe an initiative that aims to promote evidence-based policy and interventions that will reduce inequity in access to maternal and child health care in China, India, Indonesia and Viet Nam. Copyright © 2011 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies.

PubMed

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists' licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category.

Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies

PubMed Central

Topic, Elizabeta; Beletic, Andjelo; Zima, Tomas

2013-01-01

Introduction: Continuing professional development (CPD) with corresponding crediting system is recognized as essential for the laboratory medicine specialists to provide optimal service for the patients. Article presents results of the survey evaluating current CPD crediting practice among members of European Federation of Clinical Chemistry and Laboratory Medicine (EFLM). Materials and methods: A questionnaire had been forwarded to presidents/national representatives of all EFLM members, with invitation to provide information about CPD programmes and crediting policies, as well as feedback on individual CPD categories, through scoring their relevance. Results: Complete or partial answers were received from 28 of 38 members. In 23 countries, CPD programmes exist and earn credits, with 19 of them offering access to non-medical scientists. CPD activities are evaluated in all participating countries, regardless to the existence of an official CPD programme. Among participating members with mandatory specialists’ licensing (22/28), CPD is a prerequisite for relicensing in 13 countries. Main categories recognized as CPD are: continuing education (24 countries), article/book (17/14 countries) authorship and distance learning (14 countries). The highest median score of relevance (20) is allocated to professional training, editor/authorship and official activities in professional organizations, with the first category showing the least variation among scores. Conclusions: Majority of EFLM members have developed CPD programmes, regularly evaluated and accompanied by crediting systems. Programmes differ in accessibility for non-medical scientists and impact on relicensing eligibility. Continuing education, authorship and e-learning are mainly recognized as CPD activities, although the professional training is appreciated as the most important individual CPD category. PMID:24266304

Internet as a Tool for Reference Work Experiences from the IFLA/Danida Trial Project in Ghana.

ERIC Educational Resources Information Center

Kondrup, Ruth

The basic ideas of the project described in this paper are to establish Internet connections to libraries in developing countries, to give access to information and to organize training of staff. Technical solutions with radio and microwave Internet connections have been established. Access to on-line journals has been established by the PERI…

Equal Access to Early Learning. Cantigny Conference Report (Chicago, Illinois, June 5-7, 2001).

ERIC Educational Resources Information Center

National Black Child Development Inst., Inc., Washington, DC.

Despite a growing acknowledgement that the United States needs to invest more in the early care and education needs of children, the country lacks a common vision for a comprehensive approach to an early childhood care and education system. The Equal Access to Early Learning Conference, sponsored by the National Black Child Development Institute…

Access to Higher Education. Intergovernmental Conference on Policies for Higher Education in the 80s (Paris, France, October 12-14, 1981).

ERIC Educational Resources Information Center

Squires, Geoffrey; And Others

Access to higher education in countries that are members of the Organisation for Economic Co-operation and Development (OECD) is addressed. The following topics are considered: principles for quantitative planning of higher education, admission policies and the institutional framework, changing links between secondary and higher education, access…

The World's Approach toward Publishing in Springer and Elsevier's APC-Funded Open Access Journals

ERIC Educational Resources Information Center

Sotudeh, Hajar; Ghasempour, Zahra

2018-01-01

Purpose: The present study explored tendencies of the world's countries--at individual and scientific development levels--toward publishing in APC-funded open access journals. Design/Methodology/Approach: Using a bibliometric method, it studied OA and NOA articles issued in Springer and Elsevier's APC journals? during 2007-2011. The data were…

The Need for Integration of Technology in K-12 School Settings in Kenya, Africa

ERIC Educational Resources Information Center

Momanyi, Lilian; Norby, RenaFaye; Strand, Sharon

2006-01-01

Many computer users around the world have access to the latest advances in technology and use of the World Wide Web (WWW or Web). However, for a variety of political, economic, and social reasons, some peoples of the world do not have access to these resources. The educational systems of developing countries have not completely missed the…

Socio-Economic Characteristics of Women Enrolled in Higher Education Programs at the National Open University of Nigeria

ERIC Educational Resources Information Center

Chibuogwu, Nnaka V.

2015-01-01

In Nigeria, as in most developing countries, there is gender disparity in education access especially at the higher education level. Research reports on this subject link this phenomenon to the prevailing socio-cultural and economic values and practices in Nigeria. Efforts are on ground to widen access to tertiary education for all including…

Educational Access in Bangladesh. Country Policy Brief

ERIC Educational Resources Information Center

Ahmed, Manzoor

2008-01-01

This Policy Brief describes and explains patterns of access to schooling in Bangladesh. It outlines types of educational provision and provides some basic statistics on access, vulnerability and exclusion, as well as insights into the characteristics of those denied access. It is based on findings from the "Country Analytic Review on Access…

Measuring Equity in Access to Pharmaceutical Services Using Concentration Curve; Model Development.

PubMed

Davari, Majid; Khorasani, Elahe; Bakhshizade, Zahra; Jafarian Jazi, Marzie; Ghaffari Darab, Mohsen; Maracy, Mohammad Reza

2015-01-01

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts' opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Availability of and access to orphan drugs: an international comparison of pharmaceutical treatments for pulmonary arterial hypertension, Fabry disease, hereditary angioedema and chronic myeloid leukaemia.

PubMed

Blankart, Carl Rudolf; Stargardt, Tom; Schreyögg, Jonas

2011-01-01

Market authorization does not guarantee patient access to any given drug. This is particularly true for costly orphan drugs because access depends primarily on co-payments, reimbursement policies and prices. The objective of this article is to identify differences in the availability of orphan drugs and in patient access to them in 11 pharmaceutical markets: Australia, Canada, England, France, Germany, Hungary, the Netherlands, Poland, Slovakia, Switzerland and the US. Four rare diseases were selected for analysis: pulmonary arterial hypertension (PAH), Fabry disease (FD), hereditary angioedema (HAE) and chronic myeloid leukaemia (CML). Indicators for availability were defined as (i) the indications for which orphan drugs had been authorized in the treatment of these diseases; (ii) the application date; and (iii) the date upon which these drugs received market authorization in each country. Indicators of patient access were defined as (i) the outcomes of technology appraisals; (ii) the extent of coverage provided by healthcare payers; and (iii) the price of the drugs in each country. For PAH we analysed bosentan, iloprost, sildenafil, treprostinil (intravenous and inhaled) as well as sitaxentan and ambrisentan; for FD we analysed agalsidase alfa and agalsidase beta; for HAE we analysed icatibant, ecallantide and two complement C1s inhibitors; for CML we analysed imatinib, dasatinib and nilotinib. Most drugs included in this study had received market authorization in all countries, but the range of indications for which they had been authorized differed by country. The broadest range of indications was found in Australia, and the largest variations in indications were found for PAH drugs. Authorization process speed (the time between application and market authorization) was fastest in the US, with an average of 362 days, followed by the EU (394 days). The highest prices for the included drugs were found in Germany and the US, and the lowest in Canada, Australia and England. Although the prices of all of the included drugs were high compared with those of most non-orphan drugs, most of the insurance plans in our country sample provided coverage for authorized drugs after a certain threshold. Availability of and access to orphan drugs play a key role in determining whether patients will receive adequate and efficient treatment. Although the present study showed some variations between countries in selected indicators of availability and access to orphan drugs, virtually all of the drugs in question were available and accessible in our sample. However, substantial co-payments in the US and Canada represent important barriers to patient access, especially in the case of expensive treatments such as those analysed in this study. Market exclusivity is a strong instrument for fostering orphan drug development and drug availability. However, despite the positive effect of this instrument, the conditions under which market exclusivity is granted should be reconsidered in cases where the costs of developing an orphan drug have already been amortized through the use of the drug's active ingredient for the treatment of a common indication.

Towards advanced risk-sharing in health care financing: with a focus on the potential of social health insurance in developing countries.

PubMed

Carrin, G

2004-01-01

In this paper, we analyse the major health financing methods and the contribution they can make to improving access to health care among all of a country's population groups. Risk-sharing in health financing is proposed as a powerful method to achieve this improvement. The larger the degree of risk-sharing in a health financing system, the less people will have to bear the financial consequences of their own health risks, and the more they are likely to have access to needed care. Ideally countries should attempt to introduce 'advanced' risk-sharing aiming at equal access among individuals to an adequate package of health services. There are two major ways to implement advanced risk-sharing: general tax revenue may be main source of financing health services, or else social health insurance may be established. An important finding is that about 60% of the world's countries still need to pursue efforts towards the introduction of advanced risk-sharing. We further focus on the potential of social health insurance as an advanced risk-sharing method. In fact, there is recent interest in developing countries such as Côte d'Ivoire, Indonesia, Iran and Kenya in this particular health financing mechanism. Compared to health financing via general tax revenue, social health insurance spreads the immediate burden of financing among various groups, including the workers, the self-employed, enterprises and Government. Time and tedious discussions between these groups may be needed, however, before a consensus is reached, not only on the relative burden of financing but also on ways to achieve overall population coverage. It is suggested that action-research be used to test the adequacy of initial social health insurance policies.

Application of ICT in strengthening health information systems in developing countries in the wake of globalisation.

PubMed

Simba, Daudi O; Mwangu, Mughwira

2004-12-01

Information Communication Technology (ICT) revolution brought opportunities and challenges to developing countries in their efforts to strengthen the Health Management Information Systems (HMIS). In the wake of globalisation, developing countries have no choice but to take advantage of the opportunities and face the challenges. The last decades saw developing countries taking action to strengthen and modernise their HMIS using the existing ICT. Due to poor economic and communication infrastructure, the process has been limited to national and provincial/region levels leaving behind majority of health workers living in remote/rural areas. Even those with access do not get maximum benefit from ICT advancements due to inadequacies in data quality and lack of data utilisation. Therefore, developing countries need to make deliberate efforts to address constraints threatening to increase technology gap between urban minority and rural majority by setting up favourable policies and appropriate strategies. Concurrently, strategies to improve data quality and utilisation should be instituted to ensure that HMIS has positive impact on people's health. Potential strength from private sector and opportunities for sharing experiences among developing countries should be utilised. Short of this, advancement in ICT will continue to marginalise health workers in developing countries especially those living in remote areas.

Regional Water System Vulnerabilities and Strengths for Unavoidable Climate Adaptation

NASA Astrophysics Data System (ADS)

Gleick, P. H.; Palaniappan, M.; Christian-Smith, J.; Cooley, H.

2011-12-01

A wide range of options are available to help water systems prepare and adapt for unavoidable climate impacts, but these options vary depending on region, climatic conditions, economic status, and technical infrastructure in place. Drawing on case studies from the United States, India, and elsewhere, and from both urban and agricultural water systems, risks to water supply and quality are evaluated and summarized and categories of responses to help improve the effectiveness of adaptation policies are reviewed. Among the issues to be discussed are characteristics unique to developing country cities, such as the predominance of informal actors in the water sector. The formal, or government sector, which often exclusively manages water access and distribution in developed country cities, is only one among many players in the water sector in developing country cities. Informal access to water includes direct access by individuals through private groundwater systems, private water markets using vendors or sales of bottled water, and rainwater harvesting systems on individual homes. In this environment, with already existing pressures on water availability and use, the impacts of climate change on water will be strongly felt. This complicates planning for water supply and demand and risks increasing already prevalent water insecurity, especially for urban poor. In wealthier countries, any planning for water-related climate impacts tends to take the form of "business as usual" responses, such as efforts to expand supply with new infrastructure, manage demand through conservation programs, or simply put off addressing the problem to the next generation of managers and users. These approaches can be effective, but also risk missing unusual, non-linear, or threshold impacts. Examples of more informed and innovative efforts to substantively address climate change risks will be presented.

Practising cloud-based telemedicine in developing countries.

PubMed

Puustjärvi, Juha; Puustjärvi, Leena

2013-01-01

In industrialised countries, telemedicine has proven to be a valuable tool for enabling access to knowledge and allowing information exchange, and showing that it is possible to provide good quality of healthcare to isolated communities. However, there are many barriers to the widespread implementation of telemedicine in rural areas of developing countries. These include deficient internet connectivity and sophisticated peripheral medical devices. Furthermore, developing countries have very high patients-per-doctor ratios. In this paper, we report our work on developing a cloud-based health information system, which promotes telemedicine and patient-centred healthcare by exploiting modern information and communication technologies such as OWL-ontologies and SQL-triggers. The reason for using cloud technology is twofold. First, cloud service models are easily adaptable for sharing patients health information, which is of prime importance in patient-centred healthcare as well as in telemedicine. Second, the cloud and the consulting physicians may locate anywhere in the internet.

A cross-sectional ecological study of spatial scale and geographic inequality in access to drinking-water and sanitation.

PubMed

Yu, Weiyu; Bain, Robert E S; Mansour, Shawky; Wright, Jim A

2014-11-26

Measuring inequality in access to safe drinking-water and sanitation is proposed as a component of international monitoring following the expiry of the Millennium Development Goals. This study aims to evaluate the utility of census data in measuring geographic inequality in access to drinking-water and sanitation. Spatially referenced census data were acquired for Colombia, South Africa, Egypt, and Uganda, whilst non-spatially referenced census data were acquired for Kenya. Four variants of the dissimilarity index were used to estimate geographic inequality in access to both services using large and small area units in each country through a cross-sectional, ecological study. Inequality was greatest for piped water in South Africa in 2001 (based on 53 areas (N) with a median population (MP) of 657,015; D = 0.5599) and lowest for access to an improved water source in Uganda in 2008 (N = 56; MP = 419,399; D = 0.2801). For sanitation, inequality was greatest for those lacking any facility in Kenya in 2009 (N = 158; MP = 216,992; D = 0.6981), and lowest for access to an improved facility in Uganda in 2002 (N = 56; MP = 341,954; D = 0.3403). Although dissimilarity index values were greater for smaller areal units, when study countries were ranked in terms of inequality, these ranks remained unaffected by the choice of large or small areal units. International comparability was limited due to definitional and temporal differences between censuses. This five-country study suggests that patterns of inequality for broad regional units do often reflect inequality in service access at a more local scale. This implies household surveys designed to estimate province-level service coverage can provide valuable insights into geographic inequality at lower levels. In comparison with household surveys, censuses facilitate inequality assessment at different spatial scales, but pose challenges in harmonising water and sanitation typologies across countries.

Thalassaemia in children: from quality of care to quality of life.

PubMed

Amid, Ali; Saliba, Antoine N; Taher, Ali T; Klaassen, Robert J

2015-11-01

Over the past few decades, there has been a remarkable improvement in the survival of patients with thalassaemia in developed countries. Availability of safe blood transfusions, effective and accessible iron chelating medications, the introduction of new and non-invasive methods of tissue iron assessment and other advances in multidisciplinary care of thalassaemia patients have all contributed to better outcomes. This, however, may not be true for patients who are born in countries where the resources are limited. Unfortunately, transfusion-transmitted infections are still major concerns in these countries where paradoxically thalassaemia is most common. Moreover, oral iron chelators and MRI for monitoring of iron status may not be widely accessible or affordable, which may result in poor compliance and suboptimal iron chelation. All of these limitations will lead to reduced survival and increased thalassaemia-related complications and subsequently will affect the patient's quality of life. In countries with limited resources, together with improvement of clinical care, strategies to control the disease burden, such as public education, screening programmes and appropriate counselling, should be put in place. Much can be done to improve the situation by developing partnerships between developed countries and those with limited resources. Future research should also particularly focus on patient's quality of life as an important outcome of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Medical tourism today: what is the state of existing knowledge?

PubMed

Hopkins, Laura; Labonté, Ronald; Runnels, Vivien; Packer, Corinne

2010-07-01

One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

Linking the open source, spatial electrification tool (ONSSET) and the open source energy modelling system (OSeMOSYS), with a focus on Sub-Saharan Africa

NASA Astrophysics Data System (ADS)

Mentis, Dimitrios; Howells, Mark; Rogner, Holger; Korkovelos, Alexandros; Arderne, Christopher; Siyal, Shahid; Zepeda, Eduardo; Taliotis, Constantinos; Bazilian, Morgan; de Roo, Ad; Tanvez, Yann; Oudalov, Alexandre; Scholtz, Ernst

2017-04-01

In September 2015, the United Nations General Assembly adopted Agenda 2030, which comprises a set of 17 Sustainable Development Goals (SDGs) defined by 169 targets. "Ensuring access to affordable, reliable, sustainable and modern energy for all by 2030" is the seventh goal (SDG7). While access to energy refers to more than electricity, the latter is the central focus of this work. According to the World Bank's 2015 Global Tracking Framework, roughly 15% of world population (or 1.1 billion people) lack access to electricity, and many more rely on poor quality electricity services. The majority of those without access (87%) reside in rural areas. This paper presents results of a Geographic Information Systems (GIS) approach coupled with open access data and linked to the Electricity Model Base for Africa (TEMBA), a model that represents each continental African country's electricity supply system. We present least-cost electrification strategies on a country-by-country basis for Sub-Saharan Africa. The electrification options include grid extension, mini-grid and stand-alone systems for rural, peri-urban, and urban contexts across the economy. At low levels of electricity demand there is a strong penetration of standalone technologies. However, higher electricity demand levels move the favourable electrification option from stand-alone systems to mini grid and to grid extensions.

Abortion in a Progressive Legal Environment: The Need for Vigilance in Protecting and Promoting Access to Safe Abortion Services in South Africa

PubMed Central

Magwentshu, Makgoale

2013-01-01

The importance of South Africa as a model for reproductive self-determination in Africa cannot be underestimated. Abortion has been legal since 1996, and the country has some of the most developed government systems for the provision of abortion care on the continent. Yet in the same way opponents of abortion in the United States have whittled away at access with increased bureaucracy, South Africa faces similar assaults that leave women without safe care and threaten to turn back achievements made during the past 16 years. I explore the history of the law, subsequent legal challenges, and new threats to women’s access to abortion services, including service delivery issues that may influence the future of public health in the country. PMID:23327279

[Abortion: towards worldwide legalization].

PubMed

1998-09-01

A table showing the current status of abortion in the world based on two recent and detailed studies is presented. Countries are categorized according to whether they totally prohibit abortion, permit it to save the mother's life, permit it to preserve her physical health or mental health, permit it for maternal socioeconomic reasons, or provide it at the mother's request. The countries are grouped into 5 geographic areas: America and the Caribbean; Central Asia, Middle East, and North Africa; East and South Asia and the Pacific; Europe; sub-Saharan Africa. The trend toward liberalization of laws is clear. The development of abortion laws is moving in the direction of complete legalization, that is, the creation of health norms that facilitate abortion for all women, with guarantees of medical safety. There are still countries that move to restrict access to abortion, and in a few cases, such as Colombia and Poland, legalization and prohibition have alternated depending on the social and political circumstances of the moment. In the past 12 years, 28 countries liberalized their laws in some way, while 4 countries with close ties to the Vatican restricted or prohibited access.

Trade, TRIPS, and pharmaceuticals.

PubMed

Smith, Richard D; Correa, Carlos; Oh, Cecilia

2009-02-21

The World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) set global minimum standards for the protection of intellectual property, substantially increasing and expanding intellectual-property rights, and generated clear gains for the pharmaceutical industry and the developed world. The question of whether TRIPS generates gains for developing countries, in the form of increased exports, is addressed in this paper through consideration of the importance of pharmaceuticals in health-care trade, outlining the essential requirements, implications, and issues related to TRIPS, and TRIPS-plus, in which increased restrictions are imposed as part of bilateral free-trade agreements. TRIPS has not generated substantial gains for developing countries, but has further increased pharmaceutical trade in developed countries. The unequal trade between developed and developing countries (ie, exporting and importing high-value patented drugs, respectively) raises the issue of access to medicines, which is exacerbated by TRIPS-plus provisions, although many countries have not even enacted provision for TRIPS flexibilities. Therefore this paper focuses on options that are available to the health community for negotiation to their advantage under TRIPS, and within the presence of TRIPS-plus.

A long way to go - Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries.

PubMed

Roche, Rachel; Bain, Robert; Cumming, Oliver

2017-01-01

Water, sanitation and hygiene (WASH) are essential for a healthy and dignified life. International targets to reduce inadequate WASH coverage were set under the Millennium Development Goals (MDGs, 1990-2015) and now the Sustainable Development Goals (SDGs, 2016-2030). The MDGs called for halving the proportion of the population without access to adequate water and sanitation, whereas the SDGs call for universal access, require the progressive reduction of inequalities, and include hygiene in addition to water and sanitation. Estimating access to complete WASH coverage provides a baseline for monitoring during the SDG period. Sub-Saharan Africa (SSA) has among the lowest rates of WASH coverage globally. The most recent available Demographic Household Survey (DHS) or Multiple Indicator Cluster Survey (MICS) data for 25 countries in SSA were analysed to estimate national and regional coverage for combined water and sanitation (a combined MDG indicator for 'improved' access) and combined water with collection time within 30 minutes plus sanitation and hygiene (a combined SDG indicator for 'basic' access). Coverage rates were estimated separately for urban and rural populations and for wealth quintiles. Frequency ratios and percentage point differences for urban and rural coverage were calculated to give both relative and absolute measures of urban-rural inequality. Wealth inequalities were assessed by visual examination of coverage across wealth quintiles in urban and rural populations and by calculating concentration indices as standard measures of relative wealth related inequality that give an indication of how unevenly a health indicator is distributed across the wealth distribution. Combined MDG coverage in SSA was 20%, and combined basic SDG coverage was 4%; an estimated 921 million people lacked basic SDG coverage. Relative measures of inequality were higher for combined basic SDG coverage than combined MDG coverage, but absolute inequality was lower. Rural combined basic SDG coverage was close to zero in many countries. Our estimates help to quantify the scale of progress required to achieve universal WASH access in low-income countries, as envisaged under the water and sanitation SDG. Monitoring and reporting changes in the proportion of the national population with access to water, sanitation and hygiene may be useful in focusing WASH policy and investments towards the areas of greatest need.

A long way to go – Estimates of combined water, sanitation and hygiene coverage for 25 sub-Saharan African countries

PubMed Central

Bain, Robert; Cumming, Oliver

2017-01-01

Background Water, sanitation and hygiene (WASH) are essential for a healthy and dignified life. International targets to reduce inadequate WASH coverage were set under the Millennium Development Goals (MDGs, 1990–2015) and now the Sustainable Development Goals (SDGs, 2016–2030). The MDGs called for halving the proportion of the population without access to adequate water and sanitation, whereas the SDGs call for universal access, require the progressive reduction of inequalities, and include hygiene in addition to water and sanitation. Estimating access to complete WASH coverage provides a baseline for monitoring during the SDG period. Sub-Saharan Africa (SSA) has among the lowest rates of WASH coverage globally. Methods The most recent available Demographic Household Survey (DHS) or Multiple Indicator Cluster Survey (MICS) data for 25 countries in SSA were analysed to estimate national and regional coverage for combined water and sanitation (a combined MDG indicator for ‘improved’ access) and combined water with collection time within 30 minutes plus sanitation and hygiene (a combined SDG indicator for ‘basic’ access). Coverage rates were estimated separately for urban and rural populations and for wealth quintiles. Frequency ratios and percentage point differences for urban and rural coverage were calculated to give both relative and absolute measures of urban-rural inequality. Wealth inequalities were assessed by visual examination of coverage across wealth quintiles in urban and rural populations and by calculating concentration indices as standard measures of relative wealth related inequality that give an indication of how unevenly a health indicator is distributed across the wealth distribution. Results Combined MDG coverage in SSA was 20%, and combined basic SDG coverage was 4%; an estimated 921 million people lacked basic SDG coverage. Relative measures of inequality were higher for combined basic SDG coverage than combined MDG coverage, but absolute inequality was lower. Rural combined basic SDG coverage was close to zero in many countries. Conclusions Our estimates help to quantify the scale of progress required to achieve universal WASH access in low-income countries, as envisaged under the water and sanitation SDG. Monitoring and reporting changes in the proportion of the national population with access to water, sanitation and hygiene may be useful in focusing WASH policy and investments towards the areas of greatest need. PMID:28182796

Health resources and Internet with reference to HealthNet Nepal.

PubMed

Pradhan, Mohan Raj

2003-01-01

Technologies with the ability to send information in a fast, efficient and cheap fashion, such as the Internet--can provide dramatic improvements in access to information, advice and care. This article discusses importance of Internet, applications of Internet in providing information services in the health field. The Internet was developed in western countries and the information flow is from North to South. But for decision making within a country, information generated within a country is needed. For this, an organization like HealthNet Nepal is developed. The article discusses the various services of HealthNet Nepal and discusses about its unique features as compared to commercial ISPs.

An Evolving Model for Capacity Building with Earth Observation Imagery

NASA Astrophysics Data System (ADS)

Sylak-Glassman, E. J.

2015-12-01

For the first forty years of Earth observation satellite imagery, all imagery was collected by civilian or military governmental satellites. Over this timeframe, countries without observation satellite capabilities had very limited access to Earth observation data or imagery. In response to the limited access to Earth observation systems, capacity building efforts were focused on satellite manufacturing. Wood and Weigel (2012) describe the evolution of satellite programs in developing countries with a technology ladder. A country moves up the ladder as they move from producing satellites with training services to building satellites locally. While the ladder model may be appropriate if the goal is to develop autonomous satellite manufacturing capability, in the realm of Earth observation, the goal is generally to derive societal benefit from the use of Earth observation-derived information. In this case, the model for developing Earth observation capacity is more appropriately described by a hub-and-spoke model in which the use of Earth observation imagery is the "hub," and the "spokes" describe the various paths to achieving that imagery: the building of a satellite (either independently or with assistance), the purchase of a satellite, participation in a constellation of satellites, and the use of freely available or purchased satellite imagery. We discuss the different capacity-building activities that are conducted in each of these pathways, such as the "Know-How Transfer and Training" program developed by Surrey Satellite Technology Ltd. , Earth observation imagery training courses run by SERVIR in developing countries, and the use of national or regional remote sensing centers (such as those in Morocco, Malaysia, and Kenya) to disseminate imagery and training. In addition, we explore the factors that determine through which "spoke" a country arrives at the ability to use Earth observation imagery, and discuss best practices for achieving the capability to use imagery.

Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014).

PubMed

Gandhi, Gian

2015-11-30

GAVI's focus on reducing inequities in access to vaccines, immunization, and GAVI funds, - both between and within countries - has changed over time. This paper charts that evolution. A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI's phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries. Serches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI's predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes. In its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.

Recombinant Human Insulin in Global Diabetes Management – Focus on Clinical Efficacy

PubMed Central

Mbanya, Jean Claude; Sandow, Juergen; Landgraf, Wolfgang

2017-01-01

Abstract Biosynthetic human insulin and insulin analogues are the mainstay of insulin therapy for both type 1 and type 2 diabetes although access to human insulin at affordable prices remains a global issue. The world is experiencing an exponential rise in the prevalence of diabetes presenting an urgent need to establish effective diabetes therapy in countries burdened by inadequate health care budgets, malnutrition and infectious diseases. Recombinant human insulin has replaced animal insulins and animal-based semisynthetic human insulin thereby available in sufficient quantities and at affordable prices able to provide global access to insulin therapy. In many patients, analog insulins can offer additional clinical benefit, although at a considerably higher price thus severely restricting availability in low income countries. The approval process for recombinant human insulins (i.e. biosimilars) and analogue insulins is highly variable in the developing countries in contrast to Europe and in North America, where it is well established within a strict regulatory framework. This review aims to discuss the future access to human insulin therapy in a global context with an ever increasing burden of diabetes and significant economic implications. PMID:29632602

Microbes and Water Quality in Developed Countries

EPA Science Inventory

Safe drinking water has been a concern for mankind through out the world for centuries. In the developed world, governments consider access to safe and clean drinking water to be a basic human right. Government regulations generally address the quality of the source water, adequ...

Initiating a Human Variome Project Country Node.

PubMed

AlAama, Jumana; Smith, Timothy D; Lo, Alan; Howard, Heather; Kline, Alexandria A; Lange, Matthew; Kaput, Jim; Cotton, Richard G H

2011-05-01

Genetic diseases are a pressing global health problem that requires comprehensive access to basic clinical and genetic data to counter. The creation of regional and international databases that can be easily accessed by clinicians and diagnostic labs will greatly improve our ability to accurately diagnose and treat patients with genetic disorders. The Human Variome Project is currently working in conjunction with human genetics societies to achieve this by establishing systems to collect every mutation reported by a diagnostic laboratory, clinic, or research laboratory in a country and store these within a national repository, or HVP Country Node. Nodes have already been initiated in Australia, Belgium, China, Egypt, Malaysia, and Kuwait. Each is examining how to systematically collect and share genetic, clinical, and biochemical information in a country-specific manner that is sensitive to local ethical and cultural issues. This article gathers cases of genetic data collection within countries and takes recommendations from the global community to develop a procedure for countries wishing to establish their own collection system as part of the Human Variome Project. We hope this may lead to standard practices to facilitate global collection of data and allow efficient use in clinical practice, research and therapy. © 2011 Wiley-Liss, Inc.

Challenges of access to medicine and the responsibility of pharmaceutical companies: a legal perspective.

PubMed

Ahmadiani, Saeed; Nikfar, Shekoufeh

2016-05-04

The right to health as a basic human right- and access to medicine as a part of it- have been a matter of attention for several decades. Also the responsibilities of different parties- particularly pharmaceutical companies- in realization of this right has been emphasized by World Health Organization. This is while many companies find no incentive for research and development of medicines related to rare diseases. Also some legal structures such as "patent agreements" clearly cause huge difficulties for access to medicine in many countries. High prices of brand medicine and no legal production of generics can increase the catastrophic costs- as well as morbidity-mortality of medication in lower income countries. Here we evidently review the current challenges in access to medicine and critically assess its legal roots. How societies/governors can make the pharmaceutical companies responsible is also discussed to have a look on possible future and actions that policy makers- in local or global level- can take.

Abortion and maternal mortality in the developing world.

PubMed

Okonofua, Friday

2006-11-01

Unsafe abortion is an important public health problem, accounting for 13% of maternal mortality in developing countries. Of an estimated annual 70,000 deaths from unsafe abortion worldwide, over 99% occur in the developing countries of sub-Saharan Africa, Central and Southeast Asia, and Latin America and the Caribbean. Factors associated with increased maternal mortality from unsafe abortion in developing countries include inadequate delivery systems for contraception needed to prevent unwanted pregnancies, restrictive abortion laws, pervading negative cultural and religious attitudes towards induced abortion, and poor health infrastructures for the management of abortion complications. The application of a public health approach based on primary, secondary, and tertiary prevention can reduce morbidity and mortality associated with unsafe abortion in developing countries. Primary prevention includes the promotion of increased use of contraception by women (and by men) at risk for unwanted pregnancy; secondary prevention involves the liberalization of abortion laws and the development of programs to increase access to safe abortion care in developing countries. In contrast, tertiary prevention includes the integration and institutionalization of post-abortion care for incomplete abortion and the early and appropriate treatment of more severe complications of abortion. Efforts to address these problems will contribute both to reducing maternal mortality associated with induced abortion and to achieving the Millennium Development Goals in developing countries.

Health indicators and human development in the Arab region

PubMed Central

Boutayeb, Abdesslam; Serghini, Mansour

2006-01-01

Background The present paper deals with the relationship between health indicators and human development in the Arab region. Beyond descriptive analysis showing geographic similarities and disparities inter countries, the main purpose is to point out health deficiencies and to propose pragmatic strategies susceptible to improve health conditions and consequently enhance human development in the Arab world. Methods Data analysis using Principal Components Analysis is used to compare the achievements of the Arab countries in terms of direct and indirect health indicators. The variables (indicators) are seen to be well represented on the circle of correlation, allowing for interesting interpretation and analysis. The 19 countries are projected on the first and second plane respectively. Results The results given by the present analysis give a good panorama of the Arab countries with their geographic similarities and disparities. The high correlation between health indicators and human development is well illustrated and consequently, countries are classified by groups having similar human development. The analysis shows clearly how health deficits are impeding human development in the majority of Arab countries and allows us to formulate suggestions to improve health conditions and enhance human development in the Arab World. Discussion The discussion is based on the link between different direct and indirect health indicators and the relationship between these indicators and human development index. Without including the GDP indicator, our analysis has shown that the 19 Arab countries may be classified, independently of their geographic proximity, in three different groups according to their global human development level (Low, Medium and High). Consequently, while identifying health deficiencies in each group, the focus was made on the countries presenting a high potential of improvement in health indicators. In particular, maternal mortality and infant mortality which are really challenging health authorities of the first and third group were critically discussed. Conclusion The Arab countries have made substantial economic and social progress during the last decades by improving life expectancy and reducing maternal and infant mortality. However, considering its natural wealth and human resources, the Arab region has accomplished less than expected in terms of human development. Huge social inequalities and health inequities exist inter and intra Arab countries. In most Arab countries, a large percentage of populations, especially in rural areas, are deprived of access to health facilities. Consequently, many women still die during pregnancy and labour, yielding unacceptable levels of maternal and infant mortality. However, the problem is seen to be more complex, going beyond geography and technical accessibility to health care, it compasses, among others, levels of literacy, low social and economic status of women, qualification of health staff, general behaviour and interactions between patients and medical personnel (including corruption). PMID:17194309

Give your heart a workout

MedlinePlus

... mph Hiking uphill Cross-country skiing Stair climbing Soccer Jogging Jumping rope Tennis (singles) Basketball Heavy yard ... us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National ...

International comparisons of disparities in access to care for people with mental health conditions.

PubMed

Corscadden, Lisa; Callander, Emily J; Topp, Stephanie M

2018-06-21

Relatively little is known about experiences of barriers in access to overall care for people with mental health conditions (MHCs), or disparities between people with and without MHCs, or how patterns vary across countries. The 2016 Commonwealth Fund International Health Policy Survey of adults was used to compare access barriers for people with MHCs across 11 countries, and disparities within countries between people with and without an MHC, using normalized scores. Disparities were also assessed by using multivariable models adjusting for age, sex, immigrant status, income, and self-rated health. On average, people with MHCs had a higher prevalence of barriers, with a gap of 7 percentage points between people with and without MHCs. The gap ranged from 5 to 9% across countries. For people with an MHC, the most common access barriers were skipping care due to cost (26%) and receiving conflicting information from providers (26%). For all countries, having an MHC was associated with higher odds of experiencing barriers of access to care on several measures, with at least 1 case where the adjusted odds were greater than 2. There is an imperative to improve monitoring of access to overall health care for people with MHCs and an opportunity learn from countries with fewer barriers and disparities in access to care. Copyright © 2018 John Wiley & Sons, Ltd.

Can developing countries leapfrog the centralized electrification paradigm?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levin, Todd; Thomas, Valerie M.

Due to the rapidly decreasing costs of small renewable electricity generation 'systems, centralized power systems are no longer a necessary condition of universal access to modern energy services. Developing countries, where centralized electricity infrastructures are less developed, may be able to adopt these new technologies more quickly. We first review the costs of grid extension and distributed solar home systems (SHSs) as reported by a number of different studies. We then present a general analytic framework for analyzing the choice between extending the grid and implementing distributed solar home systems. Drawing upon reported grid expansion cost data for three specificmore » regions, we demonstrate this framework by determining the electricity consumption levels at which the costs of provision through centralized and decentralized approaches are equivalent in these regions. We then calculate SHS capital costs that are necessary for these technologies provide each of five tiers of energy access, as defined by the United Nations Sustainable Energy for All initiative. Our results suggest that solar home systems can play an important role in achieving universal access to basic energy services. The extent of this role depends on three primary factors: SHS costs, grid expansion costs, and centralized generation costs. Given current technology costs, centralized systems will still be required to enable higher levels of consumption; however, cost reduction trends have the potential to disrupt this paradigm. By looking ahead rather than replicating older infrastructure styles, developing countries can leapfrog to a more distributed electricity service model. (C) 2016 International Energy Initiative. Published by Elsevier Inc. All rights reserved.« less

An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study.

PubMed

Choi, Bernard C K

2005-10-01

An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program. The objective was to compare the issues, risk factors, social determinants, and challenges in women's occupational health, according to the status of economic development as defined by the World Bank. Data were collected through 27 key informant interviews of high-ranking government officials and senior researchers, self-administered questionnaires on country or regional statistics and 16 courtesy calls. Results indicated that women's occupational health problems common in these countries or regions included women's long hours of work (double workday), shift work and a caring role for family and friends. Problems reported in developing countries but not developed countries included poor access to training and protective equipment, and insufficient legislation to protect women's rights. Problems reported in developed countries but not in developing countries included obesity, smoking and not including women in health research. This paper provides insights into the changing environment in the workplace, such as increasing participation of women in the paid workforce and changes in gender differences due to the changing country economy, for improving women's occupational health.

American Security and the International Energy Situation. Volume 4. Collected Papers

DTIC Science & Technology

1975-04-15

piograms as jet engine sales Wheat shipments may permit the Soviets to keep chemical industries onenled l.siim.«,, ,1 Pi.l.vs.., I...security and economic interde- pendence among Western advanced industrialized countries. Periodic con- flicts have been replaced by a "security... industrialized countries, creating an "interpenetration of econ- omies." Each development affects the dimensions of the access-to- resources

Enhancing medicine price transparency through price information mechanisms

PubMed Central

2014-01-01

Background Medicine price information mechanisms provide an essential tool to countries that seek a better understanding of product availability, market prices and price compositions of individual medicines. To be effective and contribute to cost savings, these mechanisms need to consider prices in their particular contexts when comparing between countries. This article discusses in what ways medicine price information mechanisms can contribute to increased price transparency and how this may affect access to medicines for developing countries. Methods We used data collected during the course of a WHO project focusing on the development of a vaccine price and procurement information mechanism. The project collected information from six medicine price information mechanisms and interviewed data managers and technical experts on key aspects as well as observed market effects of these mechanisms. The reviewed mechanisms were broken down into categories including objective and target audience, as well as the sources, types and volumes of data included. Information provided by the mechanisms was reviewed according to data available on medicine prices, product characteristics, and procurement modalities. Results We found indications of positive effects on access to medicines resulting from the utilization of the reviewed mechanisms. These include the uptake of higher quality medicines, more favorable results from contract negotiations, changes in national pricing policies, and the decrease of prices in certain segments for countries participating in or deriving data from the various mechanisms. Conclusion The reviewed mechanisms avoid the methodological challenges observed for medicine price comparisons that only use national price databases. They work with high quality data and display prices in the appropriate context of procurement modalities as well as the peculiarities of purchasing countries. Medicine price information mechanisms respond to the need for increased medicine price transparency and have the potential to contribute to improved access to medicines in developing countries. Additional research is required to explore more specific aspects. These include the market effects of dedicated donor funds for certain medicines to explain the driving force of user demands, and the effects of increased price transparency on different groups of medicines in context of the maturity of their markets. PMID:24885767

Enhancing medicine price transparency through price information mechanisms.

PubMed

Hinsch, Michael; Kaddar, Miloud; Schmitt, Sarah

2014-05-08

Medicine price information mechanisms provide an essential tool to countries that seek a better understanding of product availability, market prices and price compositions of individual medicines. To be effective and contribute to cost savings, these mechanisms need to consider prices in their particular contexts when comparing between countries. This article discusses in what ways medicine price information mechanisms can contribute to increased price transparency and how this may affect access to medicines for developing countries. We used data collected during the course of a WHO project focusing on the development of a vaccine price and procurement information mechanism. The project collected information from six medicine price information mechanisms and interviewed data managers and technical experts on key aspects as well as observed market effects of these mechanisms.The reviewed mechanisms were broken down into categories including objective and target audience, as well as the sources, types and volumes of data included. Information provided by the mechanisms was reviewed according to data available on medicine prices, product characteristics, and procurement modalities. We found indications of positive effects on access to medicines resulting from the utilization of the reviewed mechanisms. These include the uptake of higher quality medicines, more favorable results from contract negotiations, changes in national pricing policies, and the decrease of prices in certain segments for countries participating in or deriving data from the various mechanisms. The reviewed mechanisms avoid the methodological challenges observed for medicine price comparisons that only use national price databases. They work with high quality data and display prices in the appropriate context of procurement modalities as well as the peculiarities of purchasing countries. Medicine price information mechanisms respond to the need for increased medicine price transparency and have the potential to contribute to improved access to medicines in developing countries.Additional research is required to explore more specific aspects. These include the market effects of dedicated donor funds for certain medicines to explain the driving force of user demands, and the effects of increased price transparency on different groups of medicines in context of the maturity of their markets.

HIV vaccines: current challenges and future directions.

PubMed

Avrett, Sam; Collins, Chris

2002-07-01

Volume seven of the Review will mark the tenth anniversary of the Canadian HIV/AIDS Legal Network with a series of articles that describe past developments and future directions in several areas of policy and law related to HIV/AIDS. The following article is the first of these, discussing current challenges and future directions in the development of and access to HIV vaccines. It argues that governments are under public health, ethical, and legal obligations to develop and provide access to HIV vaccines. It further explains what is required for governments to fulfill their obligations: additional commitment and resources for HIV vaccine development in the context of increased global research and development regarding diseases of the poor; increased support and advocacy for partnerships to develop HIV vaccines; enhanced regulatory capacity in every country to review, approve, and monitor HIV vaccines; and assurance of global supply of, procurement of, delivery of, and access to vaccines in the context of efforts to increase global access to public health measures and technologies.

Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya.

PubMed

Janisch, C P; Albrecht, M; Wolfschuetz, A; Kundu, F; Klein, S

2010-01-01

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.

Housing Quality and Access to Material and Learning Resources within the Home Environment in Developing Countries

PubMed Central

Bradley, Robert H.; Putnick, Diane L.

2011-01-01

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. PMID:22277008

"Capital Cities Centrism" as the Cause of Social Inequality in the Russian System of Higher Education

ERIC Educational Resources Information Center

Latova, N. V.; Latov, Iu. V.

2013-01-01

Social inequality in access to superior quality higher education in Russia is due to the unequal development of the regions of Russia. The country's two biggest cities and the areas adjacent to them account for a quarter of Russia's infrastructure that offers young people an access to a higher education. The regional colleges and universities in…

Evaluating Decoupling Process in OECD Countries: Case Study of Turkey

NASA Astrophysics Data System (ADS)

An, Nazan; Şengün Ucal, Meltem; Kurnaz, M. Levent

2017-04-01

Climate change is at the top of the present and future problems facing humanity. Climate change is now largely attributed to human activities and economic activities are the source of human activities that cause climate change by creating pressure on the environment. Providing the sustainability of resources for the future seems possible by reducing the pressure of these economic activities on the environment. Given the increasing population pressure and growth-focused economies, it is possible to say that achieving decoupling is not so easy on a global basis. It is known that there are some problems in developing countries especially in terms of accessing reliable data in transition and implementation process of decoupling. Developed countries' decoupling practices and proper calculation methods can also be a guide for developing countries. In this study, we tried to calculate the comparative decoupling index for OECD countries and Turkey in terms of data suitability, and we showed the differences between them. We tried to indicate the level of decoupling (weak, stable, strong) for each country. We think that the comparison of Turkey can be an example in terms of developing countries. Acknowledgement: This research has been supported by Bogazici University Research Fund Grant Number 12220.

Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

PubMed Central

Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

2017-01-01

ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. PMID:28146177

Analysing inter-relationships among water, governance, human development variables in developing countries

NASA Astrophysics Data System (ADS)

Dondeynaz, C.; Carmona Moreno, C.; Céspedes Lorente, J. J.

2012-10-01

The "Integrated Water Resources Management" principle was formally laid down at the International Conference on Water and Sustainable development in Dublin 1992. One of the main results of this conference is that improving Water and Sanitation Services (WSS), being a complex and interdisciplinary issue, passes through collaboration and coordination of different sectors (environment, health, economic activities, governance, and international cooperation). These sectors influence or are influenced by the access to WSS. The understanding of these interrelations appears as crucial for decision makers in the water sector. In this framework, the Joint Research Centre (JRC) of the European Commission (EC) has developed a new database (WatSan4Dev database) containing 42 indicators (called variables in this paper) from environmental, socio-economic, governance and financial aid flows data in developing countries. This paper describes the development of the WatSan4Dev dataset, the statistical processes needed to improve the data quality, and finally, the analysis to verify the database coherence is presented. Based on 25 relevant variables, the relationships between variables are described and organised into five factors (HDP - Human Development against Poverty, AP - Human Activity Pressure on water resources, WR - Water Resources, ODA - Official Development Aid, CEC - Country Environmental Concern). Linear regression methods are used to identify key variables having influence on water supply and sanitation. First analysis indicates that the informal urbanisation development is an important factor negatively influencing the percentage of the population having access to WSS. Health, and in particular children's health, benefits from the improvement of WSS. Irrigation is also enhancing Water Supply service thanks to multi-purpose infrastructure. Five country profiles are also created to deeper understand and synthetize the amount of information gathered. This new classification of countries is useful in identifying countries with a less advanced position and weaknesses to be tackled. The relevance of indicators gathered to represent environmental and water resources state is questioned in the discussion section. The paper concludes with the necessity to increase the reliability of current indicators and calls for further research on specific indicators, in particular on water quality at national scale, in order to better include environmental state in analysis to WSS.

You Have to Be a Servant of All: Melanesian Women's Educational Leadership Experiences

ERIC Educational Resources Information Center

Strachan, Jane; Akao, Shalom; Kilavanwa, Bessie; Warsal, Daisy

2010-01-01

This article presents findings from research on women's educational leadership experiences in Melanesia, a least developed part of the world. Specific context research is needed so that theories and strategies developed that help women access educational leadership in developing countries are grounded in grassroots experience. (Contains 4 notes.)

In the Shadow of the Durand Line: Security, Stability, and the Future of Pakistan and Afghanistan

DTIC Science & Technology

2009-06-01

130 From: “Balchistan: Terrorist Related Incidents,” http://satp.org/satporgtp/countries/pakistan/ Balochistan /index.html (accessed Apr 1, 2009...satporgtp/countries/pakistan/ Balochistan /index.html (accessed Apr 2, 2009). 59 60 and has over the years clearly operated covertly and overtly in...satporgtp/countries/pakistan/ Balochistan /index.html (accessed Apr 2, 2009). Balchistan: Terrorist Related Incidents. South Asian Terrorism Portal

E-Learning and North-South collaboration: the experience of two public health schools in France and Benin.

PubMed

Edouard, Guévart; Dominique, Billot; Moussiliou, Paraïso Noël; Francis, Guillemin; Khaled, Bessaoud; Serge, Briançon

2009-10-14

Distance learning (e-learning) can facilitate access to training. Yet few public health E-learning experiments have been reported; institutes in developing countries experience difficulties in establishing on-line curricula, while developed countries struggle with adapting existing curricula to realities on the ground. In 2005, two schools of public health, one in France and one in Benin, began collaborating through contact sessions organised for Nancy University distance-learning students. This experience gave rise to a partnership aimed at developing training materials for e-Learning for African students. The distance-learning public health course at Nancy teaches public health professionals through a module entitled "Health and Development." The module is specifically tailored for professionals from developing countries. To promote student-teacher exchanges, clarify content and supervise dissertations, contact sessions are organized in centres proximate and accessible to African students. The Benin Institute's main feature is residential team learning; distance-learning courses are currently being prepared. The two collaborating institutions have developed a joint distance-learning module geared toward developing countries. The collaboration provides for the development, diffusion, and joint delivery of teaching modules featuring issues that are familiar to African staff, gives the French Institute credibility in assessing research work produced, and enables modules on specific African issues and approaches to be put online. While E-learning is a viable educational option for public health professionals, periodic contact can be advantageous. Our analysis showed that the benefit of the collaboration between the two institutions is mutual; the French Institute extends its geographical, cultural and contextual reach and expands its pool of teaching staff. The Benin Institute benefits from the technical partnership and expertise, which allow it to offer distance learning for Africa-specific contexts and applications.

Safe drinking water production in rural areas: a comparison between developed and less developed countries.

PubMed

Cotruvo, J A; Trevant, C

2000-01-01

At the fundamental level, there are remarkable parallels between developed and less developed countries in problems of providing safe drinking water in rural areas, but of course, they differ greatly in degree and in the opportunities for resolution. Small water supplies frequently encounter difficulty accessing sufficient quantities of drinking water for all domestic uses. If the water must be treated for safety reasons, then treatment facilities and trained operating personnel and finances are always in short supply. Ideally, each solution should be sustainable within its own cultural, political and economic context, and preferably with local personnel and financial resources. Otherwise, the water supply will be continuously dependent on outside resources and thus will not be able to control its destiny, and its future will be questionable. The history of success in this regard has been inconsistent, particularly in less developed but also in some developed countries. The traditional and ideal solution in developing countries has been central water treatment and a piped distribution network, however, results have had a mixed history primarily due to high initial costs and operation and maintenance, inadequate access to training, management and finance sufficient to support a fairly complex system for the long term. These complete systems are also slow to be implemented so waterborne disease continues in the interim. Thus, non-traditional, creative, cost-effective practical solutions that can be more rapidly implemented are needed. Some of these options could involve: small package central treatment coupled with non piped distribution, e.g. community supplied bottled water; decentralized treatment for the home using basic filtration and/or disinfection; higher levels of technology to deal with chemical contaminants e.g. natural fluoride or arsenic. These technological options coupled with training, technical support and other essential elements like community commitment provide opportunities that should be explored both for rural small communities and in rapidly growing periurban areas in developing countries.

Vaccines: Shaping global health.

PubMed

Pagliusi, Sonia; Ting, Ching-Chia; Lobos, Fernando

2017-03-14

The Developing Countries Vaccine Manufacturers' Network (DCVMN) gathered leaders in immunization programs, vaccine manufacturing, representatives of the Argentinean Health Authorities and Pan American Health Organization, among other global health stakeholders, for its 17th Annual General Meeting in Buenos Aires, to reflect on how vaccines are shaping global health. Polio eradication and elimination of measles and rubella from the Americas is a result of successful collaboration, made possible by timely supply of affordable vaccines. After decades of intense competition for high-value markets, collaboration with developing countries has become critical, and involvement of multiple manufacturers as well as public- and private-sector investments are essential, for developing new vaccines against emerging infectious diseases. The recent Zika virus outbreak and the accelerated Ebola vaccine development exemplify the need for international partnerships to combat infectious diseases. A new player, Coalition for Epidemic Preparedness Innovations (CEPI) has made its entrance in the global health community, aiming to stimulate research preparedness against emerging infections. Face-to-face panel discussions facilitated the dialogue around challenges, such as risks of viability to vaccine development and regulatory convergence, to improve access to sustainable vaccine supply. It was discussed that joint efforts to optimizing regulatory pathways in developing countries, reducing registration time by up to 50%, are required. Outbreaks of emerging infections and the global Polio eradication and containment challenges are reminders of the importance of vaccines' access, and of the importance of new public-private partnerships. Copyright © 2017.

Access to Essential Medicines in Pakistan: Policy and Health Systems Research Concerns

PubMed Central

Zaidi, Shehla; Bigdeli, Maryam; Aleem, Noureen; Rashidian, Arash

2013-01-01

Introduction Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns. Methods An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder’s Roundtable. Findings A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review. Conclusion Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda. PMID:23717442

Housing quality and access to material and learning resources within the home environment in developing countries.

PubMed

Bradley, Robert H; Putnick, Diane L

2012-01-01

This study examined home environment conditions (housing quality, material resources, formal and informal learning materials) and their relations with the Human Development Index (HDI) in 28 developing countries. Home environment conditions in these countries varied widely. The quality of housing and availability of material resources at home were consistently tied to HDI; the availability of formal and informal learning materials a little less so. Gross domestic product (GDP) tended to show a stronger independent relation with housing quality and material resources than life expectancy and education. Formal learning resources were independently related to the GDP and education indices, and informal learning resources were not independently related to any constituent indices of the overall HDI. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

Measurement of the dimensions of food insecurity in developed countries: a systematic literature review.

PubMed

Ashby, Stephanie; Kleve, Suzanne; McKechnie, Rebecca; Palermo, Claire

2016-11-01

Food insecurity is a salient health issue comprised of four dimensions - food access, availability, utilization and stability over time. The aim of the present study was to conduct a systematic literature review to identify all multi-item tools that measure food insecurity and explore which of the dimensions they assess. Five databases were searched (CENTRAL, CINAHL plus, EMBASE, MEDLINE, TRIP) for studies published in English since 1999. Inclusion criteria included human studies using multi-item tools to measure food security and studies conducted in developed countries. Manuscripts describing the US Department of Agriculture Food Security Survey Module, that measures 'food access', were excluded due to wide acceptance of the validity and reliability of this instrument. Two authors extracted data and assessed the quality of the included studies. Data were summarized against the dimensions of food insecurity. A systematic review of the literature. The majority of tools were developed in the USA and had been used in different age groups and cultures. Eight multi-item tools were identified. All of the tools assessed the 'food access' dimension and two partially assessed the dimensions 'food utilization' and 'stability over time', respectively. 'Food availability' was not assessed by existing tools. Current tools available for measuring food insecurity are subjective, limited in scope, with a majority assessing only one dimension of food insecurity (access). To more accurately assess the true burden of food insecurity, tools should be adapted or developed to assess all four dimensions of food insecurity.

Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

PubMed Central

Akande, Tokunbo; Shankar, Anita V.; McIntire, Katherine N.; Gounder, Celine R.; Gupta, Amita; Yang, Wei-Teng

2014-01-01

Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services. PMID:24900921

Advancing Migrant Access to Health Services in Europe (AMASE): Protocol for a Cross-sectional Study

PubMed Central

Álvarez-del Arco, Débora; Monge, Susana; Copas, Andrew J; Gennotte, Anne-Francoise; Volny-Anne, Alain; Göpel, Siri; Touloumi, Giota; Prins, Maria; Barros, Henrique; Staehelin, Cornelia; del Amo, Julia; Burns, Fiona M

2016-01-01

Background Migrants form a substantial proportion of the population affected by the human immunodeficiency virus (HIV) epidemic in Europe, yet HIV prevention for this population is hindered by poor understanding of access to care and of postmigration transmission dynamics. Objective We present the design and methods of the advancing Migrant Access to health Services in Europe (aMASE) study, the first European cross-cultural study focused on multiple migrant populations. It aims to identify the structural, cultural, and financial barriers to HIV prevention, diagnosis, and treatment and to determine the likely country of HIV acquisition in HIV-positive migrant populations. Methods We delivered 2 cross-sectional electronic surveys across 10 countries (Belgium, France, Germany, Greece, Italy, the Netherlands, Portugal, Spain, Switzerland, and United Kingdom). A clinic survey aimed to recruit up to 2000 HIV-positive patients from 57 HIV clinics in 9 countries. A unique study number linked anonymized questionnaire data to clinical records data (viral loads, CD4 cell counts, viral clades, etc). This questionnaire was developed by expert panel consensus and cognitively tested, and a pilot study was carried out in 2 countries. A Web-based community survey (n=1000) reached those living with HIV but not currently accessing HIV clinics, as well as HIV-negative migrants. It was developed in close collaboration with a community advisory group (CAG) made up of representatives from community organizations in 9 of the participating countries. The CAG played a key role in data collection by promoting the survey to higher-risk migrant groups (sub-Saharan Africans, Latin Americans, men who have sex with men, and people who inject drugs). The questionnaires have considerable content overlap, allowing for comparison. Questions cover ethnicity, migration, immigration status, HIV testing and treatment, health-seeking behavior, sexual risk, and drug use. The electronic questionnaires, which were available in 15 languages, allowed for complex routing, preventing respondents from answering irrelevant questions. Results In total, we recruited 2249 participants from 57 HIV clinics as part of the clinic survey and retrieved 1637 complete responses as part of the community survey. Conclusions The findings will provide much-needed information for improving HIV prevention interventions and access to services for migrant communities. PMID:27185491

A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals.

PubMed

Ahmadi, Maryam; Khorrami, Farid; Dehnad, Afsaneh; Golchin, Mohammad H; Azad, Mohsen; Rahimi, Shafei

2018-01-01

The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations. The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran. All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level. We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)). A study of barriers to the use of managers of HIS in hospitals is suggested.

Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

PubMed

Burger, Nicholas E; Kopf, Daniel; Spreng, Connor P; Yoong, Joanne; Sood, Neeraj

2012-01-01

Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility.

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

PubMed Central

Burger, Nicholas E.; Kopf, Daniel; Spreng, Connor P.; Yoong, Joanne; Sood, Neeraj

2012-01-01

Background Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. Conclusions/Significance The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to finance when they have the business processes in place for operating a successful business and health facility. PMID:22383944

Presence of nursing information on hospital websites in five countries: a review.

PubMed

Chen, L L; Liu, Y L

2010-06-01

The aims of this study were to (1) examine the presence of nursing information on 50 hospital websites across five countries; (2) describe the accessibility, range and depth of nursing information provided; and (3) compare the characteristics of nursing web information across the countries. Providing information on hospital website is an increasingly popular strategy for marketing hospital services, and it has been playing unique and important roles for nursing. So far, the nursing information offered via hospital websites is not uncommon worldwide, but the amount, content and form of such information presented by the institutions of different countries have not been examined systematically. Objective sampling was employed to select 50 top hospital websites from five countries, with ten for each geographical region, namely, Australia (Oceania), China (Asia), South Africa (Africa), UK (Europe) and the USA (North America). A self-developed checklist was used to examine the presence of nursing information on the above-mentioned hospital websites. The most frequently presented information on the hospital websites was nursing employment (job placement), nursing education, and news and events concerning the nursing profession, but information about other aspects of nursing was relatively lacking. The hospital websites in the USA and Australia provided more information as compared with those in China and the UK. Nursing information was almost unavailable on hospital websites in South Africa. Although the accessibility of nursing-related information has been improved, the presence of nursing information was not strong on the hospital websites across the five countries. The nursing information presented on hospital websites varied with different countries. Efforts have to be made to improve the presence and accessibility of nursing information. Information about the nursing services, professional image of nurses and nursing employment should be enhanced.

Challenges in the management of breast cancer in low- and middle-income countries.

PubMed

Yip, Cheng-Har; Taib, Nur Aishah

2012-12-01

The incidence of breast cancer is rising in low- and middle-income countries (LMICs) due to 'westernization' of risk factors for developing breast cancer. However, survival remains low because of barriers in early detection and optimal access to treatment, which are the two main determinants of breast cancer outcome. A multidisciplinary approach to treatment gives the best results. An accurate diagnosis is dependent on a reliable pathology service, which will provide an adequate pathology report with prognostic and predictor information to allow optimal oncological treatment. Stratification of clinical practice guidelines based on resource level will ensure that women will have access to treatment even in a low-resource setting. Advocacy and civil society play a role in galvanizing the political will required to meet the challenge of providing opportunities for breast cancer control in LMICs. Collaboration between high-income countries and LMICs could be a strategy in facing these challenges.

Affordable antiretroviral drugs for the under-served markets: how to expand equitable access against the backdrop of challenging scenarios?

PubMed

Dionisio, Daniele; Cao, Yunzhen; Hongzhou, Lu; Kraisintu, Krisana; Messeri, Daniela

2006-01-01

Threats by enforced Intellectual Property (IP) rights to equitable HIV treatment access by poor populations are impending. India and China's policy directions in the field will be crucial in ultimately affecting the affordability and accessibility of antiretroviral (ARV) therapy in the under-served markets. These directions, together with the exploitation level of IP-bound flexibilities and the evolutionary modelling in partnerships and trade agreements between research-based and generic pharmaceutical industry, will also affect the outcomes of self-sufficiency efforts now at their beginning in the developing world as far as domestic manufacturing of generic ARV drugs is concerned. This paper explores key issues, implications and interaction dynamics across these challenging scenarios while attempting to provide equitable solution glimpses into the near future. Access-oriented long-term drug policy strategies entitled to pass muster of governments, research-based as well as generic industries in both developed and developing countries are needed if equitable access to affordable ARV treatments by poor people has to be achieved despite enforced IP rights. Predictable dynamics between western multinationals and transitional country generic corporations let regard IP-bound Voluntary License flexibilities as a fitting measure into just mentioned needs especially if substantial incentives to generic corporations are concurrently secured. Efforts to equitably expand ARV drug access through exploiting IP opportunities should encompass attainment of self-sufficiency in domestic drug manufacturing whenever basic requirements are in place in the developing world as a whole. A credible industrial potential would act, indeed, as a boosting factor for drawing branded drug producers into technology transfer agreements, the terms of which would let all contractors enjoy substantial advantages. These perspectives consistently bind up with the foreseeable long-term trade and drug policy directions of India and China according to frontier crossing implications of their key IP management trends as well as their multifaceted penetration strategies of both the wealthy and under-served markets worldwide. As coherent with these perspectives, more disbursement by wealthy country governments and donors to basic infrastructure development in sub-Saharan African nations with stable governments in place is urged both as a priority for improving Africa's economy and a prerequisite for allowing domestic industrial plants to take off. Aiming at the targets just underscored, WHO's brokering role in negotiated agreements between wealthy and developing country-based firms as well as its technical guidance in setting international standards have always to be sought if equitable and appropriate end results are to be attained. Overall insights in this paper would mean that, while research-based corporations are to be praised whenever waiving, on humanitarian purposes, part of their profits, the trade and profit rules cannot basically be given up if long-term sustainable results are the goal to look for. Only negotiated agreements securing all contracting parties lasting advantages may ensure shifting of such a goal from mere vision to a really sustainable attainment.

Access to timely formal dementia care in Europe: protocol of the Actifcare (ACcess to Timely Formal Care) study.

PubMed

Kerpershoek, Liselot; de Vugt, Marjolein; Wolfs, Claire; Jelley, Hannah; Orrell, Martin; Woods, Bob; Stephan, Astrid; Bieber, Anja; Meyer, Gabriele; Engedal, Knut; Selbaek, Geir; Handels, Ron; Wimo, Anders; Hopper, Louise; Irving, Kate; Marques, Maria; Gonçalves-Pereira, Manuel; Portolani, Elisa; Zanetti, Orazio; Verhey, Frans

2016-08-23

Previous findings indicate that people with dementia and their informal carers experience difficulties accessing and using formal care services due to a mismatch between needs and service use. This mismatch causes overall dissatisfaction and is a waste of the scarce financial care resources. This article presents the background and methods of the Actifcare (ACcess to Timely Formal Care) project. This is a European study aiming at best-practice development in finding timely access to formal care for community-dwelling people with dementia and their informal carers. There are five main objectives: 1) Explore predisposing and enabling factors associated with the use of formal care, 2) Explore the association between the use of formal care, needs and quality of life and 3) Compare these across European countries, 4) Understand the costs and consequences of formal care services utilization in people with unmet needs, 5) Determine the major costs and quality of life drivers and their relationship with formal care services across European countries. In a longitudinal cohort study conducted in eight European countries approximately 450 people with dementia and informal carers will be assessed three times in 1 year (baseline, 6 and 12 months). In this year we will closely monitor the process of finding access to formal care. Data on service use, quality of life and needs will be collected. The results of Actifcare are expected to reveal best-practices in organizing formal care. Knowledge about enabling and predisposing factors regarding access to care services, as well as its costs and consequences, can advance the state of the art in health systems research into pathways to dementia care, in order to benefit people with dementia and their informal carers.

Assistive technology in developing countries: a review from the perspective of the Convention on the Rights of Persons with Disabilities.

PubMed

Borg, Johan; Lindström, Anna; Larsson, Stig

2011-03-01

The 'Convention on the Rights of Persons with Disabilities' (CRPD) requires governments to meet the assistive technology needs of citizens. However, the access to assistive technology in developing countries is severely limited, which is aggravated by a lack of related services. To summarize current knowledge on assistive technology for low- and lower-middle-income countries published in 1995 or later, and to provide recommendations that facilitate implementation of the CRPD. Literature review. Literature was searched in web-based databases and reference lists. Studies carried out in low- and lower-middle-income countries, or addressing assistive technology for such countries, were included. The 52 included articles are dominated by product oriented research on leg prostheses and manual wheelchairs. Less has been published on hearing aids and virtually nothing on the broad range of other types of assistive technology. To support effective implementation of the CRPD in these countries, there is a need for actions and research related particularly to policies, service delivery, outcomes and international cooperation, but also to product development and production. The article has a potential to contribute to CRPD compliant developments in the provision of assistive technology in developing countries by providing practitioners with an overview of published knowledge and researchers with identified research needs.

[Clinical trials in developing countries: who should define ethics?].

PubMed

Béréterbide, F; Hirsch, F

2008-04-01

Many clinical trials have proved much more difficult to implement in developing countries than in the Northern countries if not totally impossible. Should we therefore just observe this situation and approve a "double ethical standard"? Clinical trials in developing countries are also a means for volunteers to have access to medical care, therefore how could the process of informed consent keep its significance? In this context, should the participation in clinical trials be restricted or even stopped? If so, we would thus justify the superiority of an international duty of charity compared with the right of autonomy of these populations. This theoretical analysis cannot be precisely justified. On the contrary, it reveals that while informed consent, international organisations and guidelines have the tendency to play a major role in this debate, local ethics committee are too absent although they represent the more relevant and legitimate discussion partners in this dilemma.

Breast health in developing countries.

PubMed

Yip, C H; Taib, N A

2014-12-01

Breast cancer is one of the leading cancers world-wide. While the incidence in developing countries is lower than in developed countries, the mortality is much higher. Of the estimated 1 600 000 new cases of breast cancer globally in 2012, 794 000 were in the more developed world compared to 883 000 in the less developed world; however, there were 198 000 deaths in the more developed world compared to 324 000 in the less developed world (data from Globocan 2012, IARC). Survival from breast cancer depends on two main factors--early detection and optimal treatment. In developing countries, women present with late stages of disease. The barriers to early detection are physical, such as geographical isolation, financial as well as psychosocial, including lack of education, belief in traditional medicine and lack of autonomous decision-making in the male-dominated societies that prevail in the developing world. There are virtually no population-based breast cancer screening programs in developing countries. However, before any screening program can be implemented, there must be facilities to treat the cancers that are detected. Inadequate access to optimal treatment of breast cancer remains a problem. Lack of specialist manpower, facilities and anticancer drugs contribute to the suboptimal care that a woman with breast cancer in a low-income country receives. International groups such as the Breast Health Global Initiative were set up to develop economically feasible, clinical practice guidelines for breast cancer management to improve breast health outcomes in countries with limited resources.

Sri Lanka's national assessment on innovation and intellectual property for access to medical products.

PubMed

Beneragama, Hemantha; Shridhar, Manisha; Ranasinghe, Thushara; Dissanayake, Vajira Hw

2016-09-01

In 2008, the Global strategy and plan of action on public health, innovation and intellectual property (GSPA-PHI) was launched by the World Health Organization, to stimulate fresh thinking on innovation in, and access to, medicines and to build sustainable research on diseases disproportionately affecting low- and middle-income countries. As part of the activities of the GSPA-PHI, Sri Lanka has been the first country to date to assess the national environment for medical technology and innovation. This year-long, multistakeholder, participative analysis facilitated identification of clear and implementable policy recommendations, for the government to increase its effectiveness in promoting innovation in health products through institutional development, investment and coordination among all areas relevant to public health. The assessment also highlighted areas for priority action, including closing the technology gap in development of health products, facilitating technology transfer, and building the health-research and allied workforces. The Sri Lankan experience will inform the ongoing independent external evaluation of the GSPA-PHI worldwide. The assessment process coincided with the passing of the National Medicines Regulatory Authority Act in 2015. In addition, there is growing recognition that regional cooperation will be critical to improving access to medical products in the future. Sri Lanka is therefore actively promoting cooperation to establish a regional regulatory affairs network. Lessons learnt from the Sri Lankan assessment may also benefit other countries embarking on a national GSPA-PHI assessment.

Analysis of prices paid by low-income countries - how price sensitive is government demand for medicines?

PubMed

Srivastava, Divya; McGuire, Alistair

2014-07-30

Access to medicines is an important health policy issue. This paper considers demand structures in a selection of low-income countries from the perspective of public authorities as the evidence base is limited. Analysis of the demand for medicines in low-income countries is critical for effective pharmaceutical policy where regulation is less developed, health systems are cash constrained and medicines are not typically subsidised by a public health insurance system This study analyses the demand for medicines in low-income countries from the perspective of the prices paid by public authorities. The analysis draws on a unique dataset from World Health Organization (WHO) and Health Action International (HAI) using 2003 data on procurement prices of medicines across 16 low-income countries covering 48 branded drugs and 18 therapeutic categories. Variation in prices, the mark-ups over marginal costs and estimation of price elasticities allows assessment of whether these elasticities are correlated with a country's national income. Using the Ramsey pricing rule, the study's findings suggest that substantial cross-country variation in prices and mark-ups exist, with price elasticities ranging from -1 to -2, which are weakly correlated with national income. Government demand for medicines thus appears to be price elastic, raising important policy implications aimed at improving access to medicines for patients in low-income countries.

The global drug gap.

PubMed

Reich, M R

2000-03-17

Global inequities in access to pharmaceutical products exist between rich and poor countries because of market and government failures as well as huge income differences. Multiple policies are required to address this global drug gap for three categories of pharmaceutical products: essential drugs, new drugs, and yet-to-be-developed drugs. Policies should combine "push" approaches of subsidies to support targeted drug development, "pull" approaches of financial incentives such as market guarantees, and "process" approaches aimed at improved institutional capacity. Constructive solutions are needed that can both protect the incentives for research and development and reduce the inequities of access.

Healthcare Information Systems for the epidemiologic surveillance within the community.

PubMed

Diomidous, Marianna; Pistolis, John; Mechili, Aggelos; Kolokathi, Aikaterini; Zimeras, Stelios

2013-01-01

Public health and health care are important issues for developing countries and access to health care is a significant factor that contributes to a healthy population. In response to these issues, the World Health Organization (WHO) has been working on the development of methods and models for measuring physical accessibility to health care using several layers of information integrated in a GIS. This paper describes the methodological approach for the development of a real time electronic health record, based on the statistical and geographic information for the identification of various diseases and accidents that can happen in a specific place.

Access to Strong Opioid Analgesics in the Context of Legal and Regulatory Barriers in Eleven Central and Eastern European Countries.

PubMed

Vranken, Marjolein J M; Mantel-Teeuwisse, Aukje K; Schutjens, Marie-Hélène D B; Scholten, Willem K; Jünger, Saskia; Medic, Dr Rer; Leufkens, Hubert G M

2018-04-06

In 2011-2013, >95% of the global opioid analgesics consumption occurred in three regions, accounting for 15% of the world population. Despite abundant literature on barriers to access, little is known on the correlation between actual access to opioid analgesics and barriers to access, including legal and regulatory barriers. This study aimed to evaluate the correlation between access to strong opioid analgesics and barriers to access in national legislation and regulations in 11 central and eastern European countries that participated in the Access to Opioid Medication in Europe (ATOME) project. Two variables were contrasted to assess their correlation: the country level of access to strong opioid analgesics indicated by the Adequacy of Consumption Measure (ACM) and the number of potential legal and regulatory barriers identified by an external review of legislation and regulations. A linear correlation was evaluated using a squared linear correlation coefficient. Evaluation of the correlation between the ACM and the number of potential barriers produces an R 2 value of 0.023 and a correlation plot trend line gradient of -0.075, indicating no correlation between access to strong opioid analgesics and the number of potential barriers in national legislation and regulations in the countries studied. No correlation was found, which indicates that other factors besides potential legal and regulatory barriers play a critical role in withholding prescribers and patients essential pain medication in the studied countries. More research is needed toward better understanding of the complex interplay of factors that determine access to strong opioid analgesics.

Contingent and Marginalised? Academic Development and Part-Time Teachers

ERIC Educational Resources Information Center

Anderson, Valerie

2007-01-01

Academics employed on non-standard contracts are a numerically significant part of the labour market in higher education. Concerns about access to formal academic development for this staff group have been articulated in many countries in the context of increasing emphasis on teaching quality assessment and employment regulation of…

Getting Inclusion Right in South Africa

ERIC Educational Resources Information Center

Walton, Elizabeth

2011-01-01

The years after the Second World War have seen many countries in the developed and developing world dismantle separate special education systems and promote the education of children with disabilities or other support needs in regular rather than separate classes. This process of increasing access and participation and reducing exclusionary…

Environmental--Access to Safe Water Learning Module. Development Education Program.

ERIC Educational Resources Information Center

World Bank, Washington, DC.

This learning module has two main goals: (1) to increase students' knowledge and understanding of the often complex relationship between sustainable development and the social, economic, and environmental conditions in a country; and (2) to strengthen students' ability to perform statistical calculations, make and interpret maps, charts, and…

Asia's Four Little Tigers: A Comparison of the Role of Education in Their Development.

ERIC Educational Resources Information Center

Morris, Paul

1996-01-01

In four rapidly developing east Asian nations, educational similarities include strong national curricula and highly competitive selective systems. However, the countries differ in educational funding sources; access to education, particularly tertiary education; extent of state control; relative emphasis on general and technical education; nature…

The Young Athletes Curriculum: Impact on Children with Disabilities in Kenya

ERIC Educational Resources Information Center

Favazza, Paddy C.; Siperstein, Gary N.; Ghio, Kathleen; Wairimu, Jane; Masila, Susan

2016-01-01

Research consistently demonstrates that children with developmental disabilities exhibit motor skill deficits, but motor skill interventions can positively affect motor abilities and other areas of development. These findings have particular relevance for children with disabilities in developing countries, where there is limited access to early…

The Indonesian Digital Library Network Is Born To Struggle with the Digital Divide.

ERIC Educational Resources Information Center

Fahmi, Ismail

2002-01-01

Describes the Indonesian Digital Library Network that is designed to develop Indonesia as a knowledge-based society. Highlights include the digital divide; problems in a developing country, including Internet accessibility, bandwidth capacity, and network delays; gathering information about national assets; information infrastructure; data…

ICT or I See Tea? Modernity, Technology and Education in Nepal

ERIC Educational Resources Information Center

Shields, Robin

2011-01-01

The use of information and communications technology (ICT) for education in developing countries has been a subject of great interest and speculation, with its proponents arguing that ICT improves educational quality, develops critical thinking skills, expands access, increases economic competitiveness and facilitates inclusion in a rapidly…

Technical and Vocational Education in Cameroon and Critical Avenues for Development

ERIC Educational Resources Information Center

Che, S. Megan

2007-01-01

Technical and vocational education (TVE) can influence development and economic progress for post-colonial societies. Some newly independent sub-Saharan African countries attempted curricular transformation that might produce a skilled workforce through widespread access to versions of TVE. In Cameroon, no such post-colonial curricular revolution…

Informatics for Secondary Education: A Curriculum for Schools.

ERIC Educational Resources Information Center

International Federation for Information Processing, Geneva (Switzerland).

UNESCO (United Nations Educational, Scientific and Cultural Organization) aims to ensure that all countries, both developed and developing, have access to the best educational facilities necessary to prepare young people to play a full role in modern society. Understanding information technology (IT) and mastering IT's basic skills and concepts…

Combining instrumental and contextual approaches: nanotechnology and sustainable development.

PubMed

Liao, Nina

2009-01-01

Billions of people live in poverty, with no access to safe drinking water or solutions for other critical health and medical needs. Nanotechnology is poised to create workable solutions for large-scale public health needs in developing countries, including improving water quality and providing life-saving pharmaceuticals. There are two views on how emerging technologies such as nanotechnology can influence and affect developing countries. Instrumentalists believe that the international community can transfer nanotechnology from one context to another and use it to assist the poor. Contextualists warn that nanotechnology can increase inequality in underdeveloped regions. Because of inadequacies in both positions, the international community must adopt a mixed strategy. This article argues that this mixed strategy should target the bottom of the pyramid, develop native capability, implement emergency protocols in projects, create accountability, and engage the public. Managed well, this strategy can propel developing countries toward sustainable development.

Factors influencing global antiretroviral procurement prices

PubMed Central

2009-01-01

Background Antiretroviral medicines (ARVs) are one of the most costly parts of HIV/AIDS treatment. Many countries are struggling to provide universal access to ARVs for all people living with HIV and AIDS. Although substantial price reductions of ARVs have occurred, especially between 2002 and 2008, achieving sustainable access for the next several decades remains a major challenge for most low- and middle-income countries. The objectives of the present study were twofold: first, to analyze global ARV prices between 2005 and 2008 and associated factors, particularly procurement methods and key donor policies on ARV procurement efficiency; second, to discuss the options of procurement processes and policies that should be considered when implementing or reforming access to ARV programs. Methods An ARV-medicines price-analysis was carried out using the Global Price Reporting Mechanism from the World Health Organization. For a selection of 12 ARVs, global median prices and price variation were calculated. Linear regression models for each ARV were used to identify factors that were associated with lower procurement prices. Logistic regression models were used to identify the characteristics of those countries which procure below the highest and lowest direct manufactured costs. Results Three key factors appear to have an influence on a country's ARV prices: (a) whether the product is generic or not; (b) the socioeconomic status of the country; (c) whether the country is a member of the Clinton HIV/AIDS Initiative. Factors which did not influence procurement below the highest direct manufactured costs were HIV prevalence, procurement volume, whether the country belongs to the least developed countries or a focus country of the United States President's Emergency Plan For AIDS Relief. Conclusion One of the principal mechanisms that can help to lower prices for ARV over the next several decades is increasing procurement efficiency. Benchmarking prices could be one useful tool to achieve this. PMID:19922690

Comparison of legislation, regulations and national health strategies for palliative care in seven European countries (Results from the Europall Research Group): a descriptive study

PubMed Central

2013-01-01

Background According to EU policy, anyone in need of palliative care should be able to have access to it. It is therefore important to investigate which palliative care topics are subject to legislation and regulations in Europe and how these are implemented in (national) health care plans. This paper aims to deliver a structured overview of the legislation, existing regulations and the different health care policies regarding palliative care in seven European countries. Methods In 2008 an inventory of the organisation of palliative care was developed by the researchers of the Europall project. Included were two open questions about legislation, regulations, and health policy in palliative care. This questionnaire was completed using palliative care experts selected from Belgium, England, France, Germany, the Netherlands, Poland and Spain. Additionally, (grey) literature on palliative care health policy and regulations from the participating countries was collected to complete the inventory. Comparative analysis of country specific information was performed afterwards. Results In all countries palliative care regulations and policies existed (either in laws, royal decrees, or national policies). An explicit right to palliative care was mentioned in the Belgium, French and German law. In addition, access to palliative care was mentioned by all countries, varying from explicit regulations to policy intentions in national plans. Also, all countries had a national policy on palliative care, although sometimes mainly related to national cancer plans. Differences existed in policy regarding palliative care leave, advance directives, national funding, palliative care training, research, opioids and the role of volunteers. Conclusions Although all included European countries have policies on palliative care, countries largely differ in the presence of legislation and regulations on palliative care as well as the included topics. European healthcare policy recommendations should support palliative care access across Europe. PMID:23866928

Globalization, global health, and access to healthcare.

PubMed

Collins, Téa

2003-01-01

It is now commonly realized that the globalization of the world economy is shaping the patterns of global health, and that associated morbidity and mortality is affecting countries' ability to achieve economic growth. The globalization of public health has important implications for access to essential healthcare. The rise of inequalities among and within countries negatively affects access to healthcare. Poor people use healthcare services less frequently when sick than do the rich. The negative impact of globalization on access to healthcare is particularly well demonstrated in countries of transitional economies. No longer protected by a centralized health sector that provided free universal access to services for everyone, large segments of the populations in the transition period found themselves denied even the most basic medical services. Only countries where regulatory institutions are strong, domestic markets are competitive and social safety nets are in place, have a good chance to enjoy the health benefits of globalization.

Accessing the medical devices market in Egypt and Saudi Arabia: a systematic review of policies and regulations.

PubMed

Gad, Mohamed; Kriza, Christine; Fidler, Armin; Kolominsky-Rabas, Peter

2016-07-01

Despite the significant medical devices market size in Egypt and Saudi Arabia, information regarding policies and regulations for medical devices market access is highly deficient. The aim of this paper is to provide a systematic review on market access policies and regulations in both countries, to allow safe and timely access to medical technology. The following databases were searched: PubMed, Science Direct, Scopus, and Al Manhal Arabic database. Additionally, the web portals of regulatory authorities of both countries were searched. There are 34 records included in the qualitative synthesis of this review. Expert commentary: Main findings include; adopted regulatory framework from reference countries, and interim main regulatory documents, In conclusion, the market access schemes are relatively structured. However, some recommendations are put forward to navigate towards a more comprehensive policy framework in both countries.

Access to essential drugs in poor countries: a lost battle?

PubMed

Pécoul, B; Chirac, P; Trouiller, P; Pinel, J

1999-01-27

Drugs offer a simple, cost-effective solution to many health problems, provided they are available, affordable, and properly used. However, effective treatment is lacking in poor countries for many diseases, including African trypanosomiasis, Shigella dysentery, leishmaniasis, tuberculosis, and bacterial meningitis. Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market. Moreover, research and development in tropical diseases have come to a near standstill. This article focuses on the problems of access to quality drugs for the treatment of diseases that predominantly affect the developing world: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate research and development for new drugs for the developing world; and (4) potential consequences of recent World Trade Organization agreements on the availability of old and new drugs. These problems are not independent and unrelated but are a result of the fundamental nature of the pharmaceutical market and the way it is regulated.

Trade in Services: The Doha Development Agenda Negotiations and U.S. Goals

DTIC Science & Technology

2010-04-07

doctor, enjoying a meal at the restaurant ). However, rapid changes in technology are reducing even these restrictions on services (computer software...establish a presence in the country of the consumer. For example, hotel and restaurant services require a presence in the country of the consumer...wholesale, and franchising services. This access would include both services direct delivery to the customer or remotely through catalogue, video, or

Community-level antibiotic access and use (ABACUS) in low- and middle-income countries: Finding targets for social interventions to improve appropriate antimicrobial use – an observational multi-centre study

PubMed Central

Wertheim, Heiman F.L.; Chuc, Nguyen Thi Kim; Punpuing, Sureeporn; Khan, Wasif Ali; Gyapong, Margaret; Asante, Kwaku Poku; Munguambe, Khatia; Gómez-Olivé, F. Xavier; Ariana, Proochista; John-Langba, Johannes; Sigauque, Betuel; Toan, Tran Khanh; Tollman, Stephen; Cremers, Amelieke J.H.; Do, Nga T.T.; Nadjm, Behzad; van Doorn, H. Rogier; Kinsman, John; Sankoh, Osman

2017-01-01

In many low- and middle-income countries (LMICs), a poor link between antibiotic policies and practices exists. Numerous contextual factors may influence the degree of antibiotic access, appropriateness of antibiotic provision, and actual use in communities. Therefore, improving appropriateness of antibiotic use in different communities in LMICs probably requires interventions tailored to the setting of interest, accounting for cultural context. Here we present the ABACUS study (AntiBiotic ACcess and USe), which employs a unique approach and infrastructure, enabling quantitative validation, contextualization of determinants, and cross-continent comparisons of antibiotic access and use. The community infrastructure for this study is the INDEPTH-Network (International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries), which facilitates health and population research through an established health and demographic surveillance system. After an initial round of formative qualitative research with community members and antibiotic suppliers in three African and three Asian countries, household surveys will assess the appropriateness of antibiotic access, provision and use. Results from this sample will be validated against a systematically conducted inventory of suppliers. All potential antibiotic suppliers will be mapped and characterized. Subsequently, their supply of antibiotics to the community will be measured through customer exit interviews, which tend to be more reliable than bulk purchase or sales data. Discrepancies identified between reported and observed antibiotic practices will be investigated in further qualitative interviews. Amartya Sen’s Capability Approach will be employed to identify the conversion factors that determine whether or not, and the extent to which appropriate provision of antibiotics may lead to appropriate access and use of antibiotics. Currently, the study is ongoing and expected to conclude by 2019. ABACUS will provide important new insights into antibiotic practices in LMICs to inform social interventions aimed at promoting optimal antibiotic use, thereby preserving antibiotic effectiveness. PMID:29707652

Wheelchair accessibility to public buildings in Istanbul.

PubMed

Evcil, A Nilay

2009-03-01

Accessibility to public environment is the human right and basic need of each citizen and is one of the fundamental considerations for urban planning. The aim of this study is to determine the compliance of public buildings in central business districts (CBD) of Istanbul, Turkey, to wheelchair accessibility to the guidelines of the instrument and identify architectural barriers faced by wheelchair users. This is a descriptive study of 26 public buildings in CBD of Istanbul. The instrument used is the adapted Useh, Moyo and Munyonga questionnaire to collect the data from direct observation and measurement. Descriptive statistics of simple percentages and means are used to explain the compliance to the guidelines of the instrument and wheelchair accessibility. The descriptive survey results indicate that wheelchair users experience many accessibility problems in public environment of the most urbanised city (cultural capital of Europe in 2010) in a developing country. It is found that the major architectural barrier is the public transportation items with the lowest mean compliance (25%). Beside this, the most compliant to the instrument is entrance to building items with 79% as mean percentage. It is also found that there is an intention to improve accessibility when building construction period is investigated. This article describes the example of the compliance of public buildings accessibility when the country has legislation, but lacking regulations about accessibility for the wheelchair users.

Controversies and consensus in the innovation access for cancer therapy in the European countries: on the subject of metastatic prostate cancer.

PubMed

Oudard, S; Courbon, F

2017-02-01

Innovative cancer therapies and advances in drug development have created new hopes for patients and health providers. The purpose of this article was to evaluate the discrepancies in the assessment of the magnitude of benefit of four new drugs (abiraterone acetate, enzalutamide, cabazitaxel, radium-223 dichloride) for the treatment of metastatic castration-resistant prostate cancer (mCRPC). The comparison was done among three European countries (UK, Germany and France) and Canada, according to the statement of each country and to the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale. Whereas those drugs are authorized by the European Medical Agency, one can observed that clear discrepancies in the magnitude of benefit assessment exist between selected countries, as well as between national pricing evaluation agencies and ESMO. However, price setting and reimbursement decisions remain national responsibility with differences in assessment of the medical value of new treatment across countries, leading to a heterogeneous accessibility to cancer treatments. In conclusion, several procedures have to be implemented to overcome the patchwork of administrative assessments. Among them, the assessment of medical value should be based on independent statements of learned societies, and the harmonization of access to cancer therapy in Europe has to be driven by a common European reimbursement and pricing policy. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Palliative Care for Children with Cancer in the Middle East: A Comparative Study.

PubMed

Mojen, Leila Khanali; Rassouli, Maryam; Eshghi, Peyman; Sari, Ali Akbari; Karimooi, Majideh Heravi

2017-01-01

High incidence rates of childhood cancer and the consequent deaths in the Middle East is one of the major reasons for the need for palliative care in these countries. Using the experiences and innovations of the other countries can provide a pattern for the countries of the region and lead to the development of palliative care in children. Therefore, the aim of this study is to compare the status of pediatric palliative care in Egypt, Lebanon, Jordan, Turkey, and Iran. This is a comparative study in which the information related to pediatric palliative care system in the target countries (from 2000 to 2016) has been collected, summarized, and classified by searching in databases, such as "PubMed, Scopus, Google scholar, Ovid, and science direct." Palliative care in children in the Middle East is still in its early stages and there are many obstacles to its development, namely, lack of professional knowledge, inadequate support of policy-makers, and lack of access to opioids and financial resources. Despite these challenges, providing services at the community level, support of nongovernmental organizations (NGOs), using trained specialists and multi-disciplinary approach is an opportunity in some countries. Considering the necessity of the development of pediatric palliative care in the region, solutions such as training the human resources, integrating palliative care programs into the curriculum of the related fields, establishing facilitating policies in prescription and accessibility of opioids, providing the necessary support by policy-makers, doing research on assessment of palliative care quality, as well as NGOs' participation and public education are suggested.

A Panel Analysis of the Strategic Association Between Information and Communication Technology and Public Health Delivery

PubMed Central

Wu, Sarah Jinhui

2012-01-01

Background In this exploratory research, we use panel data analysis to examine the correlation between Information and Communication Technology (ICTs) and public health delivery at the country level. Objective The goal of this exploratory research is to examine the strategic association over time between ICTs and country-level public health. Methods Using data from the World Development Indicators, we construct a panel data set of countries of five different income levels and look closely at the period from 2000 to 2008. The panel data analysis allows us to explore this dynamic relationship under the control for unobserved country-specific effects by using a fixed-effects estimation method. In particular,, we examine the association of five ICT factors with five public health indicators: adolescent fertility rate, child immunization coverage, tuberculosis case detected, life expectancy, and adult mortality rate. Results First, overall ICTs’ factors substantially improve a country’s public health delivery on the top of wealth effect. Second, among all the ICTs’ factors, accessibility is the only one that is associated with improvements in all aspects of public health delivery, while the contributions from the usage, quality, and applications are negligible. ICTs’ accessibility factor is associated with a considerable extension to life expectancy and reduced adult mortality rate. Third, all entity-specific factors are significant in each model, indicating that countries’ economic development level does influence their public health delivery. Conclusions Our results indicate that ICT accessibility has a strong association with effective delivery of public health. There are others, but the key strategic applications are eHealth and mHealth. The findings of this study will help government officials and public health policy makers to formulate strategic decisions regarding the best ICT investments and deployment. For example, the study shows that providing accessibility should be a critical focus. PMID:23089193

Juridical and sociocultural problems on the definition of a law concerning property, usage and access to genetic resources in Colombia.

PubMed

Calle, R

1996-04-01

The property, usage, and access to genetic resources, is today one of the primary topics in international business, as a result of the strategic importance of the resources for the biotechnology industry. Internationally, the sovereignty that each country has over its natural patrimony is recognized. However, the new laws of international marketing have obligated countries in the process of development, such as Colombia, to adopt and copy a concept of intellectual property on living resources that does not have anything to do with the country's sociocultural identity, and sometimes even does not take into account its material enjoyment. The new juridical movement that treats genetic resources as private property produces a cultural conflict between indigenous populations, Afro-Americans and peasants, because for them the genetic resources are an element of community life. In these communities, knowledge is freely transmitted; it is an understanding that they have to conserve their agricultural customs and the relationship that they have with the environment. They do not recognize the term "property' according to patenting laws. These elements have to be considered, respected, and guaranteed in the laws that recognize the genetic resources in the country. On the other hand, not even countries that are pioneers in biotechnological development can adopt a concept about patents that is in agreement with the particularities that the living materials possess. This is obviously the reason for the numerous discussions on the legal interpretation, as well as complicated debates in court. Confronting that situation, there are countries rich in biodiversity, such as Colombia, but which do not have a proper concept and are not economically strong in the international context. These countries have to copy inadequate protection policies that do not take into account all their rights. This paper describes some of the technical, juridical, and sociocultural difficulties which Colombia has to confront, in order to set a guideline on patenting living organisms, and on the access and usage of the genetic resources.

Complementary therapy.

PubMed

1998-01-01

In developing countries with little access to antiviral therapy, there is evidence that counseling and adopting a health lifestyle may delay the progression of AIDS. In India, some doctors have reported that of 460 persons counseled on lifestyle, 85 percent had CD4 counts over 500. The lifestyle changes included maintaining a positive attitude, yoga, adhering to a balanced vegetarian diet with vitamin supplementation, minimum medication use, and not using tobacco. It is noted that these "treatment" methods are not considered alternative medicine, since they are the main source of treatment in some developing countries.

Making stem cells count for global health.

PubMed

McMahon, Dominique S; Thorsteinsdóttir, Halla

2011-11-01

Developing countries such as China, India and Brazil are making large investments in the stem cell field. Here we argue that hands-on involvement in the field by these countries is essential if the products developed are going to be locally relevant, affordable and appropriate. However, stem cells are a high-risk investment and any global health impacts are still likely to be far off. Even if they are eventually successful, better clinical oversight and measures to ensure access are required for stem cells to have a substantial and equitable impact.

Security and privacy issues of personal health.

PubMed

Blobel, Bernd; Pharow, Peter

2007-01-01

While health systems in developed countries and increasingly also in developing countries are moving from organisation-centred to person-centred health service delivery, the supporting communication and information technology is faced with new risks regarding security and privacy of stakeholders involved. The comprehensively distributed environment puts special burden on guaranteeing communication security services, but even more on guaranteeing application security services dealing with privilege management, access control and audit regarding social implication and connected sensitivity of personal information recorded, processed, communicated and stored in an even internationally distributed environment.

Assessment of exchange of crop in view of change climate and International Treaties.

PubMed

Singh, Anil Kumar; Pedapati, Annitaa; Manibhushan

2015-01-01

To meet the UN millennium development goal of reducing the number of hungry people to half by 2015, there is utmost need to breed potentially high yielding varieties to match up the requirement along with corrective measures to bridge the gap between the potential yield and yield harvested by farmers. The scenario has changed from free access to limited access of plant genetic resources (PGR) and therefore, it is important to understand the issues in view of national and international agreements, intellectual property rights (IPR'S), climate change conditions and expanded scope of breeders and farmers rights for developed genotypes. For efficient management of PGR, developing countries need to understand the implications of PGR related IPR'S as stronger IPR'S in developed countries could have harmful effects by reduced exchange of genetic resources from developed countries. Keeping in view the existing realities every possible effort should be taken for enrichment of crop gene pool by introducing them from each and every corner of the globe. Keeping these facts in view this paper describes the priorities for introduction and exchange of important crop groups/crops along with some of their potential wild and weedy relatives and thrust has been given to generate awareness among the workers engaged in the breeders/crop improvement works. Information provided in this presentation can be utilized by prospective crop improvement works to plan to meet out the nationalfood security.

The Development and Performance of After-Hours Primary Care in the Netherlands: A Narrative Review.

PubMed

Smits, Marleen; Rutten, Martijn; Keizer, Ellen; Wensing, Michel; Westert, Gert; Giesen, Paul

2017-05-16

In many Western countries, hospital emergency departments are overcrowded, leading to the desire to strengthen primary care, particularly after hours. To achieve this goal, an increasing number of Western nations are reorganizing their after-hours primary care systems into large-scale primary care physician (PCP) cooperatives. This article provides an overview of the organization, performance, and development of PCP cooperatives in the Netherlands. The Dutch after-hours primary care system might offer opportunities for other countries facing problems with after-hours care and inappropriate emergency department visits. During the past several years, the number of contacts with Dutch PCP cooperatives has increased to 245 contacts per 1000 citizens per year. Many contacts (45%) are nonurgent, and about half occur as part of a series of primary care contacts. Low accessibility and availability of daytime primary care are related to greater use of after-hours primary care. To prevent unnecessary attendance at the cooperatives, physicians advocate copayment, a stricter triage system, and a larger role for telephone doctors. More than half of the PCP cooperatives in the Netherlands have integrated with hospital emergency departments, forming "emergency care access points." This collaboration has decreased emergency department use by 13% to 22%, and treatment of self-referrals by PCP cooperatives in emergency care access points is safe and cost-effective. Direct access to diagnostic facilities may optimize efficiency even more. Other recent developments include access to electronic health records of daytime primary care practices, task substitution from physicians to nurses, and the launch of a 2-year training program for PCPs to become experts in emergency care.

Biological therapy in inflammatory bowel diseases: Access in Central and Eastern Europe

PubMed Central

Rencz, Fanni; Péntek, Márta; Bortlik, Martin; Zagorowicz, Edyta; Hlavaty, Tibor; Śliwczyński, Andrzej; Diculescu, Mihai M; Kupcinskas, Limas; Gecse, Krisztina B; Gulácsi, László; Lakatos, Peter L

2015-01-01

Biological drugs opened up new horizons in the management of inflammatory bowel diseases (IBD). This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed. Moreover, we provide an estimation on prevalence of IBD as well as biological treatment rates. In all countries with the exception of Romania, lower biological treatment rates were observed in ulcerative colitis (UC) compared to Crohn’s disease despite the higher prevalence of UC. Great heterogeneity (up to 96-fold) was found in access to biologicals across the CEE countries. Poland, Bulgaria, Romania and the Baltic States are lagging behind Hungary, Slovakia and the Czech Republic in their access to biologicals. Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria, Latvia, Lithuania, and Poland, but association with other possible determinants (differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, and cost-effectiveness results) was not proven. We assume, nevertheless, that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD. In conclusion, access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors, drug prices or total health expenditure. Changes in reimbursement policy could contribute to better access to biologicals in some countries. PMID:25684937

Educational Development and Reformation in the Malaysian Education System: Challenges in the New Millennium.

ERIC Educational Resources Information Center

bin Zakaria, Haji Azmi

2000-01-01

Development of the education system in Malaysia is tied to the National Development Policy. Malaysia will address issues related to equity, access, and democratization of education, education quality, efficiency, and values education as the country responds to the demands of being part of the global village while ensuring domestic growth and…

Poverty, health & intellectual property rights with special reference to India.

PubMed

Satyanarayana, K; Srivastava, S

2007-10-01

This paper examines the nexus between poverty and global health with specific focus on IPR protection and attempts to highlight the current global endeavours to overcome barriers to access to medicines for diseases of the poor. The number of very poor people in the world has increased by 10.4 per cent between 1987 and 2001 to 2735 million. India is now home to the largest number of millionaires in the developing countries. But over 800 million Indians who still survive on Rs 20.0 (US$0.5) a day, and rural poverty is on the rise. The link between poverty and health is well established with the underprivileged are more vulnerable to major health risks due to poor nutrition, inadequate access to clean drinking water, sanitation, exposure to indoor smoke, etc. all of which contribute to the huge and growing burden of disease in the poor countries. The global disease burden is not just huge but growing: over 10 million children die of preventable conditions including vaccine-preventable diseases, about 14 million are killed by infectious diseases every year, 90-95 per cent in poor countries. An estimated third of global population has limited or no access to essential medicines. While the number of poor and unhealthy is growing, Government expenditure on health is dwindling. Many of the diseases of the poor require new medicines and none are forthcoming as there is little R&D for these infections. There are several barriers to access to existing and the newly discovered drugs. One major reason is the general lack of interest by the pharma industry to discover new medicines for diseases of the poor due to very limited market in developing countries. In addition, global intellectual property rights (IPR) protection regimes like the Trade Related Intellectual Property Rights (TRIPS) are considered a major obstacle for the poor access to medicines. There have been some global initiatives on the need to improve affordability and accessibility of medicines. Some strategies to promote R&D on diseases of the poor such as Prize Fund Model, the Medical R&D Treaty and steps to invoke flexibilities in TRIPS read with Doha Declaration are discussed. Health of the poor is a global problem that requires global solutions with global participation and commitment.

South Africa’s protracted struggle for equal distribution and equitable access – still not there

PubMed Central

2014-01-01

The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa’s transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce. Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows. PMID:24885691

The ethics of intellectual property rights in an era of globalization.

PubMed

Shah, Aakash Kaushik; Warsh, Jonathan; Kesselheim, Aaron S

2013-01-01

Since the 1980s, developed countries, led by the United States and the countries of the European Union, have sought to incorporate intellectual property rights provisions into global trade agreements. These countries successfully negotiated the World Trade Organization's 1994 Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which required developing countries to adopt intellectual property provisions comparable to developed countries. In this manuscript, we review the policy controversy surrounding TRIPS and examine the two main ethical arguments articulated in its support--a theory of natural rights and a utilitarian argument. We contend that these theories provide insufficient bases for an intellectual property rights regime that compromises access to essential medicines in the developing world. While the policy community has engaged in active debate around the policy effects of TRIPS, scholars have not thoroughly considered the full ethical underpinnings of those policy arguments. We believe that a more robust understanding of the ethical implications of the agreement should inform policy discussions in the future. © 2013 American Society of Law, Medicine & Ethics, Inc.

Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

PubMed

Edoh, Thierry Oscar; Teege, Gunnar

2011-10-01

One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems.

University Access for Disadvantaged Children: A Comparison across Countries

ERIC Educational Resources Information Center

Jerrim, John; Vignoles, Anna

2015-01-01

In this paper, we consider whether certain countries are particularly adept (or particularly poor) at getting children from disadvantaged homes to study for a bachelor's degree. A series of university access models are estimated for four English-speaking countries (England, Canada, Australia and the USA), which include controls for comparable…

A review of global access to emergency contraception.

PubMed

Westley, Elizabeth; Kapp, Nathalie; Palermo, Tia; Bleck, Jennifer

2013-10-01

Emergency contraception has been known for several decades, and dedicated products have been on the market for close to 20 years. Yet it is unclear whether women, particularly in low-resource countries, have access to this important second-chance method of contraception. To review relevant policies, regulations, and other factors related to access to emergency contraception worldwide. A wide range of gray literature was reviewed, several specific studies were commissioned, and a number of online databases were searched. Several positive policies and regulations are in place: emergency contraception products are registered in the majority of countries around the world, listed in many countries' essential medicines lists, included in widely used guidance, and supported by most donors. Yet analysis of demographic data shows that the majority of women in low-income countries have never heard of emergency contraception, and surveys find that many providers have negative attitudes toward providing emergency contraception. Despite more than a decade of concerted international and country-level efforts to ensure that women have access to emergency contraception, accessibility remains limited. © 2013.

Migrant's access to preventive health services in five EU countries.

PubMed

Rosano, Aldo; Dauvrin, Marie; Buttigieg, Sandra C; Ronda, Elena; Tafforeau, Jean; Dias, Sonia

2017-08-23

Preventive health services (PHSs) form part of primary healthcare with the aim of screening to prevent disease. Migrants show significant differences in lifestyle, health beliefs and risk factors compared with the native populations. This can have a significant impact on migrants' access to health systems and participation in prevention programmes. Even in countries with widely accessible healthcare systems, migrants' access to PHSs may be difficult. The aim of the study was to compare access to preventive health services between migrants and native populations in five European Union (EU) countries. Information from Health Interview Surveys of Belgium, Italy, Malta, Portugal and Spain were used to analyse access to mammography, Pap smear tests, colorectal cancer screening and flu vaccination among migrants. The comparative risk of not accessing PHSs was calculated using a mixed-effects multilevel model, adjusting for potential confounding factors (sex, education and the presence of disability). Migrant status was defined according to citizenship, with a distinction made between EU and non-EU countries. Migrants, in particular those from non-EU countries, were found to have poorer access to PHSs. The overall risk of not reporting a screening test or a flu vaccination ranged from a minimum of 1.8 times (colorectal cancer screening), to a high of 4.4 times (flu vaccination) for migrants. The comparison among the five EU countries included in the study showed similarities, with particularly limited access recorded in Italy and in Belgium for non-EU migrants. The findings of this study are in accordance with evidence from the scientific literature. Poor organization of health services, in Italy, and lack of targeted health policies in Belgium may explain these findings. PHSs should be responsive to patient diversity, probably more so than other health services. There is a need for diversity-oriented, migrant-sensitive prevention. Policies oriented to removing impediments to migrants' access to preventive interventions are crucial, to encourage more positive action for those facing the risk of intersectional discrimination.

[Industry, Academia and Government Partnership through the Global Health Innovative Technology Fund (GHIT)].

PubMed

Hinoshita, Eiji

2016-01-01

In developing countries, many people are unable to access basic healthcare services, resulting in many avoidable deaths and/or disabilities. The United Nations adopted the Millennium Development Goals in order to resolve this problem, and Japan has been contributing greatly to the achievement of these goals. In this context, in 2013 the Government of Japan proposed its Strategy on Global Health Diplomacy, and since then has been promoting Universal Health Coverage. Since the beginning of the 21st century, the particular importance of addressing neglected tropical diseases (NTDs) has been stressed by the international community. Nevertheless, of the 1 billion people world-wide who are currently living with NTDs, about three-fourths of these are living in poverty, and of these, nearly 65% are unable to acquire or access drugs for the prevention and treatment of these diseases. Under these circumstances, Japan decided to support the Global Health Innovative Technology (GHIT) Fund in order to support the research and development of drugs for people in developing countries, as well as the manufacture, supply and administration of these drugs. Over the last two years, the GHIT Fund has been supporting the research and development of five new candidate drugs for three NTDs (Chagas disease, leishmaniasis and malaria). Japan also hopes to stimulate domestic pharmaceutical industries in developing countries, as well as to increase international cooperation through various activities such the utilization of our capacity to research and develop new drugs.

Brazil's National Program for Improving Primary Care Access and Quality (PMAQ)

PubMed Central

Harris, Matthew J.; Rocha, Marcia Gomes

2017-01-01

Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil. PMID:28252498

Why Are Women Dying When They Reach Hospital on Time? A Systematic Review of the ‘Third Delay’

PubMed Central

Knight, Hannah E.; Self, Alice; Kennedy, Stephen H.

2013-01-01

Background The ‘three delays model’ attempts to explain delays in women accessing emergency obstetric care as the result of: 1) decision-making, 2) accessing services and 3) receipt of appropriate care once a health facility is reached. The third delay, although under-researched, is likely to be a source of considerable inequity in access to emergency obstetric care in developing countries. The aim of this systematic review was to identify and categorise specific facility-level barriers to the provision of evidence-based maternal health care in developing countries. Methods and Findings Five electronic databases were systematically searched using a 4-way strategy that combined search terms related to: 1) maternal health care; 2) maternity units; 3) barriers, and 4) developing countries. Forty-three original research articles were eligible to be included in the review. Thirty-two barriers to the receipt of timely and appropriate obstetric care at the facility level were identified and categorised into six emerging themes (Drugs and equipment; Policy and guidelines; Human resources; Facility infrastructure; Patient-related and Referral-related). Two investigators independently recorded the frequency with which barriers relating to the third delay were reported in the literature. The most commonly cited barriers were inadequate training/skills mix (86%); drug procurement/logistics problems (65%); staff shortages (60%); lack of equipment (51%) and low staff motivation (44%). Conclusions This review highlights how a focus on patient-side delays in the decision to seek care can conceal the fact that many health facilities in the developing world are still chronically under-resourced and unable to cope effectively with serious obstetric complications. We stress the importance of addressing supply-side barriers alongside demand-side factors if further reductions in maternal mortality are to be achieved. PMID:23704943

Global trends in world fisheries: impacts on marine ecosystems and food security.

PubMed

Pauly, Daniel; Watson, Reg; Alder, Jackie

2005-01-29

This contribution, which reviews some broad trends in human history and in the history of fishing, argues that sustainability, however defined, rarely if ever occurred as a result of an explicit policy, but as result of our inability to access a major part of exploited stocks. With the development of industrial fishing, and the resulting invasion of the refuges previously provided by distance and depth, our interactions with fisheries resources have come to resemble the wars of extermination that newly arrived hunters conducted 40,000-50,000 years ago in Australia, and 11,000-13,000 years ago against large terrestrial mammals arrived in North America. These broad trends are documented here through a map of change in fish sizes, which displays characteristic declines, first in the nearshore waters of industrialized countries of the Northern Hemisphere, then spread offshore and to the Southern Hemisphere. This geographical extension met its natural limit in the late 1980s, when the catches from newly accessed stocks ceased to compensate for the collapse in areas accessed earlier, hence leading to a gradual decline of global landing. These trends affect developing countries more than the developed world, which have been able to meet the shortfall by increasing imports from developing countries. These trends, however, together with the rapid growth of farming of carnivorous fishes, which consumes other fishes suited for human consumption, have led to serious food security issues. This promotes urgency to the implementation of the remedies traditionally proposed to alleviate overfishing (reduction of overcapacity, enforcement of conservative total allowable catches, etc.), and to the implementation of non-conventional approaches, notably the re-establishment of the refuges (also known as marine reserves), which made possible the apparent sustainability of pre-industrial fisheries.

Global trends in world fisheries: impacts on marine ecosystems and food security

PubMed Central

Pauly, Daniel; Watson, Reg; Alder, Jackie

2005-01-01

This contribution, which reviews some broad trends in human history and in the history of fishing, argues that sustainability, however defined, rarely if ever occurred as a result of an explicit policy, but as result of our inability to access a major part of exploited stocks. With the development of industrial fishing, and the resulting invasion of the refuges previously provided by distance and depth, our interactions with fisheries resources have come to resemble the wars of extermination that newly arrived hunters conducted 40 000–50 000 years ago in Australia, and 12 000–13 000 years ago against large terrestrial mammals in North America. These broad trends are documented here through a map of change in fish sizes, which displays characteristic declines, first in the nearshore waters of industrialized countries of the Northern Hemisphere, then spread offshore and to the Southern Hemisphere. This geographical extension met its natural limit in the late 1980s, when the catches from newly accessed stocks ceased to compensate for the collapse in areas accessed earlier, hence leading to a gradual decline of global landing. These trends affect developing countries more than the developed world, which have been able to meet the shortfall by increasing imports from developing countries. These trends, however, together with the rapid growth of farming of carnivorous fishes, which consumes other fishes suited for human consumption, have led to serious food security issues. This promotes urgency to the implementation of the remedies traditionally proposed to alleviate overfishing (reduction of overcapacity, enforcement of conservative total allowable catches, etc.), and to the implementation of non-conventional approaches, notably the re-establishment of the refuges (also known as marine reserves), which made possible the apparent sustainability of pre-industrial fisheries. PMID:15713585

Participatory ergonomics intervention in an industrially developing country--a case study.

PubMed

Helali, Faramarz; Lönnroth, Emma-Christin; Shahnavaz, Houshang

2008-01-01

In industrially developing countries, a few ergonomists have directed great efforts towards developing ergonomics awareness among managers and workers in organizations. There is little research on the degree of their success, though. Furthermore, access of organizations to ergonomics knowledge is usually very difficult, especially in industrially developing countries. Thus, building ergonomics awareness is certainly the first phase of the process. Three companies from one industry (44 people: 14 females and 30 males) participated in a project aimed at improving their work system. At the beginning, we needed to create a common goal and ensure participation with appropriate ergonomics tools. The findings of this study were the key issue for the ergonomics intervention (i.e., a shared vision, awakened need of change and learning). Further, to build ergonomics awareness and develop a continuous learning process in the company, it was necessary to use more ergonomics tools through workers' participation in different workplaces.

UNFPA stresses importance of reproductive health.

PubMed

Sadik, N

1998-12-01

This article summarizes statements made by Dr. Nafis Sadik on October 19, 1998, to TICAD II. The address focused on the health challenges that Africa faces. The 1998 population in Africa of 780 million will double to about 1.5 billion in about 25 years. It is likely that this growth will impede socioeconomic development. Quality of life will be reduced by high infant and maternal mortality and high levels of HIV/AIDS. Only a small minority of Africans have access to basic health and reproductive health (RH) services. There are many unwanted births. The impact of HIV/AIDS on women has been very harsh. Life expectancy in some countries has been reduced. 50% of new HIV infections are among young people, who are poorly informed about RH. Health services are not suitable for youth needs. The consequences of early marriage and childbearing are limits to education and employment. Young women face the threat of domestic violence and abuse. Teenagers can be protected against HIV/AIDS and sexually transmitted diseases by institutionalization of sex education. RH needs to stress male responsibility in sexual health and childbearing. Sexual responsibility can be a life-and-death situation. African countries are beginning to integrate population and development policies. African countries need to adopt goals to increase access to RH services and family planning. Access should increase to 20% of population by the year 2000. Integrated programs, empowerment of women in development, male responsibility, and increased literacy should be expanded. UNFPA will continue to give Africa priority through increased resources, staff, and other partnerships.

Critical role of ethics in clinical management and public health response to the West Africa Ebola epidemic.

PubMed

Folayan, Morenike O; Haire, Bridget G; Brown, Brandon

2016-01-01

The devastation caused by the Ebola virus disease (EVD) outbreak in West Africa has brought to the fore a number of important ethical debates about how best to respond to a health crisis. These debates include issues related to prevention and containment, management of the health care workforce, clinical care, and research design, all of which are situated within the overarching moral problem of severe transnational disadvantage, which has very real and specific impacts upon the ability of citizens of EVD-affected countries to respond to a disease outbreak. Ethical issues related to prevention and containment include the appropriateness and scope of quarantine and isolation within and outside affected countries. The possibility of infection in health care workers impelled consideration of whether there is an obligation to provide health services where personal protection equipment is inadequate, alongside the issue of whether the health care workforce should have special access to experimental treatment and care interventions under development. In clinical care, ethical issues include the standards of care owed to people who comply with quarantine and isolation restrictions. Ethical issues in research include appropriate study design related to experimental vaccines and treatment interventions, and the sharing of data and biospecimens between research groups. The compassionate use of experimental drugs intersects both with research ethics and clinical care. The role of developed countries also came under scrutiny, and we concluded that developed countries have an obligation to contribute to the containment of EVD infection by contributing to the strengthening of local health care systems and infrastructure in an effort to provide fair benefits to communities engaged in research, ensuring that affected countries have ready and affordable access to any therapeutic or preventative interventions developed, and supporting affected countries on their way to recovery from the impact of EVD on their social and economic lives.

Going global: do consumer preferences, attitudes, and barriers to using e-mental health services differ across countries?

PubMed

Clough, Bonnie A; Zarean, Mostafa; Ruane, Ilse; Mateo, Niño Jose; Aliyeva, Turana A; Casey, Leanne M

2017-08-31

e-Mental health services have the capacity to overcome barriers to care and reduce the unmet need for psychological services, particularly in developing countries. However, it is unknown how acceptable e-mental health interventions may be to these populations. The purpose of the current study was to examine consumer attitudes and perceived barriers to e-mental health usage across four countries: Australia, Iran, the Philippines and South Africa. An online survey was completed by 524 adults living in these countries, assessing previous contact with e-mental health services, willingness to use e-mental health services, and perceived barriers and needs for accessing e-mental health services. Although previous contact with e-mental health services was low, the majority of respondents in each sample reported a willingness to try e-mental health services if offered. Barriers toward e-mental health usage were higher among the developing countries than Australia. The most commonly endorsed barriers concerned needing information and assurances regarding the programmes. Across countries, participants indicated a willingness to use e-mental health programmes if offered. With appropriate research and careful implementation, e-mental health has the potential to be a valuable part of mental healthcare in developing countries.

European Universities' Guidance on Research Integrity and Misconduct.

PubMed

Aubert Bonn, Noémie; Godecharle, Simon; Dierickx, Kris

2017-02-01

Research integrity is imperative to good science. Nonetheless, many countries and institutions develop their own integrity guidance, thereby risking incompatibilities with guidance of collaborating institutions. We retrieved guidance for academic integrity and misconduct of 18 universities from 10 European countries and investigated accessibility, general content, principles endorsed, and definitions of misconduct. Accessibility and content differ substantially between institutions. There are general trends of common principles of integrity and definitions of misconduct, yet differences remain. Parallel with previous research, we distinguish different approaches in integrity guidance; one emphasizes broad values of integrity, and the other details negative behaviors of misconduct. We propose that a balance between both approaches is necessary to preserve trust, meaning, and realism of guidance on research integrity.

Agricultural biotechnology and smallholder farmers in developing countries.

PubMed

Anthony, Vivienne M; Ferroni, Marco

2012-04-01

Agricultural biotechnology holds much potential to contribute towards crop productivity gains and crop improvement for smallholder farmers in developing countries. Over 14 million smallholder farmers are already benefiting from biotech crops such as cotton and maize in China, India and other Asian, African and Central/South American countries. Molecular breeding can accelerate crop improvement timescales and enable greater use of diversity of gene sources. Little impact has been realized to date with fruits and vegetables because of development timescales for molecular breeding and development and regulatory costs and political considerations facing biotech crops in many countries. Constraints to the development and adoption of technology-based solutions to reduce yield gaps need to be overcome. Full integration with broader commercial considerations such as farmer access to seed distribution systems that facilitate dissemination of improved varieties and functioning markets for produce are critical for the benefits of agricultural biotechnology to be fully realized by smallholders. Public-private partnerships offer opportunities to catalyze new approaches and investment while accelerating integrated research and development and commercial supply chain-based solutions. Copyright © 2011. Published by Elsevier Ltd.

Open access for operational research publications from low- and middle-income countries: who pays?

PubMed Central

Kumar, A. M. V.; Reid, A. J.; Van den Bergh, R.; Isaakidis, P.; Draguez, B.; Delaunois, P.; Nagaraja, S. B.; Ramsay, A.; Reeder, J. C.; Denisiuk, O.; Ali, E.; Khogali, M.; Hinderaker, S. G.; Kosgei, R. J.; van Griensven, J.; Quaglio, G. L.; Maher, D.; Billo, N. E.; Terry, R. F.; Harries, A. D.

2014-01-01

Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the ‘open-access spectrum’. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access. PMID:26400799

Local production of medical technologies and its effect on access in low and middle income countries: a systematic review of the literature

PubMed Central

Kaplan, Warren Allan; Ritz, Lindsay Sarah; Vitello, Marie

2011-01-01

Objectives: The objective of this study was to assess the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products. Our preliminary hypothesis is that studies showing a robust relationship between local production and access to medical products are sparse, at best. Methods: An extensive literature search was conducted using a wide variety of databases and search terms intending to capture as many different aspects of this issue as possible. The results of the search were reviewed and categorized according to their relevance to the research question. The literature was also reviewed to determine the rigor used to examine the effects of local production and what implications these experiences hold for other developing countries. Results: Literature addressing the benefits of local production and the link between it and access to medical products is sparse, mainly descriptive and lacking empirical evidence. Of the literature we reviewed that addressed comparative economics and strategic planning of multinational and domestic firms, there are few dealing with emerging markets and lower-middle income countries and even fewer that compare local biomedical producers with multinational corporations in terms of a reasonable metric. What comparisons exist mainly relate to prices of local versus foreign/multinational produced medicines. Conclusions: An assessment of the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products reveals a paucity of literature explicitly dealing with this issue. Of the literature that does exist, methods used to date are insufficient to prove a robust relationship between local production of medical products and access to these products. There are mixed messages from various studies, and although the studies may correctly depict specific situations in specific countries with reference to specific products, such evidence cannot be generalized. Our review strongly supports the need for further research in understanding the dynamic link between local production and access to medical products PMID:23093883

Establishing a baseline to measure change in political will and the use of data for decision-making in maternal and newborn health in six African countries.

PubMed

Nove, Andrea; Hulton, Louise; Martin-Hilber, Adriane; Matthews, Zoe

2014-10-01

The Evidence for Action (E4A) program assumes that both resource allocation and quality of care can improve via a strategy that combines evidence and advocacy to stimulate accountability. The present paper explains the methods used to collect baseline monitoring data using two tools developed to inform program design in six focus countries. The first tool is designed to understand the extent to which decision-makers have access to the data they need, when they need it, and in meaningful formats, and then to use the data to prioritize, plan, and allocate resources. The second tool seeks the views of people working in the area of maternal and newborn health (MNH) about political will, including: quality of care, the political and financial priority accorded to MNH, and the extent to which MNH decision-makers are accountable to service users. Findings indicate significant potential to improve access to and use of data for decision-making, particularly at subnational levels. Respondents across all six program countries reported lack of access by ordinary citizens to information on the health and MNH budget, and data on MNH outcomes. In all six countries there was a perceived inequity in the distribution of resources and a perception that politicians do not fully understand the priorities of their constituents. Copyright © 2014. Published by Elsevier Ireland Ltd.

Beyond the Millennium Development Goals: public health challenges in water and sanitation.

PubMed

Rheingans, R; Dreibelbis, R; Freeman, M C

2006-01-01

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities.

International perspectives on sharing clinical data with patients.

PubMed

Prey, Jennifer E; Polubriaginof, Fernanda; Kuperman, Gilad J; Tiase, Victoria; Collins, Sarah A; Vawdrey, David K

2016-02-01

Engaging patients in their care has become a topic of increasing importance, and enabling patients to have access to their clinical data is a key aspect of such engagement. We investigated, on an international scale, the current state of approaches for providing patients with access to their own clinical information. Individuals from 28 countries were invited to participate in a cross-sectional semi-structured interview. Interview questions focused on social and cultural influences that affected patient engagement activities, government support for current and planned initiatives, data ownership models, and technical issues. Interviews were conducted with individuals from 16 countries representing six continents. Respondents reported substantive initiatives for providing information to patients in the majority of countries interviewed. These initiatives were diverse in nature and stage of implementation. Enabling patient access to data is occurring on an international scale. There is considerable variability in the level of maturity, the degree of government involvement, the technical infrastructure, and the plans for future development across the world. As informaticians, we are still in the early stages of deploying patient engagement technologies and have yet to identify optimal strategies in this arena. Efforts to improve patient access to data are active on a global-scale. There are many open questions about best practices and much can be learned by adopting an international perspective to guide future implementation efforts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Key strategies to further reduce stunting in Southeast Asia: lessons from the ASEAN countries workshop.

PubMed

Bloem, Martin W; de Pee, Saskia; Hop, Le Thi; Khan, Nguyen Cong; Laillou, Arnaud; Minarto; Moench-Pfanner, Regina; Soekarjo, Damayanti; Soekirman; Solon, J Antonio; Theary, Chan; Wasantwisut, Emorn

2013-06-01

To further reduce stunting in Southeast Asia, a rapidly changing region, its main causes need to be identified. Assess the relationship between different causes of stunting and stunting prevalence over time in Southeast Asia. Review trends in mortality, stunting, economic development, and access to nutritious foods over time and among different subgroups in Southeast Asian countries. Between 1990-2011, mortality among under-five children declined from 69/1,000 to 29/1,000 live births. Although disease reduction, one of two direct causes of stunting, has played an important role which should be maintained, improvement in meeting nutrient requirements, the other direct cause, is necessary to reduce stunting further. This requires dietary diversity, which is affected by rapidly changing factors: economic development; urbanization, giving greater access to larger variety of foods, including processed and fortified foods; parental education; and modernizing food systems, with increased distance between food producers and consumers. Wealthier consumers are increasingly able to access a more nutritious diet, while poorer consumers need support to improve access, and may also still need better hygiene and sanitation. In order to accelerate stunting reduction in Southeast Asia, availability and access to nutritious foods should be increased by collaboration between private and public sectors, and the Association of Southeast Asian Nations (ASEAN) can play a facilitating role. The private sector can produce and market nutritious foods, while the public sector sets standards, promotes healthy food choices, and ensures access to nutritious foods for the poorest, e.g, through social safety net programs.

Modeling Social Dimensions of Oral Health among Older Adults in Urban Environments

ERIC Educational Resources Information Center

Metcalf, Sara S.; Northridge, Mary E.; Widener, Michael J.; Chakraborty, Bibhas; Marshall, Stephen E.; Lamster, Ira B.

2013-01-01

In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by…

Inquiry-Based Practical Work in Physical Sciences: Equitable Access and Social Justice Issues

ERIC Educational Resources Information Center

Tsakeni, Maria

2018-01-01

Physical sciences education comes with high expectations for learners to be successfully placed in tertiary institutions in related fields, and developing countries' aspirations to develop advanced and specialised skills to drive economies. However, some of the prevailing instructional strategies in science classrooms work to marginalise learners.…

Gender, Information Technology, and Developing Countries: An Analytic Study.

ERIC Educational Resources Information Center

Hafkin, Nancy; Taggart, Nancy

This report and executive summary examines the current situation of gender and information technology (IT) in developing nations. The first section describes women as users of IT, producers of IT, and IT decision makers. The second section notes obstacles to women's access (literacy and education, language, time, cost, geographic location, social…

Critical Discussions on the Massive Open Online Course (MOOC) in India and China

ERIC Educational Resources Information Center

Trehan, Sangeeta; Sanzgiri, Janesh; Li, Chenxi; Wang, Rongsheng; Joshi, Rakesh Mohan

2017-01-01

Massive Open Online Courses (MOOCs) have been a relatively recent entrant in the field of online learning, yet with their "massiveness" and "openness" were posited to have the potential to transform learning and development in developing countries by providing willing learners with ready access to knowledge and Higher Education…

Changing Patterns of Access to Education in Anglophone and Francophone Countries in Sub Saharan Africa: Is Education for All Pro-Poor? CREATE Pathways to Access. Research Monograph No. 52

ERIC Educational Resources Information Center

Lewin, Keith M.; Sabates, Ricardo

2011-01-01

This paper explores patterns of growth in participation in six Anglophone and seven Francophone countries in SSA. The countries are Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, Benin, Burkina Faso, Cameroon, Madagascar, Mali, Niger and Senegal. These countries all have large scale Universal Primary Education programmes and all have…

Biomedical Scientific and Professional Social Networks in the Service of the Development of Modern Scientific Publishing.

PubMed

Masic, Izet; Begic, Edin

2016-12-01

Information technologies have found their application in virtually every branch of health care. In recent years they have demonstrated their potential in the development of online library, where scientists and researchers can share their latest findings. Academia.edu, ResearchGate, Mendeley, Kudos, with the support of platform GoogleScholar, have indeed increased the visibility of scientific work of one author, and enable a much greater availability of the scientific work to the broader audience. Online libraries have allowed free access to the scientific content to the countries that could not follow the economic costs of getting access to certain scientific bases. Especially great benefit occurred in countries in transition and developing countries. Online libraries have great potential in terms of expanding knowledge, but they also present a major problem for many publishers, because their rights can be violated, which are signed by the author when publishing the paper. In the future it will lead to a major conflict of the author, the editorial board and online database, about the right to scientific content This question certainly represents one of the most pressing issues of publishing, whose future in printed form is already in the past, and the future of the online editions will be a problem of large-scale.

Biomedical Scientific and Professional Social Networks in the Service of the Development of Modern Scientific Publishing

PubMed Central

Masic, Izet; Begic, Edin

2016-01-01

Information technologies have found their application in virtually every branch of health care. In recent years they have demonstrated their potential in the development of online library, where scientists and researchers can share their latest findings. Academia.edu, ResearchGate, Mendeley, Kudos, with the support of platform GoogleScholar, have indeed increased the visibility of scientific work of one author, and enable a much greater availability of the scientific work to the broader audience. Online libraries have allowed free access to the scientific content to the countries that could not follow the economic costs of getting access to certain scientific bases. Especially great benefit occurred in countries in transition and developing countries. Online libraries have great potential in terms of expanding knowledge, but they also present a major problem for many publishers, because their rights can be violated, which are signed by the author when publishing the paper. In the future it will lead to a major conflict of the author, the editorial board and online database, about the right to scientific content This question certainly represents one of the most pressing issues of publishing, whose future in printed form is already in the past, and the future of the online editions will be a problem of large-scale. PMID:28077905

The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access

PubMed Central

2012-01-01

Background The reform of pharmaceutical policy can often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a legislative amendment that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only two orders of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda have been exported. Future use of the regime appears unlikely. This research aimed to examine the politics of CAMR. Methods Parliamentary Committee hearing transcripts from CAMR's legislative development (2004) and legislative review (2007) were analysed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analysed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR. Results In 2004, policy debates in Canada were dominated by two themes: intellectual property rights and the TRIPS Agreement. The right to medicines as a basic human right and CAMR's potential impact on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. Conclusions The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access. PMID:22472291

The politics behind the implementation of the WTO Paragraph 6 Decision in Canada to increase global drug access.

PubMed

Esmail, Laura C; Kohler, Jillian Clare

2012-04-03

The reform of pharmaceutical policy can often involve trade-offs between competing social and commercial goals. Canada's Access to Medicines Regime (CAMR), a legislative amendment that permits compulsory licensing for the production and export of medicines to developing countries, aimed to reconcile these goals. Since it was passed in 2004, only two orders of antiretroviral drugs, enough for 21,000 HIV/AIDS patients in Rwanda have been exported. Future use of the regime appears unlikely. This research aimed to examine the politics of CAMR. Parliamentary Committee hearing transcripts from CAMR's legislative development (2004) and legislative review (2007) were analysed using a content analysis technique to identify how stakeholders who participated in the debates framed the issues. These findings were subsequently analysed using a framework of framing, institutions and interests to determine how these three dimensions shaped CAMR. In 2004, policy debates in Canada were dominated by two themes: intellectual property rights and the TRIPS Agreement. The right to medicines as a basic human right and CAMR's potential impact on innovation were hardly discussed. With the Departments of Industry Canada and International Trade as the lead institutions, the goals of protecting intellectual property and ensuring good trade relations with the United States appear to have taken priority over encouraging generic competition to achieve drug affordability. The result was a more limited interpretation of patent flexibilities under the WTO Paragraph 6 Decision. The most striking finding is the minimal discussion over the potential barriers developing country beneficiaries might face when attempting to use compulsory licensing, including their reluctance to use TRIPS flexibilities, their desire to pursue technological development and the constraints inherent in the WTO Paragraph 6 Decision. Instead, these issues were raised in 2007, which can be partly accounted for by experience in implementing the legislation and hence a greater representation of the interests of potential beneficiary country governments. The Canadian Government designed CAMR as a last resort measure. Increased input from the developing country beneficiaries and shifting to institutions where the right to health gets prioritized may lead to policies that better achieves affordable drug access.

The effect of social franchising on access to and quality of health services in low- and middle-income countries.

PubMed

Koehlmoos, Tracey Perez; Gazi, Rukhsana; Hossain, S Shahed; Zaman, K

2009-01-21

Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries. To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007). Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services. Two review authors independently applied the criteria for inclusion and exclusion of studies to scan titles and abstracts. The same two review authors independently screened full reports of selected citations . At each stage, results were compared and discrepancies settled through discussion. No studies were found which were eligible for inclusion in this review. There is a need to develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.

An Analysis of Determinants of Under-5 Mortality across Countries: Defining Priorities to Achieve Targets in Sustainable Developmental Goals.

PubMed

Acheampong, Michael; Ejiofor, Chukwudi; Salinas-Miranda, Abraham

2017-06-01

Objectives The end of the era of millennium development goals (MDGs) ushered in the sustainable development goals (SDGs) with a new target for the reduction of under-five mortality rates (U5MR). Although U5MR decreased globally, the reduction was insufficient to meet MDGs targets because significant socioeconomic inequities remain unaddressed across and within countries. Thus, further progress in achieving the new SDGs target will be hindered if there is no adequate prioritization of important socioeconomic, healthcare, and environmental factors. The objective of this study was to assess factors that account most for the differences in U5MR between countries around the globe. Methods We conducted an ordinary least squares (OLS) regression-based prioritization analysis of socioeconomic, healthcare, and environmental variables from 109 countries to understand which factors explain the differences in U5MR best. Results All indicators examined individually affected differences in U5MR between countries. However, the results of multivariate OLS regression showed that the most important factors that accounted for the differences were, in order: fertility rate, total health expenditure per capita, access to improved water and sanitation, and female employment rate. Conclusions To achieve the new global target for U5MR, policymakers must focus on certain priority areas, such as interventions that address access to affordable maternal healthcare services, educational programs for mothers, especially those who are adolescents, and safe drinking water and sanitation.

Financing mental health services in low- and middle-income countries.

PubMed

Dixon, Anna; McDaid, David; Knapp, Martin; Curran, Claire

2006-05-01

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Sustainable electricity generation by solar pv/diesel hybrid system without storage for off grids areas

NASA Astrophysics Data System (ADS)

Azoumah, Y.; Yamegueu, D.; Py, X.

2012-02-01

Access to energy is known as a key issue for poverty reduction. The electrification rate of sub Saharan countries is one of the lowest among the developing countries. However this part of the world has natural energy resources that could help raising its access to energy, then its economic development. An original "flexy energy" concept of hybrid solar pv/diesel/biofuel power plant, without battery storage, is developed in order to not only make access to energy possible for rural and peri-urban populations in Africa (by reducing the electricity generation cost) but also to make the electricity production sustainable in these areas. Some experimental results conducted on this concept prototype show that the sizing of a pv/diesel hybrid system by taking into account the solar radiation and the load/demand profile of a typical area may lead the diesel generator to operate near its optimal point (70-90 % of its nominal power). Results also show that for a reliability of a PV/diesel hybrid system, the rated power of the diesel generator should be equal to the peak load. By the way, it has been verified through this study that the functioning of a pv/Diesel hybrid system is efficient for higher load and higher solar radiation.

[Health care access barriers and facilitators: a qualitative systematic review].

PubMed

Hirmas Adauy, Macarena; Poffald Angulo, Lucy; Jasmen Sepúlveda, Anita María; Aguilera Sanhueza, Ximena; Delgado Becerra, Iris; Vega Morales, Jeanette

2013-03-01

To determine whether health care access barriers and facilitators cut across different populations, countries, and pathologies, and if so, at which stages of health care access they occur most frequently. A qualitative systematic review of literature published between 2000 and 2010 was undertaken drawing on six international sources: Fuente Académica, MEDLINE (full-text), Academic Search Complete (a full-text multidisciplinary academic database), PubMed, SciELO, and LILACS. Scientific appraisal guidelines from the Critical Appraisal Skills Programme Español (CASPe) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) were applied. Gray literature was also reviewed. From the review of scientific literature, 19 of 1 160 articles and 8 of 12 gray literature documents were selected. A total of 230 barriers and 35 facilitators were identified in countries with different contexts and degrees of development. The 230 barriers were classified according to the Tanahashi framework: 25 corresponded to availability, 67 to access, 87 to acceptability, and 51 to contact. Most of the barriers were related to acceptability and access. The facilitating elements that were identified had to do with personal factors, the provider-client relationship, social support, knowledge about diseases, and adaptation of the services to patients. The barriers and facilitators were seen mostly in people who initiated contact with the health systems, and they occurred at all stages of health care access. Only a few of the studies looked at people who did not initiate contact with the health services. The barriers and facilitators identified were socially determined and largely a reflection of existing social inequities in the countries. To reduce or eliminate them, joint action with other non-health sectors will be necessary.

Experiences from the implementation of a biosafety system in Slovenia.

PubMed

Milavec, Mojca; Racman, Darja Stanic

2007-09-01

The development and implementation of an effective national biosafety system is important for several key reasons: to ensure safe access to products of modern biotechnology, to build public confidence, to encourage the growth of domestic modern biotechnology, and to comply with international standards and agreements. There is no single best approach in the development and implementation of a national biosafety system and each country is faced with unique challenges. Slovenia is a small country and a new EU Member State. However, it has developed and implemented an efficient national biosafety system. The key elements of this system are administrative procedure, risk assessment, enforcement, and public participation and information.

Three-dimensional Printing in Developing Countries

PubMed Central

Ibrahim, Ahmed M. S.; Jose, Rod R.; Rabie, Amr N.; Gerstle, Theodore L.; Lee, Bernard T.

2015-01-01

Summary: The advent of 3-dimensional (3D) printing technology has facilitated the creation of customized objects. The lack of regulation in developing countries renders conventional means of addressing various healthcare issues challenging. 3D printing may provide a venue for addressing many of these concerns in an inexpensive and easily accessible fashion. These may potentially include the production of basic medical supplies, vaccination beads, laboratory equipment, and prosthetic limbs. As this technology continues to improve and prices are reduced, 3D printing has the potential ability to promote initiatives across the entire developing world, resulting in improved surgical care and providing a higher quality of healthcare to its residents. PMID:26301132

Three-dimensional Printing in Developing Countries.

PubMed

Ibrahim, Ahmed M S; Jose, Rod R; Rabie, Amr N; Gerstle, Theodore L; Lee, Bernard T; Lin, Samuel J

2015-07-01

The advent of 3-dimensional (3D) printing technology has facilitated the creation of customized objects. The lack of regulation in developing countries renders conventional means of addressing various healthcare issues challenging. 3D printing may provide a venue for addressing many of these concerns in an inexpensive and easily accessible fashion. These may potentially include the production of basic medical supplies, vaccination beads, laboratory equipment, and prosthetic limbs. As this technology continues to improve and prices are reduced, 3D printing has the potential ability to promote initiatives across the entire developing world, resulting in improved surgical care and providing a higher quality of healthcare to its residents.

Do less populous countries receive more development assistance for health per capita? Longitudinal evidence for 143 countries, 1990-2014.

PubMed

Martinsen, Lene; Ottersen, Trygve; Dieleman, Joseph L; Hessel, Philipp; Kinge, Jonas Minet; Skirbekk, Vegard

2018-01-01

Per capita allocation of overall development assistance has been shown to be biased towards countries with lower population size, meaning funders tend to provide proportionally less development assistance to countries with large populations. Individuals that happen to be part of large populations therefore tend to receive less assistance. However, no study has investigated whether this is also true regarding development assistance for health. We examined whether this so-called 'small-country bias' exists in the health aid sector. We analysed the effect of a country's population size on the receipt of development assistance for health per capita (in 2015 US$) among 143 countries over the period 1990-2014. Explanatory variables shown to be associated with receipt of development assistance for health were included: gross domestic product per capita, burden of disease, under-5 mortality rate, maternal mortality ratio, vaccination coverage (diphtheria, tetanus and pertussis) and fertility rate. We used the within-between regression analysis, popularised by Mundluck, as well as a number of robustness tests, including ordinary least squares, random-effects and fixed-effects regressions. Our results suggest there exists significant negative effect of population size on the amount of development assistance for health per capita countries received. According to the within-between estimator, a 1% larger population size is associated with a 0.4% lower per capita development assistance for health between countries (-0.37, 95% CI -0.45 to -0.28), and 2.3% lower per capita development assistance for health within countries (-2.29, 95% CI -3.86 to -0.72). Our findings support the hypothesis that small-country bias exists within international health aid, as has been previously documented for aid in general. In a rapidly changing landscape of global health and development, the inclusion of population size in allocation decisions should be challenged on the basis of equitable access to healthcare and health aid effectiveness.

Shortening the decade-long gap between adult and paediatric drug formulations: a new framework based on the HIV experience in low- and middle-income countries.

PubMed

Penazzato, Martina; Lewis, Linda; Watkins, Melynda; Prabhu, Vineet; Pascual, Fernando; Auton, Martin; Kreft, Wesley; Morin, Sébastien; Vicari, Marissa; Lee, Janice; Jamieson, David; Siberry, George K

2018-02-01

Despite the coordinated efforts by several stakeholders to speed up access to HIV treatment for children, development of optimal paediatric formulations still lags 8 to 10 years behind that of adults, due mainly to lack of market incentives and technical complexities in manufacturing. The small and fragmented paediatric market also hinders launch and uptake of new formulations. Moreover, the problems affecting HIV similarly affect other disease areas where development and introduction of optimal paediatric formulations is even slower. Therefore, accelerating processes for developing and commercializing optimal paediatric drug formulations for HIV and other disease areas is urgently needed. The Global Accelerator for Paediatric Formulations (GAP-f) is an innovative collaborative model that will accelerate availability of optimized treatment options for infectious diseases, such as HIV, tuberculosis and viral hepatitis, affecting children in low- and middle-income countries (LMICs). It builds on the HIV experience and existing efforts in paediatric drug development, formalizing collaboration between normative bodies, research networks, regulatory agencies, industry, supply and procurement organizations and funding bodies. Upstream, the GAP-f will coordinate technical support to companies to design and study optimal paediatric formulations, harmonize efforts with regulators and incentivize manufacturers to conduct formulation development. Downstream, the GAP-f will reinforce coordinated procurement and communication with suppliers. The GAP-f will be implemented in a three-stage process: (1) development of a strategic framework and promotion of key regulatory efficiencies; (2) testing of feasibility and results, building on the work of existing platforms such as the Paediatric HIV Treatment Initiative (PHTI) including innovative approaches to incentivize generic development and (3) launch as a fully functioning structure. GAP-f is a key partnership example enhancing North-South and international cooperation on and access to science and technology and capacity building, responding to Sustainable Development Goal (SDG) 17.6 (technology) and 17.9. (capacity-building). By promoting access to the most needed paediatric formulations for HIV and high-burden infectious diseases in low-and middle-income countries, GAP-f will support achievement of SDG 3.2 (infant mortality), 3.3 (end of AIDS and combat other communicable diseases) and 3.8 (access to essential medicines), and be an essential component of meeting the global Start Free, Stay Free, AIDS Free super-fast-track targets. © 2018 World Health Organization; licensee IAS.

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions.

PubMed

Simen-Kapeu, Aline; Seale, Anna C; Wall, Steve; Nyange, Christabel; Qazi, Shamim A; Moxon, Sarah G; Young, Mark; Liu, Grace; Darmstadt, Gary L; Dickson, Kim E; Lawn, Joy E

2015-01-01

Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity. Methods A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections. Results For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges. Conclusions Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups. PMID:26391217

Has the implementation of the TRIPS Agreement in Latin America and the Caribbean produced intellectual property legislation that favours public health?

PubMed

Oliveira, Maria Auxiliadora; Bermudez, Jorge Antonio Zepeda; Chaves, Gabriela Costa; Velásquez, Germán

2004-11-01

The World Trade Organization's Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement establishes minimum standards for intellectual property rights, including patent protection for pharmaceuticals; therefore, it may make it difficult for developing countries to gain access to medicines, especially those countries that are the least developed. This study aims to determine whether implementation of the TRIPS Agreement in Latin American and Caribbean countries has generated patent legislation that is sensitive to public health needs. Legislation in 11 Latin American and Caribbean countries was analysed. The variables considered in the analysis were: the term of patents issued, patentable subject matter, transition periods (that is, time until legislation was enacted), reversal of the burden of proof of patent infringement, exhaustion of rights, compulsory licensing and the early working exception (which allows a country to complete all procedures necessary to register a generic product before the original patent expires). By 2000, all of the countries studied had reformed their legislation to conform to the agreement. Brazil and Argentina used the transition period until 2005 to grant patents in the pharmaceutical industry. All countries, except Panama, made use of the safeguards and flexibilities available through the agreement by including mechanisms for compulsory licensing in their legislation. Argentina; Bolivia, Colombia, Ecuador, Peru and Venezuela (countries that represented the Andean community); the Dominican Republic; and Panama included mechanisms to allow parallel importation. Mexico did not. Brazil only permits parallel importation after a compulsory licence has been issued. The early working exception is included in legislation in Brazil and the Dominican Republic. The countries in this study did not incorporate all of the mechanisms allowed for by the Agreement and are not adequately using the provisions that enable World Trade Organization (WTO) members to obtain better health for the public, particularly in regard to gaining access to medicines. This situation may deteriorate in future if other agreements establish more restrictive rules for intellectual property rights.

A snapshot of health information exchange across five nations: an investigation of frontline clinician experiences in emergency care.

PubMed

Klapman, Seth; Sher, Emily; Adler-Milstein, Julia

2018-06-01

Ensuring the ability to exchange patient information among disparate electronic health records systems is a top priority and a domain of substantial public investment across countries. However, we know little about the extent to which current capabilities meet the needs of frontline clinicians. We conducted in-person, semistructured interviews with emergency care physicians and nurses in select hospitals in Canada, Denmark, Finland, Germany, and the USA. We characterized the state of health information exchange (HIE) by country and used thematic analysis to identify the perceived benefits of access to complete past medical history (PMH), the conditions under which PMH is sought, and the challenges to accessing and using HIE capabilities. HIE approaches, and the information electronically accessible to clinicians, differed by country. Benefits of access to PMH included safer care, reduced patient length of stay, and fewer lab and imaging orders. Conditions under which PMH was sought included moderate-acuity patients, patients with chronic conditions, and instances where accessing PMH was convenient. Challenges to HIE access and use included difficulty knowing where information is located, delay in receiving information, and difficulty finding information within documents. Even with different HIE approaches across countries, all clinicians reported shortcomings in their country's approach. Notably, challenges were similar and shaped the conditions under which PMH was sought. As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another.

Measuring Gender (In)Equality: Introducing the Gender, Institutions and Development Data Base (GID). OECD Development Centre Working Paper No. 247

ERIC Educational Resources Information Center

Jutting, Johannes P.; Morrisson, Christian; Dayton-Johnson, Jeff; Drechsler, Denis

2006-01-01

Efforts to establish, test and analyse hypotheses regarding cross-country variations in women's economic status are hampered by the lack of a readily accessible and easily used information resource on the various dimensions of gender inequality. Addressing this gap, this paper introduces the Gender, Institutions and Development data base (GID)…

Public funding for abortion where broadly legal.

PubMed

Grossman, Daniel; Grindlay, Kate; Burns, Bridgit

2016-11-01

The objective was to investigate public funding policies for abortion in countries with liberal or liberally interpreted laws (defined as permitting abortion for economic or social reasons or upon request). In May 2011-February 2012 and June 2013-December 2014, we researched online resources and conducted an email-based survey among reproductive health experts to determine countries' public funding policies for abortion. We categorized countries as follows: full funding for abortion (provided for free at government facilities, covered under state-funded health insurance); partial funding (partially covered by the government, covered for certain populations based on income or nonincome criteria, or less expensive in public facilities); funding for exceptional cases (rape/incest/fetal impairment, health/life of the woman or other limited cases) and no public funding. We obtained data for all 80 countries meeting inclusion criteria. Among the world's female population aged 15-49 in countries with liberal/liberally interpreted abortion laws, 46% lived in countries with full funding for abortion (34 countries), 41% lived in countries with partial funding (25 countries), and 13% lived in countries with no funding or funding for exceptional cases only (21 countries). Thirty-one of 40 high-income countries provided full funding for abortion (n=20) or partial funding (n=11); 28 of 40 low- to middle-income countries provided full (n=14) or partial funding for abortion (n=14). Of those countries that did not provide public funding for abortion, most provided full coverage of maternity care. Nearly half of countries with liberal/liberally interpreted abortion laws had public funding for abortion, including most countries that liberalized their abortion law in the past 20 years. Outliers remain, however, including among developed countries where access to abortion may be limited due to affordability. Since cost of services affects access, country policies regarding public funding for services should be monitored, and advocacy should prioritize ensuring the affordability of care for low-income women. Copyright © 2016 Elsevier Inc. All rights reserved.

Information and communication technologies and health in low income countries: the potential and the constraints.

PubMed Central

Chandrasekhar, C. P.; Ghosh, J.

2001-01-01

This paper outlines the potential offered by technological progress in the information and communication technologies (ICTs) industries for the health sector in developing countries, presents some examples of positive experiences in India, and considers the difficulties in achieving this potential. The development of ICTs can bring about improvements in health in developing countries in at least three ways: as an instrument for continuing education they enable health workers to be informed of and trained in advances in knowledge; they can improve the delivery of health and disaster management services to poor and remote locations; and they can increase the transparency and efficiency of governance, which should, in turn, improve the availability and delivery of publicly provided health services. These potential benefits of ICTs do not necessarily require all the final beneficiaries to be reached directly, thus the cost of a given quantum of effect is reduced. Some current experiments in India, such as the use of Personal Digital Assistants by rural health workers in Rajasthan, the disaster management project in Maharashtra and the computerized village offices in Andhra Pradesh and Pondicherry, suggest creative ways of using ICTs to improve the health conditions of local people. However, the basic difficulties encountered in using ICTs for such purposes are: an inadequate physical infrastructure; insufficient access by the majority of the population to the hardware; and a lack of the requisite skills for using them. We highlight the substantial cost involved in providing wider access, and the problem of resource allocation in poor countries where basic infrastructure for health and education is still lacking. Educating health professionals in the possible uses of ICTs, and providing them with access and "connectivity", would in turn spread the benefits to a much wider set of final beneficiaries and might help reduce the digital divide. PMID:11584733

Built environment and diabetes

PubMed Central

Pasala, Sudhir Kumar; Rao, Allam Appa; Sridhar, G. R.

2010-01-01

Development of type 2 diabetes mellitus is influenced by built environment, which is, ‘the environments that are modified by humans, including homes, schools, workplaces, highways, urban sprawls, accessibility to amenities, leisure, and pollution.’ Built environment contributes to diabetes through access to physical activity and through stress, by affecting the sleep cycle. With globalization, there is a possibility that western environmental models may be replicated in developing countries such as India, where the underlying genetic predisposition makes them particularly susceptible to diabetes. Here we review published information on the relationship between built environment and diabetes, so that appropriate modifications can be incorporated to reduce the risk of developing diabetes mellitus. PMID:20535308

History of the development of radiotherapy in Latin America.

PubMed

Pinillos, Luis; Pinto, Joseph A; Sarria, Gustavo

2017-01-01

Radiotherapy was the first nonsurgical treatment for malignant tumours and represents one of the oldest disciplines of oncology. In Latin America, as in many parts of the world, the history of modern oncology begins with the implementation of radiation therapy facilities. The development of radiotherapy in Latin America was possible thanks to the seminal work of radiation oncologists in different countries. As a large territory, there is a need to implement modern facilities and equipment, but unfortunately there are disparities in the access and quality of radiotherapy services across Latin America and even within individual countries. In this review, we describe the history, challenges and success in the implementation of radiotherapy and the frustration caused by the lack of facilities in several Latin American countries.

Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues.

PubMed

Swindale, Anne; Bilinsky, Paula

2006-05-01

The United States Public Law 480 Title II food aid program is the largest U.S. government program directed at reducing hunger, malnutrition, and food insecurity in the developing world. USAID and Title II implementing partners face challenges in measuring the success of Title II programs in reducing household food insecurity because of the technical difficulty and cost of collecting and analyzing data on traditional food security indicators, such as per capita income and caloric adequacy. The Household Food Insecurity Access Scale (HFIAS) holds promise as an easier and more user-friendly approach for measuring the access component of household food security. To support the consistent and comparable collection of the HFIAS, efforts are under way to develop a guide with a standardized questionnaire and data collection and analysis instructions. A set of domains have been identified that is deemed to capture the universal experience of the access component of household food insecurity across countries and cultures. Based on these domains, a set of questions has been developed with wording that is deemed to be universally appropriate, with minor adaptation to local contexts. These underlying suppositions, based on research in multiple countries, are being verified by potential users of the guide. The key remaining issue relates to the process for creating a categorical indicator of food insecurity status from the HFIAS.

Technology and the future of medical equipment maintenance.

PubMed

Wear, J O

1999-05-01

Maintenance of medical equipment has been changing rapidly in the past few years. It is changing more rapidly in developed countries, but changes are also occurring in developing countries. Some of the changes may permit improved maintenance on the higher technology equipment in developing countries, since they do not require onsite expertise. Technology has had an increasing impact on the development of medical equipment with the increased use of microprocessors and computers. With miniaturization from space technology and electronic chip design, powerful microprocessors and computers have been built into medical equipment. The improvement in manufacturing technology has increased the quality of parts and therefore the medical equipment. This has resulted in increased mean time between failures and reduced maintenance needs. This has made equipment more reliable in remote areas and developing countries. The built-in computers and advances in software design have brought about self-diagnostics in medical equipment. The technicians now have a strong tool to be used in maintenance. One problem in this area is getting access to the self-diagnostics. Some manufacturers will not readily provide this access to the owner of the equipment. Advances in telecommunications in conjunction with self-diagnostics make available remote diagnosis and repair. Since components can no longer be repaired, a remote repair technician can instruct an operator or an on-site repairman on board replacement. In case of software problems, the remote repair technician may perform the repairs over the telephone. It is possible for the equipment to be monitored remotely by modern without interfering with the operation of the equipment. These changes in technology require the training of biomedical engineering technicians (BMETs) to change. They must have training in computers and telecommunications. Some of this training can be done with telecommunications and computers.

Development of Palliative Care in China: A Tale of Three Cities.

PubMed

Yin, Zhenyu; Li, Jinxiang; Ma, Ke; Ning, Xiaohong; Chen, Huiping; Fu, Haiyan; Zhang, Haibo; Wang, Chun; Bruera, Eduardo; Hui, David

2017-11-01

China is the most populous country in the world, but access to palliative care is extremely limited. A better understanding of the development of palliative care programs in China and how they overcome the barriers to provide services would inform how we can further integrate palliative care into oncology practices in China. Here, we describe the program development and infrastructure of the palliative care programs at three Chinese institutions, using these as examples to discuss strategies to accelerate palliative care access for cancer patients in China. Case study of three palliative care programs in Chengdu, Kunming, and Beijing. The three examples of palliative care delivery in China ranged from a comprehensive program that includes all major branches of palliative care in Chengdu, a program that is predominantly inpatient-based in Kunming, and a smaller program at an earlier stage of development in Beijing. Despite the numerous challenges related to the limited training opportunities, stigma on death and dying, and lack of resources and policies to support clinical practice, these programs were able to overcome many barriers to offer palliative care services to patients with advanced diseases and to advance this discipline in China through visionary leadership, collaboration with other countries to acquire palliative care expertise, committed staff members, and persistence. Palliative care is limited in China, although a few comprehensive programs exist. Our findings may inform palliative care program development in other Chinese hospitals. With a population of 1.3 billion, China is the most populous country in the world, and cancer is the leading cause of death. However, only 0.7% of hospitals offer palliative care services, which significantly limits palliative care access for Chinese cancer patients. Here, we describe the program development and infrastructure of three palliative care programs in China, using these as examples to discuss how they were able to overcome various barriers to implement palliative care. Lessons from these programs may help to accelerate the progress of palliative cancer care in China. © AlphaMed Press 2017.

3 CFR 8439 - Proclamation 8439 of October 15, 2009. White Cane Safety Day, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... development of new assistive technologies, we must also improve access to existing tools. The Braille code has opened a doorway to literacy for countless individuals, but far too many blind children in our country...

22 CFR 203.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT REGISTRATION OF PRIVATE VOLUNTARY ORGANIZATIONS (PVOs) § 203... information may be accessed in the daily course of conducting business. (e) International Private Voluntary... country in which it is domiciled; (2) Is a private nongovernmental organization (NGO) that solicits and...

22 CFR 203.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT REGISTRATION OF PRIVATE VOLUNTARY ORGANIZATIONS (PVOs) § 203... information may be accessed in the daily course of conducting business. (e) International Private Voluntary... country in which it is domiciled; (2) Is a private nongovernmental organization (NGO) that solicits and...

22 CFR 203.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Relations AGENCY FOR INTERNATIONAL DEVELOPMENT REGISTRATION OF PRIVATE VOLUNTARY ORGANIZATIONS (PVOs) § 203... information may be accessed in the daily course of conducting business. (e) International Private Voluntary... country in which it is domiciled; (2) Is a private nongovernmental organization (NGO) that solicits and...

Perceptions of people living with HIV/AIDS regarding access to health care.

PubMed

Vaswani, Vina; Vaswani, Ravi

2014-04-01

Although the health care is replete with technology in the present day, it is not freely accessible in a developing country. The situation could be even more compromised in the case of people living with HIV/AIDS, with the added dimension of stigma and discrimination. What are the factors that act as barriers to health care? This study was conducted to look into perceptions of people living with HIV/AIDS with regard to access to health care. The study looked into accessibility of general health vis-à-vis access to antiretroviral therapy. Demographic variables like age, gender, income were studied in relation to factors such as counseling, confidentiality, stigma and discrimination, which are known to influence access to health care. People living with HIV/AIDS perceive general health care as more accessible than care for HIV treatment. Discrimination by health care workers causes a barrier to accessibility.

Access to electronic health knowledge in five countries in Africa: a descriptive study.

PubMed

Smith, Helen; Bukirwa, Hasifa; Mukasa, Oscar; Snell, Paul; Adeh-Nsoh, Sylvester; Mbuyita, Selemani; Honorati, Masanja; Orji, Bright; Garner, Paul

2007-05-17

Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives. Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use. In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords. Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.

Vaccines as a global imperative--a business perspective.

PubMed

Stéphenne, Jean

2011-06-01

During the past thirty years, vaccines have experienced a renaissance. Advances in science, business, and distribution have transformed the field to the point where vaccines are recognized as a "best buy" in global health, a driver of pharmaceutical industry growth, and a key instrument of international development. With many new vaccines available and others on the horizon, the global community will need to explore new ways of ensuring access to vaccines in developing nations. So-called tiered pricing, which makes vaccines available at different prices for countries at different levels of economic development; innovative financing mechanisms such as advance market commitments or offers of long-term and high-volume contracts to vaccine producers; and technology transfers such as sharing intellectual property and production techniques among companies and countries can all play a part in bringing new life-saving vaccines for pneumonia, rotavirus, malaria, and other diseases to developing countries.

Patients without borders: understanding medical travel.

PubMed

Whittaker, Andrea; Manderson, Lenore; Cartwright, Elizabeth

2010-10-01

The rapidly growing medical travel industry has implications for the health systems of both sending and receiving countries. This article outlines the political economy of the industry and the potential opportunities and disadvantages it poses for access, equity, and the right to health. Although the trade carries economic benefits for countries receiving foreign medical patients, it comes at a cost to the provision of public health, through distortions in the health workforce and the development of two-tiered health systems. Inequalities and failures in the health systems of sending countries largely drive the need to travel for care.

Inequities in access to inpatient rehabilitation after stroke: an international scoping review.

PubMed

Lynch, Elizabeth A; Cadilhac, Dominique A; Luker, Julie A; Hillier, Susan L

2017-12-01

Background Inequities in accessing inpatient rehabilitation after stroke have been reported in many countries and impact on patient outcomes. Objective To explore variation in international recommendations regarding which patients should receive inpatient rehabilitation after stroke and to describe reported access to rehabilitation. Methods A scoping review was conducted to identify clinical guidelines with recommendations regarding which patients should access inpatient rehabilitation after stroke, and data regarding the proportion of patients accessing stroke rehabilitation. Four bibliographic databases and grey literature were searched. Results Twenty-eight documents were included. Selection criteria for post-acute inpatient rehabilitation were identified for 14 countries or regions and summary data on the proportion of patients receiving inpatient rehabilitation were identified for 14 countries. In Australia, New Zealand, and the United Kingdom, it is recommended that all patients with stroke symptoms should access rehabilitation, whereas guidelines from the United States, Canada, and Europe did not consistently recommend rehabilitation for people with severe stroke. Access to inpatient rehabilitation ranged from 13% in Sweden to 57% in Israel. Differences in availability of early supported discharge/home rehabilitation programs and variations in reporting methods may influence the ability to reliably compare access to rehabilitation between regions. Conclusion Recommendations regarding which patients with moderate and severe strokes should access ongoing rehabilitation are inconsistent. Clinical practice guidelines from different countries regarding post-stroke rehabilitation do not always reflect the evidence regarding the likely benefits to people with stroke. Inequity in access to rehabilitation after stroke is an international issue.

Building capacity in health research in the developing world.

PubMed Central

Lansang, Mary Ann; Dennis, Rodolfo

2004-01-01

Strong national health research systems are needed to improve health systems and attain better health. For developing countries to indigenize health research systems, it is essential to build research capacity. We review the positive features and weaknesses of various approaches to capacity building, emphasizing that complementary approaches to human resource development work best in the context of a systems and long-term perspective. As a key element of capacity building, countries must also address issues related to the enabling environment, in particular: leadership, career structure, critical mass, infrastructure, information access and interfaces between research producers and users. The success of efforts to build capacity in developing countries will ultimately depend on political will and credibility, adequate financing, and a responsive capacity-building plan that is based on a thorough situational analysis of the resources needed for health research and the inequities and gaps in health care. Greater national and international investment in capacity building in developing countries has the greatest potential for securing dynamic and agile knowledge systems that can deliver better health and equity, now and in the future. PMID:15643798

Tuberculosis in Asia and the pacific: the role of socioeconomic status and health system development.

PubMed

Wu, Jie; Dalal, Koustuv

2012-01-01

To identify the relationship between socioeconomic status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific. Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological-behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used. The worst three tuberculosis affected countries were Cambodia, India and Indonesia, while the least affected was Australia. Tuberculosis incidence, prevalence and mortality rate were higher in countries with lower human development index, corruption perception index, gross domestic product (GDP) per capita and countries with more people under minimum food supplements. Among the health system variables, total health expenditure per capita, governmental health expenditure per capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis. Socioeconomic determinants and health system development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation.

Building capacity in health research in the developing world.

PubMed

Lansang, Mary Ann; Dennis, Rodolfo

2004-10-01

Strong national health research systems are needed to improve health systems and attain better health. For developing countries to indigenize health research systems, it is essential to build research capacity. We review the positive features and weaknesses of various approaches to capacity building, emphasizing that complementary approaches to human resource development work best in the context of a systems and long-term perspective. As a key element of capacity building, countries must also address issues related to the enabling environment, in particular: leadership, career structure, critical mass, infrastructure, information access and interfaces between research producers and users. The success of efforts to build capacity in developing countries will ultimately depend on political will and credibility, adequate financing, and a responsive capacity-building plan that is based on a thorough situational analysis of the resources needed for health research and the inequities and gaps in health care. Greater national and international investment in capacity building in developing countries has the greatest potential for securing dynamic and agile knowledge systems that can deliver better health and equity, now and in the future.

Pharmaceutical strategic purchasing requirements in Iran: Price interventions and the related effective factors.

PubMed

Bastani, Peivand; Dinarvand, Rasoul; SamadBeik, Mahnaz; Pourmohammadi, Kimia

2016-01-01

Pharmaceutical access for the poor is an essential factor in developing countries that can be improved through strategic purchasing. This study was conducted to identify the elements affecting price in order to enable insurance organizations to put strategic purchasing into practice. This was a qualitative study conducted through content analysis with an inductive approach applying a five-stage framework analysis (familiarization, identifying a thematic framework, indexing, mapping, and interpretation). Data analysis was started right after transcribing each interview applying ATLAS.ti. Data were saturated after 32 semi-structured interviews by experts. These key informants were selected purposefully and through snowball sampling. Findings showed that there are four main themes as Pharmaceutical Strategic Purchasing Requirements in Iran as follows essential and structural factors, international factors, economical factors, and legal factors. Moreover, totally 14 related sub-themes were extracted in this area as the main effective variables. It seems that paying adequate attention to the four present themes and 14 sub-themes affecting price can enable health system policy-makers of developing countries like Iran to make the best decisions through strategic purchasing of drugs by the main insurers in order to improve access and health in the country.

A data infrastructure for the assessment of health care performance: lessons from the BRIDGE-health project.

PubMed

Bernal-Delgado, Enrique; Estupiñán-Romero, Francisco

2018-01-01

The integration of different administrative data sources from a number of European countries has been shown useful in the assessment of unwarranted variations in health care performance. This essay describes the procedures used to set up a data infrastructure (e.g., data access and exchange, definition of the minimum common wealth of data required, and the development of the relational logic data model) and, the methods to produce trustworthy healthcare performance measurements (e.g., ontologies standardisation and quality assurance analysis). The paper ends providing some hints on how to use these lessons in an eventual European infrastructure on public health research and monitoring. Although the relational data infrastructure developed has been proven accurate, effective to compare health system performance across different countries, and efficient enough to deal with hundred of millions of episodes, the logic data model might not be responsive if the European infrastructure aims at including electronic health records and carrying out multi-cohort multi-intervention comparative effectiveness research. The deployment of a distributed infrastructure based on semantic interoperability, where individual data remain in-country and open-access scripts for data management and analysis travel around the hubs composing the infrastructure, might be a sensible way forward.

Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.

PubMed

Gomez-de-León, Andrés; Gómez-Almaguer, David; Ruiz-Delgado, Guillermo J; Ruiz-Arguelles, Guillermo J

2017-09-01

The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.

Telecommunication Policies in Seventeen Countries: Propects for Future Competitive Access.

ERIC Educational Resources Information Center

Eward, Ronald S.

This document is a review and study of current and prospective telecommunication policies in 17 countries with regard to the competitive market access those policies foster or promise. It explores the policies of each country toward information flow that will also have an impact on international competition. The aim of the study is to identify the…

Complex care systems in developing countries: breast cancer patient navigation in Ethiopia.

PubMed

Dye, Timothy D; Bogale, Solomon; Hobden, Claire; Tilahun, Yared; Hechter, Vanessa; Deressa, Teshome; Bizé, Marion; Reeler, Anne

2010-02-01

As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently. This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed. Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital. Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from 1 health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers. The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral. Copyright 2009 American Cancer Society.

The history of antiretroviral therapy and of its implementation in resource-limited areas of the world.

PubMed

Vella, Stefano; Schwartländer, Bernard; Sow, Salif Papa; Eholie, Serge Paul; Murphy, Robert L

2012-06-19

HIV/AIDS not only represents the most severe epidemic in modern times, but also the greatest public health challenge in history. The response of the scientific community has been impressive and in just a few years, turned an inevitably fatal disease into a chronic manageable although not yet curable condition. The development of antiretroviral therapy is not only the history of scientific advancements: it is the result of the passionate 'alliance' towards a common goal between researchers, doctors and nurses, pharmaceutical industries, regulators, public health officials and the community of HIV-infected patients, which is rather unique in the history of medicine. In addition, the rapid and progressive development of antiretroviral therapy has not only proven to be life-saving for many millions but has been instrumental in unveiling the inequities in access to health between rich and poor countries of the world. Optimal benefits indeed, are not accessible to all people living with HIV, with challenges to coverage and sustainability in low and middle income countries. This paper will review the progress made, starting from the initial despairing times, till the current battle towards universal access to treatment and care for all people living with HIV.

Getting the 'blues': the existence, diffusion and influence of pornography on young peoples' sexual health in Sierra Leone.

PubMed

Day, Andrea

2014-01-01

While substantial research has examined the effects of pornography on young people in developed societies, existing studies fall short in addressing how sexually-explicit material affects young people in developing countries. The importance of such knowledge increases as the globalising effects of technology expand young peoples' access and exposure to pornography. During the summer of 2012, a study was undertaken in Sierra Leone examining factors affecting young peoples' sexual and reproductive health. The research assessed the influence of HIV knowledge, communication about sex, civil war and contraception myths on sexual behaviours, while remaining open to unanticipated factors. During data collection, respondents identified pornography, also called blues, as an influential factor, detailing its newfound accessibility driven by improved access to information and communication technologies in the country. Respondents also addressed several presumed ways in which pornography impacts young peoples' decisions about sexual health. The following study examines perceived effects of young peoples' exposure to pornography based on existing literature. It then outlines the findings of research conducted in Sierra Leone, drawing on primary data from the respondents and relevant published literature and concludes with proposals for addressing its negative effects.

Conflicts of interest in research involving human beings.

PubMed

Greco, Dirceu; Diniz, Nilza Maria

2008-01-01

Conflicts of interest are inherent to the majority of relationships among individuals and of these with companies and institutions and, certainly, research involving human beings is no exception. In relation to clinical research, the main focus of this manuscript, conflicts of interest occur at different levels and usually permeate among them: In the pharmaceutical industry in their decisions to invest to develop new products, especially vaccines and drugs, and also in relation to marketing of these products; Among the investigators the conflicts may be related to the financial gains to participate in pharma sponsored trials, or to the expected academic career boost attained with the publication of the results of the trials and also to personal interests such as the financial support for trips to international conferences. Often the participation of host country investigators is restricted to performing phase III or IV protocols developed abroad, many times with low scientific relevance, and even lower relevance to public health; Universities or research institutes themselves also have conflicts of interest, as the sponsored projects may help increase their budgets, both directly (taxes) and indirectly (e.g., improvement of physical infrastructure of laboratories or out patient clinics); For the trial volunteers in developing countries, and Brazil is no exception despite free and universal access to its health system, participation in clinical trials is many times seen as, and can really be, an unique opportunity of receiving better health care, better treatment by the health professionals, easier access to costly lab exams and also to receiving certain medications which would otherwise be difficult to have access to. In order to handle these conflicts of interest, Brazil has a well-established and respected legal support and ethical normatization. The latter is represented by Resolution 196/96 of the Brazilian National Research Ethics Committee (CONEP). This national system was established in 1996 providing guidance to all research involving human beings and currently there are approximately 500 local research ethical committees certified by CONEP in all States of Brazil. However, there is intense international pressure mainly from the pharmaceutical industry especially to the ethical requirements emanated from the Declaration of Helsinki (DH), aiming to lower the level of ethical requirements in research to be carried out with volunteers from developing countries. Fallacious reasoning includes that the equity stated at the DH, especially the access to the best proven medical care and to the developed products to all volunteers independently of where the trial is being held, would inflate the costs of research and drive the sponsors away from the developing countries. In this line of thought, if the volunteers have not the same rights that would constitute an unacceptable double standard, or in other words, the best for the volunteers from developed countries and whatever is possible for those in developing countries. This manuscript will focus on the various levels where conflict of interest issues are more prone to happen, such as in the actions of pharmaceutical industries, their relation to health professionals, the participation of universities and research institutes, the ethical research committees and their members, including the possible pressures exerted on them by researchers, sponsors and even their institutions. Emphasis will be given to the interrelation between conflicts of interest and vulnerability, and also the causes and possible solutions to lower the risks of exploitation of volunteers in research. It will also emphasize the need to guarantee access to products that are proven efficacious to all individuals who may need them. Possible ways of empowering these volunteers will be evaluated, so that they become aware of their rights and demand for them. It will discuss the need of separating economic interests from the real needs of public health and of demystifying economic arguments used in order to justify the lowering of ethical requirements. And finally it will address the search for or the establishment of real and effective involvement of all stakeholders in an international organism really representing everyone (e.g., WHO) in order to evaluate, debate, and decrease the risks of several conflicts of interest, aiming at the establishment of research projects that can truly contribute to lower the obscene disparities of health between developed and developing countries.

Engaging Students in Water Resources Issues in Developing Countries (Invited)

NASA Astrophysics Data System (ADS)

Thomas, J.; Lutz, A.

2010-12-01

When all is said and done, what does it mean to work in the developing world? The need for access to clean water and sanitation and the desire to end poverty and disease cannot be disputed. But as engineers and physical scientists, we often step into a scenario with a problem-identification-and-solving approach. However, to successfully apply engineering and science in developing countries, we should also consider questions such as: how the problems have come to be; have our approaches been appropriate; and what have the effects of projects been on local populations? A short course to help us better address critical needs begins with readings that cover the history of development, development theories, review of “players” in development, case studies, and possibilities on the road ahead. It is also important to include key guest speakers with experience in developing countries as part of an international course curriculum. Within this overall course context, discussion of case studies provides an opportunity to critically assess positive, negative, and a combination of outcomes for communities. These case studies are building blocks for solving some of the most important water and sanitation issues in developing countries.

My revolutionary adventures in the development of modern emergency medical systems in our country.

PubMed

Edlich, Richard F

2008-05-01

The purpose of this article is to describe my exciting adventures in the development of the emergency medical systems in our country. After my training in plastic surgery at the University of Virginia, I accepted the position of Acting Director of the Emergency Room at the University of Virginia Health Science Center. Working with gifted physicians, basic scientists, nurses, and students, we coordinated the development of an emergency medical system that has been replicated throughout our country. Our system included the following: State legislation for the sexual assault victim, public access by the 9-1-1 telephone number, training of rescue squads, emergency radio communication system, trauma centers, poison control centers, emergency medical plan for the President of the United States, national telecommunications system for the deaf, and the first air medical transportation system in Virginia.

An Economic Analysis of United States Assistance to Selected Less Developed Countries.

DTIC Science & Technology

1983-07-01

and peoples, upon request, assistance of such nature and in such amounts as the United States deems advisable and as may be effectively used by free...country has the capability to absorb and utilize the arms effectively . (11) What other military interests--for example, overflight rights or access to...expenditures has created the opposite effect . Internal stability has been sacrificed as a result of a defense build up. As an exampl,- -f lthrs phnnomnenon

U.S. National Interests in the Asia-Pacific Region

DTIC Science & Technology

1991-04-22

ADDRESS (City, State, and ZIP Code) 10 SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK WORK UNIT ELEMENT NO. NO. NO. ACCESSION %0 11. TITLE (Include...through the work of missionaries while the Asian countries would produce "bolts of cloth", his vision that the traffic would be a two- way affair has...critical freeway which links a number of countries with extreme diversity in history, culture , and economic development. This diversity ranges from an

Global disparity in the supply of commercial weather and climate information services

PubMed Central

Georgeson, Lucien; Maslin, Mark; Poessinouw, Martyn

2017-01-01

Information about weather and climate is vital for many areas of decision-making, particularly under conditions of increasing vulnerability and uncertainty related to climate change. We have quantified the global commercial supply of weather and climate information services. Although government data are sometimes freely available, the interpretation and analysis of those data, alongside additional data collection, are required to formulate responses to specific challenges in areas such as health, agriculture, and the built environment. Using transactional data, we analyzed annual spending by private and public organizations on commercial weather and climate information in more than 180 countries by industrial sector, region, per capita, and percentage of GDP (gross domestic product) and against the country’s climate and extreme weather risk. There are major imbalances regarding access to these essential services between different countries based on region and development status. There is also no relationship between the level of climate and weather risks that a country faces and the level of per capita spending on commercial weather and climate information in that country. At the international level, action is being taken to improve access to information services. With a better understanding of the flows of commercial weather and climate information, as explored in this study, it will be possible to tackle these regional and development-related disparities and thus to increase resilience to climate and weather risks. PMID:28560335

Strengthening global vaccine access for adolescents and adults.

PubMed

Nanni, Angeline; Meredith, Stefanie; Gati, Stephanie; Holm, Karin; Harmon, Tom; Ginsberg, Ann

2017-12-14

Global immunization efforts to date have heavily focused on infants and children, with noted success on public health. Healthy adolescents and adults contribute to the economic growth and development of countries but efforts to ensure vaccine coverage for these groups receive inadequate global attention and resources. Emerging epidemics for a number of infectious diseases including Ebola, Zika, dengue, malaria and the continuing epidemics of tuberculosis and several sexually transmitted infections, including HIV, HPV and Hepatitis B, have high incidence and prevalence in adolescents and adults. New vaccines under development for these diseases and under-used vaccines such as for human papilloma virus will have the greatest health and economic impact in these populations. Global consensus, political will, policies, global and country infrastructure, and financing mechanisms are needed to accelerate access for the billions of adolescents and adults living under the threat of devastating infectious disease outbreaks and epidemics, especially in lower income countries. The global health community and countries cannot afford to delay planning for implementation of adolescent and adult vaccine programs that will potentially save millions of lives and strengthen global and national economies. The article examines this next challenge and suggests a research agenda and a framework for action to galvanize global and national policy decision-makers to begin preparations for future immunization challenges. Copyright © 2017 Elsevier Ltd. All rights reserved.

Refugee Students at College and University: Improving Access and Support

NASA Astrophysics Data System (ADS)

Hannah, Janet

1999-03-01

This article summarizes the findings and recommendations of a study into access to, and experience of, colleges of further education and universities by refugees in Sydney, Australia. The study sought to identify examples of institutional good practice which are potentially transferable to other major host countries for refugees in the developed world. It focuses upon the factors influencing the decision to enter college or university, sources and usefulness of information and advice, access courses and special entry schemes, the recognition of prior learning and overseas qualifications and institutional sensitivity and support. It concludes with a series of recommendations for providers of further and higher education to improve access and support for students from refugee backgrounds.

Chronic Hemodialysis Therapy in the West.

PubMed

Rocco, Michael V

2015-12-01

Chronic hemodialysis (HD) in the 1960s encompassed a wide variety of prescriptions from twice weekly to five times per week HD. Over time, HD prescriptions in the West became standardized at three times per week, 2.5-4 h per session, with occasional additional treatments for volume overload. When clinical trials of dialysis dose failed to show significant benefit of extending time compared with the traditional dialysis prescription, interest in more frequent HD was renewed. Consequently, there has been growth in home HD therapies as well as alternative dialysis prescriptions. Data from recent randomized clinical trials have demonstrated the benefits and risks of these more frequent therapies, with surprising differences in outcomes between short daily HD and long nocturnal HD. More frequent therapies improve control of both hypertension and hyperphosphatemia, but at the expense of increased vascular access complications and, at least for nocturnal HD, a faster loss of residual renal function. In the West, the standard HD prescription is three treatments per week with a minimal time of 3.0 h and dialysis is performed in an outpatient dialysis center. A minority of patients will have a fourth treatment per week for volume issues. Alternative HD prescriptions, although rare, are more available compared to the recent past. (1) While developed Western and Asian countries provide end-stage renal disease patients full access to HD, healthcare systems from South and South-East Asia can offer access to HD only to a limited fraction of the patients in need. Even though the annual costs of HD are much lower in less developed countries (for instance 30 times lower in India compared to the US), patients often cannot afford costs not covered by health insurance. (2) The recommended dialysis pattern in the West is at least three sessions weekly with high-flux dialyzers. Studies from Shanghai and Taiwan might however indicate a benefit of twice versus thrice weekly sessions. In less developed Asian countries, a twice weekly pattern is common, sometimes with dialyzer reuse and inadequate water treatment. A majority of patients decrease session frequency or discontinue the program due to financial constraint. (3) As convective therapies are gaining popularity in Europe, penetration in Asia is low and limited by costs. (4) In Asian countries, in particular in the South and South-East, hepatitis and tuberculosis infections in HD patients are higher than in the West and substantially increase mortality. (5) Progress has recently been made in countries like Thailand and Brunei to provide universal HD access to all patients in need. Nevertheless, well-trained personnel, reliable registries and better patient follow-up would improve outcomes in low-income Asian countries.

[Safe illegal abortion would make an important contribution to decreasing maternal mortality and female suffering].

PubMed

Kleiverda, G

2008-03-01

Unsafe abortion is a major public health concern in many developing countries, contributing to a substantial proportion of maternal deaths. Increased legal access to abortion services is associated with improvement in mortality and morbidity. Safe illegal abortion by means of drugs is another possible way to prevent this unnecessary harm to women. The Dutch government, however, is now proposing legal changes that will diminish the access to medical abortion by general practitioners.

Quantifying and Mapping Global Data Poverty.

PubMed

Leidig, Mathias; Teeuw, Richard M

2015-01-01

Digital information technologies, such as the Internet, mobile phones and social media, provide vast amounts of data for decision-making and resource management. However, access to these technologies, as well as their associated software and training materials, is not evenly distributed: since the 1990s there has been concern about a "Digital Divide" between the data-rich and the data-poor. We present an innovative metric for evaluating international variations in access to digital data: the Data Poverty Index (DPI). The DPI is based on Internet speeds, numbers of computer owners and Internet users, mobile phone ownership and network coverage, as well as provision of higher education. The datasets used to produce the DPI are provided annually for almost all the countries of the world and can be freely downloaded. The index that we present in this 'proof of concept' study is the first to quantify and visualise the problem of global data poverty, using the most recent datasets, for 2013. The effects of severe data poverty, particularly limited access to geoinformatic data, free software and online training materials, are discussed in the context of sustainable development and disaster risk reduction. The DPI highlights countries where support is needed for improving access to the Internet and for the provision of training in geoinfomatics. We conclude that the DPI is of value as a potential metric for monitoring the Sustainable Development Goals of the Sendai Framework for Disaster Risk Reduction.

'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan

PubMed Central

2011-01-01

Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs). Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector. PMID:21752236

Understanding healthcare practices in superdiverse neighbourhoods and developing the concept of welfare bricolage: Protocol of a cross-national mixed-methods study.

PubMed

Phillimore, Jenny; Bradby, Hannah; Knecht, Michi; Padilla, Beatriz; Brand, Tilman; Cheung, Sin Yi; Pemberton, Simon; Zeeb, Hajo

2015-06-28

Diversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision. This protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods - with varying deprivations levels and trajectories of change - in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries. This study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.

Oral Health Care for Children in Countries Using Dental Therapists in Public, School-Based Programs, Contrasted with That of the United States, Using Dentists in a Private Practice Model

PubMed Central

Friedman, Jay W.; Nash, David A.

2013-01-01

The United States faces a significant problem with access to oral health care, particularly for children. More than 50 countries have developed an alternative dental provider, a dental therapist, practicing in public, school-based programs, to address children’s access to care. This delivery model has been demonstrated to improve access to care and oral health outcomes while providing quality care economically. We summarize elements of a recent major review of the global literature on the use of dental therapists, “A Review of the Global Literature on Dental Therapists: In the Context of the Movement to Add Dental Therapists to the Oral Health Workforce in the United States.” We contrast the success of a school-based model of caring for children by dental therapists with that of the US model of dentists providing care for children in private practices. PMID:23865650

Use of certain alternative fuels in road transport in Poland

NASA Astrophysics Data System (ADS)

Gis, W.; Pielecha, J.; Waśkiewicz, J.; Gis, M.; Menes, M.

2016-09-01

The development of biomethane and hydrogen technology in the road transport in the EU countries is recommended, among the others, in the Directive of the European Parliament and of the Council 2014/94/EU of 22 October 2014. Under the provisions of the said Directive, it is recommended to EU countries to use biomethane and progressively ensure accessibility to hydrogen cars on their territories, and above all to ensure the possibility of driving hydrogen vehicles between the member States. The territorial accessibility for biomethane vehicles is determined by the availability of biomethane refuelling infrastructure in the first place in cities and then on the road network distances recommended in this directive. The territorial accessibility for hydrogen vehicles is determined by the availability of hydrogen refuelling infrastructure, in the first place along the TEN-T network. The article presents the possibilities of using these alternative fuels in Poland, presenting some of the results of research and analysis in this area.

Brain Drain and the Disenchantment of Being a Higher Education Student in Portugal

ERIC Educational Resources Information Center

Cerdeira, Luísa; Machado-Taylor, Maria de Lourdes; Cabrito, Belmiro; Patrocínio, Tomás; Brites, Rui; Gomes, Rui; Lopes, João Teixeira; Vaz, Henrique; Peixoto, Paulo; Magalhães, Dulce; Silva, Sílvia; Ganga, Rafaela

2016-01-01

The efforts made by most countries to accelerate economic development have included a significant investment in education. It has been argued that investment in education, particularly higher education, was itself a potential factor in economic development. Education has become a relatively easy means of improving access to the labour market.…

Developing a Nutrition and Health Education Program for Primary Schools in Zambia

ERIC Educational Resources Information Center

Sherman, Jane; Muehlhoff, Ellen

2007-01-01

School-based health and nutrition interventions in developing countries aim at improving children's nutrition and learning ability. In addition to the food and health inputs, children need access to education that is relevant to their lives, of good quality, and effective in its approach. Based on evidence from the Zambia Nutrition Education in…

Who Drops out from Primary Schools in China? Evidence from Minority-Concentrated Rural Areas

ERIC Educational Resources Information Center

Lu, Meichen; Cui, Manlin; Shi, Yaojiang; Chang, Fang; Mo, Di; Rozelle, Scott; Johnson, Natalie

2016-01-01

One of the Millennium Development Goals is to ensure universal access to primary education by 2015. However, primary school dropout remains a challenge in many developing countries. While official statistics in China report aggregated primary school dropout of only 0.2%, almost no independent, survey-based studies have sought to verify these…

A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services’ accessibility in economic migrants

PubMed Central

2012-01-01

Background Access to health services is an important health determinant. New research in health equity is required, especially amongst economic migrants from developing countries. Studies conducted on the use of health services by migrant populations highlight existing gaps in understanding which factors affect access to these services from a qualitative perspective. We aim to describe the views of the migrants regarding barriers and determinants of access to health services in the international literature (1997–2011). Methods A systematic review was conducted for Qualitative research papers (English/Spanish) published in 13 electronic databases. A selection of articles that accomplished the inclusion criteria and a quality evaluation of the studies were carried out. The findings of the selected studies were synthesised by means of metasynthesis using different analysis categories according to Andersen’s conceptual framework of access and use of health services and by incorporating other emergent categories. Results We located 3,025 titles, 36 studies achieved the inclusion criteria. After quality evaluation, 28 articles were definitively synthesised. 12 studies (46.2%) were carried out in the U.S and 11 studies (42.3%) dealt with primary care services. The participating population varied depending mainly on type of host country. Barriers were described, such as the lack of communication between health services providers and migrants, due to idiomatic difficulties and cultural differences. Other barriers were linked to the economic system, the health service characteristics and the legislation in each country. This situation has consequences for the lack of health control by migrants and their social vulnerability. Conclusions Economic migrants faced individual and structural barriers to the health services in host countries, especially those with undocumented situation and those experimented idiomatic difficulties. Strategies to improve the structures of health systems and social policies are needed. PMID:23245431

Development and management of a geographic information system for health research in a developing-country setting: a case study from Bangladesh.

PubMed

Sugimoto, Jonathan D; Labrique, Alain B; Ahmad, Salahuddin; Rashid, Mahbubur; Klemm, Rolf D W; Christian, Parul; West, Keith P

2007-12-01

In the last decade, geographic information systems (GIS) have become accessible to researchers in developing countries, yet guidance remains sparse for developing a GIS. Drawing on experience in developing a GIS for a large community trial in rural Bangladesh, six stages for constructing, maintaining, and using a GIS for health research purposes were outlined. The system contains 0.25 million landmarks, including 150,000 houses, in an area of 435 sq km with over 650,000 people. Assuming access to reasonably accurate paper boundary maps of the intended working area and the absence of pre-existing digital local-area maps, the six stages are: to (a) digitize and update existing paper maps, (b) join the digitized maps into a large-area map, (c) reference this large-area map to a geographic coordinate system, (d) insert location landmarks of interest, (e) maintain the GIS, and (f) link it to other research databases. These basic steps can produce a household-level, updated, scaleable GIS that can both enhance field efficiency and support epidemiologic analyses of demographic patterns, diseases, and health outcomes.

Development and Management of a Geographic Information System for Health Research in a Developing-country Setting: A Case Study from Bangladesh

PubMed Central

Sugimoto, Jonathan D.; Labrique, Alain B.; Salahuddin, Ahmad; Rashid, Mahbubur; Klemm, Rolf D.W.; Christian, Parul; West, Keith P.

2007-01-01

In the last decade, geographic information systems (GIS) have become accessible to researchers in developing countries, yet guidance remains sparse for developing a GIS. Drawing on experience in developing a GIS for a large community trial in rural Bangladesh, six stages for constructing, maintaining, and using a GIS for health research purposes were outlined. The system contains 0.25 million landmarks, including 150,000 houses, in an area of 435 sq km with over 650,000 people. Assuming access to reasonably accurate paper boundary maps of the intended working area and the absence of pre-existing digital local-area maps, the six stages are: to (a) digitize and update existing paper maps, (b) join the digitized maps into a large-area map, (c) reference this large-area map to a geographic coordinate system, (d) insert location landmarks of interest, (e) maintain the GIS, and (f) link it to other research databases. These basic steps can produce a household-level, updated, scaleable GIS that can both enhance field efficiency and support epidemiologic analyses of demographic patterns, diseases, and health outcomes. PMID:18402187

High youth access to movies that contain smoking in Europe compared with the USA.

PubMed

Hanewinkel, Reiner; Sargent, James D; Karlsdóttir, Sólveig; Jónsson, Stefán Hrafn; Mathis, Federica; Faggiano, Fabrizio; Poelen, Evelien A P; Scholte, Ron; Florek, Ewa; Sweeting, Helen; Hunt, Kate; Morgenstern, Matthis

2013-07-01

Based on evidence that exposure to smoking in movies is associated with adolescent smoking, the WHO has called on countries to assign a rating that restricts youth access to such movies. To evaluate youth access to movies that portray smoking in European countries and compare with that in the USA. The authors identified the most commercially successful movies screened in six European countries (Germany, Iceland, Italy, the Netherlands, Poland and UK) and the USA between 2004 and 2009. The authors coded the 464 movies that were screened in both Europe and the USA according to whether or not they portrayed smoking. 87% of the movies were 'youth' rated in Europe (ratings board classification as suitable for those younger than 16 years) compared to only 67% in the USA (suitable for those younger than 17 years). Smoking was portrayed in 319 (69%) movies. 85% of the movies that portrayed smoking were 'youth' rated in Europe compared with only 59% in the USA (p<0.001). Tobacco imagery is still common in popular films shown in European countries and the USA. None of the seven countries examined followed the WHO recommendations on restricting youth access to movies that portray smoking. Compared to the USA, European youths have access to substantially more movies in general, and this gives them access to more movies that portray smoking in particular.

Initiatives and strategies for development of nanotechnology in nations: a lesson for Africa and other least developed countries

PubMed Central

2014-01-01

It is a known fact that the progress and development of different nations of the world is strongly connected with the type of materials under their use. This paper highlighted the development of nanotechnology in some selected countries of the world through a careful review of their road maps by way of public and private initiatives, funding/investment profile, human resources development, industrial potentials, and focus in order to draw inferences. The peculiar challenges and opportunities for some African nations and other least developed countries (LDC) were drawn for their economic and technological developments. This investigation was simply based on open access literatures. The review showed that although nanotechnology is new globally, most countries of the world have had growing public and private investments aimed at bringing about new materials and systems that can impact positively on their economy and ensure their global competitiveness and sustainability. The global scenario suggests the crucial role of cooperation in a multidisciplinary collaboration/partnership between government ministries, agencies, institutions, and private sector/donor agencies in order to pool enough resource capital required for activities in nanotechnology. PMID:24650295

Initiatives and strategies for development of nanotechnology in nations: a lesson for Africa and other least developed countries.

PubMed

Ezema, Ikechukwu C; Ogbobe, Peter O; Omah, Augustine D

2014-03-20

It is a known fact that the progress and development of different nations of the world is strongly connected with the type of materials under their use. This paper highlighted the development of nanotechnology in some selected countries of the world through a careful review of their road maps by way of public and private initiatives, funding/investment profile, human resources development, industrial potentials, and focus in order to draw inferences. The peculiar challenges and opportunities for some African nations and other least developed countries (LDC) were drawn for their economic and technological developments. This investigation was simply based on open access literatures. The review showed that although nanotechnology is new globally, most countries of the world have had growing public and private investments aimed at bringing about new materials and systems that can impact positively on their economy and ensure their global competitiveness and sustainability. The global scenario suggests the crucial role of cooperation in a multidisciplinary collaboration/partnership between government ministries, agencies, institutions, and private sector/donor agencies in order to pool enough resource capital required for activities in nanotechnology.

Innovative technology in hearing instruments: matching needs in the developing world.

PubMed

McPherson, Bradley

2011-12-01

Hearing instrument technology research is almost entirely focused on the projected needs of the consumer market in the developed world. However, two thirds of the world's population with hearing impairment live in developing countries and this proportion will increase in future, given present demographic trends. In developing regions, amplification and other hearing health needs may differ from those in industrialized nations, for cultural, health, or economic reasons. World Health Organization estimates indicate that at present only a small percentage of individuals in developing countries who are in need of amplification have access to hearing aid provision. New technologies, such as trainable hearing aids, advanced noise reduction algorithms, feedback reduction circuitry, nano coatings for hearing aid components, and innovative power options, may offer considerable potential benefits, both for individuals with hearing impairment in developing countries and for those who provide hearing health care services in these regions. This article considers the possible supporting role of innovative hearing instrument technologies in the provision of affordable hearing health care services in developing countries and highlights the need for research that considers the requirements of the majority of the world population in need of hearing instrument provision.

Initiatives and strategies for development of nanotechnology in nations: a lesson for Africa and other least developed countries

NASA Astrophysics Data System (ADS)

Ezema, Ikechukwu C.; Ogbobe, Peter O.; Omah, Augustine D.

2014-03-01

It is a known fact that the progress and development of different nations of the world is strongly connected with the type of materials under their use. This paper highlighted the development of nanotechnology in some selected countries of the world through a careful review of their road maps by way of public and private initiatives, funding/investment profile, human resources development, industrial potentials, and focus in order to draw inferences. The peculiar challenges and opportunities for some African nations and other least developed countries (LDC) were drawn for their economic and technological developments. This investigation was simply based on open access literatures. The review showed that although nanotechnology is new globally, most countries of the world have had growing public and private investments aimed at bringing about new materials and systems that can impact positively on their economy and ensure their global competitiveness and sustainability. The global scenario suggests the crucial role of cooperation in a multidisciplinary collaboration/partnership between government ministries, agencies, institutions, and private sector/donor agencies in order to pool enough resource capital required for activities in nanotechnology.

A review of acute and chronic peritoneal dialysis in developing countries

PubMed Central

Abraham, Georgi; Varughese, Santosh; Mathew, Milly; Vijayan, Madhusudan

2015-01-01

Various modalities of renal replacement therapy (RRT) are available for the management of acute kidney injury (AKI) and end-stage renal disease (ESRD). While developed countries mainly use hemodialysis as a form of RRT, peritoneal dialysis (PD) has been increasingly utilized in developing countries. Chronic PD offers various benefits including lower cost, home-based therapy, single access, less requirement of highly trained personnel and major infrastructure, higher number of patients under a single nephrologist with probably improved quality of life and freedom of activities. PD has been found to be lifesaving in the management of AKI in patients in developing countries where facilities for other forms of RRT are not readily available. The International Society of Peritoneal Dialysis has published guidelines regarding the use of PD in AKI, which has helped in ensuring uniformity. PD has also been successfully used in certain special situations of AKI due to snake bite, malaria, febrile illness, following cardiac surgery and in poisoning. Hemodialysis is the most common form of RRT used in ESRD worldwide, but some countries have begun to adopt a ‘PD first’ policy to reduce healthcare costs of RRT and ensure that it reaches the underserved population. PMID:26034593

Paucity of family planning.

PubMed

Hawkins, C

1988-04-01

A wall chart compiled by the Population Crisis Committee of Washington D.C. called "World Access to Birth Control" is described. The chart compares developing countries and developed countries with respect to need of effective contraception, using data from the World Fertility Surveys. Up to 250 million women need contraception; a substantial percentage want no more children, over half in several large countries. The chart ranks the United Kingdom as 1st in providing family planning services, information, education and advertising. All of the developed countries were considered good except Russia and Romania, although some had deficiencies, such as Japan for lacking sterilization services. The U.S. ranked 7th, failing to provide women the full range of contraceptive methods, to provide adequate sex education and services to adolescents, and to publish information and adequate advertising about birth control. The USSR was placed 14th on the list of 15 because of poor quality and erratic supplies. Among the developing countries, Libya, Kampuchea and Laos were cited as having no services whatsoever. In contrast, several Asian national family planning programs, notably China, Taiwan, Singapore, South Korea and Hong Kong, had such excellent programs that fertility had declined over 30% in 15 years. In China, fertility has fallen 50% in that time.

Challenges associated with tracking resources allocation for reproductive health in sub-Saharan African countries: the UNFPA/NIDI resource flows project experience.

PubMed

Sidze, Estelle M; Beekink, Erik; Maina, Beatrice W

2015-05-05

Universal access to reproductive health services entails strengthening health systems, but requires significant resource commitments as well as efficient and effective use of those resources. A number of international organizations and governments in developing countries are putting efforts into tracking the flow of health resources in order to inform resource mobilization and allocation, strategic planning, priority setting, advocacy and general policy making. The UNFPA/NIDI-led Resource Flows Project ("The UNFPA/NIDI RF Project") has conducted annual surveys since 1997 to monitor progress achieved by developing countries in implementing reproductive health financial targets. This commentary summarizes the Project experiences and challenges in gathering data on allocation of resources for reproductive health at the domestic level in sub-Saharan African countries. One key lesson learnt from the Project experience is the need for strengthening tracking mechanisms in sub-Saharan African countries and making information on reproductive health resources and expenditures available, in particular the private sector resources.

Social Class, Ethnicity and Access to Higher Education in the Four Countries of the UK: 1996-2010

ERIC Educational Resources Information Center

Croxford, Linda; Raffe, David

2014-01-01

This paper compares access to full-time undergraduate higher education (HE) by members of less advantaged social classes and ethnic minorities across the four "home countries" of the UK. It uses data on applicants to HE in selected years from 1996 to 2010. In all home countries students from intermediate and working-class backgrounds…

Report of a workshop on ensuring sustainable access to safe blood in developing countries: International Blood Safety Forum, March 24, 2017.

PubMed

Katz, Louis M; Donnelly, John J; Gresens, Christopher J; Holmberg, Jerry A; MacPherson, James; Zacharias, Peter J K; Stanley, Jean; Bales, Christine

2018-05-01

On March 24, 2017, more than 90 experts in blood safety and international development from blood centers, industry, government, and international and nongovernmental organizations gathered in Arlington, Virginia, for the Third International Blood Safety Forum, cosponsored by America's Blood Centers and Global Healing. This report summarizes presentations and major conclusions. The meeting explored ways to increase access to affordable, safe blood for low- and lower-middle-income countries (LMICs) in an era when funding from the US President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund has been redirected from preventing the spread of human immunodeficiency virus (HIV) to diagnosing and treating the 25 million-plus people living with HIV in LMICs. More effective management systems must be developed to improve cost recovery for blood. While blood systems become more sustainable, continued investment is required to keep them operating. The traditional model of large grants from bilateral and multilateral donors will need to be supplemented (or replaced) with public-private partnerships and nongovernmental investment. A continued emphasis on quality is fundamental. Blood systems must build quality programs, based on accepted standards, including hospitals, clinics, and rural health care providers to ensure proper and safe use of blood. Proposals to resolve health care inequities between LMICs and high-income countries (HICs) must include helping LMICs to define sustainable national policies and practices for blood availability and utilization to suit local contexts. The blood safety lexicon should be revised to include availability, accessibility, and affordability of safe blood and blood products as the goal of all blood safety initiatives. © 2018 AABB.

Access to care and medicines, burden of health care expenditures, and risk protection: results from the World Health Survey.

PubMed

Wagner, Anita K; Graves, Amy Johnson; Reiss, Sheila K; Lecates, Robert; Zhang, Fang; Ross-Degnan, Dennis

2011-05-01

We assessed the contribution of health insurance and a functioning public sector to access to care and medicines and household economic burden. We used descriptive and logistic regression analyses on 2002/3 World Health Survey data in 70 countries. Across countries, 286,803 households and 276,362 respondents contributed data. More than 90% of households had access to acute care. However, less than half of respondents with a chronic condition reported access. In 51 low and middle income countries (LMIC), health care expenditures accounted for 13-32% of total 4-week household expenditures. One in four poor households in low income countries incurred potentially catastrophic health care expenses and more than 40% used savings, borrowed money, or sold assets to pay for care. Between 41% and 56% of households in LMIC spent 100% of health care expenditures on medicines. Health insurance and a functioning public sector were both associated with better access to care and lower risk of economic burden. To improve access, policy makers should improve public sector provision of care, increase health insurance coverage, and expand medicines benefit policies in health insurance systems. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Findings from the PISA for Development Field Trial of the School-Based Assessment. PISA for Development Brief 16

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

The PISA for Development (PISA-D) project aims to make PISA more accessible and relevant to middle- and low-income countries by introducing new features to the assessment, including tests that are specially designed to measure lower levels of performance, contextual questionnaires that better reflect the situations of 15-year-olds across a diverse…

Addressing the Issue of Gender Equity in the Presidency of the University System in the Southern African Development Community (SADC) Region

ERIC Educational Resources Information Center

Guramatunhu-Mudiwa, Precious

2010-01-01

The Southern African Development Community (SADC) is a regional economic grouping of 15 countries whose common vision is to promote economic, social and political development and growth. Arguably, sustainable growth can be realized if there is equal access to all positions of power and influence in the area, but an investigation of 117…

IMPLICATIONS OF GLOBAL PRICING POLICIES ON ACCESS TO INNOVATIVE DRUGS: THE CASE OF TRASTUZUMAB IN SEVEN LATIN AMERICAN COUNTRIES.

PubMed

Pichon-Riviere, Andres; Garay, Osvaldo Ulises; Augustovski, Federico; Vallejos, Carlos; Huayanay, Leandro; Bueno, Maria del Pilar Navia; Rodriguez, Alarico; de Andrade, Carlos José Coelho; Buendía, Jefferson Antonio; Drummond, Michael

2015-01-01

Differential pricing, based on countries' purchasing power, is recommended by the World Health Organization to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage, and accessibility for patients with breast cancer in Latin America (LA). A Markov model was designed to estimate life-years (LYs), quality-adjusted life-years (QALYs), and costs from a healthcare perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country. Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 U.S. dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0 percent probability that trastuzumab is CE if the willingness-to-pay threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3 percent and 26.6 percent, respectively). Trastuzumab price would need to decrease between 69.6 percent to 94.9 percent to became CE in LA. Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.

Democratizing molecular diagnostics for the developing world.

PubMed

Abou Tayoun, Ahmad N; Burchard, Paul R; Malik, Imran; Scherer, Axel; Tsongalis, Gregory J

2014-01-01

Infectious diseases that are largely treatable continue to pose a tremendous burden on the developing world despite the availability of highly potent drugs. The high mortality and morbidity rates of these diseases are largely due to a lack of affordable diagnostics that are accessible to resource-limited areas and that can deliver high-quality results. In fact, modified molecular diagnostics for infectious diseases were rated as the top biotechnology to improve health in developing countries. In this review, we describe the characteristics of accessible molecular diagnostic tools and discuss the challenges associated with implementing such tools at low infrastructure sites. We highlight our experience as part of the "Grand Challenge" project supported by the Gates Foundation for addressing global health inequities and describe issues and solutions associated with developing adequate technologies or molecular assays needed for broad access in the developing world. We believe that sharing this knowledge will facilitate the development of new molecular technologies that are extremely valuable for improving global health.

The Motivation-Facilitation Theory of Prenatal Care Access.

PubMed

Phillippi, Julia C; Roman, Marian W

2013-01-01

Despite the availability of services, accessing health care remains a problem in the United States and other developed countries. Prenatal care has the potential to improve perinatal outcomes and decrease health disparities, yet many women struggle with access to care. Current theories addressing access to prenatal care focus on barriers, although such knowledge is minimally useful for clinicians. We propose a middle-range theory, the motivation-facilitation theory of prenatal care access, which condenses the prenatal care access process into 2 interacting components: motivation and facilitation. Maternal motivation is the mother's desire to begin and maintain care. Facilitation represents the goal of the clinic to create easy, open access to person-centered beneficial care. This simple model directs the focus of research and change to the interface of the woman and the clinic and encourages practice-level interventions that facilitate women entering and maintaining prenatal care. © 2013 by the American College of Nurse‐Midwives.

Lighting the World: the first application of an open source, spatial electrification tool (OnSSET) on Sub-Saharan Africa

NASA Astrophysics Data System (ADS)

Mentis, Dimitrios; Howells, Mark; Rogner, Holger; Korkovelos, Alexandros; Arderne, Christopher; Zepeda, Eduardo; Siyal, Shahid; Taliotis, Costantinos; Bazilian, Morgan; de Roo, Ad; Tanvez, Yann; Oudalov, Alexandre; Scholtz, Ernst

2017-08-01

In September 2015, the United Nations General Assembly adopted Agenda 2030, which comprises a set of 17 Sustainable Development Goals (SDGs) defined by 169 targets. ‘Ensuring access to affordable, reliable, sustainable and modern energy for all by 2030’ is the seventh goal (SDG7). While access to energy refers to more than electricity, the latter is the central focus of this work. According to the World Bank’s 2015 Global Tracking Framework, roughly 15% of the world’s population (or 1.1 billion people) lack access to electricity, and many more rely on poor quality electricity services. The majority of those without access (87%) reside in rural areas. This paper presents results of a geographic information systems approach coupled with open access data. We present least-cost electrification strategies on a country-by-country basis for Sub-Saharan Africa. The electrification options include grid extension, mini-grid and stand-alone systems for rural, peri-urban, and urban contexts across the economy. At low levels of electricity demand there is a strong penetration of standalone technologies. However, higher electricity demand levels move the favourable electrification option from stand-alone systems to mini grid and to grid extensions.

Pathways and access to mental health care services by persons living with severe mental disorders and epilepsy in Uganda, Liberia and Nepal: a qualitative study.

PubMed

Kisa, Rose; Baingana, Florence; Kajungu, Rehema; Mangen, Patrick O; Angdembe, Mangesh; Gwaikolo, Wilfred; Cooper, Janice

2016-08-31

Access to mental health care services for patients with neuropsychiatric disorders remains low especially in post-conflict, low and middle income countries. Persons with mental health conditions and epilepsy take many different paths when they access formal and informal care for their conditions. This study conducted across three countries sought to provide preliminary data to inform program development on access to care. It thus sought to assess the different pathways persons with severe mental disorders and epilepsy take when accessing care. It also sought to identify the barriers to accessing care that patients face. Six in depth interviews, 27 focus group discussions and 77 key informants' interviews were conducted on a purposively selected sample of health care workers, policy makers, service users and care takers in Uganda, Liberia and Nepal. Data collected along predetermined themes was analysed using Atlas ti software in Uganda and QSR Nvivo 10 in Liberia and Nepal Individual's beliefs guide the paths they take when accessing care. Unlike other studies done in this area, majority of the study participants reported the hospital as their main source of care. Whereas traditional healers lie last in the hierarchy in Liberia and Nepal, they come after the hospital as a care option in Uganda. Systemic barriers such as: lack of psychotropic medicines, inadequate mental health specialists and services and negative attitudes of health care workers, family related and community related barriers were reported. Access to mental health care services by persons living with severe mental disorders and epilepsy remains low in these three post conflict countries. The reasons contributing to it are multi-faceted ranging from systemic, familial, community and individual. It is imperative that policies and programming address: negative attitudes and stigma from health care workers and community, regular provision of medicines and other supplies, enhancement of health care workers skills. Ultimately reducing the accessibility gap will also require use of expert clients and families to strengthen the treatment coalition.

Integrating Web-based technology into distance education for nurses in China: computer and Internet access and attitudes.

PubMed

Cragg, C E Betty; Edwards, Nancy; Yue, Zhao; Xin, Song Li; Hui, Zou Dao

2003-01-01

To increase continuing education accessibility, nurses around the world are turning to Web-based instruction. However, for Internet education to be successful, particularly in developing countries, nurses must have access to computers and the Internet as well as positive attitudes toward this form of learning. As part of a distance education project for nurses of the Tianjin Municipality in China, a survey of nurses was conducted to examine their sources of professional knowledge as well as their computer and Internet access and attitudes. The attitudes of the nurses were generally positive, and there was evidence of rapidly increasing use of and access to computers and the Internet. This article reports the results of that survey and their implications for Web-based teaching of Chinese nurses.

Global access to surgical care: a modelling study.

PubMed

Alkire, Blake C; Raykar, Nakul P; Shrime, Mark G; Weiser, Thomas G; Bickler, Stephen W; Rose, John A; Nutt, Cameron T; Greenberg, Sarah L M; Kotagal, Meera; Riesel, Johanna N; Esquivel, Micaela; Uribe-Leitz, Tarsicio; Molina, George; Roy, Nobhojit; Meara, John G; Farmer, Paul E

2015-06-01

More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. At least 4·8 billion people (95% posterior credible interval 4·6-5·0 [67%, 64-70]) of the world's population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Most of the world's population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. None. Copyright © 2015 Alkire et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Current and future management of treatment failure in low- and middle-income countries.

PubMed

Boyd, Mark A

2010-01-01

Access to second-line therapy in low- and middle-income countries has been limited to date. The WHO predicts that between 500 000 and 800 000 HIV-infected people on first-line combination antiretroviral therapy will require switch to second-line therapy by 2010. This paper aims to describe and review access to second-line therapy in low- and middle-income countries at present and examine future possibilities. The majority of HIV-infected patients failing first-line combination antiretroviral therapy is identified by way of routine monitoring of clinical and immunological status as a surrogate for virological monitoring. Evidence suggests that immunological and clinical monitoring lack both sensitivity and specificity for virological failure. Consequently, at treatment failure, patients have often selected a degree of resistance within the nucleoside/nucleotide reverse transcriptase inhibitor class that questions the efficacy of using nucleoside/nucleotide reverse transcriptase inhibitors in a second-line regimen. There is a paucity of good-quality evidence on which to base guidelines and policy. Optimally, a second-line regimen would be simple, potent, tolerable and lend itself to provision according to the successful 'public health' approach. Provision of second-line therapy to HIV-infected individuals failing first-line therapy is a major challenge to the ongoing success of access to HIV care programmes in low- and middle-income countries. The optimal second-line combination antiretroviral therapies are unknown. Research trials to help define best practice are in advanced stages of development and implementation.

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization

PubMed Central

Ahonkhai, Vincent; Portet, Alexandre; Hartman, Dan

2016-01-01

Background The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world’s poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. Methods and Findings A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization’s prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. Conclusions We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups. PMID:27851831

Speeding Access to Vaccines and Medicines in Low- and Middle-Income Countries: A Case for Change and a Framework for Optimized Product Market Authorization.

PubMed

Ahonkhai, Vincent; Martins, Samuel F; Portet, Alexandre; Lumpkin, Murray; Hartman, Dan

2016-01-01

The United Nations Millennium Development Goals galvanized global efforts to alleviate suffering of the world's poorest people through unprecedented public-private partnerships. Donor aid agencies have demonstrably saved millions of lives that might otherwise have been lost to disease through increased access to quality-assured vaccines and medicines. Yet, the introduction of these health interventions in low- and middle-income countries (LMICs) continues to face a time lag due to factors which remain poorly understood. A recurring theme from our partnership engagements was that an optimized regulatory process would contribute to improved access to quality health products. Therefore, we investigated the current system for medicine and vaccine registration in LMICs as part of our comprehensive regulatory strategy. Here, we report a fact base of the registration timelines for vaccines and drugs used to treat certain communicable diseases in LMICs. We worked with a broad set of stakeholders, including the World Health Organization's prequalification team, national regulatory authorities, manufacturers, procurers, and other experts, and collected data on the timelines between first submission and last approval of applications for product registration sub-Saharan Africa. We focused on countries with the highest burden of communicable disease and the greatest need for the products studied. The data showed a typical lag of 4 to 7 years between the first regulatory submission which was usually to a regulatory agency in a high-income country, and the final approval in Sub-Saharan Africa. Two of the three typical registration steps which products undergo before delivery in the countries involve lengthy timelines. Failure to leverage or rely on the findings from reviews already performed by competent regulatory authorities, disparate requirements for product approval by the countries, and lengthy timelines by manufacturers to respond to regulatory queries were key underlying factors for the delays. We propose a series of measures which we developed in close collaboration with key stakeholders that could be taken to reduce registration time and to make safe, effective medicines more quickly available in countries where they are most needed. Many of these recommendations are being implemented by the responsible stakeholders, including the WHO prequalification team and the national regulatory authorities in Sub-Saharan Africa. Those efforts will be the focus of subsequent publications by the pertinent groups.

Liberal Learning and Management: A Mutually Beneficial Relationship.

ERIC Educational Resources Information Center

Butler, David W.

1986-01-01

Management, which generates wealth, determines the distribution of wealth, and helps control the direction and accessibility of careers in most developed countries, is a subject worthy of the humanities, and deserves to be pursued more aggressively as a point of contact among disciplines. (MSE)

Too Much or Too Little

ERIC Educational Resources Information Center

Obeng, Letitia E.

1975-01-01

All countries require an ample supply of water for agricultural and industrial uses. Most have sufficient water supplies, but availability and accessibility vary. With the development of water irrigation systems, health conditions often deteriorate. The author recommends a water management program to control quality and quantity of available…

Structured Peer Mentoring: Enhancing Lifelong Learning in Pakistani Universities

ERIC Educational Resources Information Center

Naseem, Nosheen Rachel

2012-01-01

Higher Education in developing countries is frequently restricted to students from privileged backgrounds, especially those from private secondary education. In Pakistan, access to Higher Education, while competitive, is more broadly based, with state universities particularly recruiting students from diverse backgrounds. Just as Widening…

Biochemical Approaches to Improved Nitrogen Fixation

USDA-ARS?s Scientific Manuscript database

Improving symbiotic nitrogen fixation by legumes has emerged again as an important topic on the world scene due to the energy crisis and lack of access to nitrogen fertilizer in developing countries. We have taken a biochemical genomics approach to improving symbiotic nitrogen fixation in legumes. L...

The potential exploitation of research participants in high income countries who lack access to health care

PubMed Central

Rid, Annette; Emanuel, Ezekiel; Wendler, David

2016-01-01

There are millions of individuals living in North America and the European Union who lack access to healthcare services. When these individuals participate in research, they are at increased risk of being exposed to the risks and burdens of clinical trials without realizing the benefits that result from them. The mechanisms that have been proposed to ensure that research participants in low‐ and middle‐income countries are not exploited are unlikely to protect participants in high‐income countries. The present manuscript argues that one way to address concerns about exploitation in high‐income countries would be to require sponsors to provide targeted benefits such as medical treatment during the trial, or the study drug after the trial. The latter could be achieved through extension studies, expanded access programs, or named‐patient programs. Sponsors also might provide non‐medical benefits, such as education or social support. Ethical and regulatory guidance should be revised to ensure that research participants in high‐income countries who lack access to healthcare services receive sufficient benefits. PMID:26743927

Basic survival needs and access to medicines--coming to grips with TRIPS: conversion + calculation.

PubMed

Van Puymbroeck, Rudolf V

2010-01-01

"Access to medicines" is a broad concept. After a review of three authoritative frameworks that help to identify its constitutive components, this essay summarizes the actual situation on the ground in low- and middle-income countries on the basis of recent empirical work. An analysis of survey data from 36 countries concluded that developing countries should promote generic medicines as a key policy option for improving access to medicines. Taking an international perspective to that recommendation, this essay reviews the World Trade Organization's Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and, particularly, how this agreement has been applied in practice. As shown by the experience of Thailand, Brazil, and the Philippines, in order to deal effectively with international pressures for an excessive application of the TRIPS Agreement, some sort of conversion experience appears to be required, which then leads to a switch from a private enterprise, supply-driven approach to a public health vision that insists on universal and affordable access. But moral conviction is not sufficient. In order to muster and sustain the political will to face down international forces, civil society and government offices must be able and ready to show the costs and other adverse consequences of the TRIPS-based model for medicines. This calculation needs to reach beyond the health sector and calls for new alliances, nationally as well as internationally. © 2010 American Society of Law, Medicine & Ethics, Inc.