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Medical donations are not always free: An assessment of compliance of medicine and medical device donations with World Health Organization guidelines (2009-2017)
Abstract
Medicine and medical device donations have the potential to improve access to healthcare in some of the poorest parts of the world, but can do more harm than good. World Health Organization guidelines advise donors on how to make effective and useful donations. Our objective was to assess compliance of recent medicine or medical device donations with WHO guidelines from 2009 onwards. We searched media, academic and gray literature, including industry and organizational documents, to identify reports describing specific incidences of the donation of medicines or devices. We collected data on donation characteristics and guideline compliance. We identified 88 reports describing 53 donations. Most did not comply with at least some items in WHO guidelines and no reports provided sufficient information to assess compliance against all items. Donations that fail to comply with guidelines may be excessive, expired and/or burden recipient countries with storage and disposal costs. It was estimated that 40-70% of donated medical devices are not used as they are not functional, appropriate, or staff lack training. More effective donations involved needs assessments, training and the use of existing distribution networks. The donation of medicines and medical devices is frequently inadequately reported and at times inappropriate. Guidelines need to be enforced to ensure effective donations.
... While well-implemented health donation programs have the potential to improve access to new products, a significant number of donation programs have been fraught with several challenges [7,8]. These include poor forecasting, inappropriate product type, misaligned timing of donation with required changes in policy to support the new product, gaps in resourcing national programmes for implementation, fragmented and uncoordinated donor efforts, etc [8][9][10]. ...
... Governments have cited the reputational risk of huge expiries, disposal fees accrued from the expiry of short-dated or excessive volumes, and a lack of focus on sustainability planning when the donation programme ends as some of the reasons for such reluctance [8]. Although the World Health Organization (WHO) has established guidelines to help address these challenges with medical donations, a review conducted in 2018 showed that most donation programmes still did not comply with the WHO guidelines [7]. Unitaid, in line with its mandate of accelerating access to innovative health products, identifies the importance of catalytic product introductions with clear sustainability pathways as vital, and hence designed an innovative approach that seeks to address some of the aforementioned challenges. ...
... Another benefit of the EMAV strategy is its demand-driven design. With countries or recipients being responsible for the request and quantification for the new commodity, EMAVs reduce the risk of experiencing donation of unwanted or excessive product volumes; a common challenge with standard donation programs [7,8]. While EMAVs may face the risk of overestimated requests, an attempt at mitigating this risk is made through the validation process that occurs during the review of applications. ...
Low-and middle-income countries (LMICs) account for a significant proportion of the burden of disease for communicable illnesses globally; with malaria, tuberculosis (TB), and HIV/AIDS being the leading causes of death. Despite this disparity, LMICs often have limited or delayed access to newer optimal health products compared to high-income countries (HICs). This limitation in access, driven by a myriad of barriers, undermines the potential health benefits that could be gained in LMICs through the introduction of better health products. To improve this inequity, governments in HICs, non-governmental organizations, and pharmaceutical companies, often resort to establishing donation programs for LMICs, to circumvent some of the access barriers. While well-implemented donation programs have the potential to improve access to new products, poorly executed donation programmes are common. These often have negative effects such as: overreliance on donations by recipient countries, dumping of short-dated or unwanted products, costs of waste disposal where unsuitable or excess products are received, and a lack of focus on access sustainability planning. Unitaid’s early market access vehicle (EMAV) is an innovative demand-driven access model for introducing new optimal health commodities in LMICs. An EMAV entails a conditional purchase commitment to the manufacturer for a defined quantity of selected products in exchange for a set of access commitments, required to facilitate equitable access in the target markets. EMAVs are designed to link catalytic donations to pathways for sustainable access. Unitaid, in collaboration with its partners, has leveraged the EMAV to introduce two innovative health products in a number of LMICs. This article discusses the EMAV model and builds the case on why stakeholders working on new product access should consider this approach as an alternative to traditional donation programmes.
... If the quality of a product is unacceptable to a donor country, it is unacceptable for that product to be donated to a recipient country. Evidence-based reviews of country compliance with the 2010 Guidelines, undertaken in 2015 [7] and 2019 [8] respectively, recommended that WHO implement further revisions to the Guidelines. Cañigueral-Vila et al. [7] discussed the need for specific wording, inclusion of donation checklists and contrasting between acute and long-term emergency situations. ...
... Cañigueral-Vila et al. [7] discussed the need for specific wording, inclusion of donation checklists and contrasting between acute and long-term emergency situations. McDonald et al. [8] concluded that most of the 53 donations that they identified "did not comply with at least some items in WHO guidelines and no reports provided sufficient information to assess compliance against all items. " They suggested there be an emphasis on encouraging donors and recipients to regularly report the status and completion of medicine donations. ...
... Recipient countries were limited to LDCs because these countries are those most likely to face significant financial barriers to access, and thus the most likely candidates for medicine donations (particular during times of public health crisis). In addition, countries in the LDC group were the most likely to be listed as donation recipients in the article by McDonald et al. [8]. ...
Background
To help promote the effective delivery of drug donations, the World Health Organization (WHO) developed the Guidelines for Medicine Donations. The need for revisions is timely given the large-scale influx of medicine donations since the start of the COVID-19 pandemic. This study analyses current policies of donors and recipients that are commensurate with the recommendations in the Guidelines and examines current practices, challenges, and revision suggestions.
Results
A search for medicine donation policies of donors and recipients was conducted in May/June 2022 and repeated in January 2023. Potential donor countries were identified from the high-income countries on the United Nation’s (UN) List of G20 Countries. Potential pharmaceutical company donors were selected from those with 2021 revenue of $30 billion or greater. Potential non-government organization donors came from the WHO list of non-governmental organizations (NGOs) and two other sources. Potential recipient countries were those on the UN List of Least Developed Countries. These four lists were supplemented with actual donors and recipients identified from the literature. All policies retrieved were screened to identify which of the 12 recommendations from the WHO Guidelines were incorporated. We identified 38 policies from 1 donor country, 6 brand-name multinational pharmaceutical companies, 6 NGOs and 25 recipient countries. Most policies incorporated all 12 recommendations. Twenty-five of the 38 policies were developed in 2010 or later. The majority of actual donors and recipients did not have policies that were publicly available. A rapid literature review for publications from 2010 onwards identified challenges in implementing the WHO Guidelines and suggested for revisions. Challenges included: (1) information management; (2) medication presentation; (3) influence from the pharmaceutical industry; (4) donation sustainability; and (5) the belief that donations are inherently good.
Conclusions
Our findings suggest that both donors and recipients could further align their policies with the existing Guidelines and both groups should be consulted on any revisions to ensure that their experiences are reflected and their needs are addressed. While the current WHO Guidelines for Medicine Donations are a solid base for medical humanitarian efforts, evidence points to the need for an update to meet current challenges.
... 11 13 Concerns about the regulation and oversight of medical devices continue to be raised globally, owing to the significant number of medical devices found to be of poor quality, unsafe and abandoned across health settings. [14][15][16][17] In African countries, medical devices are often donated or procured for use from high-income settings, are seldom designed for use in lower-resource settings and may not be appropriate for adoption and use. 15 16 18 Other challenges such as mismatches between donations and recipient needs, incompatibility of devices with tropical environmental conditions, limited availability of enabling infrastructure such as space, power and water supply, inadequately trained personnel for proper use and maintenance and limited access to spare parts and accessories for long-term maintenance have been highlighted. ...
... [14][15][16][17] In African countries, medical devices are often donated or procured for use from high-income settings, are seldom designed for use in lower-resource settings and may not be appropriate for adoption and use. 15 16 18 Other challenges such as mismatches between donations and recipient needs, incompatibility of devices with tropical environmental conditions, limited availability of enabling infrastructure such as space, power and water supply, inadequately trained personnel for proper use and maintenance and limited access to spare parts and accessories for long-term maintenance have been highlighted. 15 18 19 There are also concerns about significant harm or risks to patients arising from the introduction of poor quality, obsolete or malfunctioning devices into health facilities and improper use by healthcare providers. ...
... 15 16 18 Other challenges such as mismatches between donations and recipient needs, incompatibility of devices with tropical environmental conditions, limited availability of enabling infrastructure such as space, power and water supply, inadequately trained personnel for proper use and maintenance and limited access to spare parts and accessories for long-term maintenance have been highlighted. 15 18 19 There are also concerns about significant harm or risks to patients arising from the introduction of poor quality, obsolete or malfunctioning devices into health facilities and improper use by healthcare providers. 2 19-21 Most of these challenges are linked to inadequate governance of medical devices, including regulation, oversight and management. 1 22 23 Yet, in many low and lowmiddle income countries, including countries in Africa, the regulation of medical devices remains generally less well established and defined than those for other health technologies such as medicines and vaccines. ...
Regulatory and other governance arrangements influence the introduction of medical devices into health systems and are essential for ensuring their effective and safe use. Challenges with medical device safety, quality and use are documented globally, with evidence suggesting these are linked to poor governance. Yet, medical device regulation and oversight remain inadequately defined and described, particularly in low-income and middle-income settings. Through this review, we sought to examine the literature available on regulatory and oversight processes for medical devices in African countries.
Following a systematic approach, we searched academic databases including PubMed, Embase (Ovid) and MEDLINE (Ovid), supplemented by search for grey literature and relevant organisational websites, for documents describing medical device regulation and oversight in African countries. We summarised the data to present key actors, areas for regulation and oversight and challenges.
A total of 39 documents reporting regulation and oversight of medical devices were included for analysis. Regulatory and oversight guidelines and processes were reported as inadequate, including limited pre-market testing, reliance on international certifications and limited processes for post-market monitoring and reporting of adverse events. Challenges for regulation and oversight reported included inadequate funding, personnel and technical expertise to perform regulatory functions. The literature highlighted gaps in guidelines for donated medical devices and in information on governance processes at the national level.
The current literature provides a general overview of medical device regulatory guidelines and limited evidence on the implementation of regulatory/oversight processes at national and especially subnational levels. We recommend further research to elucidate existing governance arrangements for medical devices within African countries and propose a conceptual framework to inform future studies. The framework provides entry points for careful examination of governance and oversight in policy and practice, the exploration of governance realities across the health system and the influence of wider system dynamics.
... For off-site disposal, another 2334 tons worth of infectious, chemical, and radioactive waste are shipped off to disposal facilities every year [15]. Medical device supply chains are responsible for 80% of the emissions, such as greenhouse gases, from healthcare sources in the USA [17]. Holistically, the USA healthcare sector contributes 9-10% of greenhouse gases [3]. ...
... As a matter of fact, Neurosurgeons at Toronto Western Hospital were able to reduce disposable usage by 30% and save $570,000 USD [27]. Beneficially, Sally McDonald from the Charles Perkins Centre and School of Pharmacy writes that institutions that are prepared to reuse equipment can quickly respond to demand surges [17]. They are less impacted by supply chain disruptions, manufacturing shortages, price shocks, or trade [17]. ...
... Beneficially, Sally McDonald from the Charles Perkins Centre and School of Pharmacy writes that institutions that are prepared to reuse equipment can quickly respond to demand surges [17]. They are less impacted by supply chain disruptions, manufacturing shortages, price shocks, or trade [17]. Importantly, the SARS-CoV-2 pandemic has shed light on the potential and importance of reusable equipment, and the public is starting to pay attention. ...
The healthcare sector is struggling to become more environmentally friendly compared to other industries, evidently seen by the contribution to global emissions. These struggles have elicited some research on sustainable methods regarding the lifecycle of medical devices. Indeed, the World Health Organization (WHO) encourages the reuse of equipment and ethical donations, namely for the sake of the environment and sustainable global health. However, there is a lack of synthesis–multiple greener alternatives to the current healthcare system are developing without a connection to each other, hindering an increase in sustainability. Thus, there is a lack of global organization and standardization in medical equipment lifecycles. Inspired by the findings and guidelines of the Safe and Sustainable Medical Equipment Supply Subgroup (SASMES) of the International Rotary Fellowship of Healthcare Professionals, we created the Re-processing Medical Equipment: Rotarian Research Group for the Environment (Re-MERGE) to expand on these challenges. Re-MERGE follows the life cycle of medical devices in the United States of America through its initial stages of classification and various regulatory pathways, the middle stage of post-market requirements, and the end stage of disposal or donation and reprocessing. Our findings indicate that current medical device end-stages are inefficient, damaging to the environment, and burdensome to donation recipients; however, existing processes can provide improvements to medical device end-stage methods by drastically reducing environmental damage, improving healthcare globally, and increasing sustainability in the field. We identify that more research is needed to connect the implications of different medical device end stages. Additionally, we encourage the findings to be implemented to create more sustainable, effective methods of medical device disposal, donation, and reprocessing.
... Relief materials often originate from an overwhelmed response to disaster rather than a consideration of the disaster victims' actual needs ( Nicoli et al., 2018 ). This mismatch results in the convergence of short or limited lifecycle products at the disaster site ( Das and Dutta, 2013 ( McDonald et al., 2019 ). These issues can also lead to shortages of critical medical supplies and storage space, and the occurrence of network choke ( Diedrichs et al., 2016 ;Özpolat et al., 2015 ). ...
... The waste can propagate new infections that can contribute towards further complications in relief work ( Boxall, 2004 ;Kummerer, 2003 ;Zhang et al., 2016 ). McDonald et al. (2019) have analysed 53 donations during 2009-2018 and estimated that 40-70% of the donated medical devices were unusable. For example, Catholic healthcare organisations have found that 60% of donors provided broken and unusable equipment. ...
... The guidelines published by WHO aim to reduce the instances of inappropriate donations. However, as reported by Bero et al. (2010) and McDonald et al. (2019) , compliance with the WHO guidelines is alarmingly low. Abrahams (2014) has highlighted that aid agencies rarely consider environmental sustainability. ...
Medical and pharmaceutical products (MPP) are critical elements in humanitarian relief efforts. Relief operations are often burdened with inappropriate and unusable MPP, which leads to the wastage of resources and causes harm to the environment. This study investigates MPP management and facilitates the adoption of sustainability practices in the humanitarian medical supply chain. The study identifies 20 potential barriers for sustainability and categorises them into six different issues (material, operational, logistics, human, funding, and exogenous). Fuzzy best-worst method and analytic network process methodologies were adopted to prioritise barriers according to their degree of influence. Findings from the study suggest that stakeholders should focus attention on the material, operations, and logistical issues. Poor compliance with the World Health Organisation guidelines is reported as the most significant barrier to sustainability. Long-term collaboration and promotion of cash-based donation are suggested as suitable alternatives to product donation. The key recommendations of the study are to sensitise donors and media regarding donation practices and disaster relief victim requirements, build local capacity, design coordination mechanisms, and develop a performance measurement system incorporating the triple bottom line of sustainability. The study outcome reveals connections between barriers to sustainability and sheds light on the socioenvironmental aspect of donations. The study lays a foundation for future research, exploring how to better enable sustainability in the relief supply chain.
... Due to paucity of effective medical equipment, access to decent healthcare is frequently hampered in LMICs. The Centre for disease prevention (CDC) reported that due to disparities in the global health care, almost 80% of healthcare equipment in low-resource countries is donated or paid for by other parties such as foreign governments or non-governmental organizations [12], [13]. Nonetheless, a substantial number (40-70%) of this donated medical equipment is still dysfunctional. ...
... These devices also lack instruction manuals or are in a foreign language, and donors typically do not give enough training for device operation and maintenance [16]. As a result, the recipient country bears the nancial and logistical burden of processing, distributing, and disposing of these devices [13]. ...
A newborn baby less than 28 days is considered a neonate, according to the World Health Organization. A child has the greatest chance of dying within the first 28 days of life. This is due to the fact that a newborn's body is still developing. Neonatal have respiratory problems and can't regulate their body temperatures. In Ghana, neonatal deaths account for around half of all pediatric mortality. Most of these fatalities occur at nearby medical facilities. This is because incubators are now too expensive and challenging to access in such places. The most well-known modern methods—the heated cot and kangaroo mother care—have drawbacks but are nonetheless widely used today. With this research, a low-cost neonatal incubator will be created for Ghanaian community healthcare facilities. The incubator generates heat from LED stripes, which may be operated by a minimum voltage of 19V, rather than the heated filament found in conventional incubators. In order to keep the infant alive, this created the correct humidity and temperature conditions. For use during power outages, load shedding, or interruptions, a power bank was constructed using a simple laptop battery. Temperature and humidity levels are maintained via the incubator's central cooling system, which consists of a fan and an atomizer. Last but not least, the housing of the incubator was created utilizing widely accessible and inexpensive bamboo and acrylic. Adopting this plan will therefore aid in lowering Ghana's high infant mortality rate in rural communities.
... Testing revealed that the whole shipment was unusable (DRDO, 2020). McDonald et al. (2019) reviewed drug donation compliance according to the World Health Organization (WHO) guidelines for medical donations and highlighted that compliance remains a challenge. The study reviewed long-term programs and disasterrelated donations, which comprised disease outbreaks. ...
... The key criticisms emerge from the practices of inappropriate drug donations that waste resources and create complications for PSC operations (Jenny et al., 2016;Patil et al., 2021a, b, c). The critical complications include increased competition and hindered coordination (Altay and Pal, 2014;John et al., 2019), traffic jam and reduced agility ( € Ozpolat et al., 2015), time and resource wastage (Holgu ın-Veras et al., 2012), potential environmental damage (Kamba et al., 2017) and the additional burden of drug disposal cost (McDonald et al., 2019). Alem et al. (2016) and Nicoli et al. (2018) reported that PSC struggles with the donated products' quality, packaging, shelf life and labelling. ...
Purpose:
Pharmaceutical donations are a practical approach to increase medicine availability during disasters such as disease outbreaks. However, often donated pharmaceuticals are inappropriate and unsuitable. This convergence of inappropriate pharmaceuticals is a severe operational challenge and results in environmental hazards. This study explores the Pharmaceutical Supply Chains (PSC) during a disease outbreak to relieve the negative impact of the material convergence problem (MCP).
Methodology:
This study adopts a situation-actors-process learning-action-performance (SAP-LAP) linkage framework to understand the PSC dynamics. The problem-solving component of the SAP-LAP analysis provides the strategies catering to MCP. The findings from the SAP-LAP helped to develop the causal loop diagram (CLD). This study conducts several experiments on the proposed strategies by integrating CLD into a stock and flow diagram. Later, a disease outbreak case study accessed the pharmaceutical donations effect on PSC performance.
Findings:
The study synthesises and evaluates propositions and strategies to incorporate circular economy principles in PSC. This study proposed two strategies; one to sort and supply and the other to sort, supply, and resell. The reuse policy improves humanitarian organisations' finances in the simulation study. This study verified the operational improvement of PSC by reducing the transport and storage burden due to MCP.
Value:
This study comprehensively approaches the issue of drug donation and uniquely produced several propositions for incorporating a circular economy perspective in PSC. The study also proposed a unique simulation approach to model the donation arrivals in response to a disease outbreak using Susceptible, Exposed, Infectious and recovered modelling.
... Underinvestment in equipment maintenance and manufacturing companies often neglectful in providing the necessary repairs leaves about 40% of healthcare equipment out of service in low-resource countries (18,19). Furthermore, inaccurate packaging/labeling, poor compliance with WHO's donation guidelines, inadequate stock keeping, cultural barriers, and lack of education and training substantially contribute to the barriers in donated medical equipment (19)(20)(21)(22)(23). The mass amount of unusable equipment in facilities that desperately need them is a significant contributor to the inequity in surgical and anesthetic care seen in low-resource countries (24). ...
Background
Access to surgical equipment is critical to providing safe and equitable operative care. This is the first nationwide study to provide data on the availability of surgical equipment in Kenya.
Materials and methods
This cross-sectional study collected data from May to July 2018 on the availability of non-pharmaceutical equipment, patient care, intra-operative, and anesthesia supplies in level 4 hospitals. Information regarding infrastructure such as the number of functional operating rooms, sterilization capacity, and sources of water and electricity was also collected.
Results
The availability of intra-operative and anesthesia equipment was 44.5% and 47%, respectively. Nearly 60% of facilities had general patient care supplies. Over 80% of the facilities had running water in maternity wards (83.1%). Sterilization equipment was present in about half of the facilities (range: 42.6–68.3%). Additionally, 79.1% had a generator as a backup source of electricity. Only 35% of facilities always had an X-ray on-site, and 52.6% of the facilities obtained blood from the national or a regional center.
Conclusion
This study provides data on the availability of surgical equipment and infrastructure in level 4 hospitals in Kenya. Availability of radiology services and blood supply was lower than that in other sub-Saharan African countries, highlighting the need for improved surgical care resources in these community-based facilities.
... Nicoli et al. (2018) discuss whether the medication return program should be encouraged, and they find that this program can lower expenses for patients and health facilities. McDonald et al. (2019) suggest adopting guidelines to ensure effective donations, as analysis of collected data indicates that donated drugs and medical equipment are often underestimated. Tat and Heydari (2021) introduce a donation program to mitigate the risk of drug waste entering the environment. ...
The frequent occurrence of public emergencies seriously threatens human health. As the supplier of drugs, besides producing drugs, pharmaceutical manufacturers also actively launch drug donations. However, whether this donation will affect the procurement decisions of hospital pharmacies and help relieve the supply pressure is worthy of attention. This paper aims to analyze the procurement and donation decisions under non‐directed donation scenario. Besides, we extend the application of collaborative decisions in the pharmaceutical supply chain. Our results point out that donations made by the pharmaceutical manufacturer always benefit the hospital pharmacy and the pharmaceutical supply chain system, and only in certain circumstances can it make itself more profitable. In non‐directed donation scenario, drug donation and procurement quantities under centralized decision are always higher than that under decentralized decision. The social collaborative decision has more advantages in improving members' decisions and profits. The coordination effect of collaborative decisions is often better when there are significant fluctuations in the wholesale price. Through our analysis, it can provide a reference for pharmacies and pharmaceutical manufacturers to make appropriate procurement and donation decisions.
... Currently, it is vital to ensure that recipient areas possess the necessary electrical infrastructure and voltage capacity for proper device operation. 74 Noncompliant donations risk burdening recipient nations with unusable equipment adding storage and disposal complexities. 75 Studies have revealed that emergency donations often have a brief shelf life due to a wide range of problems including inadequate labeling. ...
Background
Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low‐ and middle‐income (LMICs) countries.
Observations
This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices.
Conclusion
There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges.
Trial registration number: Not applicable.
... Estimates suggest that ≈40% of medical equipment in the hospital setting in developing countries remains out of service, predominantly because of a lack of infrastructure, training, and maintenance (24)(25)(26)(27). Given the smaller number of veterinary laboratories compared with human health laboratories, we expect that the equipment management and sustainability challenges in human health laboratories are likely more pronounced. ...
Substantial investments into laboratories, notably sophisticated equipment, have been made over time to detect emerging diseases close to their source. Diagnostic capacity has expanded as a result, but challenges have emerged. The Equipment Management and Sustainability Survey was sent to the Veterinary Services of 182 countries in mid-2019. We measured the status of forty types of laboratory equipment used in veterinary diagnostic laboratories. Of the 68,455 items reported from 227 laboratories in 136 countries, 22% (14,894/68,455) were improperly maintained, and 46% (29,957/65,490) were improperly calibrated. Notable differences were observed across World Bank income levels and regions, raising concerns about equipment reliability and the results they produce. Our results will advise partners and donors on how best to support low-resource veterinary laboratories to improve sustainability and fulfill their mandate toward pandemic prevention and preparedness, as well as encourage equipment manufacturers to spur innovation and develop more sustainable products that meet end-users’ needs.
... 9 There is also a long tradition of sending unused medical products near their expiry date to LMICs, potentially leaving them with large stocks of out-of-date medicines without safe disposal options. 10 Thus, HICs have an urgent responsibility to identify and implement strategies to mitigate their global pollution footprint. Initiatives such as the PREMIER project are supporting this, by addressing the scarcity and access to data on the environmental impacts of pharmaceutical pollution, 3 to inform decision making. ...
... In general, donation initiatives inherently create a power imbalance between the provider and recipient of the aid (Zarka, Farhat & Gidron 2018). Those completed in the absence of input from local stakeholders run the risk of neglecting community needs and cultural landscapes and can be wasteful and deleterious (Bauer 2017;McDonald et al. 2019). Recognising the power structures in place whilst conducting this study, the research team took steps to preserve autonomy and promote beneficence in the target population. ...
Background: There exist many psychosocial sequelae associated with mobility impairment, especially in low-resource settings where access to mobility assistive devices is limited.
Objectives: This study aims to (1) define the burden and presenting aetiologies of mobility impairment in the rural Northern Region of Malawi and (2) assess the relationship between physical disability, life satisfaction and access to mobility aids.
Methods: At mobility device donation clinics throughout the Northern Region of Malawi, adults living with mobility impairment were surveyed with a demographic questionnaire and a series of validated surveys to assess their physical activity levels (Global Physical Activity Questionnaire [GPAQ]), degree of mobility impairment (Washington Group Extended Set Questions on Disability) and life satisfaction (patient-reported outcomes measurement information systems satisfaction with participation in social roles and general life satisfaction).
Results: There were 251 participants who qualified for inclusion, of which 193 completed all surveys. Higher physical activity scores were positively correlated with increased life satisfaction: (1) satisfaction with participation in social roles (0.481, p 0.0001) and (2) general life satisfaction (0.230, p 0.001). Respondents who had previously used a formal mobility device reported 235.5% higher physical activity levels ([139.0%, 333.0%], p = 0.006), significantly higher satisfaction with participation in social roles ([0.21, 6.67], p = 0.037) and equivocally higher general life satisfaction ([−1.77, 3.84], p = 0.470).
Conclusion: Disability and mental health do not exist in isolation from one another. Given the positive correlations between formal mobility device usage and both physical activity and life satisfaction, interventions that increase access to mobility-assistive devices in undertreated populations are imperative.
Contribution: This study contributes to the understanding of the complex relationship between physical disability, access to mobility aids, and life satisfaction. Results from this study suggest the potential benefit that increasing access to mobility aids may have in improving the quality of life of mobility impaired persons in resource-limited settings, such as the Northern Region of Malawi.
... we can be confident enough that as a society we will need support if we are pursuing a way of life. [5] Friendship NGO, Donate -Saving to support or improve life in an amazing way -Friendship NGO: ...
... we can be confident enough that as a society we will need support if we are pursuing a way of life. [5] Friendship NGO, Donate -Saving to support or improve life in an amazing way -Friendship NGO: ...
Many people in India live in extreme poverty. So, it becomes difficult for those people with low income to pay for their health care and medication. As a result, they live with several diseases and as a result, the number of deaths increases daily. Apart from that, there are various people who are overdosing on drugs even after they have stopped their medication. Here, we have set up a website for donating medicines to NGOs. This program will help people in donating their unused medicines to NGOs and they can distribute them to people who need them. This site will help in reducing the cost of health services by making better use of unused drugs as well as helping poor or people with low income to get better healthcare. This site is also assisted in assessing the availability of essential medicines for nearby NGO's. The purpose of this project is to donate unused medicines. Unused medicine can be donated to the poor for further use. This application helps users donate unused medicines to NGOs. Administrators manage members by logging in and deleting and blocking users who have provided incorrect or expired medications. The administrator needs to confirm the expiration date of the uploaded image. NGOs help manage inventory and track available medications.
... The failure is attributed to contextual factors, for example facilities that do not meet the initial mandatory device requirements, such as running supply of distilled water or regular supply of oxygen or a reliable source of energy [55]. The sustainability in the use of the devices is jeopardised by the lack of access to parts or consumables that are needed for repair and maintenance, or trained personnel to operate the equipment for long-term use [56,57]. In some cases, the devices are sent with operating manuals in languages that are unfamiliar to recipients or without instructions altogether [55]. ...
Objectives
: The paper reviews the critical elements in the design and development of medical devices in general and orthopedic devices in particular as well as illustrates by means of examples the initiatives that have been put in place to incorporate contextual factors in low resource settings.
Methods
: Data was collected by means of a targeted literature review from different databases using key terms. The search was done using combinations of key terms namely ‘medical devices’, ‘low- and middle-income countries’, ‘high income countries, drivers of innovation’, ‘technology transfer’ and ‘local production’.
Results
: The study yielded five critical elements which are indispensable in the development of medical devices. It emerged that the context of use, by virtue of encompassing the stakeholders, geographical space and medical devices provides a vantage point for addressing the complexities in the development of medical devices in low resource countries. The paper argues that approaching the critical elements from a contextual standpoint provides a systematic perspective for developing medical devices that are customised to the prevailing environments in low- to middle- income countries.
Conclusion
: With the growing markets for medical devices, the review highlights the importance of forging strategic alliances between high income and low- to middle- income countries in developing appropriate medical devices for the users. The paper contributes to the policy discourse targeting both local and foreign manufacturers of medical devices as well as stakeholders from the public sector, industry and not for profit organisations on the importance of contextual awareness in the development of technologies.
Public interest abstract
: The paper reviews the factors that influence the development of medical devices in general and orthopedic devices in particular. Focusing on low- and middle- income countries which tend to rely on medical devices and donations, the study advocates for the need to address context-oriented challenges that interfere with usability and compatibility, such as lack of electricity to operate the technologies and spare parts for maintenance. To minimise these problems, it is imperative to consider the prevailing conditions of developing countries in their broad context in order to customise the medical devices and enhance their usability. This study illustrates by means of examples the initiatives that can be adopted to facilitate collaboration between developing and developed countries for their mutual benefit. The study is useful to policy makers, local and international producers of medical devices and other stakeholders as it illuminates the importance of context in the production of medical devices.
... 12,13 However, it is estimated that between 40% and 70% of donated equipment goes unused because it is not functional, it is not appropriate, or staff lack adequate training in its use. [14][15][16][17][18] Communication is key for procurement of appropriate equipment, improved sustainability, and decreased waste. Training in equipment operation and organized maintenance is equally important. ...
... We have to guess if the persistent infections stem from the water used to disinfect the scalpel, or the soap used to wash our hands [25,26]. After all, they may just as well be a result of the fact that we run out of drugs [27], or have to prescribe drugs which are counterfeit [28,29], or which have been kindly donated but do not meet WHO guidelines (like the near-expiry Carbapenems dumped in Gaza in 2018) [30]. In these contexts, patients are exposed in equal measure to viruses, superbugs, cephalosporins [31], and missiles exploding in the rooms they have come for consultation. ...
This Viewpoint calls for a greater understanding of the role that water plays in the transmission of anti-microbial resistance and covid-19 in protracted urban armed conflict, in order to develop a 'pathogen-safe' practice. It argues that dealing with the twin threats is difficult enough in the best of circumstances, and is so little understood in war zones that surgeons and water engineers now question if their practice does more harm than good. Experience suggests that the known transmission routes are complicated by a great number of factors, including the entry of heavy metals through bullets in patients' wounds, hospital over-crowding, mutation in treated water or wastewater, and other threats which endure long after the bombing has stopped. The skeleton research agenda proposes greater sewage surveillance, testing of phages and monitoring of treatment designed to dispel or substantiate these assertions.
... Several Ministries of Health, as well as academic consortiums and global institutions like the WHO have created guidelines meant to guide medical donations from planning to sourcing to operationalizing and feedback and evaluation (52). Yet, the evidence suggests that donors still fail to adhere to these guidelines (53). Such poorly coordinated medical equipment donations, characterized by the 'dumping' of obsolete equipment in LMICs and driven by the 'anything is better than nothing' mentality, can be more burdensome to healthcare workers and the entire health system (50,54). ...
Non-governmental organizations (NGOs) are indispensable to social and economic development, particularly in states with limited resources or poor governance. With about five billion people globally lacking access to safe, timely and affordable surgical and anesthesia care, mostly in low-income and middle-income countries (LMICs), NGOs can play a critical role in meeting this significant surgical need and advancing the global surgery and anesthesia goals set by the Lancet Commission on Global Surgery in alignment with the Sustainable Development Goals (SDGs). Surgical-NGOs (s-NGOs) have historically and continue to play a vital role in reducing the surgical burden globally, providing at least 3 million surgical procedures annually in LMICs. They have done this primarily through service delivery by employing temporary platforms such as short-term surgical trips and self-contained surgical platforms or through the setting up of specialized hospitals. With the advent of the SDGs, s-NGOs are increasingly investing in strengthening local health systems by supporting various dimensions of the health systems building blocks. Health systems strengthening interventions by s-NGOs have primarily focused on the training of skilled local surgical workforce (pre-service and in-service) and investing in health infrastructure through equipment and supplies donations to capacitate local health facilities to provide high-quality sustainable surgical and anesthesia care. Despite these laudable efforts, s-NGOs have not been without challenges and criticism especially around the cost-effectiveness, sustainability, equity and quality of care provided. In this article, we review the current landscape of s-NGOs and the challenges they face. We also examine the roles of s-NGOs in advancing the global surgery and anesthesia goals and SDGs in light of the ongoing COVID-19 pandemic.
... In China, medical treatment has become a social focus, since Chinese medical care faces a lot of problems in medical treatment, including lack of medical resources, inadequate communication between doctors and patients, and difficulty in seeing a doctor [1]. Real and effective medical information and medical information are often not very easy to sought, which significantly reduces the efficiency of hospital management and medical work [2]. With the advent of the information age, the way for patients to obtain medical information has become diversified, partially solving the problem of difficult medical treatment caused by lack of information sources [3]. ...
While the significance of strengthening the biomedical workforce in resource-limited settings has been widely acknowledged, there remains a paucity of information specific to the local context. In this regard, we underscore the importance of formulating a biomedical engineering policy based on empirical evidence. To provide such evidence, we conducted an analysis of the government-led biomedical training program in Tanzania, titled 'Capacity Enhancement of Medical Equipment Technical Services (CEOMETS)'. The program demonstrated statistically significant outcomes at the individual level, as evidenced by a T-test comparing pre- and post-self-assessments of self-efficacy indicators from 2018 to 2022 (n=121) (***p < 0.001). However, the program's impact was largely confined to individual-level capacity building, with limited effects at the systemic level. The findings also revealed substantial structural and institutional gaps, as well as a lack of engagement from global stakeholders and key actors in the field of biomedical engineering. From this perspective, therefore, we emphasize the necessity of two key preconditions. First, on a national level, there is an urgent need to develop strategic plans, guidelines, and workforce policies that formally integrate biomedical engineers into efforts to strengthen the health system in Tanzania. The other arm is a way to call for action to the global health players to engage more actively in supporting biomedical engineering development in such contexts. Ultimately, this perspective paper aims to set a milestone in establishing the policy-making process regarding biomedical engineering as a health policy issue in Tanzania.
Access to medical equipment (ME) is an essential component of the healthcare infrastructure. Due to the high manufacturing cost, low- and middle-income countries (LMICs) rely on donations from high-resource settings to meet their demand for ME. International organizations such as the World Health Organization (WHO) have prescribed guidelines for sustainable donations. A few research studies have assessed current donation practices’ compliance with new and used ME. This study aims to investigate commonly recurring challenges and compile practical recommendations for ME donation programs in LMICs. To validate the findings from the literature review, semi-structured interviews were conducted with three different types of recipients across Pakistan and Sierra Leone. There are some obstacles affecting this sustainable ME donation program. These hurdles can be overcome by strict compliance with the official WHO guidelines, empowering the recipient through communication and policy, establishing vital metrics, and developing sustainable long-term donor-recipient relationships, and by comprehensive evaluation of the impact of all the stakeholders in the ME ecosystem. This study concludes that well-established guidelines and policies are critical to successful ME donation programs.
Purpose of review
There is an ever-growing focus on climate change and its impact on our society. With healthcare contributing a sizeable proportion of carbon emissions, the sector has a duty to address its environmental impact. We highlight the recent progress, current challenges, and future prospects for reducing the carbon footprint in diagnostic urology, specifically for imaging, without compromising patient care.
Recent findings
The review is separated into four key areas of recent research: the design of a green radiology department, considering both infrastructural as well as behavioural changes that promote sustainability; individual scanners, where we provide an update on recent technological advancements and changes in behaviour that may enhance sustainable use; responsible resource allocation, where it is important to derive the maximal benefit for patients through the smallest use of resources; the recent research regarding single versus reusable urologic endoscopes as a case example.
Summary
We offer an overview of the present sustainability landscape in diagnostic urology with the aim of encouraging additional research in areas where existing practices may be challenged. To protect the environment, attention is drawn to both more simple steps that can be taken as well as some more complex and expensive ones.
Patients with kidney disease, especially those with kidney failure, are particularly susceptible to the adverse effects of disasters because their survival depends on functional infrastructure, advanced technology, the availability of specific drugs and well-trained medical personnel. The risk of poor outcomes across the entire spectrum of patients with kidney diseases (acute kidney injury, chronic kidney disease and kidney failure on dialysis or with a functioning transplant) increases as a result of disaster-related logistical challenges. Patients who are displaced face even more complex problems owing to additional threats that arise during travel and after reaching their new location. Overall, risks may be mitigated by pre-disaster preparedness and training. Emergency kidney disaster responses depend on the type and severity of the disaster and include medical and/or surgical treatment of injuries, treatment of mental health conditions, appropriate diet and logistical interventions. After a disaster, patients should be evaluated for problems that were not detected during the event, including those that may have developed as a result of the disaster. A retrospective review of the disaster response is vital to prevent future mistakes. Important ethical concerns include fair distribution of limited resources and limiting harm. Patients with kidney disease, their care-givers, health-care providers and authorities should be trained to respond to the medical and logistical problems that occur during disasters to improve outcomes.
This article sheds light on the issue of medical waste in humanitarian supply chains. The challenges of managing medical waste in the volatile humanitarian context will be discussed, along with ways to address these challenges using digital tools and technologies, inter-organisational collaboration and the ‘designing out’ of waste. This article will contextualise the lessons learnt from the humanitarian sector for healthcare service providers, such as NHS.
The health care sector is a resource-intensive industry, consuming significant amounts of water and energy, and producing a multitude of waste. Health care providers are increasingly implementing strategies to reduce energy use and waste. Little is currently known about existing sustainability strategies and how they may be supported by radiology practices. Here, we review concepts and ideas that minimize energy use and waste, and that can be supported or implemented by radiologists.
Background
As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya.Methods
Voluntary semi-structured interviews were conducted with 43 host surgical personnel at a tertiary referral hospital in Kijabe, Kenya. Qualitative analysis was used to identify salient and recurring themes related to host experiences with visiting surgical personnel. Perceived benefits and challenges of HIC involvement and host interest in bidirectional exchange were assessed.ResultsBenefits of visitor involvement included positive learning experiences (95.3%), capacity building (83.7%), exposure to diverse practices and perspectives (74.4%), improved work ethic (51.2%), shared workload (44.2%), access to resources (41.9%), visitor contributions to patient care (41.9%), and mentorship opportunities (37.2%). Challenges included short stays (86.0%), visitor adaptation and integration (83.7%), cultural differences (67.4%), visitors with problematic behaviors (53.5%), learner saturation (34.9%), language barriers (32.6%), and perceived power imbalances between HIC and LMIC personnel (27.9%). Nearly half of host participants expressed concerns about the lack of balanced exchange between HIC and LMIC programs (48.8%). Almost all (96.9%) host trainees expressed interest in a bidirectional exchange program.Conclusion
As the field of global surgery continues to evolve, further assessment and representation of host perspectives is necessary to identify and address challenges and promote equitable, mutually beneficial partnerships between surgical programs in HIC and LMIC.
The main purpose of this study is to find barriers to sustainability in humanitarian logistics (HL) and to determine their mutual relationship. Applying interpretive structural modeling (ISM) and cross-impact matrix multiplication classification (MICMAC) assessment to develop a hierarchy model of the study variables. The key findings of this study are, the identification of the variables that can be seen as barriers to sustainability in HL, and the ISM approach is applied to determine the group of variables that have perfect control, low dependence, and strategic significance. The hierarchy of the variables reflects a valuable tool for all stakeholders of catastrophe, specifically for governments, donors,as well as humanitarian organizations (HOs)to focus on the identified variables in order to overcome the inhibitors to sustainability in HL, as they are constantly seeking strategies for sustainable HL. This study extends a hierarchy-based model of inhibitors to sustainability in HL through ISM methodology, which has not been investigated before.
Background
A manifold cause of global disparity in medical and surgical care exists, among which lack of access to proper biomedical equipment including surgical tools are a recurrent theme. Use and reuse of such donated tools are common in low resource settings including countries like Nepal; however, there is a lack of adequate data and less has been explored. Through this nationwide study, we aimed to discover the knowledge of donated medical and surgical devices and the practice of reusing single-use equipment by Nepalese medical practitioners and surgeons.
Methods
An online, questionnaire-based cross-sectional study was conducted using SurveyMonkey from October 2020 through January 2021. The link was sent to target respondents via email and social media and responses were recorded. Data processing and analysis were done using the same platform.
Results
Among 466 respondents, 349 completed the survey. Around 81.5% recorded that their institute has never received medical devices or donations in the past, while 18.34% believed they had received such commodities. Most of the donations were received from countries like the United States, China, Japan, and India. Around 24% of the respondents reused the tools meant for single-use and only 5% communicated with the donors. Commodities like laparoscopic sets, sutures, dialysis machines, magnetic resonance imaging machines, surgical retractors, face masks, sanitizers, personal protective equipment, endoscopy apparatus, etc., were received. The majority of them were concerned about national guidelines regarding donating reusable tools which might not be acceptable through custom rules of the country, although the facilitation of functional yet unused tools is always welcome in the underserved regions of Nepal.
Conclusion
Nepalese medical professionals had adequate knowledge about the donated medical devices and only a few of them had practiced reusing single-use equipment. Mutual cooperation between donors and recipients is one of the most important aspects of safe medical/surgical tools delivery.
This project aims to donate medicines which are unused. The unused medicine can be donated for further utilization by a needy person. This application helps the user to donate unused medicines to NGO. Admin will login and manage members by deleting and blocking the users providing improper or expired medicines. Admin has to verify the uploaded image for their expiry date.NGO manages the stock which helps to maintain a record of the available medicine. Members can also check their previous data of medicine transactions. The donation of unused medicines is not accepted worldwide, although it is legal in some countries. A constant increase in the rate of prescription writing has prompted several charity organizations to collect a growing number of unused medicines. WHO guidelines for drug donations discourage donation of unused medicines, as this may create a number of problems. Detrimental effects of drug donations for use in emergency situations have been reported, as the arrival of unsorted, useless and expired medicines requires management and sorting, which may take up the time of health workers and eventually lead to the appearance of these drugs on the black market. However, cases of regulated donations have been reported in the USA, where several states have adopted laws in order to facilitate the redistribution of unused drugs to indigent and uninsured patients.This project aims to donate medicines which are unused. The unused medicine can be donated for further utilization by a needy person. This application helps the user to donate unused medicines to NGO. Admin will login and manage members by deleting and blocking the users providing improper or expired medicines. Admin has to verify the uploaded image for their expiry date.NGO manages the stock which helps to maintain a record of the available medicine.Members can also check their previous data of medicine transactions.
Oncology drug repository programs allow patients to donate oral chemotherapy that can be redispensed to patients in need and could ultimately reduce drug waste. Medically integrated pharmacies can serve as a platform for drug repository programs because of the integration of healthcare providers and pharmacists at one location, facilitating an effective transition from donation to redispensing. Before implementing a program, pharmacies should consider state laws regarding who can donate medications, the type of setting (including open or closed systems), as well as how to assess the quality of the medication donated, expiration dates, storing and maintenance of a separate inventory, written policies and procedures, and a priority list for dispensing medications to patients. In this article, we provide the initial steps to assist states and oncology pharmacists interested in developing a drug repository program.
In some low- and middle-income countries, the national stores and public-sector health facilities contain large stocks of pharmaceuticals that are past their expiry dates. In low-income countries like Uganda, many such stockpiles are the result of donations. If not adequately monitored or regulated, expired pharmaceuticals may be repackaged and sold as counterfeits or be dumped without any thought of the potential environmental damage. The rates of pharmaceutical expiry in the supply chain need to be reduced and the disposal of expired pharmaceuticals needs to be made both timely and safe. Many low- and middle-income countries need to: (i) strengthen public systems for medicines’ management, to improve inventory control and the reliability of procurement forecasts; (ii) reduce stress on central medical stores, through liberalization and reimbursement schemes; (iii) strengthen the regulation of drug donations; (iv) explore the salvage of officially expired pharmaceuticals, through re-analysis and possible shelf-life extension; (v) strengthen the enforcement of regulations on safe drug disposal; (vi) invest in an infrastructure for such disposal, perhaps based on ultra-high-temperature incinerators; and (vii) include user accountability for expired pharmaceuticals within the routine accountability regimes followed by the public health sector.
Schistosomiasis, one of the 17 neglected tropical diseases listed by the World Health Organization, presents a substantial public health and economic burden. Of the 261 million people requiring preventive chemotherapy for schistosomiasis in 2013, 92% of them lived in sub-Saharan Africa and only 12.7% received preventive chemotherapy. Moreover, in 2010, the WHO reported that schistosomiasis mortality could be as high as 280 000 per year in Africa alone. In May 2012 delegates to the sixty-fifth World Health Assembly adopted resolution WHA65.21 that called for the elimination of schistosomiasis, and foresees the regular treatment of at least 75% of school age children in at-risk areas. The resolution urged member states to intensify schistosomiasis control programmes and to initiate elimination campaigns where possible. Despite this, in June 2015, schistosomiasis was indicated to have the lowest level of preventive chemotherapy implementation in the spectrum of neglected tropical diseases. It was also highlighted as the disease most lacking in progress. This is perhaps unsurprising, given that it was also the only NTD with access to drug donations but without a coalition of stakeholders that collaborates to boost commitment and implementation. As a consequence, and to ensure that the WHO NTDs Roadmap Targets of 2012 and World Health Assembly Resolution WHA65.21 are met, the Global Schistosomiasis Alliance (GSA) has been set up. Diverse and representative, the GSA aims to be a partnership of endemic countries, academic and research institutions, international development agencies and foundations, international organizations, non-governmental development organizations, private sector companies and advocacy and resource mobilisation partners. Ultimately, the GSA calls for a partnership to work for the benefit of endemic countries by addressing health inequity and rural poverty.
Objective:
To describe a 6-month follow-up of a specialized paediatric wheelchair and seating programme in Haiti.
Design:
Descriptive design using a structured survey and open-ended questions.
Methods:
Concurrent with a seating and wheelchair programme conducted in northern Haiti, beneficiaries and their families were introduced to the study, and 86 of 91 consented to future contact. A survey was developed with input from international and local partners, and administered by face-to-face or telephone interviews. Donated wheelchairs were assessed in 5 categories: wheelchair utilization, maintenance, fit, environmental access, and perceived benefits of wheelchair use.
Results:
A total of 57 beneficiaries (age range < 2-31 years) were located 6 months after receiving their custom-fit wheelchair and consented to the survey. All respondents still had the wheelchair, 70.2% were using it a minimum of 3-5 days/week, 17.5% were using it < 3 days/week and 12.3% were not using it at all. Primary reasons for not using the wheelchair were that it was broken, uncomfortable, or difficult to transport. The commonly reported benefits were improved mobility, independence, participation and social interaction.
Conclusion:
The majority of people who received customized wheelchairs continued to use their equipment 6 months later, with predominantly beneficial outcomes. In future seating initiatives in low-resource settings, efforts to optimize equipment durability and training of local technicians should be supported and evaluated.
Background:
Between 2007 and 2012, Children Without Worms (CWW) oversaw the Johnson & Johnson (J&J) donation of Vermox (mebendazole) for treatment of school-age children to control soil-transmitted helminthiasis (STH). To identify factors associated with on-time, delayed, or missed mass drug administration (MDA) interventions, and explore possible indicators for supply chain performance for drug donation programs, we reviewed program data for the 14 STH-endemic countries CWW supported during 2007-2012.
Methodology:
Data from drug applications, shipping records, and annual treatment reports were tracked using Microsoft Excel. Qualitative data from interviews with key personnel were used to provide additional context on the causes of delayed or missed MDAs. Four possible contributory factors to delayed or missed MDAs were considered: production, shipping, customs clearance, and miscellaneous in-country issues. Coverage rates were calculated by dividing the number of treatments administered by the number of children targeted during the MDA.
Principal findings:
Of the approved requests for 78 MDAs, 54 MDAs (69%) were successfully implemented during or before the scheduled month. Ten MDAs (13%) were classified as delayed; seven of these were delayed by one month or less. An additional 14 MDAs (18%) were classified as missed. For the 64 on-time or delayed MDAs, the mean coverage was approximately 88%.
Conclusions and significance:
To continue to assess the supply chain processes and identify areas for improvement, we identified four indicators or metrics for supply chain performance that can be applied across all neglected tropical disease (NTD) drug donation programs: (1) donor having available inventory to satisfy the country request for donation; (2) donor shipping the approved number of doses; (3) shipment arriving at the Central Medical Stores one month in advance of the scheduled MDA date; and (4) country programs implementing the MDA as scheduled.
Introduction:
Health service delivery in the Philippines is constantly challenged by disasters and emergencies. This descriptive study documented existing policies for medicines management in the Philippines and then assessed these in the public sector response post-Haiyan.
Method:
We used desk a review of existing laws, regulations and related issuances and a series of interviews of key informants from various national and local health agencies.
Results:
We found that while numerous national policies covered critical aspects of medicines management, implementation post-Haiyan was problematic at all levels of the decentralized health-care system. We identified issues of quantification, warehousing, distribution, utilization monitoring and disposal. Donated medicines also added additional burden for storage and disposal, especially for expired and unwanted medicines.
Discussion:
While the process of managing medicines during disasters did not differ greatly from non-emergency situations, the Haiyan experience highlighted the system's weaknesses. With the current gaps in implementation, as well as the logistical obstacles brought about by disasters, there is a need to have integrated mechanisms for medicines management in the Philippines. This assessment provided an important opportunity to review the medicines management policies at national and local levels.
Background:
In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions.
Methods:
We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010-November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure.
Results:
Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US 2.14 per DALY averted.
Conclusions:
Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.
Pulse oximetry is widely accepted as essential monitoring for safe anaesthesia, yet is frequently unavailable in resource-limited settings. The Lifebox pulse oximeter, and associated management training programme, was delivered to 79 non-physician anaesthetists attending the 2011 Uganda Society of Anaesthesia Annual Conference. Using a standardised assessment, recipients were tested for their knowledge of oximetry use and hypoxia management before, immediately following and 3–5 months after the training. Before the course, the median (IQR [range]) test score for the anaesthetists was 36 (34–39 [26–44]) out of a maximum of 50 points. Immediately following the course, the test score increased to 41 (38–43 [25–47]); p < 0.0001 and at the follow-up visit at 3–5 months it was 41 (39–44 [33–49]); p = 0.001 compared with immediate post-training test scores, and 75/79 (95%) oximeters were in routine clinical use. This method of introduction resulted in a high rate of uptake of oximeters into clinical practice and a demonstrable retention of knowledge in a resource-limited setting.
According to World Health Organization (WHO) prevalence estimates, 1.1 million people in Mexico are infected with Trypanosoma cruzi, the etiologic agent of Chagas disease (CD). However, limited information is available about access to antitrypanosomal treatment. This study assesses the extent of access in Mexico, analyzes the barriers to access, and suggests strategies to overcome them.
Semi-structured in-depth interviews were conducted with 18 key informants and policymakers at the national level in Mexico. Data on CD cases, relevant policy documents and interview data were analyzed using the Flagship Framework for Pharmaceutical Policy Reform policy interventions: regulation, financing, payment, organization, and persuasion. Data showed that 3,013 cases were registered nationally from 2007-2011, representing 0.41% of total expected cases based on Mexico's national prevalence estimate. In four of five years, new registered cases were below national targets by 11-36%. Of 1,329 cases registered nationally in 2010-2011, 834 received treatment, 120 were pending treatment as of January 2012, and the treatment status of 375 was unknown. The analysis revealed that the national program mainly coordinated donation of nifurtimox and that important obstacles to access include the exclusion of antitrypanosomal medicines from the national formulary (regulation), historical exclusion of CD from the social insurance package (organization), absence of national clinical guidelines (organization), and limited provider awareness (persuasion).
Efforts to treat CD in Mexico indicate an increased commitment to addressing this disease. Access to treatment could be advanced by improving the importation process for antitrypanosomal medicines and adding them to the national formulary, increasing education for healthcare providers, and strengthening clinical guidelines. These recommendations have important implications for other countries in the region with similar problems in access to treatment for CD.
Although it is highly preventable and treatable, cervical cancer is the most common and most deadly cancer among women in Rwanda.
By mobilizing a diverse coalition of partnerships, Rwanda became the first country in Africa to develop and implement a national strategic plan for cervical cancer prevention, screening and treatment.
Rwanda - a small, landlocked nation in East Africa with a population of 10.4 million - is well positioned to tackle a number of "high-burden" noncommunicable diseases. The country's integrated response to infectious diseases has resulted in steep declines in premature mortality over the past decade.
In 2011-2012, Rwanda vaccinated 227 246 girls with all three doses of the human papillomavirus (HPV) vaccine. Among eligible girls, three-dose coverage rates of 93.2% and 96.6% were achieved in 2011 and 2012, respectively. The country has also initiated nationwide screening and treatment programmes that are based on visual inspection of the cervix with acetic acid, testing for HPV DNA, cryotherapy, the loop electrosurgical excision procedure and various advanced treatment options.
Low-income countries should begin to address cervical cancer by integrating prevention, screening and treatment into routine women's health services. This requires political will, cross-sectoral collaboration and planning, innovative partnerships and robust monitoring and evaluation. With external support and adequate planning, high nationwide coverage rates for HPV vaccination and screening for cervical cancer can be achieved within a few years.
Limited access to drugs is a crucial barrier to reducing the growing impact of cancer in low- and middle-income countries. Approaches based on drug donations or adaptive pricing strategies yield promising but varying results across countries or programs, The Glivec International Patient Assistance Program (GIPAP) is a program designed to provide imatinib free of charge to patients with chronic myeloid leukemia (CML) or gastrointestinal stromal tumors (GIST). The objective of this work was to identify institutional factors associated with enrollment and patient survival in GIPAP.
We analyzed follow-up data from 4,946 patients participating in 47 institutions within 44 countries between 2003 and 2010. Active status in the program was considered as a proxy for survival.
Presence of >=1 hematologist or oncologist at the institution was associated with increased patient enrollment. After adjusting for individual factors such as age (>55 years: Hazard Ratio [HR] = 1.42 [1.16; 1.73]; p = 0.001) and initial stage of disease (accelerated or blast crisis at diagnosis: HR = 4.16 [1.87; 9.25]; p < 10-4), increased survival was found in institutions with research capabilities (HR = 0.55 [0.35; 0.86]; p = 0.01) and those with enrollment of >5 patients/year into GIPAP (HR = 0.48 [0.35; 0.67]; p < 10-4), while a non-significant trend for decreased survival was found for treatment at a public institution (HR = 1.32 [0.95; 1.84]; p = 0.10). The negative impact of an accelerated form of CML was attenuated by the presence of >=1 hematologist or oncologist at the institution (interaction term HR = 0.43 [0.18; 0.99]; p = 0.05).
Application of these findings to the support and selection of institutions participating in GIPAP may help to optimize care and outcomes for CML and GIST patients in the developing world. These results may also be applicable to the treatment of patients with other forms of cancer, due to the overlap of infrastructure and staff resources used to treat a variety of cancer indications. A multi-sector approach is required to address these barriers.
Background
Transmission of HIV from mother-to-child during pregnancy, labor, or breastfeeding is the primary cause of pediatric HIV infection in sub-Saharan Africa. A regimen of single-dose nevirapine administered to both HIV-positive pregnant women and their infants has been shown to lower the risk of mother-to-child transmission (MTCT) of HIV. In an effort to facilitate scale-up of PMTCT programs in low-income countries, Boehringer Ingelheim, the manufacturer of Viramune (branded nevirapine), initiated the Viramune Donation Programme (VDP) in 2000. The aim of this study was to evaluate the impact of the VDP on participating institutions.
Methods
A total of 164 institutions in 60 countries were included in the VDP over its 11-year duration. An online quantitative and qualitative questionnaire was submitted to all program managers. The questionnaire collected data on the impact of the VDP on initiation and scale-up of PMTCT services, operational capacity, national PMTCT policies, access to funding, and national and international partnerships. Participants were asked for their opinion of how VDP was perceived by different stakeholders (medical community, patients, government authorities, communities).
Results
Ninety-nine managers (60.4%) in 34 countries responded to the online questionnaire; 89 of institutions (89.9%) were located in Africa The most positive aspects of the VDP identified were: helped to expand PMTCT services (85.9% of program managers), reduced stigma against HIV-positive pregnant women, increased social support mechanisms (78.8%), fostered partnerships with national and international organizations (69.0%), and encouraged access to donor funding (63.0%). Implementation of the VDP triggered improvements in training hospitals and logistical capacity and was associated with changes in policy strategies at the national level.
Conclusion
A drug donation program such as the VDP can act as a catalyst for systemic changes at the institutional and national levels. The VDP provides a model for how private initiatives can have a significant impact on public health issues and foster diverse public-private partnerships among governments, commercial organizations, local institutions, and international NGOs.
Objectives:
Maintaining a well-stocked dispensary at a private non-profit clinic in a developing country can often be challenging due to limited financial and human resources. Organizations face frequent drug shortages, excesses of unnecessary medications and potentially inappropriate international donations. To promote adherence to international recommendations and enable targeted requests for international drug donations, this paper describes a process using a public-health approach to create a site-specific pharmacy formulary in a resource-poor setting using the World Health Organization's (WHO) Model List of Essential Medicines ('Model List').
Methods:
The study site was a Malawian-run non-profit private clinic serving over 3000 people annually. The organization focuses on providing community support for orphans from the HIV/AIDS crisis in sub-Saharan Africa. While using the Model List as a backbone, we incorporated the clinic's drug inventory, patient needs, clinician prescribing patterns, and the country's national drug list into the final formulary. After analyzing site-specific factors, we determined which WHO Model List therapeutic classes were necessary for the clinic to address in the final formulary.
Key findings:
Of the drug products currently available in the inventory, 65.6% were expired, 29.8% of which were international donations. After removing expired medications from the inventory, seven Model List priority categories remained unaddressed by the clinic's initial inventory. Based on the results of a structured needs assessment, 54 products were selected for the final simplified formulary.
Conclusions:
Conscious selection of pharmaceuticals, resulting in a systematic formulary for drug distribution management, is critical so that a clinic can focus on procuring and prescribing the most needed medications. This selection process using the WHO Model List and a public-health approach to drug management could serve as a private clinic model for pharmaceutical optimization and targeted international drug donations in sub-Saharan Africa and other resource limited settings.
Successful public-private partnerships for health control have usually included nongovernmental development organisations (NGDOs), and these have long been in the forefront of pinpointing particular social and health issues. The immensely successful control and elimination programmes for onchocerciasis are a case in point. NGDOs were the driving force in early advocacy for onchocerciasis control in West Africa, leading eventually to the remarkably effective and long lasting partnership of the Onchocerciasis Control Programme (OCP). With the donation of Mectizan(®), NGDOs were the driving force in developing onchocerciasis control in non-OCP countries, especially programmes for community based action. These were, further modified by the African Programme for Onchocerciasis Control (APOC) to become the successful Community Directed Interventions. NGDOs came together to coordinate activities in partnership with the World Health Organisation (WHO). Innovations by NGDOs led to integration of mass drug administration for Vitamin A deficiency and then for other parasitic diseases, leading to the current trend of preventive chemotherapy. The success of the NGDO Group for Onchocerciasis Control has led to the creation of similar groups for trachoma control and lymphatic filariasis elimination. These groups have now come together to form an NGDO Network for Neglected Tropical Disease control.
The expiry of medicines in the supply chain is a serious threat to the already constrained access to medicines in developing countries.
We investigated the extent of, and the main contributing factors to, expiry of medicines in medicine supply outlets in Kampala and Entebbe, Uganda. A cross-sectional survey of six public and 32 private medicine outlets was done using semi-structured questionnaires.
The study area has 19 public medicine outlets (three non-profit wholesalers, 16 hospital stores/pharmacies), 123 private wholesale pharmacies and 173 retail pharmacies, equivalent to about 70% of the country's pharmaceutical businesses. Our findings indicate that medicines prone to expiry include those used for vertical programmes, donated medicines and those with a slow turnover.
Awareness about the threat of expiry of medicines to the delivery of health services has increased. We have adapted training modules to emphasize management of medicine expiry for pharmacy students, pharmacists and other persons handling medicines. Our work has also generated more research interest on medicine expiry in Uganda.
Even essential medicines expire in the supply chain in Uganda. Sound coordination is needed between public medicine wholesalers and their clients to harmonize procurement and consumption as well as with vertical programmes to prevent duplicate procurement. Additionally, national medicine regulatory authorities should enforce existing international guidelines to prevent dumping of donated medicine. Medicine selection and quantification should be matched with consumer tastes and prescribing habits. Lean supply and stock rotation should be considered.
Humanitarian assistance to people suffering as a result of catastrophes generally includes large charitable donations of drugs from sources such as private individuals or companies, nongovernmental organizations, United Nations agencies, and foreign governments. Unfortunately, evaluations have repeatedly shown that many of the medical supplies sent are not the appropriate ones.1,2 During the war in Bosnia and Herzegovina, many areas became totally dependent on foreign help for medicines and medical supplies. Information circulated about massive quantities of irrelevant drugs that arrived in Mostar, Tuzla, Gorazde, Sarajevo, and Bihac, cities that were key targets for humanitarian assistance. These rumors prompted us . . .
In this article, I claim that using Marcel Mauss’ The Gift can prove fruitful in analyzing pharmaceutical donations, the role of interests in gift-giving, the complex intertwining of the domains of the gift and commerce, and in contributing to a theory of social justice. Drug donations refer to the practice of giving medicines “for free,” outside of the drug market, with the ultimate goal of reaching populations in need. So an object (a drug) otherwise sold on the market (even if sometimes at a subsidized price), and usually subject to a specific commercial process, enters a different circuit and distribution system. Yet, even if drug donations seem to break with the logic of exchange constitutive of the market, they are intimately linked to market dynamics. This is especially true in the case of corporate drug donations, because of the nature of the donor and the presence of ulterior motives. Accordingly, this practice can be explained with the help of a Maussian understanding of the gift, where gift-giving is not disinterested and does not have to result from pure altruism, but can very well be part of a larger process of accumulating wealth and power.
Purpose:
Neglected tropical diseases (NTDs) impose a significant burden on public health, particularly in developing nations. Many can be treated cost-effectively with drugs donated or offered at or below marginal cost. In 2012, the World Health Organization published an NTD roadmap that outlined a strategy for the prevention, control, and eradication of 17 NTDs by 2020. Inspired by this roadmap, executives from 13 pharmaceutical companies, government agencies, and other interested parties signed the London Declaration on Neglected Tropical Diseases in January 2012. In this paper, we will assess progress in meeting commitments on drug donations laid out in the London Declaration.
Methods:
We conducted Medline and LexisNexis searches of peer-reviewed publications and trade journals, as well as product development partnership and government reports. Subsequently, we designed a survey instrument and surveyed 10 company signatories (companies with drug donation programs) to the London Declaration to determine current donations and pledges.
Findings:
Nine of 10 companies with donation programs responded to the survey. The respondents reported substantial progress in meeting the goals laid out in the London Declaration. Survey respondents maintained 17 drug donation programs across 10 disease categories. In 2014, companies donated >1 billion treatments, with a dollar value of nearly $1.5 billion. However, not all donated products were distributed to patients in need. In addition, 4 of the 17 programs were slated to end before 2020, three of the 17 programs did not report explicit program objectives, and 7 of 17 did not measure the impact of programs in terms of numbers of patients treated. None of our survey respondents reported on whether the programs were leading to a reduction in disease prevalence.
Implications:
Donations are a necessary but insufficient condition for patient access to neglected disease drugs. Additional resources must be allocated to ensure delivery of donated products to patients. In addition, drug donation programs should provide explicit descriptions of program objectives, measurements of the impacts of their programs, and extension of all donation commitments through 2020. To achieve this, multiple stakeholders with a vested interest in reducing the burden of neglected diseases must collaborate in a multipronged approach toward NTD elimination.
Home mechanical ventilation is currently expanding in Chile, but its application along the country is hindered by financial and geographical reasons. In 2006 the San José Hospital in Santiago de Chile developed a non-invasive ventilation (NIV) center as a strategy to overcome the limitations of ventilator availability from public resources. Since then, this center provides intermittent diurnal sessions of NIV to patients with chronic hypercapnic respiratory failure. In 2013, a collaboratory work between the Chilean doctors, the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB = Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung) and the German non-invasive (NIV) home care provider "Heinen und Löwenstein" organized a donation of 100 second-hand ventilators (BiPAP Synchrony; Respironics, USA) including masks and tubing systems, which were provided by Heinen und Löwenstein.The ventilator devices arrived in Santiago in January 2014. Since then, the following initiatives have been launched: 1) the establishment of a domiciliary mechanical ventilation program independent of governmental founding, 2) NIV setting-titration, 3) renewal of ventilators at the hospital's intermittent NIV unit. Future goals are the establishment of a rehabilitation unit with concomitant NIV therapy and a clinical research program.Therefore, the German donation of ventilators and equipment has a reported impact on the development of NIV in Chile.
© Georg Thieme Verlag KG Stuttgart · New York.
Health centers in low-income countries often depend on donations to provide appropriate diagnostic equipment. However, donations are sometimes made without an understanding of the recipient's needs, practical constraints or sustainability of supplies.
We donated a set of physical diagnostic equipment, non-invasive instrument tests and laboratory supplies to a rural health center in the Democratic Republic of Congo. We collected information on the usage and durability of equipment and supplies for each patient encounter over a 1-year period.
We recorded 913 patient encounters. The most commonly used physical diagnostic equipment were the stethoscope (98.9%; 903/913), thermometer (81.7%; 746/913), adult scale (81.4%; 744/913), stop watch (62.6%; 572/913), adult sphygmomanometer (55.8%; 510/913), infant scale (24.9%; 228/913), measuring tape (24.3%; 222/913) and fetoscope (23.8%; 218/913). The most commonly used laboratory tests were the blood smear for malaria (53.7%; 491/913), hematocrit (23.5%; 215/913), urinalysis (20.1%; 184/913) and sputum stain for tuberculosis (13.3%; 122/913). With the exception of a penlight and solar lantern, all equipment remained functional.
This study adds valuable information about the utility and durability of equipment supplied to a health center in the Democratic Republic of Congo. Our results might aid in determining the appropriateness of donated medical equipment in similar settings. The selection of donated goods should be made with knowledge of the context in which it will be used, and utilization should be monitored.
© The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Key messages
• Technology can improve global health, and includes not
only pharmaceuticals, vaccines, and devices, but also
advances such as better sanitation and agriculture.
• At present, technology for health focuses on the needs of
the wealthy.
• More frugal technology, specifically designed for the
world’s poorest people, is needed.
• Such technology also has the potential to be a disruptive
technology for health care in high-income countries.
• Technology alone is not enough—it needs to be combined
with innovations in processes to have the greatest effect.
• Capacity to successfully create and use technology
should be part of the post-2015 assessment of global
development.
This essay sketches two international, pharmaceutical company—sponsored drug donation programs and assesses this novel integration of corporations into global health. Based on ethnographic interviews with retired and current pharmaceutical executives and scientists, international humanitarian workers, and volunteers and drug recipients in the Morogoro region of Tanzania, this essay develops a concept of "scientific sovereignty," a process through which corporate and biomedical logics supplant the state in the exercise of biopower. I assess these interventions' impact on a local health system and the theoretical implications of the global health orthodoxies on which they rely.
The magnitude 7.0 earthquake that struck Haiti on 12 January 2010 devastated the capital city of Port-au-Prince and the surrounding area. The area's hospitals suffered major structural damage and material losses. Project HOPE sought to rebuild the medical equipment and clinical engineering capacity of the country. A team of clinical engineers from the United States of America and Haiti conducted an inventory and assessment of medical equipment at seven public hospitals affected by the earthquake. The team found that only 28% of the equipment was working properly and in use for patient care; another 28% was working, but lay idle for technical reasons; 30% was not working, but repairable; and 14% was beyond repair. The proportion of equipment in each condition category was similar regardless of whether the equipment was present prior to the earthquake or was donated afterwards. This assessment points out the flaws that existed in the medical equipment donation process and reemphasizes the importance of the factors, as delineated by the World Health Organization more than a decade ago, that constitute a complete medical equipment donation.
The year 2012 marks the 25th anniversary of the donation of ivermectin to fight onchocerciasis and the projected date for elimination of transmission of the disease in the Americas. This review looks at the history of onchocerciasis, from its discovery through to 2025, by which time it is projected that the disease will have been eliminated as a public health problem, except in a handful of sub-Saharan countries, where it should be well on the way towards elimination.
Human onchocerciasis, a parasitic disease found in 28 African countries, six Latin American countries and Yemen, causes blindness and severe dermatological problems. In 1987, efforts to control this infection shifted from vector approaches to include the mass distribution of ivermectin - a drug donated by Merck & Co. for disease control in Africa and for disease elimination in the Americas. Currently, almost 25 years later, with the Americas being highly successful and now approaching elimination, new evidence points towards the possibility of successful elimination in Africa. We suggest several major changes in the programmatic approach that through focused goal-directed effort could achieve global elimination of onchocerciasis by 2025.
The donation of Mectizan® by Merck & Co Inc. in 1987 "as much as was needed for as long as was needed for onchocerciasis control" was a major change from traditional corporate drug donations. The company realised that those who needed the drug most would never be able to purchase it, and so gave it away. The donation enabled the Onchocerciasis Control Programme in West Africa to add Mectizan distribution to its ongoing control strategy. For the first time there was hope for those living in other areas of Africa, Latin America and Yemen. Governments and non-governmental development organizations quickly got together to begin treatment in these new areas. Two new programmes and partnerships were created; the African Programme for Onchocerciasis Control and the Onchocerciasis Elimination Programme for the Americas. These programmes have been in the forefront of developing new strategies, including the Community Directed approach, which has now expanded into other disease control programmes at the community level, such as Vitamin A distribution and malaria control. This donation has led not only to the probability of elimination of onchocerciasis in the Americas in the near future, but is stimulating approaches to the elimination in Africa, in areas considered impossible five years ago. Other major pharmaceutical donations have followed, initiating the plan to eliminate lymphatic filariasis worldwide, and also stimulating interest in controlling other "neglected tropical diseases," which affect the poorest billion of the world's population, making this now a reality.
to assess drug donations in terms of their adherence to the drug donation guidelines put forth by the World Health Organization (WHO).
in 2009 we searched the academic and lay literature - journal articles, media articles and industry and donor web sites - to identify reports about drug donations made from 2000 to 2008. Publications focusing on molecular mechanisms of drug action, general descriptions of guidelines or specific one-time drug donations before 2000 were excluded. For cases with sufficient information, we assessed compliance with each of the 12 articles of WHO's guidelines.
we found 95 articles describing 96 incidents of drug donations between 2000 and 2008. Of these, 50 were made in response to disaster situations, 43 involved the long-term donation of a drug to treat a specific disease and 3 were drug recycling cases. Disaster-related donations were less likely to comply with the guidelines, particularly in terms of meeting the recipient's needs, quality assurance and shelf-life, packaging and labelling, and information management. Recipient countries were burdened with the costs of destroying the drugs received through inappropriate donations. Although long-term donations were more likely to comply with WHO guidelines related to quality assurance and labelling, they did not consistently meet the needs of the recipients. Furthermore, they discouraged local drug production and development.
drug donations can do more harm than good for the recipient countries. Strengthening the structures and systems for coordinating and monitoring drug donations and ensuring that these are driven by recipient needs will improve adherence to the drug donation guidelines set forth by WHO.
Neglected tropical diseases represent one of the most serious burdens to public health. Many can be treated cost-effectively, yet they have been largely ignored on the global health policy agenda until recently. In this first paper in the Series we review the fragmented structure of elimination and control programmes for these diseases, starting with the ambiguous definition of a neglected tropical disease. We describe selected international control initiatives and present their effect, governance arrangements, and financing mechanisms, including substantial drug-donation programmes. We also discuss efforts to exploit shared features of these diseases by integration of selected control activities within countries, thus creating economies of scope. Finally we address the challenges, resulting from the diversity of disease control approaches and governance structures-both nationally and internationally-and provide some suggestions for the way forward.
More than 1000 million people in 82 countries are at risk of contracting the tropical disease lymphatic filariasis (LF). Although the disease is wide-spread, transmission of the causative parasites can be stopped through mass drug administrations based on a combination of anti-parasitic medicines. For more than 10 years, the pharmaceutical companies GlaxoSmithKline (GSK) and Merck & Co., Inc., have participated in a unique private-sector collaboration to support the global efforts to eliminate LF, through donations of drugs to prevent the disease. GSK's albendazole and Merck's ivermectin (Mectizan) now reach hundreds of millions of people each year, through national LF-elimination programmes carried out in collaboration with Ministries of Health, the World Health Organization, non-governmental organizations and local communities. Working in support of the Global Programme to Eliminate Lymphatic Filariasis, GSK and Merck not only provide donated medicines but also offer financial, programmatic and management expertise to support LF-elimination efforts worldwide.
Research electronic data capture (REDCap) is a novel workflow methodology and software solution designed for rapid development and deployment of electronic data capture tools to support clinical and translational research. We present: (1) a brief description of the REDCap metadata-driven software toolset; (2) detail concerning the capture and use of study-related metadata from scientific research teams; (3) measures of impact for REDCap; (4) details concerning a consortium network of domestic and international institutions collaborating on the project; and (5) strengths and limitations of the REDCap system. REDCap is currently supporting 286 translational research projects in a growing collaborative network including 27 active partner institutions.
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