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Miah MS, Mamun MR, Saif-Ur-Rahman KM, Rabby AA, Zakaria A. A qualitative exploration of purchasing, stockpiling, and use of drugs during the COVID-19 pandemic in an urban city of Bangladesh. PUBLIC HEALTH IN PRACTICE 2024; 7:100477. [PMID: 38379753 PMCID: PMC10878782 DOI: 10.1016/j.puhip.2024.100477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024] Open
Abstract
Objectives This research was conducted to explore the patterns and behavior of panic purchasing, stockpiling, and use of drugs during COVID-19 in the Sylhet city, Bangladesh. Study design The study adopted qualitative exploratory research design. Methods 25 in-depth interviews with drug sellers and clients and 7 key informant interviews were conducted with pharmacists and medical representatives of pharmaceutical companies in Sylhet city in Bangladesh from October 2020 to March 2021. Thematic analysis was used to evaluate the primary data. Results The findings revealed that individuals sought out, purchased, and stockpiled prescription-only drugs for self-medication purposes during the COVID-19 pandemic. News and rumor spread by social media, television, and everyday interactions concerning the severity of infections and the number of deaths caused an increase in self-medication as a preventive measure. The reason for this panic buying of drugs was identified as a fear of drug shortages, price hikes, the rise of infection, and the availability of medicines and home delivery services during the pandemic. Conclusion The purchasing, stockpiling and use of drugs by pharmacies varied based on the person dispensing the drugs, the customer, and the COVID-19 pandemic situation. Furthermore, the role of social media in spreading rumor and (dis) misinformation about drug use, a greater tendency to self-medicate, and poor regulation, influenced the individual's use of drugs. Therefore, the drug regulatory authorities and policymakers need to consider the real level of local drug use in order to encourage more rational use of drugs which will help to ensure that there is reliable access to safe, effective, and high-quality medicines and vaccines for all.
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Affiliation(s)
- Md. Shahgahan Miah
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md Razib Mamun
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - KM Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Al Amin Rabby
- Department of Sociology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - A.F.M. Zakaria
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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David A, Swalehe O, Habagusenga JDA, Banzimana S, Asingizwe D, Chacky F, Molteni F. Accessibility of malaria commodities in Geita District Council, mainland Tanzania: the experiences from healthcare providers and clients. J Pharm Policy Pract 2024; 17:2308611. [PMID: 38333577 PMCID: PMC10851820 DOI: 10.1080/20523211.2024.2308611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Background Access to essential malaria commodities is a cornerstone in malaria control. However optimal availability and access to essential malaria commodities remain a challenge in Tanzania. Therefore, this study aimed to explore the factors affecting the accessibility of malaria commodities in Tanzania. Methods This was a mixed-method cross-sectional study using both quantitative and qualitative approaches. Data were collected between February and March 2023 from health facilities, health facility staff, and patients. Results Availability of malaria commodities in government health facilities was 100% for all items while in the private and faith-based facilities, this ranged from 10% to 80%. The reasons for stockouts in Government facilities were related to delayed and inadequate quantity delivery while in private facilities the main reason was the lack of cash for procurement. Both private facilities' clients and healthcare providers concurred that most people do not access complete treatment due to the high costs of prescribed medicines and poor stocking levels. Conclusion The availability, hence the accessibility, of malaria commodities in private and faith-based health facilities is still sub-optimal. Logistic management needs to be improved to eliminate stockouts and malaria commodities high costs need a permanent solution.
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Affiliation(s)
- Anna David
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Omary Swalehe
- Department of Business Studies, Mzumbe University, Dar es salaam, Tanzania
| | - Jean D’ Amour Habagusenga
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stany Banzimana
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- EAC Regional Centre of Excellence for Vaccines, Immunization, and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Frank Chacky
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
| | - Fabrizio Molteni
- National Malaria Control Programme, Ministry of Health, Dodoma, Tanzania
- Swiss Tropical and Public Health Institute, Dar es Salaam, Tanzania
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Schurer JM, Murara E, van Oirschot J, Ooms G. Antivenom for sale? Availability and affordability of snakebite medicines across public and private health facilities in Rwanda. Toxicon 2023; 234:107292. [PMID: 37734455 DOI: 10.1016/j.toxicon.2023.107292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
Antivenom is considered the safest and most effective treatment against snake envenomation (SBE); however, global shortages mean that many low-income countries struggle to meet demand. In Rwanda, chronic shortages of essential medicines are an important barrier to robust healthcare delivery and discourage snakebite victims from seeking hospital care. The aim of this retrospective, cross-sectional study was to evaluate the availability and affordability of commodities to treat SBE at hospitals and health centers. In total, our team interviewed pharmacy managers at 111 public and 31 private health facilities (N = 142) to complete a validated quantitative questionnaire, entering data electronically through KoBoCollect. Commodity prices were collected in 2023RWF and for the lowest cost item across any category. A commodity was considered affordable if a treatment regimen cost less than one day's wages, using the international poverty line to approximate a low-income worker's wages. Across all health facilities, mean availability of SBE commodities was relatively good (77.1%). Snake antivenom was only available at public hospitals and was concentrated in urban rather than rural areas. Two snake antivenom types were observed, one of which was not appropriate for treating envenomation by East African snakes. Overall, this meant that only 4.2% of facilities stocked safe and effective antivenom. Black stones, an ineffective traditional treatment, were sold by 5.6% of health providers. Moreover, antivenom did not meet the minimum threshold for affordability, costing on average 10 days of work for a single dose among uninsured individuals. Altogether, this study highlights serious performance gaps among pharmacies responsible for procuring and supplying SBE commodities and helps to explain the widespread belief that SBE treatment is unaffordable at hospitals and health centers. Urgent action is needed to ensure that all hospital and health center pharmacies located in high-risk areas stock appropriate antivenom and that re-stocking time for essential medicines is reduced.
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Affiliation(s)
- Janna M Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda; Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, USA.
| | - Elijah Murara
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | | | - Gaby Ooms
- Health Action International, Amsterdam, the Netherlands; Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
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Ipagala P, Mlugu EM, Mwakalukwa R, Kagashe GA. Impact of COVID-19 on the supply chain of essential health commodities: a mixed method study, in Dar es Salaam, Tanzania. J Pharm Policy Pract 2023; 16:103. [PMID: 37736737 PMCID: PMC10515070 DOI: 10.1186/s40545-023-00617-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The outbreak of COVID-19 in the late 2019 led to major global health crises, including morbidities and mortalities. The pandemic has adversely affected the supply chain of essential health commodities globally. However, such data from sub-Saharan Africa including Tanzania are largely limited. We assessed the impact of COVID-19 on the supply chain of essential health commodities in Tanzania. METHOD A cross-sectional study with pragmatic mixed method design was conducted in Dar es Salaam region from January to June 2021. Grounded theory was adopted to purposeful select key informants (n = 15) from importers of essential health commodities and local pharmaceutical manufacturers. Community pharmacy dispensers (n = 242) were also recruited for the quantitative part of this study. The prices of selected tracer health commodities were extracted from the Tanzania Medicine and Medical Device Authority (TMDA) Regulatory Information Management system. The mean unit prices 1 year before the pandemic were compared with the mean prices 1 year during the pandemic using paired t test. Thematic analysis was used for qualitative data. RESULTS The information regarding the impact of COVID-19 on the supply chain of essential health commodities was synthesized into three main themes namely, reduced availability of health commodities, increased price of health commodities and increased lead time for imported essential health commodities during COVID-19. Majority (90%) of community pharmacy dispensers reported that COVID-19 reduced the availability of essential health commodities. Azithromycin, Paracetamol, Multivitamin and Vitamin C tablets were the highly demanded products and their mean unit prices increased significantly during COVID-19 as compared to 1 year before the pandemic (p < 0.05). CONCLUSIONS COVID-19 led to shortage, increased prices and delayed delivery of essential health commodities. This might happen in the future whenever unexpected crises causing disruption in the supply chain occur underscoring the need for the country preparedness measures.
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Affiliation(s)
- Pius Ipagala
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Eulambius M Mlugu
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania.
| | - Rogers Mwakalukwa
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Godeliver A Kagashe
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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Mekonnen Z, Melaku T, Tucho GT, Mecha M, Årdal C, Jahre M. The knock-on effects of COVID-19 pandemic on the supply and availability of generic medicines in Ethiopia: mixed methods study. BMC Health Serv Res 2023; 23:513. [PMID: 37210502 DOI: 10.1186/s12913-023-09535-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/09/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND COVID-19 pandemic posed a major impact on the availability and affordability of essential medicines. This study aimed to assess the knock-on effects of the COVID-19 pandemic on the supply availability of non-communicable chronic disease (NCD) medicines and paracetamol products in Ethiopia. METHODS A mixed methods study was conducted to assess the supply and availability of twenty-four NCD drugs and four paracetamol products listed on the national essential medicines list for hospitals. Data were collected from twenty-six hospitals located in seven zones of Oromia region in the southwestern part of Ethiopia. We extracted data on drug availability, cost and stock out for these drugs between May 2019 and December 2020. The quantitative data were entered into Microsoft Excel and exported to statistical package software for social science (SPSS) version 22 (IBM Corporation, Armonk, NY, USA) software for analysis. RESULTS The overall mean availability of selected basket medicines was 63.4% (range 16.7% to 80.3%) during the pre-COVID-19 time. It was 46.3% (range 2.8% to 88.7) during the pandemic. There was a relative increase in the availability of two paracetamol products [paracetamol 500 mg tablet (67.5% versus 88.7%) and suppository (74.5% versus 88%)] during the pandemic. The average monthly orders fill rates for the selected products range from 43 to 85%. Pre-COVID-19, the average order fill rate was greater or equal to 70%. However, immediately after the COVID-19 case notification, the percentage of order(s) filled correctly in items and quantities began decreasing. Political instability, shortage of trained human resources, currency inflation, and limited drug financing were considered as the major challenges to medicine supply. CONCLUSION The overall stock out situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. None of the surveyed chronic disease basket medicines met the ideal availability benchmark of 80% in health facilities. However, availability of paracetamol 500 mg tablet surprisingly improved during the pandemic. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that medicines for chronic diseases are consistently available and affordable.
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Affiliation(s)
- Zeleke Mekonnen
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Tsegaye Melaku
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia.
| | | | - Mohammed Mecha
- Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Christine Årdal
- Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Jahre
- Department of Accounting and Operations Management, BI Norwegian Business School, Oslo, Norway
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Dewi A, Pisani E, Ihsan BRP, Hariadini AL, Patel A, Palagyi A, Praveen D, Sujarwoto, Lyrawati D. Continuity of CVD treatment during the COVID-19 pandemic: evidence from East Java, Indonesia. J Pharm Policy Pract 2023; 16:50. [PMID: 36949533 PMCID: PMC10032625 DOI: 10.1186/s40545-022-00509-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/27/2022] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND In Indonesia, the world's fourth most populous country, cardiovascular diseases (CVDs) are a leading cause of death and disability. Government efforts to reduce the burden of CVD include a community-based prevention and early detection programme, and the provision of medicines to prevent cardiovascular events. Disruptions to medicine supply chains, service provision, and movement during the COVID-19 pandemic potentially threatened the continuity of these efforts. We investigated the distribution and dispensing of common CVD medicines in Malang district, East Java, before the pandemic and early in its course. METHODS From January to October 2020, we collected monthly data on stock levels, sales or dispensing volumes, and price for five common CVD medicines (amlodipine, captopril, furosemide, glibenclamide and simvastatin), from a public and a private distributor, and from public health facilities (n = 4) and private pharmacies (n = 2). We further complied monthly data on patient numbers in two primary health centres. We tracked changes in stocks held and volumes dispensed by medicine type and sector, comparing the three months before the local COVID-19 response was mobilised with the subsequent seven months. We conducted interviews with pharmacists (n = 12), community health workers (n = 2) and a supply chain logistics manager to investigate the reasons for observed changes, and to learn details of any impacts or mitigation measures. RESULTS The pandemic affected demand more than supply, causing medicine stocks to rise. Restricted service provision, lock-down measures and fear of infection contributed to a sharp drop in patient numbers and dispensing volumes in the public sector. Meanwhile private sector sales, especially of lower-priced CVD medicines, rose. Community health workers attributed some poor health outcomes to interruption in regular patient check-ups; this interruption was aggravated by formal mitigation policies. CONCLUSIONS Fears that COVID-19 would interrupt medicine availability were unfounded in East Java. Public sector patients may have compensated for reduced service access by switching to private pharmacies. Mitigation policies that ignored administrative procedures were not effective.
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Affiliation(s)
- Aksari Dewi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Elizabeth Pisani
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Devarsetty Praveen
- The George Institute for Global Health, University of New South Wales, Hyderabad, India
| | - Sujarwoto
- Department of Public Administration, Brawijaya University, Malang, East Java, Indonesia
| | - Diana Lyrawati
- Department of Pharmacy, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
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Kigenza R, Nsengiyumva E, Sabagirirwa V. The Quality Management Improvement Approach: Successes and Lessons Learned From a Workforce Development Intervention in Rwanda's Health Supply Chain. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00295. [PMID: 36853645 PMCID: PMC9972377 DOI: 10.9745/ghsp-d-22-00295] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Rwanda's supply chain is decentralized, with regional warehouse pharmacies and service delivery points (SDPs) ensuring a reliable health commodities supply. However, in 2016, the Rwanda Ministry of Health (MOH) identified challenges with the supply chain workforce contributing to a high stock-out rate, inventory stock inaccuracies, and underutilization of the electronic logistics management information system (e-LMIS). We aimed to document successes and lessons learned from implementing a workforce development intervention to address these challenges. PROGRAM DESCRIPTION Rwanda's MOH and the U.S. Agency for International Development Global Health Supply Chain Program-Procurement and Supply Management project implemented a workforce development intervention, the Quality Management Improvement Approach (QMIA), to improve and sustain Rwanda's service delivery and medicines availability. The QMIA monitors the performance of supply chain professionals while continuously building their capacity to run a smooth supply chain operation. The QMIA includes supervisory visits to measure key performance indicators and discussion sessions for experience-sharing and skill-building. The central level conducts both components, supporting regional warehouses that in turn assist SDPs through supervisory visits and discussion sessions. RESULTS Since 2017, the QMIA has been conducted twice a year in 596 SDPs and 30 regional warehouses and has trained 1,296 supply chain staff members. The intervention has contributed to major improvements in several key supply chain outcomes (2017 versus 2019): increased utilization of the e-LMIS (55% to 96%), higher inventory data accuracy (25% to 85%), and reduced stock-outs (10% to 1%). CONCLUSIONS The QMIA has proven to be a successful training and capacity-building platform for supply chain management in Rwanda, enhancing system utilization and availability of accurate data to guide decision-making. Notably, the approach fosters a positive behavioral change to build local solutions and improves communication.
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Affiliation(s)
- Rogers Kigenza
- U.S. Agency for International Development Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda.
| | - Eliezer Nsengiyumva
- Clinical and Public Health Governance Directorate, Ministry of Health of Rwanda, Kigali, Rwanda
| | - Vincent Sabagirirwa
- U.S. Agency for International Development Global Health Supply Chain Program-Procurement and Supply Management, Kigali, Rwanda
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Analysis of pharmaceutical inventory management based on ABC-VEN analysis in Rwanda: a case study of Nyamagabe district. J Pharm Policy Pract 2023; 16:30. [PMID: 36829254 PMCID: PMC10129016 DOI: 10.1186/s40545-023-00540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Pharmaceuticals account for a large portion of healthcare spending in healthcare organizations. Their effective inventory management is required to match the cost of stocks with the customer demand and avoid shortage of supplies at any health facility level. This study aimed to analyze pharmaceuticals' inventory management using ABC-VEN analysis. METHODS The study was conducted at Rwanda Medical Supply (RMS) Ltd, Nyamagabe Branch for products distributed to health facilities in Nyamagabe District catchment area from the financial years 2017-2018 to 2019-2020. It consisted of a descriptive retrospective study of 457 items. The latter are generic essential medicines distributed to public health facilities during the study period. Products were arranged according to a descending order of importance, and we performed a breakdown of products according to the Pareto Principle. Following an ABC analysis of distribution data for such drugs billed to healthcare facilities, a VEN analysis was performed to identify high-value vital products that require more attention. RESULTS During the ABC analysis, 76 products were classified in group A. These accounted for 19.84% and had a value of 74.91% of the total cost of all products. Group B included 116 products, representing 30.29% with a value of 20% of the total cost, while Group C had 191 products, representing 49.87% with a value of only 5.09% of the total cost. During the VEN analysis, 202 products (44.20%) were classified as vital, 231 (50.54%) as essential, and 24 products (75.26%) as non-vital. The analysis with ABC-VEN resulted in Class I representing 55.80% of all medicines that cost 87.88% of all total cost, Class II representing 40.70% with a total cost of 11.82%, and Class III representing 3.50% with a cost of 0.3%. CONCLUSIONS This study results show that inventory management of vital and expensive products, such as antibiotics, antihypertensive pharmaceuticals, consumables, and massive solutions would be carefully monitored to prevent a shortage of such products at health facility levels. The ABC-VEN analysis is one of the practical and affordable method to achieve their optimized supply chain.
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Mehmeti I, Bozo S, Kostrista E, Pojani E. The influence of SARS-COV-2 pandemic in the pharmaceutical service in ALBANIA. Pharm Pract (Granada) 2023; 21:2750. [PMID: 37090464 PMCID: PMC10117356 DOI: 10.18549/pharmpract.2023.1.2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/08/2023] Open
Abstract
Objective In the second year of the COVID-19 pandemic, the role of the pharmacists was confirmed as central at the territorial level. The purpose of this study was to assess knowledge, attitudes, and practices of pharmacists in Albania, critical changes in the Albanian pharmaceutical market during the COVID-19 pandemic and evaluate factors influencing the quality of the pharmaceutical service. Methods A nationwide survey was conducted, using an online questionnaire targeting Albanian pharmacists during 2021. Results Most of the respondents were females (86.2%), belonged to the 30-39 age group (51.7%) and worked in community pharmacies (73%). Although most of the respondents did participate in training courses (62.8%), only about 38% of them had good knowledge about COVID-19 (score 5/8). Moreover, the level of knowledge increases the possibility to apply the rules. 65% of the pharmacists who were very afraid of getting infected with COVID -19, stated that they followed the WHO rules compared to 37 % of those who were not afraid. Regarding the medicines offered, 64% of the respondents claimed that there have been difficulties in ensuring the adequate medicines during the pandemic. Furthermore, although 61% of the pharmacists declared that the price of medicines during the pandemic has not changed, 58% of them thought that the revenues of all pharmaceutical sectors have risen. Conclusion From this study it is concluded that although the pharmacists in Albania have demonstrated strength, professionality, and commitment to offer pharmaceutical service to the highest level, they faced numerous challenges during this difficult time. In the future, the pharmacist's role can be extended in the community to provide successful medical service and their collaboration within and between pharmacists and physicians is essential.
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Affiliation(s)
- Irsida Mehmeti
- PhD. Department of Pharmaceutical Sciences, Faculty of Pharmacy, Catholic University "Our Lady of Good Counsel", Tirana, Albania.
| | - Silvi Bozo
- PhD. Department of Chemical-Pharmaceutical and Biomolecular Technologies, Faculty of Pharmacy, Catholic University "Our Lady of Good Counsel", Tirana, Albania.
| | - Entela Kostrista
- Msc. Department of Management, Faculty of Economics, LOGOS University College, Tirana, Albania.
| | - Eftiola Pojani
- PhD. Department of the Chemical-Toxicological and Pharmacologic Evaluation of Drugs, Faculty of Pharmacy, Catholic University "Our Lady of Good Counsel", Tirana, Albania.
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Mohammed SA, Tsehay T, Faris AG, Mengstu G. Availability, price, and affordability of medicines used for the management of Covid-19 in health facilities of Dessie town WHO/HAI survey. PLoS One 2022; 17:e0279465. [PMID: 36542641 PMCID: PMC9770383 DOI: 10.1371/journal.pone.0279465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The rapidly spreading nature of Covid-19 virus associated with its high mortality and mortality rate is triggering an unprecedented public health crisis. The study assessed the availability, price, and affordability of medicines used in the management of Covid-19 in health facilities of Dessie town. METHODS A retrospective cross-sectional study design was employed in the health facilities of Dessie town from September 1 to September 20, 2021. Data was collected using a standard checklist adopted from the Logistics Indicator Assessment Tool and WHO/HAI. WHO/HAI methodology was applied to select the surveyed health facilities (30) and medicines (44). The daily wage of the lowest-paid unskilled government worker is used to estimate affordability. RESULTS Fifteen and five medicines were not found at all public and private health facilities, respectively. The originator brand (OB) and lowest price generic (LPG) availability in private health facilities was 2.03% and 51.33%, respectively. In the public sector, the availability of OB and LPG was 0% and 34.44%, respectively. In public and private health facilities, the mean number of stock-outs was 2.25 and 2.91, and the mean number of stock-out days was 177.83 and 106.16 days, respectively. Eight and one LPG medicines were out of stock in public and private health facilities, respectively. Eight (33.33%) and 6 (28.57%) had higher prices than international prices in private and public health facilities, respectively. The median price ratio in public and private health facilities ranged from 0.02 and 3.05 and 0.04 to 2.70, respectively. Eighty percent of the products were unaffordable in both sectors. CONCLUSIONS The availability of medicines was low. One-third of the medicines had higher prices than international prices. Eighty percent of the products were unaffordable. The regular supply of these medicines is crucial for better management of the disease.
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Affiliation(s)
- Solomon Ahmed Mohammed
- Department of Pharmacy, College of Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Tessema Tsehay
- Department of Pharmacy, College of Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abebe Getie Faris
- Department of Pharmacy, College of Health Sciences, Wollo University, Dessie, Ethiopia
| | - Getnet Mengstu
- Department of Pharmacy, College of Health Sciences, Wollo University, Dessie, Ethiopia
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Habinshuti P, Nshimyiryo A, Fejfar DL, Niyigena A, Cubaka VK, Karema N, Bigirimana JB, Shyirambere C, Barnhart DA, Kateera F, Fulcher I. Impact of COVID-19 on access to cancer care in Rwanda: a retrospective time-series study using electronic medical records data. BMJ Open 2022; 12:e065398. [PMID: 36535717 PMCID: PMC9764097 DOI: 10.1136/bmjopen-2022-065398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has caused disruptions in access to routine healthcare services worldwide, with a particularly high impact on chronic care patients and low and middle-income countries. In this study, we used routinely collected electronic medical records data to assess the impact of the COVID-19 pandemic on access to cancer care at the Butaro Cancer Center of Excellence (BCCOE) in rural Rwanda. METHODS We conducted a retrospective time-series study among all Rwandan patients who received cancer care at the BCCOE between 1 January 2016 and 31 July 2021. The primary outcomes of interest included a comparison of the number of patients who were predicted based on time-series models of pre-COVID-19 trends versus the actual number of patients who presented during the COVID-19 period (between March 2020 and July 2021) across four key indicators: the number of new patients, number of scheduled appointments, number of clinical visits attended and the proportion of scheduled appointments completed on time. RESULTS In total, 8970 patients (7140 patients enrolled before COVID-19 and 1830 patients enrolled during COVID-19) were included in this study. During the COVID-19 period, enrolment of new patients dropped by 21.7% (95% prediction interval (PI): -31.3%, -11.7%) compared with the pre-COVID-19 period. Similarly, the number of clinical visits was 25.0% (95% PI: -31.1%, -19.1%) lower than expected and the proportion of scheduled visits completed on time was 27.9% (95% PI: -39.8%, -14.1%) lower than expected. However, the number of scheduled visits did not deviate significantly from expected. CONCLUSION Although scheduling procedures for visits continued as expected, our findings reveal that the COVID-19 pandemic interrupted patients' ability to access cancer care and attend scheduled appointments at the BCCOE. This interruption in care suggests delayed diagnosis and loss to follow-up, potentially resulting in a higher rate of negative health outcomes among cancer patients in Rwanda.
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Affiliation(s)
- Placide Habinshuti
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Alphonse Nshimyiryo
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Anne Niyigena
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Vincent K Cubaka
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Nadine Karema
- Informatics Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Dale A Barnhart
- Research and Training Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Fredrick Kateera
- Clinical Department, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Isabel Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Wulandari LPL, Khan M, Probandari A, Batura N, Ferdiana A, Mashuri YA, Wibawa T, Daraninggar D, Dewi BK, Day R, Jan S, Schierhout G, Yeung S, Wiseman V, Liverani M. "We face the same risk as the other health workers": Perceptions and experiences of community pharmacists in Indonesia during the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000606. [PMID: 36962398 PMCID: PMC10021738 DOI: 10.1371/journal.pgph.0000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/20/2022] [Indexed: 06/18/2023]
Abstract
In many countries, community pharmacies have played an important role during the COVID-19 pandemic, providing essential medicines and personal protective equipment (PPE), disseminating information on disease prevention and management, and referring clients to health facilities. In recognition of this, there are increasing calls for an improved understanding of the challenges and experiences faced by these providers during the COVID-19 pandemic, with a view to providing them with better support and guidance now and during future emergencies. Between January and February 2021 we conducted 21 qualitative interviews to explore the experiences, safety concerns, and attitudes of pharmacists and pharmacy technicians during the COVID-19 crisis in Indonesia, a country that has recorded more than four million cases since the start of the pandemic. Interview transcripts were analysed using thematic content analysis. Findings indicate that COVID-19 has had a significant impact on pharmacy practices in Indonesia. Most participants implemented preventive measures and adapted their business models to the changing circumstances. The shift to remote sales and home delivery allowed many pharmacies to maintain, and even increase their profit margins due to greater demand for medicines and PPE. However, many participants were concerned about the increased risk of infection due to limited social distancing and prolonged interactions with clients, many of whom displayed COVID-19 symptoms. Importantly, there was a general perception that the government did not sufficiently recognize these risks. In conclusion, the government should consider developing additional operational guidelines and regulatory frameworks to improve the safety, operation, and involvement of community pharmacies in the current pandemic response efforts and any future public health emergencies.
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Affiliation(s)
- Luh Putu Lila Wulandari
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Faculty of Medicine, Universitas Udayana, Bali, Indonesia
| | - Mishal Khan
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Departments of Community Health Sciences & Pathology, Aga Khan University, Karachi, Pakistan
- Global Health Programme, Chatham House, London, United Kingdom
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Neha Batura
- Institute for Global Health, University College London, London, United Kingdom
| | - Astri Ferdiana
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Medicine, Universitas Mataram, Mataram, Indonesia
| | - Yusuf Ari Mashuri
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tri Wibawa
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Microbiology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dea Daraninggar
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Berlian Kusuma Dewi
- Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ric Day
- St Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia
| | | | - Shunmay Yeung
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Virginia Wiseman
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marco Liverani
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
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13
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Formenti B, Gregori N, Crosato V, Marchese V, Tomasoni LR, Castelli F. The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review. LE INFEZIONI IN MEDICINA 2022; 30:30-40. [PMID: 35350264 DOI: 10.53854/liim-3001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 01/06/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.
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Affiliation(s)
- Beatrice Formenti
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | | | - Francesco Castelli
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy.,Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
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Toroitich AM, Dunford L, Armitage R, Tanna S. Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya. Risk Manag Healthc Policy 2022; 15:361-374. [PMID: 35256867 PMCID: PMC8898182 DOI: 10.2147/rmhp.s348816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anthony Martin Toroitich
- Trade Affairs Department, Pharmacy and Poisons Board, Nairobi, Kenya
- Leicester School of Pharmacy, De Montfort University, Leicester, UK
- Correspondence: Anthony Martin Toroitich, Leicester School of Pharmacy, De Montfort University, The Gateway, Leicester, LE1 9BH, UK, Tel +254724065344, Email
| | - Louise Dunford
- Leicester School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Rachel Armitage
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Sangeeta Tanna
- Leicester School of Pharmacy, De Montfort University, Leicester, UK
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15
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Wang M, Yin Z, Zhang W, Jia X, Du S, Li J, Zhang X. Exploring the Pharmaceutical Care of Pharmacists in China During COVID-19—A National Multicenter Qualitative Study. Front Public Health 2022; 9:797070. [PMID: 35155350 PMCID: PMC8829323 DOI: 10.3389/fpubh.2021.797070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background Pharmacists are one of the coronavirus disease-2019 (COVID-19) treatment team members in China, yet only a few single-center studies have described the work experience of pharmacists during the pandemic. Purpose This study aimed to explore in-depth experiences of hospital pharmacists providing pharmacy services during the COVID-19 pandemic in China on a national scale. Methods This is a nationwide multicenter qualitative study that used the purposive sampling method. Semi-structured interviews were conducted with 11 pharmacists from large-scale tertiary hospitals in representative provinces of mainland China. The Colaizzi seven-step method was applied to analyze the interview data. Results Eleven semi-structured interviews were conducted. Each interview lasted 25–70 min. By analyzing the work experiences of pharmacists in COVID-19 designated treatment hospitals, five descriptive themes were categorized: (1) drug supply service; (2) routine clinical pharmacy services; (3) expanded pharmacy services during the epidemic; (4) drug management loopholes; (5) areas of improvements of pharmacy services during a pandemic. Conclusion During the COVID-19 epidemic, Chinese hospital pharmacists played various vital roles. However, there were loopholes in managing narcotic drugs, psychotropic drugs, and donated drugs. The study uncovered areas of improvement in pharmacy services during the pandemic. The emergency response capacity of hospital pharmacists should be continuously improved in the future.
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16
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Ghibu S, Juncan AM, Rus LL, Frum A, Dobrea CM, Chiş AA, Gligor FG, Morgovan C. The Particularities of Pharmaceutical Care in Improving Public Health Service during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9776. [PMID: 34574698 PMCID: PMC8468206 DOI: 10.3390/ijerph18189776] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022]
Abstract
Nowadays, humanity is confronted with one of the most difficult challenges. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified for the first time in Hubei, China in December 2019 and produced the COVID-19 pandemic, a devastating disease that led to many complications and deaths. The authorities and the global healthcare system have been alerted regarding the prevention and treatment of this pathology. Even though worldwide quarantine was declared, health care professionals, including pharmacists, have been at the frontline in this war. Since the beginning of the pandemic, the authorities relied on the involvement of the community, hospital, or clinical pharmacists in offering support to the entire population. Also, the authorities implemented measures for emergency authorization of the vaccines, or the drugs used in COVID-19 treatment. In order to facilitate the population's access to healthcare services, the authorities have established regulations regarding, the extension of prescriptions by pharmacists, working hours, prevention of shortages and price-increase, drive-thru services, etc. However, several countries have taken financial measures to support the pharmacies' activity. At the same time, pharmaceutical associations elaborated guidelines for the protection of pharmacists and patients alike. Additionally, the pharmacies have come to support the health system and patients by adapting pharmaceutical care to the new needs like preparation and supply of disinfectants, patient care, information, and counseling, especially to COVID-19 patients, as well as the implementation of home drugs-delivery systems. The important roles played by pharmacists were to perform COVID-19 tests and further vaccines, as well as to combat the abundance of misinformation and fake news. The clinical and hospital pharmacy services have also been adapted. Strengthening the role of the pharmacist in the medical team was important for the purpose of providing correct and complete information regarding drugs used in the COVID-19 pathology. In all these activities, pharmacists needed creativity and professionalism, but also the support of pharmacy owners and managers. With this crisis, pharmaceutical care has entered a new phase, demonstrating the ability of pharmacists to be competent and accessible providers of public health. Based on this information, we conducted a narrative review whose purpose was to identify the impact of the authorities' decisions on pharmaceutical practice, the involvement of professional associations, and the responsibilities of the pharmacy owners and management. On the other hand, we performed a global assessment on the pharmaceutical care services provided by community pharmacists as well as by clinical or hospital pharmacists during the COVID-19 pandemic.
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Affiliation(s)
- Steliana Ghibu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, 6A Louis Pasteur Street, 400349 Cluj-Napoca, Romania;
| | - Anca Maria Juncan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Luca Liviu Rus
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Adina Frum
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Carmen Maximiliana Dobrea
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Adriana Aurelia Chiş
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Felicia Gabriela Gligor
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
| | - Claudiu Morgovan
- Preclinical Department, Faculty of Medicine, “Lucian Blaga” University of Sibiu, 2A Lucian Blaga St., 550169 Sibiu, Romania; (A.M.J.); (L.L.R.); (A.F.); (C.M.D.); (F.G.G.); (C.M.)
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Pharmacoeconomics in Africa: needs, prospect and challenges. J Pharm Policy Pract 2021; 14:47. [PMID: 34059103 PMCID: PMC8166127 DOI: 10.1186/s40545-021-00328-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Africa as a continent has experienced a continuous increase in the cost of healthcare as its demands increase. With many of these African countries living below the poverty threshold, Africans continue to die from preventable and curable diseases. Population increases have led to an increase in demands for healthcare, which unfortunately have been met with inequitable distribution of drugs. Hence, the outcomes from healthcare interventions are frequently not maximized. These problems notably call for some economic principles and policies to guide medication selection, procurement, or donation for population prioritization or health insurance. Pharmacoeconomics drives efficient use of scarce or limited resources to maximize healthcare benefits and reduce costs. It also brings to play tools that rate therapy choice based on the quality of life added to the patient after a choice of intervention was made over an alternative. In this paper, we commented on the needs, prospect, and challenges of pharmacoeconomics in Africa.
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