Fundo Estratégico da Organização Pan-Americana da Saúde: mecanismo facilitador para melhorar o acesso aos medicamentos / The PAHO Strategic Fund: a mechanism to facilitate access to medicines

OBJETIVO: Descrever o funcionamento do Fundo Estratégico para medicamentos da Organização Pan-Americana da Saúde (OPAS). MÉTODO: Estudo retrospectivo, com recorte temporal de 2004 a 2007, fundamentado em levantamento bibliográfico e documental em arquivos dos escritórios da OPAS nos Estados Unidos, El Salvador, Guatemala, Honduras e Brasil. Foram levantados o volume total de recursos e os tipos de medicamentos movimentados por meio do Fundo Estratégico nos anos de 2004, 2005, 2006 e nos meses de janeiro a setembro de 2007. RESULTADOS: O levantamento revelou um fundo bem estruturado que movimentou recursos crescentes, de US$ 3 475 043,00 em 2004 a US$ 19 646 634,00 em 2007 (de janeiro a setembro). Houve um crescimento na participação dos antirretrovirais nesse dispêndio, de pouco menos de 8 por cento do total em 2004 a 57,89 por cento em 2007. Ainda em 2007, 66,63 por cento da movimentação financeira do Fundo Estratégico foram destinados à compra de antirretrovirais para nove países (Brasil, Guatemala, El Salvador, Equador, Honduras, Haiti, Belize, Nicarágua e Bolívia) de um total de 17 países participantes. O país que mais movimentou recursos financeiros por meio do Fundo Estratégico foi o Brasil, com 63 por cento dos gastos para compra de insumos estratégicos no período de janeiro a setembro de 2007. CONCLUSÃO: A proposta de unificar as compras de medicamentos de todos os países participantes para melhor negociação de preços e administração das compras permitirá economias de escala. O Fundo Estratégico pode contribuir para ampliar o acesso aos medicamentos e melhorar a gestão do sistema público de saúde da América Latina.

OBJECTIVE: To describe the medicine procurement activities of the PAHO Strategic Fund. METHOD: This is a retrospective study covering the period from 2004 to 2007, based on a bibliographic and document survey of Pan American Health Organization (PAHO) archives in the United States, El Salvador, Guatemala, Honduras, and Brazil. The volume of resources and the types of drugs procured by the fund were determined for the years 2004, 2005, and 2006 and for the period of January to September 2007. RESULTS: The survey revealed a well-structured fund handling increasing resources, from US$ 3 475 043.00 in 2004 to US$ 19 646 634.00 in 2007 (January to September). The participation of antiretroviral drugs in this expenditure has grown from less than 8 percent of the total in 2004 to 57.89 percent in 2007. Still, in 2007, 66.63 percent of the financial resources managed by the Strategic Fund were allocated to the purchase of antiretroviral drugs for nine countries (Brazil, Guatemala, El Salvador, Ecuador, Honduras, Haiti, Belize, Nicaragua, and Bolivia) out of a total of 17 participating countries. Brazil was the country using the most resources through the Strategic Fund, accounting for 63 percent of the expenditure for the purchase of strategic supplies between January and September 2007. CONCLUSION: The proposal to unify the purchase of medications for all participating countries to improve pricing and purchasing management will result in large-scale savings. The Strategic Fund can contribute to increasing access to medicines and improving the management of the public health care system in Latin America.

Assessment of distribution, knowledge and utilization of insecticide treated nets in selected malaria prone areas of Ethiopia

Background: Insecticide Treated Nets (ITNs) reduce malaria related mortality and morbidity significantly. Taking this into account; the Ethiopian Federal Ministry of Health has been distributing ITNs to malaria prone areas of the country through the support of the Global Fund. Objective: To study distributional coverage and assess the knowledge and utilization of insecticide treated nets in Ethiopia. Methods: A cross-sectional study was conducted in 17 malarious districts targeted for the first phase free distribution of long lasting insecticide treats nets (LLITNs) by the Ministry of Health in 9 administrative regions from October 2005 to September 2006. Region specific list of malarious districts where MOH distributed ITNs was used as the sampling frame for stratified random sampling of districts. One kebele (sub district) was selected from each of the selected districts using simple random sampling; and 15of the total households in the selected kebeles were selected using systematic random sampling. Upon obtaining informed consent from the household head or the oldest person in the household the questionnaire was administered and information was recorded. Data were double entered using EpiData version 3 and analyzed using SPSS version 12. Results: A total of 3131 households were visited; and 51.6of the respondents were males. The overall ITN distribution and utilization were 97.6and 81.6; respectively. The majority of households (53.2) owned a single net per family; highest in Dire Dawa (93.7) and lowest in Afar (17.6). Thirty eight percent of the respondents owned two nets per household. Most of the respondents (91.1) cited that ITNs are useful to control malaria either through prevention of mosquito bites (60) or prevention of the disease (39). Conclusion: ITN distribution; utilization; knowledge of users and its acceptability were good considering the recent introduction of the products. However; the person net ratio gap should be narrowed and emphasis needs to be given to vulnerable groups

The practices of spray operators in the Mpumalanga Malaria Control Programme using insecticides for residual indoor spraying

Pesticide poisoning poses a health risk to individuals throughout the world. In Mpumalanga Province spray teams apply local insecticides to indoor surfaces of households just prior to the rainy season to control malaria. Workers are exposed to pesticides during this process. This cross sectional study compared prescribed safe handling and deltamethrin application practices of Mpumalanga malaria spray operators versus actual practices in the field. Most (91) of the spray operators were included in the study. A tick list and interview was utilized to observe field practices and enquire about reasons for non-compliance. Only 28 of operators complied with all prescribed safe handling practices. Gloves; face shields and masks were not utilized as recommended and contributed to the highest levels of non-compliance. Compliance was found to be dependent on gender; age; years of experience; education level and employment status. The low compliance rate necessitates further investigation of the malaria programme occupational safety management system. All stakeholders need to be aware of the consequences of pesticide poisoning and to collaborate in efforts to work towards prevention

Control focal del paludismo: tratamiento focal usando quimioprofilaxis y rociado intradomiciliar con insecticida para el control del paludismo en el sur de México / Focal treatment with chemoprophylaxis and home spray with insecticides for the control of paludism in the Soyth of Mexico

La efectividad y eficiencia de una estrategia de aplicación focal para el control del paludismo, comparado con la estrategia tradicional de control, fueron evaluadas en dos grupos de localidades del Soconusco en el sur de Chiapas, México. El control focal consistió en la administración profiláctica de medicamentos antimaláricos a las personas que habían presentado episodios de paludismo en los dos años previos al estudio y la aplicación de rociado intradomiciliar con DDT en las casas de estas personas. El control tradicional consistió en el tratamiento de los casos de paludismo y el rociado de DDT a todas las casas de cada localidad. La estrategia de control focal mostró tener la misma efectividad (medida por el Índice Parasitario Anual) que la estrategia tradicional, pero su eficiencia fue superior con costos cuatro veces menor que los infringidos con medidas de control de cobertura total. El control focal tuvo además la ventaja de incorporar la participación comunitaria en la aplicación de las medidas de control.