Were medicine quality and pharmaceutical management contributing factors in diminishing artemisinin efficacy in Guyana and Suriname?

BACKGROUND: Recent studies in Guyana and Suriname unveiled diminished efficacy of artemisinin derivatives based on day-3 parasitaemia. The migrant characteristics of the population at risk and the potential development of resistance pose a serious health threat in the region. Assessment of factors that may have contributed to this situation is warranted, and analysis of the data generated in those countries on quality and pharmaceutical managements of anti-malarials may contribute to a better understanding of this occurrence. METHODS: Data on malaria medicine quality and pharmaceutical management, generated in the context of the Amazon Malaria Initiative (AMI), was reviewed and discussed. RESULTS: Numerous substandard artemisinin-containing malaria medicines were identified in both countries, particularly in Guyana, where a larger number and variety of anti-malarials were sampled. Poor quality was more frequent in the private and informal sector than in the public sector, posing a greater threat to the populations at risk, which are mostly located in hard to reach areas with scarce public facilities. Stock-outs identified in the public sector in Guyana could enhance the need to access those alternative sectors, exacerbating the risk of utilizing poor quality medicines. The availability of monotherapies and other non-recommended therapies for Plasmodium falciparum malaria, could also have contributed to the diminished efficacy. The type of quality deficiencies identified -reduced content of active pharmaceutical ingredient (API) and/or poor dissolution- and the irrational use of non-recommended treatments could result in non-sustained or lower levels of API in blood, favouring survival of more resistant mutants by exposing parasites to sub-lethal doses of the active ingredient. CONCLUSIONS: The quality of malaria medicines and the availability and use of non-recommended treatments could have played a role in the diminished efficacy of artemisinin derivatives described in Guyana and Suriname. However, also other factors need to be considered and a more comprehensive and extensive assessment on quality and pharmaceutical management is necessary to establish a tighter cause-effect correlation. Nevertheless, relevant authorities in these and neighbouring countries should take into consideration the reviewed data to properly address the problem when implementing corrective actions.

Rapid assessment of the performance of malaria control strategies implemented by countries in the Amazon subregion using adequacy criteria: case study.

BACKGROUND: The objective of this study was to implement a rapid assessment of the performance of four malaria control strategies (indoor spraying, insecticide-treated bed nets, timely diagnosis, and artemisinin-based combination therapy) using adequacy criteria. The assessment was carried out in five countries of the Amazon subregion (Bolivia, Colombia, Ecuador, Guyana, and Peru). METHODS: A list of criteria in three areas was created for each of the four strategies: preliminary research that supports the design and adaptation of the control strategies, coverage of the control strategies and quality of the implementation of the strategies. The criteria were selected by the research team and based on the technical guidelines established by the World Health Organization. Each criterion included in the four lists was graded relative to whether evidence exists that the criterion is satisfied (value 1), not satisfied (value 0) or partially satisfied (value 0.5). The values obtained were added and reported according to a scale of three implementation categories: adequate, intermediate and deficient. RESULTS: Implementation of residual indoor spraying and timely diagnosis was adequate in one country and intermediate or deficient in the rest. Insecticide-treated bed nets ranged between deficient and intermediate in all the countries, while implementation of artemisinin-based combination therapy (ACT) was adequate in three countries and intermediate in the other two countries evaluated. CONCLUSIONS: Although ACT is the strategy with the better implementation in all countries, major gaps exist in implementation of the other three malaria control strategies in terms of technical criteria, coverage and quality desired. The countries must implement action plans to close the gaps in the various criteria and thereby improve the performance of the interventions. The assessment tools developed, based on adequacy criteria, are considered useful for a rapid assessment by malaria control authorities in the different countries.

Análisis comparativo de los mecanismos de suministros de medicamentos en el Ministerio de Salud Pública de Nicaragua: informe final / Comparative analysis of the mechanisms of medicine supplies in the health care Ministry of Nicaragua: final report

Presenta análisis comparativo de los mecanismo del suministro y distribucion de los medicamentos en la unidades de atención del Ministerio de Salud de Nicaragua. Se hace una comparación de costos comparativos de los diferentes modelos explorados utilizando el mismo valor de compra y donaciones para funciones de desaduanaje, almacenamiento y distribución esto se realiza a través del Centro de Insumos para la Salud (CIPS). Muestra el analisis en tablas de los costos de operación de CIPS con y sin manejo de donaciones en especie , incluyen funciones, inventario con donaciones en especies y inventario de compra con fondo fiscal y proyectos donantes. El reporte aqui presentado muestra el soporte de los datos usados para las alternativas planteadas y discute en mayor detalle las necesidades que necesitan sean enfocadas a corto y mediano plazo del suministro de medicamentos a cada unidad de salud

[The relationships between organizations for technical cooperation in health and private consulting businesses]. / Las relaciones entre organizaciones de cooperación técnica en salud y empresas privadas de consultoría.

In recent years, agencies that provide technical cooperation in health have increased their contractual relationships with private consulting entities. This has made it possible to respond in a timely manner to the support needs that countries have, to develop skills at the national level, and to reduce the operating costs for the cooperation agencies. However, these relationships risk moving the cooperation agencies away from generating ideas and new knowledge, which, until recently, was considered one of their essential roles. Contracting with private enterprises will almost certainly increase in the coming years. This makes it worth reviewing the tasks that correspond to the cooperation agencies in this scenario as well as mechanisms to see that these relationships result in the greatest benefit for deprived groups. Actions that can be undertaken immediately include organizing the "structural capital" (such as programs, databases, strategies, and organizational "culture," structure, systems, and procedures) of the technical cooperation agencies, precisely identifying tasks that cannot be delegated, and adequately designing and controlling terms of reference.

Las relaciones entre organizaciones de cooperación técnica en salud y empresas privadas de consultoría / The relationships between organizations for technical cooperation in health and private consulting businesses

In recent years, agencies that provide technical cooperation in health have increased their contractual relationships with private consulting entities. This has made it possible to respond in a timely manner to the support needs that countries have, to develop skills at the national level, and to reduce the operating costs for the cooperation agencies. However, these relationships risk moving the cooperation agencies away from generating ideas and new knowledge, which, until recently, was considered one of their essential roles. Contracting with private enterprises will almost certainly increase in the coming years. This makes it worth reviewing the tasks that correspond to the cooperation agencies in this scenario as well as mechanisms to see that these relationships result in the greatest benefit for deprived groups. Actions that can be undertaken immediately include organizing the "structural capital" (such as programs, databases, strategies, and organizational "culture," structure, systems, and procedures) of the technical cooperation agencies, precisely identifying tasks that cannot be delegated, and adequately designing and controlling terms of reference

Organización, gestión y evaluación de los servicios de salud: más allá de la reforma prescrita / Health services organization, management and evaluation: beyond the prescribed reform

Inicialmente el documento plantea que a pesar de los esfuerzos invertidos pir las agencias de financiamiento internacionales en el desarrollo de propuestas metodológicamente bien diseñadas, muchas de las modificaciones más radicales y probablemente más sostenibles, en la organización y gestión de los servicios de salud están surgiendo son la participación de los gobiernos centrales que dichas agencias apoyan. Este documento presenta en su segundo capítulo, una breve descripción de la propuesta de reorganización de los servicios de salud, promovida por el binomio agencia financiera -gobierno central, que llamaremos reformas oficiales. Analiza, en un tercer capítulo, los tropiezos en la implementación de esta propuesta alrededor de dos dimensiones: la económica-ideológica y la técnica, y de cinco componentes que parecen ser constantes en la prescripción oficial: la focalización, el diseño de canastas básicas, el cambio de la mezcla público privada, la descentralización y la transformación del modelo de gestión. Para cada uno de estos componentes se tratan de describir los distintos factores que obstaculizan la reforma oficial. Finalmente, en el cuarto y último capítulo, se sugieren nuevos elementos a ser incorporados en una agenda coherente de transformación de la organización, gestión y evaluación de los servicios de salud

La fragmentacion de los sistemas nacionales de salud / The fragmentation of national health systems

The nationalistic tendencies observed in the world today, rooted in ethnic and ancestral cultural values that do not necessarily coincide with the physical boundaries of countries, have an enormous influence on societal organization, the distribution of wealth, and the processes of decentralization being carried out by governments. At the same time, the economic liberalization policies which are in fashion accentuate social divisions and favor models of health care that are fragmented according to the economic means of the user. This document explores the consequences of these trends for equity in the health and medical insurance systems of Latin America, as well as the role of the State and the private sector in the provision of services