scholarly journals Implementing pharmaceutical track-and-trace systems: a realist review

2021 ◽  
Vol 6 (Suppl 3) ◽  
pp. e003755
Author(s):  
Joeke Kootstra ◽  
Tineke Kleinhout-Vliek
Keyword(s):  
Supply Chain ◽  
Implementation Process ◽  
Realist Review ◽  
Medical Product ◽  
Pharmaceutical Supply Chain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Point Of Entry ◽  
Falsified Medicines ◽  
The Government

IntroductionOne way to prevent falsified medical products from entering the regulated pharmaceutical supply chain is to implement a pharmaceutical track-and-trace system (PTTS). Such systems in the most extensive versions generally mandate a scan at every point of contact with the medical product: from the point of entry to dispensation. There have been several attempts to implement such systems; for example, a ‘full’ PTTS in Turkey and the more pared-down version offered by the European Union’s Falsified Medicines Directive and Delegated Act. This study aims to identify facilitators and barriers to implementing (elements of) a PTTS, with the Turkish system used as a benchmark.MethodsWe conducted a ‘realist’ review, which synthesises literature and aims to establish how a specific technology works, for whom, under which circumstances. We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar databases, yielding 2,790 scholarly articles. We selected 21 for review.ResultsImplementation of PTTS elements has been attempted in different compositions in several primarily high-income and middle-income countries. Factors that affected implementation included stakeholders like the government and supply chain actors, the coordination between them, and their awareness, knowledge, and skills, as well as regulation and legislation, monetary investments, and technical and digital requirements.ConclusionThe interplay between contextual factors is crucial for successful PTTS implementation. Specifically, the findings indicate that aligning the incentives for all actors and allowing for adjustments in a continuous implementation process will likely facilitate implementation.

scholarly journals Education, Work, and Motherhood in Low and Middle Income Countries: A Review of Equality Challenges and Opportunities for Women with Disabilities

2018 ◽  
Vol 6 (1) ◽  
pp. 82-93 ◽  
Author(s):  
Belaynesh Tefera ◽  
Marloes L. Van Engen ◽  
Alice Schippers ◽  
Arne H. Eide ◽  
Amber Kersten ◽  
...  
Keyword(s):  
Cultural Practices ◽  
Women With Disabilities ◽  
Middle Income ◽  
Governmental Organization ◽  
Middle Income Countries ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Challenges And Opportunities ◽  
The Government ◽  
Low And Middle Income

This study looks at the equality challenges and opportunities for women with disabilities in low and middle income countries (LMICs) to participate and succeed in education, employment and motherhood. It is based on a systematic review of the literature from academic and non-governmental organization databases. The search of these databases yielded 24 articles, which were subsequently passed through open, axial, and selective coding. The resulting review found that women with disabilities in LMICs have severe difficulty participating and succeeding in education, employment and motherhood due to a number of interrelated factors: (i) hampered access to education, employment, intimacy and marriage, (ii) stigma and cultural practices resulting in discrimination and prejudice, and (iii) lack of support from family, teachers and institutions—all of which are exacerbated by poverty. Support from families, communities, the government, and non-governmental organizations improves women’s ability to fulfil their social roles (as students, employees and mothers), resulting in a better quality of life. Strategies that create awareness, minimize poverty and facilitate justice may improve the opportunities for women with disabilities in LMICs to participate in education, employment and motherhood, as well as their ability to succeed in these domains.

scholarly journals Strengthening Medical Product Regulation in Low- and Middle-Income Countries

PLoS Medicine ◽  
2012 ◽  
Vol 9 (10) ◽  
pp. e1001327 ◽  
Author(s):  
Charles Preston ◽  
Mary Lou Valdez ◽  
Katherine Bond
Keyword(s):  
Medical Product ◽  
Middle Income ◽  
Middle Income Countries ◽  
Product Regulation ◽  
Low And Middle Income

scholarly journals Food Systems After Covid-19

IDS Bulletin ◽  
2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ayako Ebata ◽  
Nicholas Nisbett ◽  
Stuart Gillespie
Keyword(s):  
Supply Chain ◽  
Food Systems ◽  
Small And Medium Enterprises ◽  
Food Supply Chain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Nutrition Security ◽  
Food And Nutrition ◽  
Medium Enterprises ◽  
Local Innovation Systems

Measures to slow down the spread of Covid-19 have had profound effects on the food and nutrition security of poor and marginalised households and communities. This article provides an overview of the effects of Covid-19 on food systems across low- and middle-income countries using resilience and political economy lenses, before proposing approaches to build back resilient and equitable food systems. First, future interventions need to target structural issues that limit people’s agency in accessing nutritious and diverse food and production capital. Second, local innovation systems and institutions require investment to create a market environment that benefits domestic (small and medium) enterprises and agri‑food supply chain workers without jeopardising the environment. Third, interventions need to be informed by a diverse set of opinions that include the voices of the most marginalised.

scholarly journals Case Report: Cryptococcal meningitis in an apparently immunocompetent patient in Nepal - challenges in diagnosis and treatment

2019 ◽  
Vol 4 ◽  
pp. 55
Author(s):  
Ashish Jha ◽  
Sudeep Adhikari ◽  
Keshav Raj Sigdel ◽  
Buddhi Paudyal ◽  
Buddha Basnyat ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Liposomal Amphotericin ◽  
Care Delivery ◽  
Immunocompetent Patient ◽  
Liposomal Amphotericin B ◽  
Middle Income ◽  
Middle Income Countries ◽  
Csf Analysis ◽  
The Government

A 50 year old woman from Nepal had clinical features suggestive of meningitis. Cerebrospinal fluid (CSF) analysis was normal except for the presence of cryptococcal antigen. The inclusion of test for Cryptococcus in the CSF helped in making the diagnosis of cryptococcal meningitis in our patient who was apparently immunocompetent. Treatment with liposomal amphotericin B could not be started on time due to financial constraints. The patient had a stroke and further deteriorated. Liposomal amphotericin B is stocked by the government of Nepal for free supply to patients with visceral leishmaniasis, but the policy does not allow the drug to be dispensed for other infections. The family members of our patient acquired the drug within a few days from a government center using their political connections and following administering the treatment the patient improved. This case demonstrates the utility of considering cryptococcal meningitis as a differential diagnosis, and including tests for Cryptococcus when dealing with immunocompetent patients presenting with meningitis. It also demonstrates the effects of the sociopolitical situation on health care delivery in low- and middle-income countries (LMICs) such as Nepal.

scholarly journals Private Public Partnership Vital Role

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 248s-248s
Author(s):  
W. Al Khrusi
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Needs Assessment ◽  
Human Resource Development ◽  
Fund Raising ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mobile Mammography ◽  
The Government ◽  
Stage 1

Amount raised: 3,640,000 USD Background and context: Nongovernmental Organizations especially in middle-income countries have to breed the culture of CSR and PPP within itself and the community to address the financial challenges that limit their activities and performance especially in cancer prevention and control otherwise they would not positively impact the socioeconomic aspect of cancers. We at our association appreciated the importance of integrity, professionalism, innovativeness and transparency so as to convince and achieve this partnership to serve the community. Aim: Is to fundraise to support awareness, human resource development and breast cancer screening. Strategy/Tactics: Private public partnership after needs assessment for each of our projects with full transparency and innovation. Program process: After needs assessment, we put together a full budget for each project. The negotiations with the private companies start and present through audio visuals. We receive support by the government. Repeated annual auditing of the program. We then report to the entity that assisted with the fund raising for the project and the government. Appreciating those who are working for the projects through the media and awards. Develop a cohesive partnership team.Costs and returns: 1- Mobile mammography unit: 17,800 women screenings around the country, the data are used for research. 6% found positive. Paradigm change in breast cancer presentation in the breast clinics with now higher percentage of stage 1 and 2 compared with before. Acceptance of the word “cancer: within the community. Savings of the government expenditure of treating with stage 1 is 13,000 USD, stage 4 is 300,000 USD. Reduction in the number that needs palliative care. The project won his Majesty´s award and the United Nations award in Gender section. 2- Dar Al Hanan: home away from home for children with cancer residing far from the oncology center, who need outpatient treatment. This caters to 16 families free of charge supporting accommodation, meals and a shuttle bus to the hospital. Won local and international awards. So far since 2011, it catered for 489 families with all nationalities. 3- Palliative care: training of hospital and community nurses and primary health care physicians from Oman and 51 from low- and middle-income countries. 60 of them qualified as certified trainers to continue training in their countries. What was learned: The importance of private public partnership but the nonprofit organizations have to learn a different culture on how to convince the private sector to fund the programs.

scholarly journals Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi

2020 ◽  
Author(s):  
Jakub Gajewski ◽  
Marisa Wallace ◽  
Chiara Pittalis ◽  
Gerald Mwapasa ◽  
Eric Borgstein ◽  
...  
Keyword(s):  
Rural Areas ◽  
Research Approach ◽  
Middle Income ◽  
Bachelor Of Science ◽  
Middle Income Countries ◽  
Barriers And Enablers ◽  
Surgical Workforce ◽  
District Hospitals ◽  
The Government ◽  
Clinical Officers

Background: Low- and middle-income countries (LMICs) are the worst affected by a lack of safe and affordable access to safe surgery. The significant unmet surgical need can be in part attributed to surgical workforce shortages that disproportionately affect rural areas of these countries. To combat this, Malawi has introduced a cadre of non-physician clinicians (NPCs) called clinical officers (COs), trained to the level of a Bachelor of Science (BSc) in Surgery. This study explored the barriers and enablers to their retention in rural district hospitals (DHs), as perceived by the first cohort of COs trained to BSc in Surgery level in Malawi. Methods: A longitudinal qualitative research approach was used based on interviews with 16 COs, practicing at DHs, during their BSc training (2015); and again with 15 of them after their graduation (2019). Data from both time points were analysed and compared using a top-down thematic analysis approach. Results: Of the 16 COs interviewed in 2015, 11 intended to take up a post at a DH following graduation; however, only 6 subsequently did so. The major barriers to remaining in a DH post as perceived by these COs were lack of promotion, a more attractive salary elsewhere; and unclear, stagnant career progression within surgery. For those who remained working in DH posts, the main enablers are a willingness to accept a low salary, to generate greater opportunities to engage in additional earning opportunities; the hope of promotional opportunities within the government system; and greater responsibility and recognition of their surgical knowledge and skills as a BSc-holder at the district level. Conclusion: The sustainability of surgically trained NPCs in Malawi is not assured and further work is required to develop and implement successful retention strategies, which will require a multi-sector approach. This paper provides insights into barriers and enablers to retention of this newly-introduced cadre and has important lessons for policy-makers in Malawi and other countries employing NPCs to deliver essential surgery.

scholarly journals Future Directions for Providing Conceptual Clarity Related to Context in Implementation; Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis"

2021 ◽  
Author(s):  
Amelia E. Van Pelt ◽  
Rinad S. Beidas
Keyword(s):  
Implementation Science ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Future Directions ◽  
Middle Income ◽  
Evidence Based Practices ◽  
Middle Income Countries ◽  
Stakeholder Perspectives ◽  
Conceptual Clarity ◽  
Country Analysis

In implementation science, contextual inquiry guides the implementation process for successful uptake of evidence-based practices. However, the conceptualization and measurement of context varies across frameworks and stakeholders. To advance implementation science, future efforts to advance the understanding of context should incorporate input from implementation stakeholders through co-creation, elicit stakeholders’ perspectives in low- and middle-income countries to generate a more comprehensive list of determinants, and refine inconsistencies in terminology to promote research synthesis. Greater conceptual clarity and generalizability in contextual inquiry will enable improved communication and collaboration, thus facilitating a shift in focus to development and evaluation of implementation strategies to improve healthcare and health outcomes.

scholarly journals Impact of Road Safety Laws in Colombia on Road Traffic Collision Fatalities and Injuries

2019 ◽  
Vol 34 (s1) ◽  
pp. s65-s65
Author(s):  
Killiam A. Argote ◽  
Michael S Molloy ◽  
Alexander Hart ◽  
Amalia Voskanyan ◽  
Ritu R Sarin ◽  
...  
Keyword(s):  
Road Safety ◽  
Road Traffic ◽  
General Assembly ◽  
Middle Income ◽  
Middle Income Countries ◽  
Time Period ◽  
Safety Plan ◽  
Road Traffic Collision ◽  
The Government ◽  
National Road

Introduction:Road traffic collisions (RTC) are the leading cause of preventable death among those aged 15–29 years worldwide. More than 1.2 million lives are lost each year on roads. Ninety percent of these deaths take place in low- and middle-income countries. The General Assembly of the United Nations (UN) proclaimed the period from 2011-2020 the “Decade of Action for Road Safety,” with the objective of stabilizing and reducing the number of deaths by 50% worldwide. In this context, the government of Colombia established the National Road Safety Plan (PNSV) for the period 2011–2021 with the objective of reducing the number of fatalities by 26%. However, the effectiveness of road safety policies in Colombia is still unknown.Aim:To evaluate the effect of road safety laws on the incidence of RTC, deaths, and injuries in Colombia.Methods:RTC data and fatality numbers for the time period of January 1, 2010, to December 31, 2017, were collated from official Colombian governmental publications and analyzed for reductions and trends related to the introduction of new road safety legislation.Results:Data analysis are expected to be completed by January 2019.Discussion:RTC remains the leading preventable cause of death in Colombia despite the PNSV. Data is being mined to determine the trends of these rates of crashes and fatalities, and their relation to the introduction of national traffic laws. Overall, while the absolute numbers of RTC and deaths have been increasing, the rate of RTC per 10,000 cars has been decreasing. This suggests that although the goals of the PNSV may not be realized, some of the laws emanating from it may be beneficial, but warrant further detailed analysis.

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