scholarly journals Challenges constraining availability and affordability of insulin in Bengaluru region (Karnataka, India): evidence from a mixed-methods study

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Gautam Satheesh ◽  
M. K. Unnikrishnan ◽  
Abhishek Sharma
Keyword(s):  
Mixed Methods ◽  
Public Sector ◽  
Private Sector ◽  
Human Insulin ◽  
Market Competition ◽  
Supply And Demand ◽  
Health Sector ◽  
Essential Medicine ◽  
Unskilled Worker ◽  
Consumer Prices

Abstract Introduction Considering limited global access to affordable insulin, we evaluated insulin access in public and private health sectors in Bengaluru, India. Methods Employing modified WHO/HAI methodology, we used mixed-methods analysis to study insulin access and factors influencing insulin supply and demand in Bengaluru in December 2017. We assessed insulin availability, price and affordability in a representative sample of 5 public-sector hospitals, 5 private-sector hospitals and 30 retail pharmacies. We obtained insulin price data from websites of government Jan Aushadhi scheme (JAS) and four online private-sector retail pharmacies. We interviewed wholesalers in April 2018 to understand insulin market dynamics. Results Mean availability of insulins on India’s 2015 Essential Medicine List was 66.7% in the public sector, lower than private-sector retail (76.1%) and hospital pharmacies (93.3%). Among private retailers, mean availability was higher among chain (96.7%) than independent pharmacies (68.3%). Non-Indian companies supplied 67.3% products in both sectors. 79.1% products were manufactured in India, of which 60% were marketed by non-Indian companies. In private retail pharmacies, median consumer prices of human insulin cartridges and pens were 2.5 and 3.6 times, respectively, that of human insulin vials. Analogues depending on delivery device were twice as expensive as human insulin. Human insulin vials were 18.3% less expensive in JAS pharmacies than private retail pharmacies. The lowest paid unskilled worker would pay 1.4 to 9.3 days’ wages for a month’s supply, depending on insulin type and health sector. Wholesaler interviews suggest that challenges constraining patient insulin access include limited market competition, physicians' preference for non-Indian insulins, and the ongoing transition from human to analogue insulin. Rising popularity of online and chain pharmacies may influence insulin access. Conclusion Insulin availability in Bengaluru’s public sector falls short of WHO’s 80% target. Insulin remains unaffordable in both private and public sectors. To improve insulin availability and affordability, government should streamline insulin procurement and supply chains at different levels, mandate biosimilar prescribing, educate physicians to pursue evidence-based prescribing, and empower pharmacists with brand substitution. Patients must be encouraged to shop around for lower prices from subsidized schemes like JAS. While non-Indian companies dominate Bengaluru’s insulin market, rising market competition from Indian companies may improve access.

P6147Access to essential cardiovascular medicines in Kerala, the state with the highest cardiovascular disease burden in India

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Satheesh ◽  
S Puthean ◽  
M Ansil ◽  
M K Unnikrishnan ◽  
A Sharma ◽  
...  
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Premature Mortality ◽  
Generic Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Healthcare Needs ◽  
Consumer Prices ◽  
Majority Population ◽  
Government Worker

Abstract Introduction The 2030 Agenda for Sustainable Development has prioritized the reduction of premature mortality due to NCDs – including cardiovascular diseases (CVD) - by a third. To achieve this goal, countries must achieve 80% availability of affordable essential medicines. Essential medicines as identified by the World Health Organization are those that meet the priority healthcare needs of majority population. Globally, India has the second highest CVD burden with over 1.7 million deaths annually, with the highest CVD morbidity and mortality rate in Kerala. Purpose To evaluate the availability, prices and affordability of essential CVD medicines in Kerala state to facilitate implementation of informed public health policy. Methods Using WHO/HAI methodology, we obtained data on availability and prices for 25 essential CVD medicines in a representative sample of 7 public-sector hospitals (survey anchors) and 37 private retail pharmacies located near the survey anchors in four districts. Additionally, we obtained the data from 10 government-subsidized discount pharmacies. We report availability as percentage of surveyed facilities where a given medicine was found. Median prices ratios (MPRs) were calculated by comparing consumer prices to the MSH International Reference Prices (IRPs). Medicines were considered affordable if the monthly supply costs less than one-day's wage of the lowest paid government worker. Results In the public-sector facilities (hospital and discount pharmacies combined), the mean (SD) availability of the surveyed CVD medicines was 52% (35.3%) for generic and 35.3% (20.7%) for originator brand (OB) version. 28% of surveyed medicines (including amlodipine, clopidogrel, losartan, metformin) were available in over 80% pharmacies. 12% (captopril, streptokinase and glyceryl trinitrate) were not available in any of the facilities. In the private sector, mean (SD) availability of generic and OB versions was 64.4% (37.2%) and 43.7% (34.6%), respectively. MPR was 1.28 [range: 0.02 (insulin NPH) – 16.7 (simvastatin)] for both lowest-priced generics (LPG) and most-sold generics (MSG). The lowest paid government worker in Kerala would spend 0.06 - 3.48 days' wages for the monthly supply of essential CVD medicines in the private sector. In government-subsidized discount pharmacies, mean availability was 49.3%. The generic medicine prices were 74% lower than in the private sector. Conclusions Availability of essential CVD medications in both public and private sector pharmacies fall short of the 80% target. In the private-sector, many essential CVD medications seem unaffordable especially considering the polypharmacy among CVD patients. Introducing policies to improve medicine availability in government-subsidized discount pharmacies is crucial in tackling Kerala's ever-increasing CVD burden.

Exodus of Clinicians from Public Sector to Non-Clinical Practice in Private Sector in Dar es Salaam Tanzania; Exploring the Drivers

2020 ◽  
Vol 31 (2) ◽  
pp. 45-58
Author(s):  
Elice Temu ◽  
Gasto Frumence ◽  
Nathanael Sirili
Keyword(s):  
Public Health ◽  
Clinical Practice ◽  
Public Sector ◽  
Private Sector ◽  
Work Environment ◽  
Health Workforce ◽  
Health Sector ◽  
Dar Es Salaam ◽  
Medical Doctors ◽  
The Public

Background: Globally, shortage of clinicians health workforce is among the major challenges facing the health systems of many countries including Tanzania. Migration of medical doctors from clinical practice to non-clinical practice partly contributes to this challenge. This study aimed to explore factors influencing Medical Doctors’ decision to migrate from clinical practice in the public sector to non-clinical practice in the private sector in Dar es Salaam Tanzania.Methods: An exploratory qualitative study was conducted using 12 in-depth interviews with medical doctors working in the private sector but formerly worked in the public health sector. Interviews were digitally recorded, transcribed verbatim and thematically analyzed.Results: Three main themes emerged; health system-level drivers that has three sub-themes, namely poor work environment, heavy workload due to shortage of clinicians and underfunded public health sector; individual-level drivers, which include four sub-themes: Age, area of specialization, marital status and empathy to patients; and external environment drivers consisting of two sub-themes: peer pressure and community culture.Conclusion: Improving the work environment through increased funding will partly address the main health system drivers underlying migration from the clinical practice. Furthermore, nurturing junior doctors to be enthusiastic and adapting to cultural shocks can partly help to address the individual and external drivers. Keywords: Shortage, Medical Doctors, Clinicians, Physicians, migration, health workforce, Tanzania Clinical Practice, Non-Clinical Practice.

scholarly journals Cash transfer scheme for people with tuberculosis treated by the National TB Programme in Western India: a mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033158 ◽  
Author(s):  
Bharatkumar Hargovandas Patel ◽  
Kathiresan Jeyashree ◽  
Palanivel Chinnakali ◽  
Mathavaswami Vijayageetha ◽  
Kedar Gautambhai Mehta ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Public Sector ◽  
Private Sector ◽  
Benefit Transfer ◽  
Mixed Methods Study ◽  
Secondary Outcome ◽  
Western India ◽  
Adjusted Relative Risk ◽  
Private Providers ◽  
Bank Accounts

ObjectivesThis study aimed to assess the coverage and explore enablers and challenges in implementation of direct benefit transfer (DBT) cash incentive scheme for patients with tuberculosis (TB).DesignThis is a mixed methods study comprising a quantitative cohort and descriptive qualitative study.SettingThe study was conducted in City TB Centre, Vadodara, Western India.ParticipantsWe used routinely collected data under the National TB Programme (NTP) on patients with TB notified between April and September 2018 and initiated on first-line anti-tuberculosis treatment (ATT) to assess the coverage of DBT. We interviewed NTP staff and patients to understand their perceptions.Primary and secondary outcome measuresThe study outcomes are receipt of DBT (primary), time to receipt of first instalment of DBT and treatment outcome.ResultsAmong 1826 patients, 771 (42.2%) had received at least one instalment. Significantly more patients from the public sector had received DBT (at least one instalment) compared with those from private sector (adjusted relative risk (adjRR)=16.3; 95% CI 11.6 to 23.0). Among public sector patients, 7.3% (49/671) had received first instalment within 2 months of treatment initiation. Median (IQR) time to receipt of first instalment was 5.2 (3.4, 7.4) months. Treatment in private sector, residing outside city limits and being HIV non-reactive were significantly (p<0.001) associated with longer time to receipt. Timely and sufficient fund release, adequate manpower and adequate logistics in TB centre were the enablers. Inability of patients to open bank accounts due to lack of identity/residence proof, their reluctance to share personal information and inadequate support from private providers were the challenges identified in implementation.ConclusionDuring the early phase of DBT implementation, the coverage was low and there were delays in benefit transfer. Facilitating opening of bank accounts for patients by NTP staff and better support from private providers may improve DBT coverage. Repeat assessment of DBT coverage after streamlining of implementation is recommended.

scholarly journals Reasons for Ethical Problems in the Health Sector

2012 ◽  
Author(s):  
Filiz Tepecik ◽  
Ayla Yazıcı
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Health Sector ◽  
Efficient Production ◽  
Health Care Market ◽  
Unequal Distribution ◽  
Ethical Problems ◽  
The Public ◽  
Private Entrepreneurs ◽  
Effective Use

There are two main reasons of public interventions in the health market. First, the health care market cannot make efficient production on market conditions because of its attributes such as the unequal distribution of knowledge, being a public good, the presence of positive and negative externalities. Second, the public authority has also the aim to achieve justice. These qualities are also the source of ethical problems in the health sector, whether the service is generated, by the public or the private sector. Almost in all countries the health sector is usually provided by the public sector because of externalities. But because the side effects of the production of health services by the public sector emerged in recent years, the participation of the private sector was ensured to minimize these effects. For developing countries such as Turkey and Eurasian countries, a more effective use of the funds used for the health sector is recommended, and the space these expenditures cover in the budget are said can be scaled down with the opening of some areas for private entrepreneurs. However, the unique characteristics of the health sector seem to cause problems regardless whether it is produced by the public or the private sector. In this study it is attempted to give the attributes of the health sector in detail and to establish a relationship with ethical problems in the light of experiences in Turkey.

Delivery of rural and remote health care via a broadband Internet Protocol network – views of potential users

2005 ◽  
Vol 11 (8) ◽  
pp. 419-424 ◽  
Author(s):  
P Jennett ◽  
M Yeo ◽  
R Scott ◽  
M Hebert ◽  
W Teo
Keyword(s):  
Health Care ◽  
Public Sector ◽  
Rural Communities ◽  
Private Sector ◽  
Internet Protocol ◽  
Health Sector ◽  
Health Service Delivery ◽  
Broadband Internet ◽  
The Public ◽  
User Groups

summary We asked the views of potential users of a proposed Canadian broadband Internet Protocol (IP) network for health, the Alberta SuperNet. The three user groups were drawn from the public, provider and private sectors. In all, 35 health-sector participants were selected (17 government, nine health-care organizations, five providers/ practitioners and four private sector). The questionnaire was Web-based, semistructured and self-administered. It consisted of four major areas: value, readiness, effect on usual care and limitations. A total of 28 (80%) individuals responded to the questionnaire: 21 (81%) were from the public sector (three provincial, nine regional and nine organizational), three (60%) were from the provider sector and four (100%) were from the private sector. Overall, the items related to health services and health human resources were considered to be the most valuable to rural communities. Respondents identified the expansion of telehealth services as the most important, except those from the private sector, who ranked this a close second. The health system's move to the use of electronic health records was ranked second in importance by all respondents. The private-sector respondents viewed all user groups to be generally less ready (mean score 2.5 on a seven-point scale from 1 = not ready to 7 = ready), while the public-sector respondents were the most optimistic (mean score 4.0). Specific socioeconomic impact data were limited. The top-ranked disadvantage of the 10 suggested was that ‘Changes in health-service delivery practices and/or processes will be required’.

scholarly journals Real-Life Incentives Driving Public-Private Partnership in Diagnostic Services

2020 ◽  
Vol 30 (3) ◽  
Author(s):  
Akram Baniasadi ◽  
Ali Akbari Sari ◽  
Abbas Rahimi Foroushani ◽  
Mehdi Jafari Sirizi ◽  
Ebrahim Jaafaripooyan
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Health Sector ◽  
Real Life ◽  
Economic Incentives ◽  
Public Private Partnership ◽  
Structured Interviews ◽  
Private Partnership ◽  
The Individual ◽  
Public And Private Sector

BACKGROUND: Diagnostic services are highly critical in the success of treatment processes, overly costly nonetheless. Accordingly, hospitals generally seek the private partnership in the provision of such services. This study intends to explore the incentives owned by both public and private sector in their joint provision of diagnostic services under the public-private partnership agreement.METHOD: A qualitative, exploratory study was employed in Tehran hospitals from October 2017 to March 2018. Around 25 face-to-face, semi structured interviews were conducted with the purposively recruited hospital managers, heads of diagnostic services and managers of private companies. Interviews were transcribed and analyzed using conventional content analysis, assisted by "MAXQDA-12".RESULTS: Three main categories and nine sub-categories represented the incentives of public sector, and four main categories and seven sub-categories signified those of private sector. The incentives of public sector included the status-quo remediation, upstream requirements, and personal reasons. As such, the individual, social and economic incentives and legal constraints were driving the behavior of the private sector.CONCLUSIONS: Financial problem and gain were the most noted incentives by the partners. Attention to the either side’s incentives and aims is likely to ensure the durability and effectiveness of such partnerships in the health sector.

Consumer and Producer Theory

2018 ◽  
pp. 26-37
Author(s):  
Sean Hildebrand
Keyword(s):  
Decision Making ◽  
Public Sector ◽  
Service Delivery ◽  
Private Sector ◽  
Market Failure ◽  
Supply And Demand ◽  
Economic Theories ◽  
Price Controls ◽  
The Government ◽  
Enhance Efficiency

This chapter takes an in-depth look at consumer and producer economic theories. Both theories play a central role in decision making by individuals, businesses, and the government. To help understand how these theories function, the chapter provides an overview of the economic “laws” of supply and demand. The chapter continues with an exploration of government intervention in the marketplace, including the subjects of market failure, regulation, incentives, price controls, taxation, governmental hiring, and the purchase of private sector goods by public sector entities. To conclude, the chapter links government actions to consumer and producer economic theories in its daily operations as a means to enhance efficiency, effectiveness, and equitable service delivery.

Does Economic Freedom Influence Major Health Indicators in India? Cross-state Panel Estimation Results

2016 ◽  
Vol 1 (2) ◽  
pp. 203-221 ◽  
Author(s):  
Saleema Razvi ◽  
Debashis Chakraborty
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Economic Freedom ◽  
Health Sector ◽  
Health Indicators ◽  
Healthcare Outcomes ◽  
Best Interest ◽  
Indian States ◽  
The Public ◽  
The Impact

It is widely acknowledged that inadequacies in public sector health systems can only be overcome by substantial structural and institutional reforms. In India, the need for reforms in the health sector has been highlighted and stressed upon in recent period. While there is a growing belief that public and private sectors in health can potentially gain from one another, there is also recognition that, given their respective strengths and weaknesses, neither the public sector nor the private sector alone can operate in the best interest of the health system. The current study attempts to analyse the impact of enabling environments measured by the economic freedom index in 20 Indian states on select healthcare outcomes, through a panel data model. The empirical results confirm that rise in economic freedom lowers maternal mortality and infant mortality, as the resulting conducive environment enables greater private sector participation. However, the crucial role to be played by the public sector is also underlined in no uncertain terms. The obtained results strongly indicate that the health scenario in India can improve only through closer co-ordination between the public and the private sectors.

Comprehensive cancer control-research & development: knowing what we do and doing what we know

2009 ◽  
Vol 95 (5) ◽  
pp. 610-622 ◽  
Author(s):  
Jon F Kerner ◽  
Eduardo Cazap ◽  
Derek Yach ◽  
Marco A Pierotti ◽  
Maria Grazia Daidone ◽  
...  
Keyword(s):  
Public Health ◽  
Public Sector ◽  
Private Sector ◽  
Knowledge Exchange ◽  
Health Sector ◽  
Cancer Control ◽  
Lessons Learned ◽  
Comprehensive Cancer Control ◽  
The Public ◽  
Control Research

Comprehensive cancer control is defined as an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality across the cancer control continuum from primary prevention to end-of-life care. This approach assumes that when the public sector, non-governmental organizations, academia, and the private sector share with each other their skills, knowledge, and resources, a country can take advantage of all its talents and resources to more quickly reduce the burden of cancer for all its population. One critical issue for comprehensive cancer control is the extent to which the private sector can contribute to cancer prevention and control programs and policies that have historically been lead by the public health sector, and similarly how can the public sector increase its investment and involvement in clinical research and practice issues that are largely driven by the private sector worldwide? In addition, building capacity to integrate research that is appropriate to the culture and context of the population will be important in different settings, in particular research related to cancer control interventions that have the capacity to influence outcomes. To whatever extent cancer control research is ultimately funded through the private and public sectors, if investments in research discoveries are ultimately to benefit the populations that bear the greatest burden of disease, then new approaches to integrating the lessons learned from science with the lessons learned from service (public health, clinical, and public policy) must be found to close the gap between what we know and what we do. Communities of practice for international cancer control, like the ones fostered by the first three International Cancer Control Congresses, represent an important forum for knowledge exchange opportunities to accelerate the translation of new knowledge into action to reduce the burden of cancer worldwide.

scholarly journals Prices, Availability And Affordability Of Essential Medicines For Non-Communicable Diseases: A Facility Based Survey In District Abbotabad

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Khizran Mir ◽  
Hafsa Ayyub
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Public Procurement ◽  
Essential Medicine ◽  
Simple Random Sampling ◽  
Communicable Diseases ◽  
Essential Medicines ◽  
World Health ◽  
Price Ratio ◽  
Non Communicable Diseases

Background: Non communicable diseases (NCDs) are spreading like an epidemic worldwide. Essential medicines are crucial for prevention and control of NCDs. World Health Organization (WHO) has set a benchmark of 80% availability of essential medicines in public and private facilities. Availability being a predictor of access to medicines is low in Low and Middle income countries (LMICs). The objective of this study is to determine price, availability and affordability of essential medicines for NCDs in District Abbottabad. Methods: This study was based on the standardized protocol provided by WHO and Health Action International (HAI) for determination of availability, prices and affordability of medicines. A total of 50 medicines for NCDs that were enlisted in Essential Medicine List of district Khyber Pakhtun Khawa were selected for the study. Twenty seven medicine dispensing facilities belonging to public, private and other basic health units (BHUs) (managed by PPHI) sectors were surveyed in the district. Simple random sampling was employed to select facilities. Results: The mean overall percentage availability of essential medicines for NCDs was 0.1% for original brand and 1.9% for low price generic in public sector. Overall availability was better in private and other sectors (32.9% for OB and 13.8% for LPGs and 5.3% for OB and 11.1% for LPG respectively). The prices in public procurement sector were competitive. The median price ratio (MPR) in public procurement sector was 0.56. Prices were higher comparatively in private sector with MPR 2.83. Most of the medicines require less than a day wage to buy 30 days treatment. Conclusions: The availability of essential medicines for NCDs was poor in District Abbottabad. None of the sectors reached the benchmark of 80% with regard to availability of medicines. LPGs were not frequently available in the private sector. However, prices were reasonable in public sector and acceptable in private sector. Medicines were found to be affordable but affordability may differ for people living below poverty line of US $1.

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