scholarly journals Pharmacovigilance in Low and Middle-Income Countries: A review with particular focus on Africa

2021 ◽  
Author(s):  
Ronald Kiguba ◽  
Sten Olsson ◽  
Catriona Waitt
Keyword(s):  
Neglected Tropical Diseases ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Special Focus ◽  
Self Medication ◽  
High Turnover ◽  
Middle Income ◽  
Middle Income Countries ◽  
Number Of Patients ◽  
Low And Middle Income

Low- and middle-income countries (LMIC) face unique challenges with regard to the establishment of robust pharmacovigilance systems capable of generating data to inform healthcare policy and practice. These include the limited integration and reliance of pharmacovigilance systems across LMIC despite recent efforts to harmonize pharmacovigilance rules and regulations in several regional economic communities; the need to translate reporting tools into numerous local languages; low numbers of healthcare providers relative to number of patients, with very short consultation times; scarcity of well-trained pharmacovigilance personnel with little or no budgetary support for these activities from national governments; high turnover of pharmacovigilance staff whose training involves a substantial amount of resources; little awareness of pharmacovigilance among healthcare workers, decision makers and consumers; very low spontaneous reporting rates with poor quality reports which hinders robust signal detection analyses; little collaboration between public health programmes and national medicines regulatory authorities; limited investment in pharmacovigilance activities especially during mass drug administration for neglected tropical diseases; high uptake of herbal and traditional medication, mostly by self-medication; disruptive political conflicts jeopardizing fragile systems; and little or no access to drug utilization data which makes it difficult to reliably estimate the true safety risks of medicine use. This review summarises the specific challenges and areas of progress in pharmacovigilance in LMIC with special focus on the situation in Africa.

scholarly journals An International Analysis of Dialysis Services Reimbursement

2018 ◽  
Vol 14 (1) ◽  
pp. 84-93 ◽  
Author(s):  
Arjan van der Tol ◽  
Norbert Lameire ◽  
Rachael L. Morton ◽  
Wim Van Biesen ◽  
Raymond Vanholder
Keyword(s):  
Health Care ◽  
Peritoneal Dialysis ◽  
Replacement Therapy ◽  
Gdp Per Capita ◽  
Middle Income ◽  
Middle Income Countries ◽  
Number Of Patients ◽  
Kidney Replacement Therapy ◽  
Per Capita ◽  
Low And Middle Income

Background and objectivesThe prevalence of patients with ESKD who receive extracorporeal kidney replacement therapy is rising worldwide. We compared government reimbursement for hemodialysis and peritoneal dialysis worldwide, assessed the effect on the government health care budget, and discussed strategies to reduce the cost of kidney replacement therapy.Design, setting, participants, & measurementsCross-sectional global survey of nephrologists in 90 countries to assess reimbursement for dialysis, number of patients receiving hemodialysis and peritoneal dialysis, and measures to prevent development or progression of CKD, conducted online July to December of 2016.ResultsOf the 90 survey respondents, governments from 81 countries (90%) provided reimbursement for maintenance dialysis. The prevalence of patients per million population being treated with long-term dialysis in low- and middle-income countries increased linearly with Gross Domestic Product per capita (GDP per capita), but was substantially lower in these countries compared with high-income countries where we did not observe an higher prevalence with higher GDP per capita. The absolute expenditure for dialysis by national governments showed a positive association with GDP per capita, but the percent of total health care budget spent on dialysis showed a negative association. The percentage of patients on peritoneal dialysis was low, even in countries where peritoneal dialysis is better reimbursed than hemodialysis. The so-called peritoneal dialysis–first policy without financial incentive seems to be effective in increasing the utilization of peritoneal dialysis. Few countries actively provide CKD prevention.ConclusionsIn low- and middle-income countries, reimbursement of dialysis is insufficient to treat all patients with ESKD and has a disproportionately high effect on public health expenditure. Current reimbursement policies favor conventional in-center hemodialysis.

scholarly journals Pregnant Women in Low- and Middle-Income Countries Require a Special Focus During the COVID-19 Pandemic

2020 ◽  
Vol 1 ◽  
Author(s):  
Chloe R. McDonald ◽  
Andrea M. Weckman ◽  
Julie K. Wright ◽  
Andrea L. Conroy ◽  
Kevin C. Kain
Keyword(s):  
Pregnant Women ◽  
Special Focus ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Primary healthcare providers' attitudes and beliefs about the menopause-related care needs of women who have migrated from low- and middle-income countries to Australia

2020 ◽  
Vol 26 (1) ◽  
pp. 88
Author(s):  
Karin A. Stanzel ◽  
Karin Hammarberg ◽  
Jane Fisher
Keyword(s):  
Primary Healthcare ◽  
Online Survey ◽  
Healthcare Providers ◽  
Migrant Women ◽  
Care Needs ◽  
Middle Income ◽  
Structural Support ◽  
Middle Income Countries ◽  
Primary Healthcare Providers ◽  
Low And Middle Income

Health behaviour during midlife is linked to health outcomes in older age. Primary healthcare providers (PHCPs) are ideally placed to provide health-promoting information opportunistically to women in midlife. The aim of this study was to explore PHCPs views about the menopause-related care needs of migrant women from low- and middle-income countries and what they perceive as barriers and enablers for providing this. Of the 139 PHCPs who responded to an anonymous online survey, less than one-third (29.9%) routinely offered menopause-related information during consultations with migrant women. Most agreed that short appointments times (70.8%), lack of culturally and linguistically appropriate menopause information (82.5%) and lack of confidence in providing menopause-related care (32.5%) are barriers for providing comprehensive menopause-related care to migrant women. To overcome these, a menopause-specific Medicare item number and a one-stop website with health information in community languages were suggested. These findings suggest that menopause-related care is not routinely offered by PHCPs to migrant women from low- and middle- income countries and that their capacity to do this may be improved with adequate educational and structural support.

scholarly journals Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Katherine Tumlinson ◽  
Dilshad Jaff ◽  
Barbara Stilwell ◽  
Dickens Otieno Onyango ◽  
Kenneth L. Leonard
Keyword(s):  
Medical Education ◽  
Intrinsic Motivation ◽  
Healthcare Providers ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Negative Behaviors ◽  
Middle Income Countries ◽  
And Training ◽  
Low And Middle Income

AbstractRecent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

scholarly journals How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study

2019 ◽  
Vol 34 (Supplement_3) ◽  
pp. iii4-iii19 ◽  
Author(s):  
Isidore Sieleunou ◽  
Anne-Marie Turcotte-Tremblay ◽  
Manuela De Allegri ◽  
Jean-Claude Taptué Fotso ◽  
Habakkuk Azinyui Yumo ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health Services ◽  
Healthcare Providers ◽  
Study Data ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Performance Based Financing ◽  
Low And Middle Income

Abstract Performance-based financing (PBF) is being implemented across low- and middle-income countries to improve the availability and quality of health services, including medicines. Although a few studies have examined the effects of PBF on the availability of essential medicines (EMs) in low- and middle-income countries, there is limited knowledge of the mechanisms underlying these effects. Our research aimed to explore how PBF in Cameroon influenced the availability of EMs, and to understand the pathways leading to the experiential dimension related with the observed changes. The design was an exploratory qualitative study. Data were collected through in-depth interviews, using semi-structured questionnaires. Key informants were selected using purposive sampling. The respondents (n = 55) included health services managers, healthcare providers, health authorities, regional drugs store managers and community members. All interviews were recorded, transcribed and analysed using qualitative data analysis software. Thematic analysis was performed. Our findings suggest that the PBF programme improved the perceived availability of EMs in three regions in Cameroon. The change in availability of EMs experienced by stakeholders resulted from several pathways, including the greater autonomy of facilities, the enforced regulation from the district medical team, the greater accountability of the pharmacy attendant and supply system liberalization. However, a sequence of challenges, including delays in PBF payments, limited autonomy, lack of leadership and contextual factors such as remoteness or difficulty in access, was perceived to hinder the capacity to yield optimal changes, resulting in heterogeneity in performance between health facilities. The participants raised concerns regarding the quality control of drugs, the inequalities between facilities and the fragmentation of the drug management system. The study highlights that some specific dimensions of PBF, such as pharmacy autonomy and the liberalization of drugs supply systems, need to be supported by equity interventions, reinforced regulation and measures to ensure the quality of drugs at all levels.

scholarly journals Chronic Pediatric Pain in Low and Middle Income Countries

2018 ◽  
Author(s):  
Camila Walters ◽  
Matthew Kynes ◽  
Jenna Sobey ◽  
Tsitsi Chimhundu-Sithole ◽  
Kelly McQueen
Keyword(s):  
Chronic Pain ◽  
Pediatric Population ◽  
Poor Quality ◽  
Health Concern ◽  
Pediatric Pain ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pediatric Patient Population ◽  
Pain Services ◽  
Low And Middle Income

Chronic pain is a serious health concern and potentially debilitating condition, leading to anxiety, depression, reduced productivity and functionality, and poor quality of life. This condition can be even more detrimental and incapacitating in the pediatric patient population. In low and middle income countries (LMICs), pain services are inadequate or unavailable, leaving most of the world's pediatric population with chronic pain untreated. Many of these children in LMICs are suffering without treatment, and often die in pain. Awareness and advocacy for this population must be prioritized. We reviewed the available literature on the chronic pediatric pain burden in LMICs, barriers to treatments, and current efforts to treat these patients.

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