Evaluation of availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria

Objective To assess the availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria. Methods A cross-sectional survey involving 27 private pharmacies, 13 public pharmacies, and 25 private hospital pharmacies in Abuja was conducted using the standardized World Health Organization/Health Action International methodology. The availability percentage for each pharmacy sector and each medicine was analyzed. The median price ratio (MPR) (ratio of the median price to the international reference prices) of the medicines were evaluated accordingly. Affordability was assessed by calculating the number of days’ wages the lowest-paid unskilled government worker required to purchase a month worth of the standard treatment for a chronic condition. Results The availability of cardiovascular (CV) medicines ranged from 28.4% (in private hospital pharmacies) to 59.9% (in private pharmacies). There was mixed variability in the mean availability of Originator Brands (OBs) and Lowest Priced Generics (LPGs) anti-diabetic drugs with the highest availability being OBs 36% and LPGs 40.2%, in private pharmacies and public pharmacies, respectively. The availability of global drugs ranged from 49.7% in private hospitals to 68.8% in private pharmacies. Two cardiovascular and four global medicines had greater than 80% availability across the pharmaceutical sectors. The median price ratio for OBs and LPGs was 9.60 and 1.72 for procurement, it was 8.08 and 2.60 in private pharmacies, 13.56 and 2.66 in public hospitals, and 16.38 and 7.89 in private hospitals. The percentage markup on LPG was 49.4% in public hospitals, 51.4% in private pharmacies, and 323% in private hospitals. Only nine medicines in both public hospitals and private pharmacies and two in the private hospital pharmacies required less than the daily wage of the lowest-paid government worker. Conclusion The availability of cardiovascular, diabetes, and global medicines was below 80% across the different pharmaceutical sectors in Abuja and the medicines were unaffordable. Although the prices were generally exorbitant, private pharmacies offered the best options in terms of availability, pricing, and affordability of medicines. Therefore, the results of this study emphasize the pertinence of enforcing policies that facilitate the availability, pricing, and affordability of cardiovascular, diabetes, and global medicines.

Government Worker

This chapter discusses Eubie’s employment by the WPA as a composer for the Federal Theatre Project’s variety shows. The chapter also explores Eubie’s partnership with new lyricist, Milton Reddie; Reddie and Blake’s work on the show, Swing It; the show’s reception on Broadway; Reddie and Blake’s attempts to interest black bandleaders in the work of black songwriters; their formation of an association to promote black songwriters’ work; and their formation of a song-writing service for would-be popular-song tunesmiths. The chapter also examine how, inspired by the success of Gershwin’s Rhapsody in Blue, Blake wrote a few piano works that wed a classical harmonic approach to his own syncopated melodies; the illness and subsequent death of Blake’s wife Avis, and its impact on him; Blake’s reunion with Andy Razaf to compose the revue Tan Manhattan, and their attempts to have it performed; Blake’s hiring by the USO to tour American camps; difficulties on the road touring the South; and his first meeting with Marion Gant Tyler, who would become his second wife.

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

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.

Availability, prices and affordability of essential medicines for children: a cross-sectional survey in Jiangsu Province, China

ObjectiveChina has undertaken several initiatives to improve the accessibility of safe and effective medicines for children. The aim was to determine the availability, price and affordability of essential medicines for children.DesignCross-sectional survey.SettingSix cities of Jiangsu Province, China.Participants30 public hospitals and 30 retail pharmacies.Primary and secondary outcome measuresThe WHO/Health Action International standardised methodology was used to collect the availability and price data for 40 essential medicines for children. Availability was measured as the percentage of drug outlets per sector where the individual medicine was found on the day of data collection, and prices were measured as median price ratios (MPRs). Affordability was measured as the number of days’ wages required for the lowest paid unskilled government worker to purchase standard treatments for common conditions.ResultsThe mean availabilities of originator brands (OBs) and lowest priced generics (LPGs) were 7.5% and 34.2% in the public sector and 8.9% and 29.4% in the private sector. The median MPRs of LPGs in both sectors ranged from 1.41 to 2.12 and 1.10 to 2.24, respectively. However, the patient prices of OBs far exceeded the critical level in both sectors, with median MPRs ranging from 2.47 to 8.22. More than half of these LPGs were priced at 1.5 times their international reference prices in the public sector. Most LPGs were affordable for treatment of common conditions in both public and private sectors, as they each cost less than the daily wage for the lowest paid unskilled government worker.ConclusionsAccess to essential medicines for children is hampered by low availability. Further measures to enhance access to paediatric essential medicines should be taken, such as developing a national essential medicine list for children and mobilising the enthusiasm of pharmaceutical firms to develop and manufacture paediatric medicines.

A Property Tax Scam: Washington D.C. $48 Million Embezzlement

This case details how $48 million dollars was systemically stolen by one DC government worker over a nearly 20 year period; how the funds were deposited and cashed with the help of friends, family members and bank employees; how the funds were spent to support a lavish lifestyle; and how the embezzlement was eventually discovered. This case was written for use in a Business Law class.

“The Most Unjust Piece of Legislation”: Section 213 of the Economy Act of 1932 and Feminism During the New Deal

In February 1936, a former federal government worker named Gussie E. Howell penned a letter to Grace Brewer, director of the Governmental Workers' Council (gwc) of the National Woman's Party (nwp). Howell, who lived in Texas, had apparently heard from colleagues about a questionnaire sent out by the nwp about the effects of Section 213 of the Economy Act of 1932 (“Section 213”). Howell said that while she had not seen the questionnaire, she wanted to describe the effect of Section 213 on her life.