News Link n. 18

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

News  Link 18

Mai più malattie-silos. Interventi coordinati per malattie acute e croniche in Africa Sub-sahariana http://saluteinternazionale.info/2012/09/mai-piu-malattie-silos-interventi-coordinati-per-malattie-acute-e-croniche-in-africa-sub-sahariana/

-Cooperazione internazionale, requiem griffato http://comune-info.net/2012/09/requiem-griffato-per-la-cooperazione-internazionale/  

-Gauging national responses to undernutrition http://www.savethechildren.org.uk/node/2781

-Remarks at the Clinton Global Initiative  http://www.state.gov/secretary/rm/2012/09/198094.htm

-A Global Health Mystery: What’s Behind the US Government Position on AMFm?  http://blogs.cgdev.org/globalhealth/2012/09/a-global-health-mystery-whats-behind-the-us-government-position-on-amfm.php

-Will India Still Supply Cheap Drugs to the World? http://www.ipsnews.net/2012/09/will-india-still-supply-cheap-drugs-to-the-world/

-A $400,000 Drug and Why It Matters for Global Health http://blogs.cgdev.org/globalhealth/2012/09/a-400000-drug-and-why-it-matters-for-global-health.php

-UN general assembly: latest updates on UK aid http://www.dfid.gov.uk/News/Latest-news/2012/UN-General-Assembly/

-U.N. Women Demands End to Impunity for Wartime Rape and Violence  http://www.ipsnews.net/2012/09/u-n-women-demands-end-to-impunity-for-wartime-rape-and-violence/

-‘Reaching the Moon’ in Global Health http://blog.usaid.gov/2012/09/reaching-the-moon-in-global-health/

-HIV budgets come under pressure  http://mg.co.za/article/2012-09-21-00-hiv-budgets-come-under-pressure/

– News from HEALTH ECONOMICS AND HIV/AIDS RESEARCH DIVISION (HEARD)  http://www.heard.org.za/

-France wants FTT in place ‘before the end of the year’ http://www.euractiv.com/euro-finance/france-pushes-ftt-year-news-514989?utm_source=EurActiv%20Newsletter&utm_campaign=613bbabf78-newsletter_daily_update&utm_medium=email

-Q&A With Newly Appointed KIPO Commissioner  http://www.ip-watch.org/?p=23607&utm_source=post&utm_medium=email&utm_campaign=alerts

-African Union Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and malaria response in Africa  http://www.au.int/en/sites/default/files/Shared_Res_Roadmap_Rev_F[1].pdf

-Mitt Romney fleshes out vision for US foreign aid  http://www.devex.com/en/news/79273/print

-Building on Ethiopia’s development progress  http://www.devex.com/en/news/79280/print

-COCA-COLA AND THE GLOBAL FUND ANNOUNCE PARTNERSHIP TO HELP BRING CRITICAL MEDICINES TO REMOTE REGIONS http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-25_Coca-cola_and_the_Global_Fund_Announce_Partnership_to_Help_Bring_Critical_Medicines_to_Remote_Regions/?mkt_tok=3RkMMJWWfF9wsRogv6jIZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAGSMB0dvycMRAVFZl5nQhdDOWN

-Agricultural Innovation Needed In Africa, With Farmers’ Participation, WTO Panellists Say  http://www.ip-watch.org/?p=23666&utm_source=post&utm_medium=email&utm_campaign=alerts

-Cipla goes through a quiet revolution  http://www.business-standard.com/india/news/cipla-goes-throughquiet-revolution/487619/

-Cipla looking to expand contraceptive pills business; in talks with International Planned Parenthood http://economictimes.indiatimes.com/news/news-by-industry/healthcare/biotech/pharmaceuticals/cipla-looking-to-expand-contraceptive-pills-business-in-talks-with-international-planned-parenthood/articleshow/16442289.cms

-Engaging China’s Innovators as Partners in Global Health  http://www.impatientoptimists.org/en/Posts/2012/09/Engaging-Chinas-Innovators-as-Partners-in-Global-Health?mkt_tok=3RkMMJWWfF9wsRogv63NZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAGT8B0dvycMRAVFZl5nQhdDOWN

-THE BIG PUSH: Join HuffPost, Global Fund In Fight Against HIV, Tuberculosis, Malaria  http://www.huffingtonpost.com/news/big-push/

-Rethinking health systems strengthening: key systems thinking tools and strategies for transformational change  http://heapol.oxfordjournals.org/cgi/reprint/czs090?ijkey=xEo9aLNgJ3xHatJ&keytype=ref

-Starving for an Equitable Food System  http://www.ipsnews.net/2012/09/starving-for-an-equitable-food-system/

-US presidential candidates outline health policies  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961649-3/fulltext?rss=yes

 

News Link n. 17

 

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

News Link 17

-Cresce l’aspettativa di vita in America Latina http://www.cooperazioneallosviluppo.esteri.it/pdgcs/italiano/news/viewnews.asp?idx=5440

-TWAS changes name, but not its mission http://www.scidev.net/en/science-and-innovation-policy/south-south-cooperation/news/twas-changes-name-but-not-its-mission.html

-Subsidies Help Get Modern Malaria Drugs To Millions In Africa  http://www.npr.org/blogs/health/2012/09/18/161344518/subsidies-help-get-modern-malaria-drugs-to-millions-in-africa?sc=emaf

-Sanofi, TB Alliance Form Research Collaboration To Search For New Treatment Compounds  http://globalhealth.kff.org/Daily-Reports/2012/September/21/GH-092112-Sanofi-TB-Alliance.aspx#.UF2obGxpDHY.email

-U.N. Report On MDGs Shows Declining Aid; SG Ban Urges Increased Global Partnership  http://globalhealth.kff.org/Daily-Reports/2012/September/21/GH-092112-UN-MDG-Report.aspx#.UF2oP3Ap2n0.email

-Transparency – Still An Uphill Battle In The EU  http://www.ip-watch.org/?p=23521&utm_source=post&utm_medium=email&utm_campaign=alerts

-Aid at America’s front lines  http://www.devex.com/en/news/79169/print

-A Brief Look At Botswana’s New IP Law  http://www.ip-watch.org/?p=23486&utm_source=post&utm_medium=email&utm_campaign=alerts

-Nigeria still lags behind in improving maternal, newborn health http://www.ngrguardiannews.com/index.php?option=com_content&view=article&id=99186:nigeria-still-lags-behind-in-improving-maternal-newborn-health-&catid=93:science&Itemid=608  (see also GESPAM #www.equilibri.net/nuovo/articolo/nigerias-public-health-gains-and… )

-WHO Says Nigeria Not On Track To Turn Back Polio Despite Having Tools, Capacity http://globalhealth.kff.org/Daily-Reports/2012/September/12/GH-091212-Nigeria-Polio.aspx#.UFC-QHR9rfQ.email  (see also GESPAM #www.equilibri.net/nuovo/articolo/nigerias-public-health-gains-and… )

-Brazil and Chile pledge ongoing support to UNITAID http://www.unitaid.eu/resources-2/news/990-brazil-and-chile-pledge-ongoing-support-to-unitaid

-Studying the Crisis in Human Resources for Health from the Health Labour Market Perspective – African Development Bank http://www.afdb.org/en/news-and-events/article/studying-the-crisis-in-human-resources-for-health-from-the-health-labour-market-perspective-9728/?mkt_tok=3RkMMJWWfF9wsRoguKzIZKXonjHpfsX87%2B0uX6%2Bg38431UFwdcjKPmjr1YAHS8p0dvycMRAVFZl5nQhdDOWN#.UF2zlFy-XaE.email

-Blog Examines U.S. Presidential Candidates’ Foreign Policy, Science Stances With Respect To Global Health http://globalhealth.kff.org/Daily-Reports/2012/September/18/GH-091812-RR-Presidential-Candidates-Global-Health.aspx#.UFnFIAqSkAY.email

-India: Balancing Public And Private Interests In The Intellectual Property Regime  http://www.ip-watch.org/2012/09/18/india-balancing-public-and-private-interests-in-the-intellectual-property-regime/

-HIV vaccine ‘still a decade away’, say researchers http://www.scidev.net/en/health/news/hiv-vaccine-still-a-decade-away-say-researchers.html

-ACTA: Will It Ever Become A Valid International Treaty? http://www.ip-watch.org/2012/09/13/acta-will-it-ever-become-a-valid-international-treaty/

-Treatment Access Is Essential Component Of Fight Against NCDs  http://globalhealth.kff.org/Daily-Reports/2012/September/14/GH-091412-Opinion-NCD-Treatment.aspx#.UFhBM9RXV6Q.email

-GLOBAL FUND ADOPTS NEW APPROACH TO FUNDING GRANTS  http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-14_Global_Fund_Adopts_New_Approach_to_Funding_Grants/

 

 

 

 

 

 

 

 

 

 

 

Nigeria's Public Health: Gains and Challenges

Despite the collaborative efforts of both Nigerian Government, Donor Agencies and NGOs to provide an efficient and effective health care delivery in Nigeria, confronting problems render these efforts much less than desired. Some of these challenging problems include emerging and re-emerging health problems such as HIV/AIDS pandemic, inadequate payment of health workers salaries, poor quality of care, inequitable health care services, brain drain, and irrational appointment of health workers among others. The weight of these problems is further compounded by insufficient budget allocation, lack of strategic plan and preparedness for epidemics/pandemics

 

Nigeria’s Public Health: Gains and Challenges 

 

 

by Marycelin Baba*

and Babatunji Omotara 

 

Professors, College of Medical Sciences, University of Maiduguri, Nigeria


Nigeria, the most populous country in Africa with 140 million people, has more than 250 ethnic groups http://www.columbia-icap.org/wherewework/nigeria/index.html. The vast oil wealth accounts for 40% of the country’s gross domestic product. However, years of military rule, and mismanagement have limited the country’s economic growth and resulted in rising levels of poverty. The rating  by  the United Nations Human Poverty Index in 1999  revealed that  Nigeria  has been ranked  among  the poorest nations in the world.  Per capita income is estimated at $692 25th USD, with an estimated two-thirds of the population living in poverty. However, in addition to rebuilding the economic and political system of the country, the Nigerian government embarked upon rebuilding its heath infrastructure and since Nigeria operates a mixed economy, private providers of health care significantly contribute to health care delivery. Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country and is  structured such that, the Federal government’s role is mostly limited to coordinating the affairs of the University Teaching Hospitals, Federal Medical Centres (tertiary health care) while the state government manages the various general hospitals (secondary health care) and the local government focuses on dispensaries (primary health care) [1], (which are regulated by the federal government through National Primary Health Care Development Agency-NPHCDA). Although the recurrent expenditure on health has risen from Nigeria nairas 12.48 million in 1970 to 98.200 million in 2008 [2], health care system remains inefficient and plays a key role in the poverty status  of the country. Over the last two decades, Nigeria’s public health care system has deteriorated in large partly because of a lack of resources and a “brain drain”  syndrome of Nigerian doctors as well as skilled health workers to other countries. For instance, infant mortality rates have been deteriorating from 85 per 1000 live births in 1982, 87 in 1990, 93 in 1991 to 100 in 2003, according to the Nigeria Demographic and Health Survey, 2003. And in 2007, the Federal Ministry of Health reported 110 deaths per 1000 live births. Its under-five mortality rate is 197 deaths per 1000 live births, and HIV, malaria and diarrheal disease account for about a quarter of the deaths among adults http://www.psi.org/nigeria . In rural areas, access to even basic health care services is difficult.  According to the world development indicators, the life expectancy at birth in 2006 for male and female in Nigeria was 46 and 47 years, respectively [3].

Map of Nigeria showing the different states

National Health Insurance Scheme

In May 1999, the government created the National Health Insurance Scheme (NHIS), which encompasses government employees, the organized private and  informal sector. Legislative wise, the scheme also covers children under five, permanently disabled persons and prison inmates. Health insurance in Nigeria can be applied to a few instances: free health care provided and financed for all citizens, health care provided by government through a special health insurance scheme for government employees and private firms entering contracts with private health care providers http://www.nigeria.alloexpat.com/nigeria_information/healthcare_nigeria.php   

However, there are few people who fall within the three instances. Moreover, for  the past two or more  decades,  many Donor agencies and  Non-Governmental Organizations (NGOs), usually in partnership with the States and Federal Ministries of Health, have played prominent roles in intervening in the provision of public health services to the teeming Nigerian population. Many of Donor Agencies and NGOs concentrated their activities  on  the prevention and control while few others  focus on therapeutics and management   of  many endemic, emerging and reemerging diseases. Below are some of the public health interventions.

HIV/AIDS 

Nigeria has 2.9 million people living with HIV/AIDS, the largest number in the world after India and South Africa. The HIV/AIDS pandemic, which has already left at least 930,000 children orphaned, and the high rates of maternal death and disability, are outstanding public health issues in Nigeria [4]. A high incidence of unsafe abortion is driven by legal restrictions and social stigma, while an extremely low rate of contraceptive use contributes to an estimated 1.4 million unintended pregnancies each year.  In response to the growing HIV/AIDS pandemic treatment, USAID/Nigeria provides antiretroviral drugs and services to eligible patients, as well as laboratory support for the diagnosis and monitoring of HIV-positive patients.  The treatment program features reduced target costs, cost-leveraging, and health care worker training by all implementing partners to harmonize and standardize treatment services. This program provides much-needed drugs to many Nigerians with HIV but can nowhere near address the growing HIV/AIDS infection rate.  The Nigerian government has set a 2010 goal of providing universal access to HIV prevention, care, and treatment. To this end, it has implemented a number of strategies to scale up HIV services, including a national counseling and testing program and increased collaboration with external donors and non-governmental organizations.

Mental Health

The majority of mental health services are provided by 8 regional psychiatric centers and psychiatric departments and medical schools of 12 major universities. A few general hospitals also provide mental health services. The formal centres often face competition from native herbalists and faith healing centres. The ratio of psychologists and social workers is 0.02 to 100,000 [5]. 

Malaria

Malaria remains the foremost killer disease in Nigeria. It accounts for over 25% of under-5 mortality, 30% childhood mortality and 11% maternal mortality (http://www.psi.org/nigeria , Federal Ministry of Health-FMOH, 2002). To address the importance of both malaria treatment and prevention, the Society for Family Health (SFH) malaria programming centers on Pre-Packaged Therapy (PPT) and Long Lasting Insecticide Treated Nets (LLINs). Recently, the Federal Ministry of Health has implemented the new treatment policy on malaria which includes the use of Artemisinine-based Combination Therapy (ACT) as the new first line drug for the treatment of uncomplicated malaria. A new brand of ACT for Children KidACT was developed and launched in 2008. The brand is heavily subsidized for affordability to poor and vulnerable Nigerians who bear the brunt of malaria. Like other NGOs, SFH is promoting the government policy and in addition distributes PermaNet which is a long-lasting insecticide-treated net. The nets are inexpensive and distribution is an easy way of preventing malaria and possibly other vector-borne diseases from burdening the health and economic well-being of Nigerians.

Reproductive Health

Despite considerable gains in the past decade, Nigeria’s reproductive health indicators are still very poor. Country-wide, the total fertility rate is 5.7 children per mother, with a contraceptive prevalence rate of less than 10%. Furthermore, these statistics mask wide regional variations—for example, the total fertility rate in the northwestern region is as high as 7.3, with a contraceptive prevalence rate of 3% http://www.pathfind.org/our-work/where-we-work/nigeria/ . Lack of sexual health information and services make young people vulnerable to sexually transmitted infections (STIs) and unintended pregnancy. However, Nigerian government both at Federal and State is working in collaboration with many organizations to improve adolescent reproductive and sexual health through advocacy and prevention programming.

Child Survival

Child survival in Nigeria is threatened by nutritional deficiencies and illnesses, particularly malaria, diarrhoeal diseases, acute respiratory infections (ARI), and vaccine preventable diseases (VPD), which account for the majority of morbidity and mortality in childhood. Other threats include high maternal morbidity and mortality.  Regarding child health, the country has adopted and implemented to a certain extent a number of major global initiatives affecting children, such as the Safe Motherhood Initiative and its follow-up Making Pregnancy Safer, Baby-Friendly Hospital Initiative (BFHI), and Integrated Management of Childhood Illness (IMCI). Others are Roll Back Malaria Initiative (RBM), Elimination of Iodine –Dependent Diabetes, Vitamin A Deficiency Control, and National Program on Immunization (NPI), the latter with a special emphasis on the eradication of poliomyelitis. Yet the impact of interventions in child survival to a large extent have not achieved as much as would have been expected despite the amount of funds and resources that have been put into these programs. For instance, Nigeria is still one the three countries of the world harboring and spreading the three serotypes of wild polio viruses to different parts of the world despite ongoing  intensive immunization activities  because of non-compliancy to polio vaccination.  It may be recalled that in 2003, there was a political propaganda that Polio vaccine contained infertility agents, spread HIV and was reported generally unsafe [6]. Although the safety of the polio vaccine was later proven beyond all reasonable doubt globally, and frantic efforts have been made to disabuse the minds of the people,  pockets of parents still refuse their wards/children to receive the vaccine. 

Tuberculosis control

Nigeria is ranked 4th among the 22 worst affected countries in the world and the first in Africa [7]. As such, about 460,000 new TB cases occur yearly in Nigeria (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf). 

Lagos state carries 8.4% of Nigeria’s TB burden and consistently has been responsible for about 11% of the cases of TB registered in Nigeria  (Lagos State Ministry of Health – www.lagosstateministryofhealth.com/programme_info.php?programme_id=13).

The State program is implementing the internationally recommended STOP TB Strategy. 

USAID/Nigeria implements its HIV/AIDS and TB activities under a comprehensive approach with other United States Government agencies, including the Centers for Disease Control and Prevention and the Department of Defense, which are all working as part of the President’s Emergency Plan for AIDS Relief (PEPFAR) (USAID, 2012 http://nigeria.usaid.gov/program/3). Activities are designed to reduce TB transmission, improve diagnosis, and manage multi-drug-resistant-TB cases, especially among HIV positive patients.  Routine HIV testing is also a priority in USAID’s TB Directly Observed Treatment Short-Course. The control and prevention of Tuberculosis in contemporary times has many faces and challenges. These, among others, include the impact of HIV/AIDS and the emergence of multi-drug resistant tuberculosis (MDR-TB). The HIV/AIDS pandemic is not only fuelling the burden of Tuberculosis but also poses great challenge to its diagnosis and management. The recorded HIV prevalence among TB cases in Nigeria is estimated at 27% (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf).

Leprosy control Program

It has been estimated that about 5,000 leprosy cases occur yearly (FMOH 2010 http://www.who.int/hiv/pub/guidelines/nigeria_tb.pdf). By the 1940s and 50s Nigeria was ahead of many countries in its leprosy control activities.  There has been significant reduction in the registered prevalence of leprosy with some evidence of reduced transmission. This has been attributed to increased and sustained control activities resulting in the elimination of the disease as a public health problem at national level. However, there are still endemic pockets at the sub-national level. An issue of concern in leprosy control remains the rehabilitation of a large number of ex-leprosy patients who have been cured of leprosy but have disabilities. In collaboration with many NGOs, effective, integrated leprosy control programs in which both female and male patients are identified, diagnosed and treated in the early stages of leprosy by the health system are ongoing. These programs also work to prevent and reduce impairments associated with leprosy, and to provide appropriate rehabilitation and education and vocational training opportunities for persons affected by leprosy [8].

Regulation of pharmaceuticals

In 1989 legislation made effective a list of essential drugs. The regulation was also meant to limit the manufacture and import of fake or sub-standard drugs and to curtail false advertising. However, the section on essential drugs was later amended [9]. Drug quality is primarily controlled by the National Agency for Food and Drug Administration and Control (NAFDAC). Several major regulatory failures have produced international scandals:

• In 1993, adulterated paracetamol syrup entered into the health care system in Oyo and Benue State, the end result of was the death of 100 children. A year after the disaster, batches containing poisonous ethylene glycol, the major cause of the deaths, could still be purchased.

• In 1996, about 11 children died of contamination from an experimental trial of the drug trovafloxacin. The usually long delayed action of the government to prosecute the perpetrators is considered a tragedy on its own.

• In 2008-2009, at least 84 children died from a brand of contaminated teething medication http://www.rtbot.net/Health_in_Nigeria  

Geographic inequality

Health care in Nigeria is influenced by different local and regional factors that impact the quality or quantity present in one location. Due to the aforementioned, the health care system in Nigeria has shown spatial variation in terms of availability and quality of facilities in relation to need. However, this is largely as a result of the level of state and local government involvement and investment in health care programs and education. Also, the Nigerian ministry of health usually spends about 70% of its budget in urban areas where 30% of the population resides. It is assumed by some scholars that the health care service is inversely related to the need of patients. 

Emigration

Migration of health care personnel to other countries is a taxing and relevant issue in the health care system of the country. From a supply push factor, a resulting rise in exodus of health care nurses may be due to dramatic factors that make the work unbearable, and knowing and presenting changes to arrest the factors may stem the tide [10]. However, because a large number of nurses and doctors migrating abroad benefited from government funds for education, it poses a challenge to the patriotic identity of citizens and also the rate of return of federal funding of health care education. The state of health care in Nigeria has been worsened by a physician shortage as a consequence of severe ‘brain drain’. Many Nigerian doctors have emigrated to North America and Europe. In 2005, 2,392 Nigeria doctors were practicing in the US alone, in UK the number was 1,529. Retaining these expensively trained professionals has been identified as an urgent goal. Within the country, 70% of the population reside in rural areas yet many health professionals prefer urban cities for their practice leaving the rural poor void of adequate medical care.

Challenges

• As a multiethnic, cultural, and religious country, many Nigerians still attribute many health problems to witches, demons and other mythical beliefs. Therefore, even when health care facilities are available, affordable and accessible, many prefer seeking treatment from  untrained herbalist to orthodox health care institutions.

• Many health intervention programs fail because the decision and the implementation started from the top to the bottom. For example, people who never had fever are compelled to take paracetamol. The beliefs, attitudes and the behaviors of the community on a particular health problem usually is not sought before imposing the intervention strategy on the people.

• Professional conflict in the health sector is another canker worm that is killing the system. The claim of superiority of a particular health professional over others  has greatly impacted negatively to health care delivery in Nigeria.

• Persistent ‘brain drain’ is a ghost that is hunting efficient health care delivery in Nigeria.

• Lack of maintenance culture allows waste of resources in terms of equipment, finance and human resources. For instance, there is no need to procure sophisticated equipment if the operators are not properly trained to use and maintain such equipment. This negates one of the strategies of implementing Primary Health Care-Use of Appropriate Technology. Also after procuring the equipment, trained engineers  are not engaged to   regularly  service and repair  the equipment. Similarly employing experts without proper motivation and basic facility to work is effort in futility.

• Nepotism where health workers are employed based on sentiment (tribal or religious)  certainly impedes the efficiency of health care delivery in Nigeria

• Improper implementation of health policy or intervention strategy affects health care delivery adversely.

• Drug resistance, due to indiscriminate drug use and abuse, has been on the increase and  poses a serious threat to treatment efficacy

• Stigmatization associated with HIV/AIDS, Tuberculosis and Leprosy hinders early detection and control of spread.

• CORRUPTION is a plague that must be eradicated even before wild polio viruses if health care delivery in Nigeria must meet expected impact.

Conclusion

Despite the collaborative efforts of both Nigerian Government, Donor Agencies and NGOs to provide an efficient and effective health care delivery in Nigeria, confronting problems render these efforts much less than desired. Some of these challenging problems include emerging and re-emerging health problems such as HIV/AIDS pandemic, inadequate payment of health workers salaries, poor quality of care, inequitable health care services, brain drain, and irrational appointment of health workers among others. The weight of these problems is further compounded by insufficient budget allocation, lack of strategic plan and preparedness for epidemics/pandemics. 

References

1. “Federal Medical Centre Abeokuta: A Case Study in Hospital Management pp 1”. docstoc. Retrieved 13 June 2011

2. Bakare, A.S and Olubokun, S. (2011) “Health Care Expenditure and Economic Growth in Nigeria: An Empirical Study” Journal of Emerging Trends in Economics and Management. 

3. Nathaniel Umukoro (2011):Governance and Nigeria’s Public Health Care System: A Study of their Role in the Acceleration of Poverty Trap in the Niger Delta

4. Planned Parenthood (2012): Nigeria country program www.plannedparenthood.org/about-us/newsroom.htm

5. Oyedeji Ayonrinde, Oye Gureje, Rahmaan Lawal; ‘Psychiatric research in Nigeria: bridging tradition and modernisation’, The British Journal of Psychiatry (2004) 184: 536-538.

6. Guerrera M. 2007. Finish Polio: Evolutionary medicine principles and the eradication ofpolio in evolutionary medicine, Central Connecticut State University. Topics in Biology (Bio 490 / 540).

7. Dim CC, Dim NR, Morkve O. (2011):Tuberculosis: a review of current concepts and control programme in Nigeria. Niger J Med. 2011 Apr-Jun;20(2):200-6.

8. Canadian International Development Agency: Project Browser. Project profile for Leprosy Control project in Sokoto State (www.cida.gc.ca). 

9. National Drug Policy in Nigeria, O. Ransome Kuti. Journal of Public Health Policy > Vol. 13, No. 3 (Autumn, 1992), pp. 367-373

10. Clark D A, Paul F. Clark, James B. Stewart; The Globalization of the Labour Market for Health-Care Professionals. International Labour Review, Vol. 145, 2006

 

*Corresponding author: Professor, Department of Medical Laboratory Science and Director, WHO National /ITD Laboratory, University of Maiduguri, Maiduguri Borno State, NIGERIA marycelinb@yahoo.com  

 

 

 

 

News Link n. 16

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

 

-Announcement of improved harvest forecast for Sahel region: Good news but governments and UN should not take the foot off the gas | Oxfam International  http://oxf.am/JrQ

-AusAID to boost funding for health innovation research http://www.scidev.net/en/health/news/ausaid-to-boost-funding-for-health-innovation-research.html

-APEC Leaders Discuss Food Security  http://globalhealth.kff.org/Daily-Reports/2012/September/10/GH-091012-APEC-Food-Security.aspx#.UE9Geo3Qr2A.email

-Call to Action: EU Leadership on Global Health R&D Convention | msfaccess.org  http://www.msfaccess.org/content/call-action-eu-leadership-global-health-rd-convention#.UE9F4YCWLcM.email

-Members of Congress and Governors backing PhRMA/BIO, calling for 12 years data protection for biologic drugs in TPP http://keionline.org/node/1544

-Data on Chinese patent applications and grants suggests growing gap between political rhetoric and current realities http://keionline.org/node/1543

-TPP IP text would restore right to sue surgeons and other medical professionals for patent infringement. Why?  http://keionline.org/node/1514

-IRIN Africa | HEALTH: Global South leads the way towards universal healthcare coverage | Ghana | Kenya http://www.irinnews.org/Report/96280/HEALTH-Global-South-leads-the-way-t…

-Delhi High Court dismisses Roche’s patent suit against Cipla – Economic Times http://economictimes.indiatimes.com/news/news-by-industry/healthcare/bio…

-A ‘STEP FORWARD’ FOR A HUMANITARIAN PLAN IN SUDAN?  http://www.devex.com/en/news/blogs/a-step-forward-in-aid-access-in-khartoum

-An Alternative Framework for Analyzing Financial Protection in Health   http://dx.plos.org/10.1371/journal.pmed.1001294

-Global Fund Must Resolve Leadership, Governance Issues By End Of 2012 http://globalhealth.kff.org/Daily-Reports/2012/September/07/GH-090712-Op…

-U.S. Commitment To Foreign Assistance, Global Health To Rise Or Fall With Presidential Election Outcome http://globalhealth.kff.org/Daily-Reports/2012/September/05/GH-090512-Op…

-Al Jazeera Program Interviews Bill And Melinda Gates  http://globalhealth.kff.org/Daily-Reports/2012/September/04/GH-090412-Gates-Al-Jazeera.aspx#.UEc1LPUIaqU.email

-VOA Examines Global Polio Eradication Efforts http://globalhealth.kff.org/Daily-Reports/2012/September/04/GH-090412-Gl…

-Barroso: what EU federation would mean for aid, development  www.devex.com/en/news/79116/print

 

 

 

News Link n. 15

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

-Overhauling the  Global Fund http://blogs.bmj.com/bmj/2012/09/04/daniele-dionisio-overhauling-the-global-fund/

-WHO | The impact of health insurance in Africa and Asia: a systematic review  http://www.who.int/bulletin/volumes/90/9/12-102301/en/index.html#.UES8im-8hvw.email

-WHO | Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance http://www.who.int/bulletin/volumes/90/9/12-102178/en/index.html#.UES58B-Q69E.email

-China Amends Intellectual Property Laws To Allow For Issuance Of Compulsory Licenses  http://globalhealth.kff.org/Daily-Reports/2012/June/11/GH-061112-China-Compulsory-Licenses.aspx#.T9YNXGobjNM.email

-Fact Sheet: Obama Administration Accomplishments in Sub-Saharan Africa http://www.whitehouse.gov/the-press-office/2012/06/14/fact-sheet-obama-administration-accomplishments-sub-saharan-africa#.T99XU4NVQ5Q.email

-U.S., Nigeria Inaugurate Defense Reference Laboratory In Abuja  http://globalhealth.kff.org/Daily-Reports/2012/August/31/GH-083112-Nigeria-Laboratory.aspx#.UEI3pYy3KMg.email

-Remarks at the U.S.-India Strategic Dialogue http://www.state.gov/secretary/rm/2012/06/192242.htm#.T98nWB5bAr8.email

-Proposed U.S. Legislation Would ‘Set The Standard’ For Global Efforts To Combat Counterfeit Drugs  http://globalhealth.kff.org/Daily-Reports/2012/August/23/GH-082312-Opinion-Counterfeit-Drugs.aspx#.UDeczaS1648.email

-IP-Watch Brief: Novartis Challenge To India Patent Law Put Off To 11 September http://www.ip-watch.org/?p=23038&utm_source=post&utm_medium=email&utm_campaign=alerts

-Europe Reaches Agreement On Unitary Patent http://www.ip-watch.org/2012/06/29/europe-reaches-agreement-on-unitary-patent/

-Eurozone breakup would cost poorest countries $30 billion http://oxf.am/Jfh

-Deaf or dead? Better drugs needed to stop drug-resistant TB  http://kenyadailyeye.jibostudios.com/?p=14344

-ETHIOPIA- HIV prevention services for those most at risk  http://www.irinnews.org/Report/95628/ETHIOPIA-HIV-prevention-services-for-those-most-at-risk#.T-BuGz0nnBk.email

-UNDP launches East Africa agribusiness http://www.devex.com/en/news/78429/print

-Africa must turn its health research into treatments for African people  http://www.guardian.co.uk/global-development/poverty-matters/2012/jun/11/africa-health-research-treatments

-Brics nations to boost IMF funds http://www.bbc.co.uk/go/em/fr/-/news/business-18501198

-Health workers are change agents  http://www.devex.com/en/news/78390/print

-Putting an end to 7.6 million preventable child deaths http://thehill.com/blogs/congress-blog/healthcare/231725-putting-an-end-to-76-million-preventable-child-deaths

-Challenges To Eradicating Polio In Nigeria http://globalhealth.kff.org/Daily-Reports/2012/August/31/GH-083112-RR-Nigeria-Polio.aspx#.UEI3UOuAksk.email

-Implications Of Eradicating Polio, Or Failing To Do So, Go Beyond Public Health  http://globalhealth.kff.org/Daily-Reports/2012/May/30/GH-053012-Opinion-Polio-Emergency.aspx#.T8ZJ3gl66vU.email

-WHO Paper: How To Guard Against Tobacco Companies And Trade Law  http://www.ip-watch.org/2012/06/20/who-paper-how-to-guard-against-tobacco-companies-and-trade-law/

-Forbes ‘Leadership’ Blog Interviews USAID Administrator Rajiv Shah  http://globalhealth.kff.org/Home/Daily-Reports/2012/June/19/GH-061912-Forbes-Interview-Shah.aspx#.T-Gq4PBS_9s.email

-Foreign Assistance Dashboard Update  http://www.state.gov/r/pa/prs/ps/2012/06/193976.htm#.T-nNg1JOIsI.email

-Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review  http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1001244

-Una nuova “partnership” per migliorare l’assistenza materno-infantile nei paesi poveri e un’altra per globalizzare gli americani http://saluteglobale.it/2012/06/16/una-nuova-partnership-per-migliorare-lassistenza-materno-infantile-nei-paesi-poveri-e-unaltra-per-globalizzare-gli-americani/

-Priority setting in Health: building institutions for smarter public spending  http://blogs.cgdev.org/global_prosperity_wonkcast/2012/06/11/priority-setting-in-health-amanda-glassman/

-GlobalPost Reports On Cuba’s Medical Outreach To Africa  http://globalhealth.kff.org/Daily-Reports/2012/June/11/GH-061112-Cuba-Outreach-Africa.aspx#.T9YNocyy-b0.email

-Blog Examines WHO Funding  http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-RR-WHO-Funding.aspx#.T8-BaKrn7ZM.email

 

 

 

Filling the gap, China’s fight against HIV/AIDS

The incidence of HIV infection has been rising sharply these years in China, which causes increased antiretroviral drugs demand and therefore, increased cost. The Chinese government has offered free antiretroviral therapy to HIV/AIDS patients since 2003. The high cost of antiretroviral drugs, especially new, second line drugs is a big challenge for HIV prevention and control in China. To fill the gap between demand and supply of antiretroviral drugs, China now seeks to produce generic antiretroviral drugs which would be much cheaper than brand name drugs by its native pharmaceutical companies under compulsory licenses

by Hongzhou Lu*

Shanghai Public Health Clinical Center affiliated to Fudan University

 

Since the first AIDS case in China reported in a traveler from abroad who subsequently died in Beijing in 1985, the prevalence of HIV infection has been increasing significantly. There are currently an estimated 780,000 people living with HIV in China with 9,224 deaths in 2011, making HIV/AIDS the leading killer of the infectious diseases. 1

To fight against the HIV/AIDS epidemic, the Chinese government initiated the ‘€˜Four Free and One Care’€™ policy: provision of free antiretroviral (ARV) drugs for all rural residents and poor people in cities, free counseling and testing services, free treatment for pregnant women and testing for their babies, free school fees for children affected by HIV and AIDS, and financial support for affected families in December 2003. Although it declared that only rural residents and poor people in cities were eligible to get free ARV drugs, in fact, every HIV patients whose CD4 T cells count is below 350 cells/mm3 could get ARV drugs for free after his/her identity be recorded. By the end of 2011, a total of 126,000 patients have received free antiretroviral therapy (ART) in China, which plays an important role in HIV/AIDS prevention and control.1

However, despite the spreading of free ART, some patients still do not receive ART because of complicated factors, e.g. fear of privacy leak out, etc. More important, the majority of HIV/AIDS patients in China are under ART with the first-line ARV drugs, which are relatively cheaper and more toxic than the second-line drugs.
Available ARV drugs in China include didanosine (ddI, seldom used now because of its toxicity), stavudine (d4t, replaced by other nucleoside/nucleotide reverse transcriptase inhibitors gradually), zidovudine (AZT), tenofovir (TDF), efavirenz (EFV), nevirapine (NVP), indinavir (IDV), abacavir (ABC), kaletra (lopinavira/ritonavir) and raltegravir (RAL). But, in the government free ART program, TDF and kaletra are second line drugs which are available only under some medical conditions, while RAL is not included. Meanwhile, a number of patients cannot tolerate the first line drugs because of their toxicities. And, after usage of ARV drugs for a long time, drug resistance can occur. Therefore, second line ARV drugs are in urgent need in China.

Although the national budget for HIV/AIDS prevention and control increased from 4.8 million US dollars to 349 million dollars from 2003 to 2011, it is still not affordable for the Chinese government to offer every patients with second line ARV drugs since they are six times more expensive than the first line ones, especially from 2013 when the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria will no longer give China grants to fight HIV. 2  Generic drugs which are much cheaper than the brand-name drugs may well provide a solution to this problem.

Currently, there is still a huge gap between the demand and supply of generic ARV drugs in China, and only generic AZT, ddI, D4T, 3TC and NVP are available. The biggest barrier for native manufacturers to produce generic drugs is patent  protection. As a member of the World Trade Organization (WTO), China has been required by WTO rules (the Trade-Related Aspects of Intellectual Property Rights, or TRIPS) to prevent local manufacturers from producing generic drugs of expensive brand-name drugs whose patents still exist. 3  However, the 2001 Doha agreement allows a country to issue a compulsory license for a drug that treats a disease causing a severe health emergency in that country.4  Meanwhile, following the ‘€˜paragraph 6 waiver’€™ issued by the WTO, member countries who are unable to produce pharmaceuticals at home and are suffering from a serious health crisis can import generics from other nations under compulsory licenses.5  These two agreements allow China either to self-produce generic ARV drugs or to import from other countries under compulsory licenses, such as India, Brazil.

Although several drug makers have the ability to produce generic second line ARV drugs, few of them have applied to produce generic ARV drugs under compulsory licenses in China. They are reluctant to produce partially because the profit margins of generic ARV drugs are small compared with other home-made brand drugs and pharmaceutical raw materials. More important, it was difficult to apply for producing generic drugs according to the Chinese patent law in the past. As an example, application from native pharmaceutical companies to produce generic oseltamivir  during influenza A H1N1 epidemic in 2009 was denied in China.

To encourage the production of generic ARV drugs, in March 2012 the State Intellectual Property of China amended the Chinese patent law, so allowing the government to issue compulsory licenses to eligible companies to produce generic versions of patented drugs during State emergencies, or unusual circumstances, or in the interests of the public.

Some report declared that the emendation of Chinese patent law was to encourage the production of generic tenofovir, which is recommended by the World Health Organization as part of a first-line cocktail treatment for HIV/AIDS patients.6  In fact, in 2011, Gilead Sciences signed up for an agreement allowing for the production of generic versions of Viread (tenofovir) on payment of royalty in 111 countries, but not China.7  Anyway, after the emendation of patient law, some eligible drug makers would be willing to make generic ARV drugs, as the potential market in China is expanding.

With the increasing HIV/AIDS cases in the following years, while international funds withdraw, China needs to reallocate its fund on free ARV drugs properly, especially as “€œtreatment as prevention”€ has become now the most significant shift in the thinking and strategies of many public health workers.

Note: Compulsory licensing is when a government allows someone else to produce the patented product or process without the consent of the patent owner. It is one of the flexibilities on patent protection included in the WTO’€™s agreement on intellectual property -€” the TRIPS Agreement.4

 

1.UNAIDS. (2011)HIV in China: Facts and Figures

2.WHO(2011, April)HIV Drug Resistance Factsheet

3. WTO. Material on the WTO website.

4.WTO(2006)Compulsory licensing of pharmaceuticals and TRIPS

5.WTO(2003)Implementation of paragraph 6 of the Doha Declaration on the TRIPS Agreement and public health

6.Reuters. China changes patent law in fight for cheaper drugs

7. www.waifaction.org/pages/s.0007/t.5298.html   

 

————————————————————————

*Corresponding author:
Address correspondence to Hongzhou Lu. Department of Infectious Diseases, Shanghai Public Health Clinical Center affiliated to Fudan University, Caolang Road 2901, Jinshan District, Shanghai, 201508, P.R China.
Tel: š86-21-37990333 ext 3222
Fax: š86-21-57248758
E-mail: luhongzhou@fudan.edu.cn

The study supported by:
“€œThe promotion and optimization of standardized treatment strategies of patients co-infected with HIV and tuberculosis” €(2012ZX10001003-002); Chinese Twelveth Five Key projects on Infectious Disease From Chinese Ministry of Health
PI: Hongzhou Lu

News Links n.14

The news links are part of the research project GESPAM (Geopolitica, Salute Pubblica e Accesso alle Medicine/Geopolitics, Public Health and Access to Medicines), which aims to focus on the best options for the use of trade and government rules related to public health by resource-limited countries.

– Australia to double aid to Myanmar by 2015
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.devex.com/en/news/78383/print
 
– Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-dozen-countries-parliament-opposition-rises/
 
– “Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed”
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.dndi.org/index.php/global.html?ids=5
 
– Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System?
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://dx.plos.org/10.1371/journal.pmed.1001218
 
– A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG)
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://dx.plos.org/10.1371/journal.pmed.1001219
 
– From relief to resilience By Rajiv Shah on 04 June 2012
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.devex.com/en/news/78353/print
 
– UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Triple-Dependency.aspx#.T9DnxmqAX5I.email
 
– IMF agrees on new $157M package for Malawi
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.devex.com/en/news/78374/print
 
– Upcoming Event: 5th Product And Pipeline Enhancement For Generics
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeline-enhancement-for-generics/
 
– 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://keionline.org/node/1431
 
– UNITAID Urges India To Join Agency’s Airline Tax Initiative
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID-India-Airline-Tax.aspx#.T8-BIYzj2LY.email
 
-Riforma sanitaria in Cina. Too little, too late?
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-little-too-late/
 
– MSF welcomes new Executive Director of the Access Campaign | msfaccess.org
http://www.devex.com/en/news/78383/print – Anti-ACTA Protests Expected In Two Dozen Countries; Parliament Opposition Rises http://www.ip-watch.org/2012/06/08/anti-acta-protests-expected-in-two-do… – "Transforming Individual Successes into Sustainable Change to Ensure Health Innovation for Neglected Patients: Why an Essential Health R&D Convention Is Needed" http://www.dndi.org/index.php/global.html?ids=5 – Innovation and Access to Medicines for Neglected Populations: Could a Treaty Address a Broken Pharmaceutical R&D System? http://dx.plos.org/10.1371/journal.pmed.1001218 – A New Deal for Global Health R&D? The Recommendations of the Consultative Expert Working Group on Research and Development (CEWG) http://dx.plos.org/10.1371/journal.pmed.1001219 – From relief to resilience By Rajiv Shah on 04 June 2012 http://www.devex.com/en/news/78353/print – UNAIDS Executive Director Calls On African Leaders To Reduce ‘Triple Dependency’ On External Sources Of HIV Drugs, Commodities, Technologies http://globalhealth.kff.org/Daily-Reports/2012/June/07/GH-060712-RR-Trip… – IMF agrees on new $157M package for Malawi http://www.devex.com/en/news/78374/print – Upcoming Event: 5th Product And Pipeline Enhancement For Generics http://www.ip-watch.org/2012/06/06/upcoming-event-5th-product-and-pipeli… – 5 June 2012: India's statement at WTO TRIPS Council: Exchange of information on securing supply chains against counterfeit goods http://keionline.org/node/1431 – UNITAID Urges India To Join Agency’s Airline Tax Initiative http://globalhealth.kff.org/Daily-Reports/2012/June/06/GH-060612-UNITAID… -Riforma sanitaria in Cina. Too little, too late? http://saluteinternazionale.info/2012/05/riforma-sanitaria-in-cina-too-l… – MSF welcomes new Executive Director of the Access Campaign | msfaccess.org http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email”>http://www.msfaccess.org/about-us/media-room/press-releases/msf-welcomes-new-executive-director-access-campaign#.T8-B740oeHc.email