Free Medicines Research Articles

Prevalence Of Anemia, Its Diagnose, Causes and Treatment: - A Case Study of Faridabad District In Haryana

Epidemiological information and disease prevalence studies have always been vital for planning control strategies and monitoring the impact of interventions to control such diseases. The present study is an outcome of a medical camp done under the aegis of PMGY an NGO model worldwide. Being assisted by hospitals and clinics run by the state and philanthropists, the NGO provides charitable medical services, free treatment, free medicines, and even free food and clothes to underprivileged sections of society. Keeping in view the mission of the NGO, and the poor mass of underprivileged people, this study has been devised to assess the prevalence, symptoms, causes and treatment of anemia in Faridabad mostly for two reasons. Firstly, because the locality is the operating field of the NGO and secondly, because anemia is at the highest prevalence, as found in our first observation of patients coming to the slum outreach camps and clinics under study. This will help make effective strategies of intervention, control and dissemination of health-related awareness & better preventative care and treatment to the target group i.e. the poor and underprivileged sections of the society. This cross-sectional study focuses on residents of the Faridabad district who were clinically assessed and treated for free. Seven rural and 19 urban clusters where nearly 750 people with underprivileged backgrounds came forward for the study. People with ongoing ailments were assessed alongside healthy individuals who required regular health checkups with utmost precaution to prevent community transmission. The treatment protocol revolved around palliative and curative treatment for symptomatic cases and preventative care only, when necessary, for asymptomatic cases.

Ведення пацієнтів із легеневою гіпертензією в умовах воєнного стану: реалії та проблеми

Any military actions on the territory of any country can significantly influence on the quality of medical care. Especially, it could reflect on patients with rare diseases requiring expensive treatment. In this article there were analyzed the work of the specialized pulmonary hypertension (PH) center during the period of Russia’s military invasion in Ukraine and presented the results of the outpatient survey due to problems with patient access to medical care and medicine provision in the period from 24-Feb-2022 to 01-Jul-2024 (war period).We selected patients with a diagnosis of PH carried out for the periods: since 01-Jan-2018 until 30-Apr-2020 (pre-war and pre-COVID-19 period) and since 22-Feb-2022 until 01-Jul-2024 (war period): n=328 and n=394 respectively. The selection was made from the electronic hospital database and the electronic registry of patients that have been conducted in the department since 2014. With the help of the Google Form system, a questionnaire was created and sent through modern devices of communication (Viber, Facebook) to fill out online to patients who are registered (applied for outpatient or inpatient care) in the department or are subscribers to the social network accounts of the Ukrainian Association of Patients with Pulmonary hypertension and/or the Lviv City Charitable Foundation «Sisters of Dalili». We got 220 responses. It was established that martial law status in the country did not significantly affect the management of patients with different forms of PH in the specialized center. The number of treated patients and performed right heart catheterization procedures increased by 20 and 22 % respectively during the «war period», compared to the «pre-war» period. 65 % of PH patients who came abroad due to the war used the help of the specialized department for direct referral to PH centers in Poland for further treatment, including surgical one. 41,7 % of respondents changed their place of residence during the war, but only 17,9 % had interruptions in taking of drugs for the PH treatment. Along with the usual sources of free medicines (humanitarian aid from charitable organizations, the government’s free medicines program), one in five patients «shared out» medicines with other patients. In 45 % of the patients who visited foreign PH centers, the therapy previously prescribed in Ukraine was changed to more effective or safer drugs that are not registered in Ukraine.

Specialized Program for Senior Citizens of Selected Cities of National Capital Region- Philippines, towards a Revitalized Quality of Life and Improved Benefits and Privileges

The protection on the welfare of the senior citizens was first established in 1992. Republic Act No. 7432 of 1992 is an act to utilize the contribution of elderly to national building, grant the benefits and special privileges, and for any other purposes. The aim of the study is to assess elderly availment of Benefits and Privileges of Senior Citizens in terms of health; social; financial; education; and employment. Likewise, it also includes the problems encountered and the solution offered in the availment of benefits and privileges of the Senior Citizens. The study made used of three hundred sixty (360) respondents, which is compose of two groups of respondents, the senior citizen and barangay OSCA officials. Assessments revealed the following results: The common benefits and privileges enjoy by the elderly adult include: free health checkup and medicines, and discounts in private services. Free movie and access to recreational facilities; access to basic education and being offered with job opportunities fitted to their skills and talents. Moreover, the most serious problems encountered by the senior citizens is the limited medical services due to lack of adequate facilities. However, the highly recommended solution is centered on employment benefits particularly in making ties with companies which may offer job to the senior citizens. Finally, the specialized program maybe proposed should focus on dental services, recreational facilities, more discounts to grocery items; special training course; and employment

Gender labor segregation in the care economy: needs research and solutions

The purpose of the research to determine the needs and workload of people who provide free care for their elderly relatives at home. Methodology – a mixed method was applied, which included an electronic individual questionnaire with open and closed questions among 201 residents of Kazakhstani urban and rural areas. Originality / value of the research - the first study in Kazakhstan aimed at identifying the needs and the time use of people engaged in unpaid care for their elderly relatives. Findings: A social and demographic portrait of a caregiver for an older adult at home was composed, the share of institutional, paid and unpaid care in households and the distribution of household workload between spouses were estimated, and the perception of gender equality in families was defi ned. The study showed that the basic needs of people caring for their older relatives at home included benefi ts and payments, services of a public social worker /compensation for care assistant services, a solid pension, an increase in the caregiver’s social status, free medicines and medical care. A shortage of institutional care services for older people in Kazakhstan has been identifi ed, and recommendations for developing a national care system have been proposed.

LEGAL FRAMEWORK FOR PROTECTION OF MS PATIENTS’ RIGHTS IN AZERBAIJAN

Multiple sclerosis (MS) is a chronic disease that frequently results in enduring some level of disability. The rights of individuals affected by MS exhibit a nuanced and multifaceted character, extending beyond the purview of purely healthcare legislation. Assistive technologies (ATs) significantly improve the quality of life of that category of patients. To ensure MS patients’ rights, Azerbaijan health law is closely intertwined with disability law and state social security, which also includes ATs provision. The legislation of Azerbaijan in the context of ensuring the rights of MS patients is quite progressive and covers many issues, including the right to get free medicines, ATs, and recreation. The recent inclusion of some medications for MS on the WHO list of essential medicines (EML) creates the basis for further improvement of legislation in the field of treatment of this category of patients. This paper discusses MS treatment and related legislation within the framework of Azerbaijan health law.

Availability and Affordability of Essential Palliative Care Medicines in Nepal: A Cross-Sectional Study

ContextThe government of Nepal adopted the 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by the International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list. ObjectivesTo evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability, and affordability in Nepal. MethodsA cross-sectional descriptive study of the availability of EPCMs in Nepal, and their inclusion in the national essential medicines list, government health insurance medicines list, government fixed rate medicines list, and free medicines list. Affordability was assessed using the World Health Organization Daily-Define-Dose and the Nepal Government-defined minimum daily wage. ResultsA total of 27 of 33 (82%) of the IAHPC-EPCMs and 41 of 60 (68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18%, and 10% of IAHPC-EPCMs were available cost-free via district hospitals, primary healthcare centers, and health posts, respectively. The government had not included opioids on both free and fixed price lists. A total of 24 of 33 (73%) IAHPC-EPCMs were available on the Government Health Insurance Medicines List. A total of 19 of 41 (46%) available EPCMs were affordable. ConclusionMany EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with the government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.

Relationship between Family Income and Access to Primary Care of Senior Citizens in Kaytapos, Indang Cavite

The research investigates the relationship between family income and access to primary care among senior citizens in Kaytapos, Indang Cavite. A combined self-administered survey and an in-person interview was conducted to analyze the multifaceted factors shaping the accessibility of primary care for seniors. The study examined the socio-economic status, health conditions, and the extent of their access to primary healthcare services. The study mainly aimed to assess the relationship between family income and access to primary care of senior citizens in Kaytapos, Indang. This study further seeks to identify the respondents' socio-demographic profile and determine senior citizens' access to primary care in terms of awareness, accessibility, affordability, availability, acceptability, and accommodation. Based on the findings, it was revealed that senior citizens have good access and high awareness of primary care. The affordability and accessibility of related goods and services were also moderate. Additionally, primary care providers and healthcare institutions were deemed moderately accessible, very acceptable, and highly accommodating to senior patients. Moreover, the existing relationship between family income and senior citizens' access to primary care was statistically significant, yet there was a weak positive correlation. Hence, these findings could aid the government in policy-making planning to promote a more equitable and inclusive healthcare system. Overall, it was recommended that the government address the insufficient access to primary care by proposing free monthly check-ups, medicines, food, and allowances, especially for senior citizens in the lower income bracket.

Family Doctors Calling in Transcarpathian Region in the Wartime

After the russian invasion, 60,000 refugees from the eastern and southern parts of Ukraine, who had many problems with physical and mental health, arrived in Uzhgorod. A team of family doctors, residents and students with the support of volunteers and various medical, educational, charity and religious organizations started a volunteer project, which later grew into the “InterFamily” clinic. Starting as a charity center where internally displaced persons could receive free and high quality primary care and medicines purchased through donations from international partners, today it has become a licensed clinic that provides many different medical services (some of which are unique in our region), and as well as primary (i.e. psychological) and secondary care not only to refugees, but also to city residents. The “InterFamily” clinic is a training center for students and residents who gain hands-on skills and experience, and have the opportunity to become staff members as clinic assistants, providing greater autonomy and the opportunity to gain clinical and management skills. Thanks to the European-Ukrainian Support In Teaching (later EUSIT-Exchange) project, the European experts have been conducting practical lectures for Ukrainian doctors and nurses and students since the beginning of the war. The clinic’s innovative medical and educational experience is valuable not only for Ukrainian, but also for foreign specialists. The international recognition of the “InterFamily” clinic was confirmed by the WONCA Europe 5 Star Doctor Award to the director of the “InterFamily” clinic Pavlo Kolesnyk.

Enhancing Primary Health Accessibility for Elderly Citizens in Remote Indian Villages: The Mobile Medical Unit Initiative

This study aimed to address the escalating health challenges faced by India's elderly population, which is projected to reach 300 million by 2050, emphasizing the surge in chronic health conditions. The Rural areas, housing 69% of the elderly, grapple with inadequately equipped health facilities and limited access to essential services, contributing to high out-of-pocket expenditures. Health-seeking behaviour is intricately linked to factors such as availability, affordability, and accessibility, revealing disparities influenced by income and urban-rural differences. The Hans Mobile Medical Unit (MMU) project, initiated by The Hans Foundation, is being implemented across eight states in the country. This research study is conducted in 4 states, evaluates the project's impact on elderly beneficiaries, with a focus on health-seeking behaviour, prior challenges, and satisfaction levels. The results indicate a substantial reduction in out-of-pocket expenditures (71%), with notable improvements in health conditions reported by 99% of elderly beneficiaries. Major diseases include high blood pressure and back & neck pain. The project has successfully provided free medicines, diagnostics, home visits, and referrals, catering specifically to the elderly population. Despite certain limitations, including the cross-sectional design and state-specific focus, this study contributed essential insights for policymakers and healthcare practitioners working towards inclusive and accessible healthcare for the elderly in rural India.

The availability of essential medicines in primary health centres in Indonesia: achievements and challenges across the archipelago

Indonesia is making significant strides toward achieving universal health coverage, which involves providing free access to essential medicines. This study examines the availability of essential medicine in primary health centres (PHCs) across Indonesia, the reasons why medicines are unavailable, and the extent to which communities have access to alternative dispensing points. Enumerators visited each of the 9831PHCs in all 514 districts to assess the availability of 60 essential medicines and identify reasons for any absent medicines. We correlated the results with the national village census to assess the relationship between availability, poverty, and access to alternative dispensing points. Medicine availability varied greatly. The median availability for 17 priority medicines was 82%, while 58% of the broader selection of 60 essential medicines was present. The availability of maternal and childcare medicines was highest (73%) and lowest for mental health (42%). The main reasons for absence were that medicines were deemed unnecessary (46%) or not supplied (38%). The Java/Bali region had the highest medicines availability, and rural areas in Eastern Indonesia had the lowest. In these districts, the population is financially struggling, most dependent on free medicines from public providers, and had the least access to alternative dispensing points. The availability of priority medicines in PHCs is relatively high, while public-paid prices are low by international standards. To improve availability of all essential medicines, the government should prioritize areas with the highest need, increase funding for PHCs in remote areas, and implement transparent monitoring of medicines availability. Indonesian Government.

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

BackgroundAccess to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn’t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients’ perceived affordability of essential medicines, and accommodation and acceptability of the public facility.MethodsA cross-sectional study was carried out at 30 primary healthcare facilities’ drug dispensaries across three districts in Khartoum state. Within each Centre’s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan’s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26.ResultsParticipants’ ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets.ConclusionPatients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients’ access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients’ satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.

Understanding vulnerability and building resilience in small-scale fisheries: the case of Davao Gulf, Philippines

ABSTRACT Global fisheries face a significant crisis, including overexploitation of fishing grounds, marine pollution, and climate change impacts. This paper aims to assess the effects of climate change impacts and the resilience of small-scale fishers (SSF) in Davao Gulf. It investigates the effects of climate change impacts, vulnerabilities, and resilience of small-scale fishers in Governor Generoso, Lupon, Malita, Sta Maria, Don Marcelino, and Davao City using focus group discussion (FGDs) (N = 9) to identify and understand climate change resilience among participants (N = 135). The results showed that all small-scale fishing communities experienced at least two to three climate hazards i.e. northeast monsoon (Amihan), southwest monsoon (Habagat), and typhoons, which bring fierce winds and heavy rains that cause flooding. Moreover, due to the availability of an alternative non-fishing income such as driving and construction work, carpentry, or other manual labour opportunities, fishers are able to recover and recoup the days lost fishing due to climate-related hazards. The policy analysis suggests that the government should provide social benefits, such as free medical check-ups, medicines, decent housing, and water, to keep fishers and fishing communities productive and healthy. In addition, local government should create seasonal jobs and replacement of fishing gear should be given to fishers to increase their resilience. Highlights Small-scale fishing communities experienced two to three climate-related hazards annually e.g. northeast monsoon (Amihan), southwest monsoon (Habagat), and typhoons; these hazards bring flooding which can result in illness e.g. dysentery, leptospirosis; Fishing communities are disrupted by these hazards and clamour for alternative jobs to ensure their livelihoods, and more inclusive social benefits from the government could deliver large benefits; Community resiliency can be enhanced as a solution to cope with climate change impacts by raising awareness, training and disaster preparedness; stronger local policies can empower affected people and communities to act in a timely way.

Access to medicines in the Indian Public Health System – what works and what does not? A review of the National Health Mission Common Review Mission Reports (2007-2021)

Since the inception of India’s flagship “National Health Mission” (formerly known as the National Rural Health Mission), considerable efforts have been made to ensure access to quality and affordable healthcare, including medicines. Over time, there has been a differential, yet noticeable improvement in the availability and access to medicines across states. This underscores the need to review and analyse various state-specific practices in India supported or recommended by the NHM, to identify key enablers and barriers. Consequently, a review of NHM’s Common Review Mission (CRM) reports between 2007 and 2021 was undertaken. All findings relevant to medicines were identified, retrieved and analysed. Core themes pertaining to medicines included: mechanisms adopted by states for procurement and supply chain management, health system factors influencing the supply chain, the convergence of national health programs, the rollout of the Free Drugs Service Initiative and Comprehensive Primary Health Care, and awareness among the healthcare providers and community. The article further expounds on these themes in the Indian context, highlighting the determinants of access to medicines as well as their interlinkages. In conclusion, it underscores the need to strengthen the overall health system to accelerate universal access to free essential medicines at public health facilities.

Clinical profiles and outcomes of patients enrolled in the department of health: Breast cancer medicines access program in the philippines—A single center experience.

6 Background: The magnitude of breast cancer as a major public health problem throughout the world has always been emphasized. In the Philippines, the incidence of breast cancer is 17.7% in 2020, which makes it the most common malignancy among women. According to the American Cancer Society, when breast cancer is detected early, the 5-year relative survival rate is 99% as compared to a patient with distant metastasis, which decreased to 29%. Therefore, enhanced screening techniques for early disease detection and prompt treatment are necessary to improve cure and survival rates. The Breast Cancer Medicines Access Program (BCMAP) aimed to provide ready access to free medicines for the adjuvant chemotherapy treatment of Stage I-IIIb breast cancer patients to alleviate financial toxicity associated with the costly cancer treatment. This study aims to assess the impact of the BCMAP, and determine the clinical profiles and outcomes of patients enrolled in the program at National Kidney and Transplant Institute. Specifically, this study aims to identify factors causing delay of treatment, to evaluate the program and to provide recommendations for implementation improvement. Methods: This is a retrospective cohort study which included all enrolled patients at the BCMAP from October 2020 to December 2021. The patients were followed up until July 2022 to determine survival rates. Results: There were 52 eligible breast cancer patients enrolled. More than two-thirds completed systemic treatment as per physician’s discretion. The results showed that the overall survival rate is at 95.9% and the disease-free survival rate is at 88.7%. Less than 10% had progressed, and there were two mortalities reported. COVID-19 infection (p=0.0001) and unavailability of trastuzumab (p=0.0216) were identified to be significant factors for treatment delay. Conclusions: There was a trend towards a favorable overall survival and disease-free survival for patients with early breast cancer enrolled to DOH-BCMAP at 21 months follow-up. COVID-19 infection and unavailability of Trastuzumab were significant factors for treatment delay.

An Assessment of the Availability of Essential Medicines in Gadag Taluk, Karnataka: A Study of Primary Health Centers.

Background Essential medicines are those that meet the priority healthcare needs of most of the population and are included in the 2030 Agenda for Sustainable Development. The national list of essential medicines should be tailored to the specific needs of each nation and should always be accessible at reasonable prices and with guaranteed quality. Methods A cross-sectional study was done to assess the availability of essential medicines in primary health centers (PHCs) in Gadag Taluk. The data for the assessment of availability was collected using a checklist, which was prepared after reviewing the Karnataka list of essential medicines, surgical items, and miscellaneous items from 2021 to 2022 for PHCs. The sampling design was a universal sample of all 15 PHCs, as per health management information system data, to assess the availability of essential medicine in PHCs. Results Results indicate that theavailability of essential medicines in 15 PHCs in Gadag Taluk is 74.20%. The availability of anti-allergic drugs and drugs used in anaphylaxis was around 88%, whereas the availability of antidiabetic drugs and non-steroidal anti-inflammatory drugs was 86.88% and 86.66%, respectively. All other categories of drugs are available above 50%, except ophthalmic and ear, nose, and throat drugs. Conclusion The public sector should be strengthened by making sure that patients have access to free essential medicines and that essential medications are always available. This would help patients spend less money out of their own pockets and move India closer to achieving universal healthcare.

Carbon Dots as Advanced Drug-Delivery Nanoplatforms for Antiinflammatory, Antibacterial, and Anticancer Applications: A Review

Carbon dots (CDs), as rapidly developing nanomaterials, give new prospects for the treatment of various diseases. Their great biocompatibility and wide specific surface area make CDs excellent drug-delivery vehicles because they improve cellular uptake and absorption and allow for medications to bind more easily. CDs offer enormous potential as delivery systems for antiinflammatory medications. The activities of antiinflammatory drugs delivered by CDs are higher than those of free drugs. They also have controlled release, thus enhancing the cumulative effect at the inflammation site and improving pharmacokinetics. Compared with free small-molecule antibacterial medicines, CD-based drug-delivery systems have higher antibacterial efficacies, better targeting, increased cellular uptake and internalization efficiency, and decreased systemic side effects. The benefits of using CDs as anticancer drug carriers include high drug loading, increased targeting, lower drug dosage, regulated drug release, and synergistic photothermal therapy, which offers a novel approach to the diagnosis and treatment of cancer in clinical settings. However, it is important to consider the biosafety, toxicity, and impact of CDs on the immune system of an organism before using them as drug-delivery vehicles for clinical diagnosis and therapy. This review discusses the use of CDs in the delivery of antiinflammatory, antibacterial, and anticancer drugs and summarizes the current advantages and challenges of using CDs for drug delivery.

Factors Associated with Dropout from Community Mental Health Clinic in Chandigarh during COVID-19 Pandemic

Background: Dropout of patients with mental illness is high. There is inadequate research on dropout of patient with mental illness from community mental health clinics. Aim: The aim of the study was to assess the dropout rate from three community mental health clinics and evaluate factors associated with dropout in relation to the patient, caregivers, community clinics, and COVID-19 pandemic. Methods: Patients aged 18 years and above registered in community outreach clinics (COC) from March 24, 2018, to March 23, 2020, i.e., before the lockdown, for treatment of mental illnesses including substance use disorders (SUDs) were included in the study. Responses on factors associated with dropout were collected on predesigned questionnaire telephonically after resumption of regular clinics. Results: A total of 5450 patients were registered at COCs. Neurotic and anxiety disorders, SUDs, and bipolar affective disorders were the common diagnoses. The dropout rate was 21%. Sixteen percent of patients did not perceive the need to continue treatment against 84% who felt the need for treatment. However, 87% already felt improvement with treatment. Thirty percent of patients were concerned about side effects of medicine and 52% expressed difficulty to purchase medicines from market, in case of nonavailability of free medicines. Forty-nine percent of patients reported fear of contracting COVID-19 infection as the reason for dropout postlockdown. Conclusion: Fear of contracting COVID-19, compulsory testing, and quarantine was the reasons for dropout attributable to the pandemic. Patients-related and medication-related factors were other major reasons for dropout.

Chronic relationships and mental health care: global pharmaceuticals in a local healing shrine in India

The paper explores how chronicities and chronic relationships are fostered at a state-sponsored community psychiatry clinic that has been affiliated with a Sufi shrine in western India. The clinic provides free psychotropic treatment to patients, most of whom are pilgrims visiting the shrine. While the clinic has been lauded for its collaborative approach of blending ‘medicine and prayer’ in the provision of mental health care, observations of clinical encounters reflect the prevalence of a strongly medicalized perspective of mental illness, where local narratives of distress are reframed as globalized categories of mental disorder, thereby permitting pharmacological intervention. Importantly, in a context where free medicines are offered just as other freebies are in development initiatives in India, this results in the creation of long-term, ‘chronic’ relationships with patients who only seem to return for medicines, never recovering. This paper illustrates how ‘chronicity’, in many ways, is built into the project from the beginning itself. It becomes evident in the assumptions of the officials and psychiatrists that mental illness is chronic, in the case files of patients that record their consultation and medication histories, and in the clinical conversations about the importance of compliance to treatment. Given that historically, community mental health emerged in the context of reducing long hospital stays and deinstitutionalizing mental health care, it is important to reflect on how these policies and practices result in the creation of a cadre of chronic out-patients.

Palliative care management committees: a model of collaborative governance for primary health care.

The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes. Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.

Battling chronic myeloid leukemia in a resource-constrained country: A case of public-private partnerships

Pakistan, where chronic myeloid leukemia constitutes around 80% of all myeloproliferative disorders, has been exploring multiple avenues in order to ensure the accessibility and affordability of imatinib and nilotinib. While most provinces of the country have joined hands with a pharmaceutical company to dispense free anti-CML medicines as part of a public-private partnership, the patients are still facing numerous challenges in the form of geographical disparity in the availability of these medicines, other out-of-pocket expenditures and most importantly, the uncertainty associated with the long-term continuation of this public-private endeavor due to procedural delays. In light of these predicaments, channeling resources towards research and development, fostering partnerships between government and NGOs and tapping into the domain of compulsory licensing appear to be the most sustainable solutions.