Health Commodities Research Articles

An Assessment of the Records Keeping Status in Some Selected Health Institutions of Matabeleland South Province, Zimbabwe

Background and Purpose: keeping is important for a functional health delivery system in the management of important information. It forms the indispensable informational and logical link between the different levels of health care both in terms of the referral of patients, supervision, outreach services, the supply of health commodities and disease management. It is an important component of the health care delivery system. The purpose of the study was to find out the range and types of records kept by the health centres, clinics and hospitals; to find out if there are electronic records keeping systems used by the health institutions; to determine the records management and records keeping systems used by the health centres, clinics and hospitals and comparing them to internationally recommended standards; to find out the skills and experience of staff who manage records at different levels; and to suggest ways of improving records management systems in the health institutions province. Methods: The quantitative research approach was used through a descriptive exploratory survey used to gather data from a sampled population from health facilities in Matabeleland South boarder line area covering four districts in Zimbabwe. Results: The insufficiencies in health delivery and disease management can be partly attributed to poor records management practices in health institutions due to lack of training of nurses, poorly maintained infrastructure and a multiplicity of other factors discussed in this paper. Conclusions: If promoted, Keeping Systems (RKSs)* which often generate several information-based solutions can be used to complement and partially fill the gaps left by the endeavours of medical and research-based solutions in improving health systems service delivery and disease management in remote, rural communities. *Notes: A Records Keeping System is a manual or automated system that collects, organizes, and categorizes records, facilitating their preservation, retrieval, use, and disposition. Elements of a records keeping system are: Records - information resources, in any format, that are: created in the course of business, received for action, or needed to document institutional activities. People - the records management personnel such as records clerks, classification specialists, and information officers Processes - procedures on how to manage records throughout their lifecycle or continuum which are stipulated in standing orders, procedure manuals and policies as well as programmed software. Tools - equipment and software used to capture, organise, store, track, transmit/communicate and retrieve the records. Keywords : Keeping Systems (RKSs), Health Care Delivery Systems, Health Management , Marginal communities

ASSESSMENT OF LOGISTICS MANAGEMENT IN GHANA HEALTH SERVICE

Ghana Public Health Sector runs a three-tier system of managing health commodities. Suppliers, the Central Medical Store, The Regional Medical Store, Service Delivery Points and the transportation system form the supply chain. Ghana Health Service logistics system is centralized and the health care delivery system is decentralized. Logistics management in the health system is crucial. This is because there are instances where medicines and health commodities are not available at the Central Medical Stores and the Regional Medical Stores. Consequently, there is no commodity security at the service delivery points. Upon this backdrop the study seeks to assess the logistics management system in order to bring efficiency in the system. The study adopts a multi-case study approach to assess the practices of logistics management, the causes of inadequacy of logistics and the strengths and weaknesses in Ghana Health Service logistics system. Two categories of participants that is, the key players of health logistics management and end-users were involved in the study. Four variables; finance for procurement of health commodities, evenly distribution of health commodities, effective supervision and constant monitoring and evaluation were found crucial in effective and efficient logistics management. Moreover, it was found that poor procurement planning and budgeting, lack of financial resources for procurement, poor quantification and forecasting, delay in procurement process and order processing, and delay in receiving insurance claims are some of the causes of inadequacy of logistics in the health systems. It is recommended that Ghana Health Service logistics or supply system must receive constant monitoring and evaluation. Further, Ghana Health Service must ensure that there is effective top-down supervision in the system to bring up efficiency. Again, Ghana Health Service and Ministry of Health must ensure enough funds are secured from the government to procure health commodities.

Assessment of laboratory logistics management information system practice for HIV/AIDS and tuberculosis laboratory commodities in selected public health facilities in Addis Ababa, Ethiopia

IntroductionLogistics management information system for health commodities remained poorly implemented in most of developing countries. To assess the status of laboratory logistics management information system for HIV/AIDS and tuberculosis laboratory commodities in public health facilities in Addis Ababa.MethodsA cross-sectional descriptive study was conducted from September 2010-January 2011 at selected public health facilities. A stratified random sampling method was used to include a total of 43 facilities which, were investigated through quantitative methods using structured questionnaires interviews. Focus group discussion with the designated supply chain managers and key informant interviews were conducted for the qualitative method.ResultsThere exists a well-designed logistics system for laboratory commodities with trained pharmacy personnel, distributed standard LMIS formats and established inventory control procedures. However, majority of laboratory professionals were not trained in LMIS. Majority of the facilities (60.5%) were stocked out for at least one ART monitoring and TB laboratory reagents and the highest stock out rate was for chemistry reagents. Expired ART monitoring laboratory commodities were found in 25 (73.5%) of facilities. Fifty percent (50%) of the assessed hospitals and 54% of health centers were currently using stock/bin cards for all HIV/AIDS and TB laboratory commodities in main pharmacy store, among these only 25% and 20.8% of them were updated with accurate information matching with the physical count done at the time of visit for hospitals and health centers respectively.ConclusionEven though there exists a well designed laboratory LMIS, keeping quality stock/bin cards and LMIS reports were very low. Key ART monitoring laboratory commodities were stock out at many facilities at the day of visit and during the past six months. Based on findings, training of laboratory personnel's managing laboratory commodities and keeping accurate inventory control procedures were recommended.

Malaria rapid diagnostic test transport and storage conditions in Burkina Faso, Senegal, Ethiopia and the Philippines

BackgroundAs more point of care diagnostics become available, the need to transport and store perishable medical commodities to remote locations increases. As with other diagnostics, malaria rapid diagnostic tests (RDTs) must be highly reliable at point of use, but exposure to adverse environmental conditions during distribution has the potential to degrade tests and accuracy. In remote locations, poor quality diagnostics and drugs may have significant negative health impact that is not readily detectable by routine monitoring. This study assessed temperature and humidity throughout supply chains used to transport and store health commodities, such as RDTs.MethodsMonitoring devices capable of recording temperature and humidity were deployed to Burkina Faso (8), Senegal (10), Ethiopia (13) and the Philippines (6) over a 13-month period. The devices travelled through government supply chains, usually alongside RDTs, to health facilities where RDTs are stored, distributed and used. The recording period spanned just over a year, in order to avoid any biases related to seasonal temperature variations.ResultsIn the four countries, storage and transport temperatures regularly exceeded 30.0°C; maximum humidity level recorded was above 94% for the four countries. In three of the four countries, temperatures recorded at central storage facilities exceeded pharmaceutical storage standards for over 20% of the time, in another case for a majority of the time; and sometimes exceeded storage temperatures at peripheral sites.ConclusionsMalaria RDTs were regularly exposed to temperatures above recommended limits for many commercially-available RDTs and other medical commodities such as drugs, but rarely exceeded the recommended storage limits for particular products in use in these countries. The results underline the need to select RDTs, and other commodities, according to expected field conditions, actively manage the environmental conditions in supply chains in tropical and sub-tropical climates. This would benefit from a re-visit of current global standards on stability of medical commodities based in tropical and sub-tropical climatic zones.

Health commodities management system: priorities and challenges

PurposeThe purpose of this paper is to explore opinions of health workers on priorities and challenges of the HIV/AIDS commodities management system in Abuja, Nigeria. The results from this research are to inform future guideline revisions on the management of these commodities, in order to produce the most efficient and cost‐effective approach.Design/methodology/approachA qualitative research was conducted from a social constructionist perspective. Purposive sampling was used to recruit 12 health workers, comprising pharmacists, laboratory scientists and logisticians involved in HIV/AIDS commodity management in Abuja, Nigeria. Views and experiences of these workers were explored on HIV/AIDS commodity management through in‐depth interviews, to ascertain challenges of the current system and needed interventions. The data were subjected to thematic content analysis.FindingsResults of the study include the need for coordinated and integrated health commodity management system, sustainable human resource and infrastructure development and an effective data management system to address current challenges.Research limitations/implicationsThe data collection approach did not provide an opportunity for idea exchange and review in a focused group and the number of respondents was limited to 12 due to time constraints. However, the respondents were experts in the field.Practical implicationsGovernment needs to commit financial resources to support of the health supply chain to ensure sustainability beyond donor support. Donors should change their strategy of “quick fix” approach to health supply chain challenges, as these often result in Government laxity in addressing public health needs.Originality/valueThe paper provides insight into areas on which the Government of Nigeria should focus attention in health supply chain strategy, which is currently perceived as not coordinated.

Midwives and the Medical Marketplace in Modern Japan

This article deals with the commercial aspect of midwifery in Japan since the Meiji period. In focusing on the important yet often neglected aspect of the history of medically trained midwives, it aims to complement existing scholarship that tends to emphasize the role of midwives in the construction of the modern Japanese state. The article analyzes and contextualizes health-related advertisements published in San'iku shimbun, a newspaper aimed at medically trained midwives. These advertisements encouraged midwives to participate in commercial activities involving the sale and promotion of health commodities. Representations of midwives in the advertisements point towards an important aspect in the professional reality of midwifery: making a living. But the advertisers also implicitly exploited the role ascribed to midwives, as agents of health and hygiene in the context of the modernizing state. Thus the social function of medically trained midwives was informed both by their officially endorsed role in the state's vision of creating healthy citizens and the reality of their position in the medical marketplace.

HIV prevention among female sex workers in Africa

Sex work occurs to meet the demand for sexual services and is a universal phenomenon. In Africa sex work takes many forms and is an important source of income for many women. Yet sex worker reproductive health needs remain largely unmet. The criminalisation of sex work; community and service provider stigma; violence; substance use and limited access to health services and prevention commodities contribute to the high HIV burden evident among female sex workers in Africa. Following UNAIDS' three pillar approach to HIV prevention and sex work we present an overview of current opportunities, barriers and suggestions to improve HIV prevention policy and programming for sex work in Africa. Universal access to a comprehensive package of HIV services is the first pillar. Reproductive health commodities; voluntary and anonymous HIV counselling and testing; treatment of sexually transmitted infections, HIV and opportunistic infections; harm reduction for substance use and psychosocial support services make up the recommended package of services. The second pillar is a sex worker-supportive environment. The inclusion of sex worker programmes within national HIV strategic planning; sex worker-led community mobilisation and the establishment of sex work community networks (comprised of sex workers, health service providers, law enforcers and other stakeholders) enable effective programme implementation and are recommended. The reduction of sex worker vulnerability and addressing structural issues form the final pillar. The decriminalisation of sex work; development of supportive policy; gender equality and economic development are key factors that need to be addressed to increase sex worker resilience. Evidence supports the public health benefit of human rights based approaches to HIV prevention; moralistic and restrictive policy and laws towards sex work are harmful and should be removed. The establishment of these pillars will increase sex worker safety and enhance the inclusiveness of the HIV response.

Impact of dropout of female volunteer community health workers: an exploration in Dhaka urban slums.

BackgroundThe model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25 years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community.MethodsWe used the ‘ingredient approach’ to estimate the cost of recruiting and training of CHWs and the so-called ‘friction cost approach’ to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period.ResultsIn 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community.ConclusionAlthough CHWs work as volunteers in Dhaka urban slums impact of their dropout is immense both in financial term and forgone services. High cost of dropout makes the program less sustainable. However, simple and financially competitive strategies can improve the sustainability of the program.

Newborn survival in Nepal: a decade of change and future implications

Nepal is on target to meet the Millennium Development Goals for maternal and child health despite high levels of poverty, poor infrastructure, difficult terrain and recent conflict. Each year, nearly 35,000 Nepali children die before their fifth birthday, with almost two-thirds of these deaths occurring in the first month of life, the neonatal period. As part of a multi-country analysis, we examined changes for newborn survival between 2000 and 2010 in terms of mortality, coverage and health system indicators as well as national and donor funding. Over the decade, Nepal's neonatal mortality rate reduced by 3.6% per year, which is faster than the regional average (2.0%) but slower than national annual progress for mortality of children aged 1-59 months (7.7%) and maternal mortality (7.5%). A dramatic reduction in the total fertility rate, improvements in female education and increasing change in skilled birth attendance, as well as increased coverage of community-based child health interventions, are likely to have contributed to these mortality declines. Political commitment and support for newborn survival has been generated through strategic use of global and national data and effective partnerships using primarily a selective newborn-focused approach for advocacy and planning. Nepal was the first low-income country to have a national newborn strategy, influencing similar strategies in other countries. The Community-Based Newborn Care Package is delivered through the nationally available Female Community Health Volunteers and was piloted in 10 of 75 districts, with plans to increase to 35 districts in mid-2013. Innovation and scale up, especially of community-based packages, and public health interventions and commodities appear to move relatively rapidly in Nepal compared with some other countries. Much remains to be done to achieve high rates of effective coverage of community care, and especially to improve the quality of facility-based care given the rapid shift to births in facilities.

Piloting the Affordable Medicines Facility-malaria: what will success look like?

The Affordable Medicines Facility-malaria is an innovative financing mechanism, managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria. This initiative aims to increase the use of artemisinin-based combination therapies for treating malaria. A pilot is underway in eight countries to determine whether the mechanism reduces the consumer price of these drugs and increases their availability in public and private outlets, their market share and their use. To evaluate the pilot, an analysis was done to estimate predetermined "benchmarks" of success at 1 and 2 years. The analysis used a mixed-methods approach, triangulating data from a literature review with information from 33 interviews with experts. A sensitivity analysis and other methods were used to verify the results. Benchmarks used to determine success include an increase in availability of artemisinin-based combination therapies of 40 percentage points from baseline, and an increase in their use of 10-15 percentage points from baseline at year 2. These benchmarks were based on evidence that national public health programmes aimed at increasing the use of a specific health commodity in developing countries have generally achieved only modest changes in use within a 2-year time frame. Evaluation should also take individual country contexts into account.

Human resources for health care delivery in Tanzania: a multifaceted problem

BackgroundRecent years have seen an unprecedented increase in funds for procurement of health commodities in developing countries. A major challenge now is the efficient delivery of commodities and services to improve population health. With this in mind, we documented staffing levels and productivity in peripheral health facilities in southern Tanzania.MethodA health facility survey was conducted to collect data on staff employed, their main tasks, availability on the day of the survey, reasons for absenteeism, and experience of supervisory visits from District Health Teams. In-depth interview with health workers was done to explore their perception of work load. A time and motion study of nurses in the Reproductive and Child Health (RCH) clinics documented their time use by task.ResultsWe found that only 14% (122/854) of the recommended number of nurses and 20% (90/441) of the clinical staff had been employed at the facilities. Furthermore, 44% of clinical staff was not available on the day of the survey. Various reasons were given for this. Amongst the clinical staff, 38% were absent because of attendance to seminar sessions, 8% because of long-training, 25% were on official travel and 20% were on leave. RCH clinic nurses were present for 7 hours a day, but only worked productively for 57% of time present at facility. Almost two-third of facilities had received less than 3 visits from district health teams during the 6 months preceding the survey.ConclusionThis study documented inadequate staffing of health facilities, a high degree of absenteeism, low productivity of the staff who were present and inadequate supervision in peripheral Tanzanian health facilities. The implications of these findings are discussed in the context of decentralized health care in Tanzania.

Early experiences on the feasibility, acceptability, and use of malaria rapid diagnostic tests at peripheral health centres in Uganda-insights into some barriers and facilitators

BackgroundWhile feasibility of new health technologies in well-resourced healthcare settings is extensively documented, it is largely unknown in low-resourced settings. Uganda's decision to deploy and scale up malaria rapid diagnostic tests (mRDTs) in public health facilities and at the community level provides a useful entry point for documenting field experience, acceptance, and predictive variables for technology acceptance and use. These findings are important in informing implementation of new health technologies, plans, and budgets in low-resourced national disease control programmes.MethodsA cross-sectional qualitative descriptive study at 21 health centres in Uganda was undertaken in 2007 to elucidate the barriers and facilitators in the introduction of mRDTs as a new diagnostic technology at lower-level health facilities. Pre-tested interview questionnaires were administered through pre-structured patient exit interviews and semi-structured health worker interviews to gain an understanding of the response to this implementation. A conceptual framework on technology acceptance and use was adapted for this study and used to prepare the questionnaires. Thematic analysis was used to generate themes from the data.ResultsA total of 52 of 57 health workers (92%) reported a belief that a positive mRDT result was true, although only 41 of 57 (64%) believed that treatment with anti-malarials was justified for every positive mRDT case. Of the same health workers, only 49% believed that a negative mRDT result was truly negative. Factors linked to these findings were related to mRDT acceptance and use, including the design and characteristics of the device, availability and quality of mRDT ancillary supplies, health worker capacity to investigate febrile cases testing negative with the device and provide appropriate treatment, availability of effective malaria treatments, reliability of the health commodity supply chain, existing national policy recommendations, individual health worker dynamism, and vitality of supervision.ConclusionsmRDTs were found to be acceptable to and used by the target users, provided clear policy guidelines exist, ancillary tools are easy to use and health supplies beyond the diagnostic tools are met. Based on our results, health workers' needs for comprehensive case management should be met, and specific guidance for managing febrile patients with negative test outcomes should be provided alongside the new health technology. The extent, to which the implementation process of mRDT-led, parasite-based diagnosis accommodates end user beliefs, attitudes, perceptions, and satisfaction, as well as technology learnability and suitability, influences the level of acceptance and use of mRDTs. The effectiveness of the health system in providing the enabling environment and the integration of the diagnostic tool into routine service delivery is critical.

Price subsidies and the market for mosquito nets in developing countries: A study of Tanzania’s discount voucher scheme

This study uses a partial equilibrium simulation model to explore how price subsidies for insecticide-treated mosquito nets (ITNs) affect households’ purchases of ITNs. The model describes the ITN market in a typical developing country and is applied to the situation in Tanzania, where the Tanzania National Voucher Scheme (TNVS) provides a targeted subsidy to vulnerable population groups by means of a discount voucher. The data for this study come from a nationally-representative household survey completed July–August 2006 covering over 4300 households in 21 districts. The simulation results show the impact of the voucher program on ITN coverage among target households, namely those that experienced the birth of a child. More specifically, the share of target households purchasing an ITN increased from 18 to 62 percent because of the discount voucher. The model also suggests that the voucher program could cause the retail ITN price to rise due to an overall increase in demand. As a result, ITN purchases by households without a voucher may actually decline. The simulation model suggests that additional increases toward the stated goal of 80 percent ITN coverage for pregnant women and children could best be achieved through a combination of “catch up” mass distribution programs and expanding the target group for the voucher program to cover additional households. The model can be employed in other countries considering use of a targeted price subsidy for ITNs, and could be adapted to assess the impact of subsidies for other public health commodities.

An estimate of the minimum economic burden of bipolar I and II disorders in the United States: 2009

Objective To conduct an analysis yielding estimates of the direct and indirect costs accruing from bipolar I and II disorders in 2009. The last analysis of these costs pertained to 1991. Methods The analysis presented is based on recent epidemiological data, a measure of the increase in the cost of health care services and commodities between 1991 and December 31, 2009, a measure of the increase in the cost of living after partialing out of the costs of health care between 1991 and December 31, 2009 and adjustment for growth in the population of the United States between 1991 and 2009 to calculate the direct and indirect costs of bipolar I and II disorders. Results The estimated direct and indirect costs of bipolar I and II disorders in 2009 were 30.7 and 120.3 billion dollars, respectively. The estimated total economic burden imposed by these disorders was 151.0 billion dollars. The increase in costs between 1991 and 2009 was not entirely due to inflation. Bipolar I and II disorders are now estimated to have a combined prevalence exceeding that used in the calculation of costs for 1991 by 1.6154-fold. Direct costs escalated out of proportion (2.2393-fold) to indirect costs (1.6148-fold). Limitations The analysis required the acceptance assumptions that likely resulted in a net-underestimation of costs and did not take the entirety of the bipolar spectrum into account. Conclusions The findings have implications for the formulation of public policy. The lifetime prevalences of not only bipolar I and II disorders but also the high prevalence of the entire body of bipolar spectrum disorders, the suffering that they create and the economic burden imposed by them render them worthy of having a high priority in the formulation of plans for the delivery of health care services, planning educational programs for the public and informing policymakers.

Market segmentation of health information use on the Internet in Korea

Background Internet is the common way to access all kind of information, thus it becomes to have highly influential place on the range of health care as well. More and more people have been using Internet to get the latest information on the health-related matters. However, it is very important but not easy to find the correct data and select it efficiently among the enormous amount of information. To identify the information seekers and understand their needs or purposes, they would be very effective for the providers to give high-quality health information for the Internet users. Objectives The purpose of this study is to reveal the patterns of utilization of health information on the Internet. The subjects of the survey were randomly selected among the local residents by their age and gender. It was conducted in Gangwon, the province and Incheon, the metropolitan city at the same time. To investigate the similar amount of population, 0.5% of Gangwon and 0.3% of Incheon dwellers were chosen. Methods 10,325 people were responded to the telephone poll and the investigation had been conducted from July to October 2006. 8656 from 10,325 completed the survey and 1665 (19.2%) of them had used Internet to get health information in last 1-year. The use of health information on the Internet was classified into four categories as follows: general health tips, disease specific information, shopping for health commodities, and selection of hospitals. The questionnaire included articles regarding socio-demographic characteristics such as age, gender, income, education, dwelling area, health status and behaviors such as cigarette smoking and alcohol consumption. Results Of all 1665 respondents, 726 (17.2%) men (total 4210) and 939 (21.1%) women (total 4446) had used Internet for health information in last 1-year. The health information that people wanted from Internet was as follows: general health tips (64.2%), disease specific information (32.0%), shopping for health commodities (23.7%), and selection of hospitals (19.3%). The people of higher education and higher income level tended to use Internet more often for health information. Metropolitan city dwellers used health information on the Internet more than people from province did. Personal health status appeared to be the most important factor to search the information about general health tips from the Internet. Healthy people (68.3%) used the Internet more than people with diseases (44.4%) who used Internet most frequently for disease specific information (62.6%). Residence area was the most important factor of online shopping for health commodities. While 31.8% of city dwellers used the Internet, only 19.0% of metropolitan or county dwellers used it for the same purpose. Determinant factors for the utilization of the Internet for hospital selection were residence area, age, and health examination. Conclusions We found that each section of health information has its own clients concerning their personal interests and status of health and life style. That is why customized market segmentation is strongly recommended for their loyal customers. Depends on the information seekers’ health status, it should be decided which information would be more useful for them between general health tips and specific disease. On the other hand, the area where the information seekers live can be more influential on terms of shopping for health commodities. These results will be a great help to start to understand the closer atmosphere of the ideal health information market to provide more valuable services in more various use.

Promoting and prioritising reproductive health commodities : understanding the emergency contraception value chain in South Africa

Use of emergency contraception is low in South Africa despite high rates of unplanned and unwanted pregnancies. Existing studies have demonstrated that women access emergency contraception from commercial pharmacies rather than from public health facilities at no charge. Research has also demonstrated that awareness of emergency contraception is a key barrier to improving uptake, especially in the public health sector. This study investigates the low use of emergency contraception in South Africa and employs a qualitative value chain analysis to explore the role of market and regulatory structures in creating an enabling environment for the supply and promotion of emergency contraception. The results suggest that there are several 'market imperfections' and information barriers impacting on the effective supply of emergency contraception to women who are dependent on the public health sector for their health care. Balancing commercial interests with reproductive health needs, it is argued, may form a crucial part of the solution to the low uptake of emergency contraception in South Africa.

Responding to the needs of adolescents

How-ever, real progress in scaling up such approaches has been modest and slow to materialize. The Department of Child and Adolescent Health and Development at the World Health Organization is sup-porting national sexual and reproduc-tive health and HIV programmes to work together to better respond to the needs of adolescents, focusing on the following four key areas: (i) gathering, analysing and using strategic informa-tion from an adolescent perspective; (ii) developing supportive policies and strategies based on strategic informa-tion and sound evidence; (iii) scaling up the provision of health services and commodities; and (iv) engaging and strengthening other sectors.A lack of accurate, up-to-date, age-disaggregated data on sexual and reproductive health and HIV/AIDS hinders well-informed policy and strat-egy development. We are supporting countries to analyse existing data from an adolescent perspective to advocate for coordinated attention to sexual and reproductive health and HIV/AIDS in this age group.

Enhancing innovation between scientific and indigenous knowledge: pioneer NGOs in India

BackgroundUntil recently, little attention has been paid to local innovation capacity as well as management practices and institutions developed by communities and other local actors based on their traditional knowledge. This paper doesn't focus on the results of scientific research into innovation systems, but rather on how local communities, in a network of supportive partnerships, draw knowledge for others, combine it with their own knowledge and then innovate in their local practices. Innovation, as discussed in this article, is the capacity of local stakeholders to play an active role in innovative knowledge creation in order to enhance local health practices and further environmental conservation. In this article, the innovative processes through which this capacity is created and reinforced will be defined as a process of "ethnomedicine capacity".MethodsThe field study undertaken by the first author took place in India, in the State of Tamil Nadu, over a period of four months in 2007. The data was collected through individual interviews and focus groups and was complemented by participant observations.ResultsThe research highlights the innovation capacity related to ethnomedical knowledge. As seen, the integration of local and scientific knowledge is crucial to ensure the practices anchor themselves in daily practices. The networks created are clearly instrumental to enhancing the innovation capacity that allows the creation, dissemination and utilization of 'traditional' knowledge. However, these networks have evolved in very different forms and have become entities that can fit into global networks. The ways in which the social capital is enhanced at the village and network levels are thus important to understand how traditional knowledge can be used as an instrument for development and innovation.ConclusionThe case study analyzed highlights examples of innovation systems in a developmental context. They demonstrate that networks comprised of several actors from different levels can synergistically forge linkages between local knowledge and formal sciences and generate positive and negative impacts. The positive impact is the revitalization of perceived traditions while the negative impacts pertain to the transformation of these traditions into health commodities controlled by new elites, due to unequal power relations.

Creating reliable pharmaceutical distribution networks and supply chains in African countries: Implications for access to medicines

Public health-sectors of most low- and middle-income countries (LMICs) run a central medical stores (CMS) model that is monopolistic in character. Concerns raised about monopolistic CMS arrangements stress the need to encourage cost-reducing efforts and improve service levels (outputs) by having multiple competing logistics institutions. This paper examines the desirability of consolidation or multiplicity in supply logistics by focusing on the task of inventory management (that is, distribution, storage and warehousing). The paper uses theory and historical evidence to describe and suggest a desired form of multiplicity in LMICs. Consolidation shouldn't progress to the point of monopoly and multiplicity doesn't mean having an infinite number of logistics institutions. A limited number (2−10) of logistics institutions, that are full-line and national in their scope and scale of operations, should be enough to provide choice, support competition and minimize the risk of supply disruptions. Health policy and planning in LMICs should explore ways of turning existing logistics institutions in the public, private and non-governmental sectors into a multiplicity of types that are capable of assuring uninterrupted supplies of health commodities.

Medicinal plants conservation and enterprise development

The knowledge of medicinal plants, historically, was occupied by a few specialized herbal healers in rural communities; thus much of their use was observed as being primary of local interest. For past couple of decades, medicinal plants have been increasingly recognized for their role as not only for health care but also for improving the economic status. This ongoing trend towards increasing commercialization has resulted in overharvesting of some economically important medicinal plant species, many of which has become rare, endangered and threatened. Since the medicinal plants form an important health commodity, sustainable utilization and conservation of this valuable bio-resource is an urgent need of hour. India is one of the largest countries in Asia, which has the richest arrays of well-known medicinal plants and alternative medical systems including Ayurveda. A large number of manpower from herb collectors/farmers to industry is involved in the medicinal plants sector, which is largely unregulated. Realizing the continuous erosion in the traditional knowledge of many valuable plants for medicine in the past and the renewal interest at present, the need existed to review the various issues associated with the medicinal plants, especially the sustainable development of the medicinal plants sector. The present review mainly deals with the availability of medicinal plants resources and their conservation in India along with constraints in medicinal plants enterprise development and initiatives taken up by the Govt. of India to mitigate the constraints and strengthen the medicinal plants sector. On the basis of this review and existing information, recommendations are made for the benefits and development of the medicinal plants sector in India.