Interministerial Committee Research Articles

Cambodian Ministry of Health Takes Decisive Actions in the Fight against Substandard and Counterfeit Medicines

Cambodia's Ministry of Health and the Department of Drugs and Food have been actively working to reduce the amount of poor quality medicines circulating in the pharmaceutical sector since fake mefloquine and artesunate were first found in 1998. From 2005-2012, legal private sector facilities and illegal outlets in twelve Cambodian provinces were targeted for routine surveillance of medicine quality through sample collection and testing of various anti-infective medicines, the majority of which were anti-malarials and anti-biotics. The Medicine Quality Monitoring program samples from the field were analyzed through a three level approach including field and advanced laboratory testing. 4,381 medicines were collected and tested from 2005-2012; 106 have failed quality testing resulting in an overall failure rate of 2.4%. 28 of the failed samples (26.4%) were counterfeit. The most commonly found counterfeit medicines were chloroquine, artesunate, mefloquine, ampicillin and penicillin. Cambodia has closed over 99% of illegal pharmacy outlets through the Inter-Ministerial Committee to Fight against Counterfeit & Substandard Medicines (IMC) by the end of November 2011. In the past, a lack of resources as well as coordination among the various ministries was identified as a major barrier in combating the presence of poor quality medicines. With financial support from USAID, PMI, and other donors, paired with the technical support from the U.S. Pharmacopeial Convention Promoting the Quality of Medicines program, the IMC developed an action plan to significantly reduce the number of substandard and counterfeit medicines. Based on the data shown, the plan has been successful in reducing the failure rates of samples collected in Cambodia from a high of 7.4% in 2006 to a low of 0.7% in 2011. Continued efforts to monitor and actively ensure the quality of medicines in Cambodia will be required to maintain these low rates; sustainability of these efforts is critical.

Balanced Scorecard as a Tool for Sustainable Management Control: A Case Study of the Brazilian Air Force

  Abstract—The amount of waste generated in the current society has undertaken the necessary balance between the economic, social and environmental objectives. The law number 12.305, from August 2, 2010, which instituted the National Solid Waste Policy (PNRS) was regulated by Decree 7.404 of December 23, 2010, originating the Inter-ministerial Committee of solid waste policy. Its approval has initiated a process of seeking solutions to reduce the amount of solid waste and the impacts generated by it. In view of the paucity of studies on sustainability policies adopted by the public sector and multiplicity of waste generated by the Brazilian Air Force, this institution has been chosen for this case study. The method chosen for this research makes it possible to identify the holistic characteristics of an organization. The investigation relied on direct observation, semi-structured interviews, bibliographical and documental research as secondary sources of information. As a result, the paper presents a map of strategic goals and a map of tactical objectives, defining sustainability policies and the design of a sustainable Balanced Scorecard to drive a sustainable vision to be deployed in the Brazilian Air Force.

The impact of institutional arrangement on ocean governance: International trends and the case of Korea

After the Chapter 17 of Agenda 21 recommended integrated management for ocean and coastal management system, many countries undertook institutional arrangement in the government structure for efficient ocean governance. From such country cases, we can abstract 5 types of institutional change for ocean governance: type 1) Inter-ministerial commission or committee; type 2) Administration under the ministerial level of department; type 3) Administration under the ministerial level plus inter-ministerial commission or committee; type 4) Ministerial level of department; Type 5) Ministerial level of department plus inter-ministerial commission or committee.It is also supposed that an institutional arrangement can impact on the ocean governance through their elements in various ways, which was proved in the case of Korea. In Korea, the Ministry of Maritime Affairs and Fishery (MOMAF) established in 1996, which belongs to type 4 and had affected the ocean governance very positively, thus making integrated ocean policy, excellent coordination among related ministries and increasing the constituency. However, the dismantlement of MOMAF in 2008 has affected the ocean governance negatively. Reflecting the frequent government restructuring, type 1, 3 or 5 can also be more recommended in case of Korea. This shows how important an appropriate institutional arrangement is for integrated ocean governance and sheds light on the direction for the future institutional arrangement of the ocean sectors in each country.

A Respiratory Sensitization Study by a New Quantitative Structure-Activity Relationships (QSAR)

New respiratory sensitization positive/negative prediction models with discriminant functions were generated and parameter analyses were discussed on the basis of QSAR technology. Samples used in this research were selected from the list of European Chemical Bureau (ECB): R42, R42/43 for positive samples (respiratory sensitizers) and from the classification results of the Japanese Inter-ministerial Committee for negative respiratory sensitizers (controls). A total of 214 compounds (61 positive sensitizers and 153 negative sensitizers) were used in this study. Parameters were generated from 2-D and 3-D structures of compound. All of the approximately 800 parameters generated were reduced to 12 parameter set by feature selection. Various linear and non-linear discriminant analysis methods were applied using the parameter set. All data analyses were performed using ADMEWORKS/ ModelBuilder software. Perfect classification ratios (100%) were achieved using Iterative Least Squares (ILS) and AdaBoost. The highest prediction ratio of 97.2% by leave-one-out cross-validation was achieved with Support Vector Machine (SVM). This model is applicable to initial prediction of respiratory sensitization.

Influenza vaccination recording system in Belgium

Vaccination against influenza is one of the most effective measures to protect people from contracting illness during influenza epidemics and pandemics [1]. In Belgium, the Interministerial Influenza Coordination Committee defined three main objectives for the vaccination campaign against Influenza A(H1N1)2009 pandemic. The first objective was to maintain the functioning of the health care system. The staff in hospitals and health professionals was then considered as priority groups for vaccination. This could limit the transmission of the infection from professional health workers to patients. The second objective was to limit complications and mortality due to influenza. Chronic conditions possibly related to a higher rate of complications and mortality have been listed in the literature available at the time. Patients suffering from one of those affections, women in their second or third trimester of pregnancy and parents of children aged less than six months constituted the second group to be vaccinated. The third objective was to maintain the continuity of the educational system and avoid an amplifying effect in educational institutions. The school staff was therefore defined as the third group to be vaccinated [1,4]. Pandemrix (via a 10 doses phial packaging) was the only vaccine brand selected for the Bel-gian vaccination campaign. Pandemrix is an adjuvanted inactivated vaccine, containing antigens analogous to the A/California/7/2009(H1N1)v virus. The Influenza Scientific Committee recommended a single dose for persons aged 10 years or older, and two times half a dose for children aged 6 months to 9 years [1-3]. The vaccination campaign was entrusted to general practitioners and hospitals, and the distribution of the vaccine was organised through the pharmaceutical network. Simultaneously, a secure web-based tool was developed to allow practitioners to record data about patients they vaccinated. This recording system combined objectives of pharmacovigilance and evaluation of the vaccination campaign. Post-vaccine complications were recorded through a dedicated form used in the pharmacovigilance surveillance system managed by the Federal Agency for Medicines and Health Products (FAMHP). Patient data allowed the Scientific Institute of Public Health (WIV-ISP) to describe the geographical and age distribution of vaccinated persons. From 19 October until 6 November, the vaccine was available for hospital health workers only. From 7 November, the vaccine was proposed for free to other priority groups previously mentioned. The phasing of the vaccine distribution was also related to stock availability. This article describes the web-based recording system and gives some results of the data collected.

Case finding of Influenza A(H1N1)2009 in Belgium in the early pandemic

As soon as a possible worldwide spread of a new Influenza A virus was announced, Belgian health authorities decided to intervene in order to delay the spread of the new virus in the population [1,2]. The delaying strategy started on 26 April 2009 based on a systematic case finding of Influ-enza A(H1N1)2009 in travellers returning from affected areas and their contacts for the purpose of taking individual control measures. From 13 July onwards, the Interministerial Influenza Coordination Committee announced the switch to a mitigation phase [1]. This required appropriate surveillance of influenza-like illnesses. The sentinel general practitioners (SGPs) network for seasonal influenza was reinforced and took over the systematic case finding system [3]. We report on the enhanced case-based surveillance of the first cases of Influenza A(H1N1)2009 up to 13 July 2009 and the subsequent mitigation phase till the start (3 October 2009) of the classical seasonal flu period.

Confirmation diagnosis of influenza A(H1N1)2009 by Belgian sentinel laboratories during the epidemic phase

From 13 July onwards, the Interministerial Influenza Coordination Committee announced the switch from the containment phase to a mitigation phase due to the increased number of Influenza A(H1N1)2009 cases [1,2]. This modified approach means that it is no longer necessary to conduct a virological examination for every suspicious case and that the diagnosis relied on clinical criteria again. It also required the initiation of several surveillance systems allowing the follow-up of the infection. However, for some patients a virological confirmation was still needed due to their clinical evolution or clinical history. Because of the high amount of these requests, it was proposed to decentralise the diagnostic capacity from the Belgian National Influenza Centre (NIC) to a network of 'partner' laboratories. Therefore, all sentinel laboratories were invited to implement the diagnostic tests, to participate in epidemiological surveillance in the frame of the sentinel laboratory network, to participate in virological surveillance by sending laboratory results or strains to be further subtyped at the NIC. A network of 15 laboratories that responded favourably was thus installed and used as an additional tool for the virological surveillance of the Influenza A(H1N1)2009, allowing the identification of circulating types and subtypes. Here we report on the data gathered by this network for the period from week 40 to week 53 of 2009.

The Meanings of Timbuktu

Former South African president Thabo Mbeki took a proactive stand in recognizingthe significance and importance of Timbuktu’s rich AfricanMuslim scholarly legacy after he visited the city during his official visit toMali in November 2001. As a consequence of this trip, he initiated the SouthAfrica-Mali Timbuktu project, which was subsequently declared a special“South African President” project. Apart from deepening the relationsbetween these two nation-states, one extremely important outcome was theSouth African Department of Arts and Culture-supported conference held inCape Town in August 2005. The book under review, which consists of thepapers presented, was produced by Shamil Jeppie (advisor to SouthAfrica’s inter-ministerial committee, which is also responsible for this specialproject, and a historian based at the University of Cape Town) andSouleymane Bachir Diagne (professor of philosophy, Northwestern University[Illinois]).This invaluable text makes African scholarship proud and has injectednew life into Timbuktu and its manuscript tradition. The mere fact that it wasaesthetically produced and accompanied by appropriate eye-catching illustrationsis evidence that the editors took pride in compiling and editing materialthat would, upon first glance, attract the public eye. That said, the book itself is divided into five distinct sections consisting of twenty-four chapters,including the editors’ two introductory chapters ...

Ageing in India

About 7.6% of India’s population is above 60 years old. The elderly in India face multiple social, political, economic and cultural challenges including suboptimal financial security, decline of traditional extended family systems due to rural-urban migration of young people, and increasing costs of health care. In India, as is the case in many developing countries, the health systems are inadequate to promote, support and protect health and social well-being of the elderly due in part to lack of human and financial resources. The elderly find themselves exposed to harsh realities of globalization; changes in cultural values and beliefs, high disease burden from chronic noncommunicable diseases, and weak family and social welfare system. To address the health and welfare needs of this vulnerable section of society, the Government of India in 1999 developed and adopted the National Policy for Older Persons. A National Council for Older Persons and an Inter-Ministerial Committee was set up to implement the policy directions. To date, Government of India with its partners, have introduced various schemes and initiatives to promote and protect the welfare of the elderly. These initiatives include financial assistance for the construction of and maintenance of old peoples’ homes and non-institutional services to the elderly, as well as the provision of nutritious food and appropriate medical services. The Government of India, through the National Rural Health Mission has embarked on efforts to strengthen provision of primary health services and to reorient health care professionals from curative to preventive services at various levels. However, challenges remain for the health system, social welfare and health financing as the elderly population continue to rise.

A decision support system to compare different strategies for achieving the Italian Kyoto Protocol commitment

In order to meet the Italian Kyoto Protocol commitment, in 2002 the Interministerial Committee for Economic Planning (CIPE) approved the national allocation plan for the reduction of Greenhouse Gases (GHGs), envisioning various alternative scenarios. In this paper an extended impact assessment of the plan is accomplished and some further options are conceived and analysed in order to find an optimal trade-off among the different economic, environmental and social items at stake. After the selection of a set of independent indicators, nine different scenarios for the GHG reductions were evaluated and they were sorted according to the principles of the multicriteria analysis. The results of the evaluation process show that the preferable options are also the ones realising a good compromise between economic investment and reduction of GHG emissions. Although the model is necessarily affected by some subjective choices, it has a high level of transparency and scientific reliability.

Update on Implementation of GHS in Korea and Revision of Industrial Safety and Health Act in Relation to GHS

To implement the globally harmonized system of classification and labelling of chemicals (GHS) in Korea, an inter-ministerial GHS committee, involving 8 ministries and an expert working group composed of 9 experts from relevant organizations and one private consultant, have made some progress towards implementation by 2008. As such, the first revision of the official Korean translated version of the GHS in accordance with the GHS purple book revision 1 in 2005, including annexes, started in August, 2006, was completed in December, 2006. The Ministry of Labor also finally revised the Industrial Safety and Health Act (ISHA) relating to the GHS and the detailed notification was announced on Dec 12, 2006 and became effective immediately. The revised ISHA will allow continued use of the existing hazard communication system until Jun 30, 2008. Other revisions of chemical-related regulations will follow soon to facilitate the implementation of the GHS by 2008. Besides, inter-ministerial collaborative efforts on harmonizing regulations and disseminating the GHS in Korea will continue to avoid any confusion or duplication and for the effective use of resources.

The Impact of Article 39.3 in India: A Practical Perspective

During the negotiations of the Agreement on Trade Related Aspects of Intellectual Property (TRIPS) and following India’s accession to the World Trade Organisation (WTO), India adopted the position that Article 39.3 does not require that pharmaceutical test data be granted exclusivity for any period of time. However, as subsequent bilateral and free trade agreements between the United States and developing countries have impressed a reading of Article 39.3 requiring data exclusivity, India’s stand against such a regime has become much more subdued. The debate surrounding Article 39.3 has largely concentrated on textual interpretation and how to “balance” the investments by innovator companies against the interests of generic pharmaceutical manufacturers and public health. Given the ambiguity regarding what the minimum requirements of Article 39.3 are, commentators more recently have offered an alternative reading of the text, and have proposed that data exclusivity is not required by Article 39.3 but that “compensatory liability” is. While this new textual interpretation may not be accurate, it is being raised as a possible way to appease those Member States demanding a strict data exclusivity regime. An Inter-Ministerial Committee, set up in 2004 to decide on how to implement Article 39.3 of TRIPS, recently convened a meeting which tabled a number of proposals and recommendations, including the payment of a royalty to the originator of the data. However, many of the proposals and recommendations appear to have been made in the abstract, without examining the practical implications a data exclusivity regime would have on actual medicines on the market today. Due to this gap in the ongoing discussions, a different perspective addressing these practical realities is necessary. Decision makers and stakeholders need to be aware of the potential pitfalls of proposals that may seem attractive on paper but have the potential to become problematic in practice. This paper is premised on the assumption that the reader already has an understanding of the academic and legal discussions around Article 39.3. We have set out below a consolidated analysis of the current debate in India, this time with a view toward the practical effects of the various proposals. Using examples of medicines that are already on the market, and some which do not yet have marketing approval in India, we attempt to demonstrate how the current proposal of a three-year data exclusivity period would impact access to these medicines. Additionally, we provide analysis and recommendations relating to the current proposals being considered, which we hope will provide further thought to the debate.

Financing the culture in Italy

The paper deals with financing the culture in Italy. The public expenses for the culture are shared as expenses of the government, of the regions, of the provinces and of the municipalities. The relationships of the cultural organisations with the public sector are very strong because they belong to the public sector, or they broadly depend on public funds. A specific attention is devoted to other forms of financing, about the role of the entrance fees and the entrances of the game “Lotto”, which subsidy the cultural goods and the Interministerial Committee for the Economic Planning (CIPE) allocations to the depressed areas. We will also be faced up to the examination of other sources of private financing as the sponsorships, the entrances of collateral services about museum visits (coffee and bookstore) and the supply of banking foundations. The fiscal incentives refer directly to the cultural institution or to the external financing of the nonprofit institutions by donations or sponsorships. Finally, the cultural institutions will have always to operate more and more by a strategic vision of financial and managerial field, on the basis of high qualitative standards. The activities and cultural projects will have to be able to attract additional sources of income in addition to the public one; the search of private financial resources is developed in a situation of increasing competition among the institutions, while tools of innovative finance have to be used to satisfy the increasing demand of culture. It is difficult nevertheless to define the possible best method of public–private financing, if you take consideration of the distinctive features of the different institutions and interests of the operators who are involved: artists, cultural institutions, public bureaucracy, besides the economic effects which follow alternative choices. The recent evolution of the institutional, financial and managerial models of the culture in Italy plans a larger integration between public and private sectors for a great involvement of individuals, enterprises and foundations about the financing of the cultural services offer.

France: alcohol today

France: alcohol today

Planning Contracts in Southern Italy, 1986-1997: A Preliminary Evaluation

In this paper we analyse the so called which were adopted by the Italian Government in 1986 to promote industrial development in the South, that is the least favoured area of the country. The paper is organised in two sections. First, we present a full and detailed picture of the planning contracts as they stood in December 1997, reconstructed on the basis of the CIPI (Inter-ministerial committee for industrial policy) and CIPE (Inter-ministerial committee for economic planning) deliberations and discuss the degree to which investment plans and objectives of regional policy coincide. Second, we attempt a stylisation by means of a simplified model. The aim of the exercise is basically to make some considerations of a methodological nature of the coherence between the contractual plan and the objectives of regional policy which should be pursued through the instrument of the planning contracts. The conclusions of our paper underline that interest in the planning contracts can be attributed to the offer of a public incentive which is agile and designed as far as possible to suit the specific case, so that it may attract productive capital from stronger areas to the less developed ones. However we suggest that the requisites of the planning contract need to be reformulated. In particular, the outpayments should be linked, at least in part, to progress made towards the objectives of the policy of technological and employment re-balancing. In this way the management will not inflate employment in the first period and reduce it when its contractual commitment expires. In this sense the ex-ante, initinere and ex-post evaluation mechanisms for the planning contracts would need to be thoroughly reconsidered.

Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000–January 2001)

Introduction: The Ebola virus, belonging to the family of filoviruses, was first recognized in 1976 when it caused concurrent outbreaks in Yambuku in the Democratic Republic of Congo (DRC), and in the town of Nzara in Sudan. Both countries share borders with Uganda. A total of 425 cases and 224 deaths attributed to Ebola haemorrhagic fever (EHF) were recorded in Uganda in 2000/01. Although there was delayed detection at the community level, prompt and efficient outbreak investigation led to the confirmation of the causative agent on 14 October 2000 by the National Institute of Virology in South Africa, and the subsequent institution of control interventions. Control interventions: Public health interventions to contain the epidemic aimed at minimizing transmission in the health care setting and in the community, reducing the case fatality rate due to the epidemic, strengthening co-ordination for the response and building capacity for on-going surveillance and control. Co-ordination of the control interventions was organized through the Interministerial Committee, National Ebola Task Force, District Ebola Task Forces, and the Technical Committees at national and district levels. The World Health Organization (WHO) under the Global Outbreak Alert and Response Network co-ordinated the international response. The post-outbreak control interventions addressed weaknesses prior to outbreak detection and aimed at improving preparations for future outbreak detection and response. Challenges to control efforts included inadequate and poor quality protective materials, deaths of health workers, numerous rumors and the rejection of convalescent cases by members of the community. Conclusions: This was recognized as the largest reported outbreak of EHF in the world. Control interventions were very successful in containing the epidemic. The community structures used to contain the epidemic have continued to perform well after containment of the outbreak, and have proved useful in the identification of other outbreaks. This was also the first outbreak response co-ordinated by the WHO under the Global Outbreak Alert and Response Network, a voluntary organization recently created to co-ordinate technical and financial resources to developing countries during outbreaks.

An Indian national GEF strategy

This paper describes the process of developing a national strategy for preparing, processing, implementing, monitoring and evaluating GEF projects in India. The Ministry of Environment and Forests, Government of India, requested the paper. A brainstorming meeting was organized to kick off discussions for the preparation of the strategy. Subsequently, several interviews were conducted in New Delhi with officials familiar with preparation and execution of GEF projects. The draft strategy was presented to the government in December 2002. The strategy identified the problems plaguing the current portfolio of GEF projects in India such as lack of impact, a stagnating portfolio with too many incoherent concepts and a lack of interest in GEF Council meetings. The paper proposes measures to address the identified problems and recommends actions to implement the elements of the strategy. Several of the recommendations such as the establishment of an interministerial coordination committee for GEF projects and the decoupling of the office of GEF Council Member from South Asia from the office of the Indian Executive Director of the World Bank have been accepted by the government.

News and Notes: 2

News and Notes: 2

Sur les traces de l'expertOn the track of the expert

The collective risk situations put the settings of expertise to the test. In this paper, we study the activity of the french interministerial committee called for answering the problems caused by the bovine spongiform encephalopathy. The analyse of the activity of expertise is focused on the rules and the procedures mobilized by the experts to produce their advices, without separating their production from the framewok of justification of the governmental action. We show how this committee formed a collective producer of documents in order to leave traces of the way he carries out his mission, and particularly his relationships with his administrative supervision through a game of written questions and answers. Les situations de risque collectif mettent à l'épreuve les dispositifs d'expertise. Dans cet article, nous étudions l'activité du comité interministériel français convoqué pour répondre aux problèmes posés par l'encéphalopathie spongiforme bovine. L'acte d'expertise est analysé à partir des règles et des procédures mobilisées par les experts pour produire leurs avis, sans séparer la production de ceux-ci du cadre de justification dans lequel s'inscrit l'action publique. Nous montrons comment le comité s'est constitué en collectif producteur d'écrits d'action afin de laisser des traces de l'exercice de sa mission.

Japan may lift industry-academy barrier

tokyo Japan has announced plans to set up an inter-ministerial committee to explore ways of giving university researchers more freedom to work in collaboration with industry.