046:127 Pharmaceutical Management for Underserved Populations

Introduction to Course Global and Local Context for

Pharmaceutical Products for Underserved Populations

Class Period #1, 17 January 2007Prof. Hazel H. Seaba

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• How to contact me• Course time, building• Grading: assignments, not examinations

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Course is new and being offered for the first time

• What does a new course mean for the students?• Why is it being taught?

– Context for course• Crisis Montage: courtesy of Maureen McCue, MD, PhD,

Coordinator Iowa Physicians for Social Responsibility, Adjunct Clin Prof in Public Health and Anthropology

• Why is course content important?– World Shrink– World health care worker crisis: WHO [source for following WHO slides]

• Unique relationship with Management Sciences for Health (MSH)

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Crisis Montage

Reflection:1.How does this montage make you feel?

2.What does it make you want to learn?

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Why is this Course Important?• Point 1: In a global society, the health of every human being is

relevant to each of us.• Point 2: Prosperity is inextricably linked to health, so it is in our

interest to improve the health of underserved populations.

• Point 3: By reducing human suffering, improved health can contribute to political stability and, in turn,

make other nations more secure.• Point 4: By increasing productivity, improved health can reduce the

need for domestic and/or foreign aid and contribute to international prosperity.

• Point 5: The world is wealthy enough to be able to afford aid• Point 6: We need to honor commitments we have already made.• Point 7: Local and global health interventions work.• Point 8: Improving the health of all people is the right thing to do.

Adapted and taken from:Rx for Survival — A Global Health Challenge, Co-Production of the WGBH/NOVA Science Unit and Vulcan Productions, Inc.http://www.pbs.org/wgbh/rxforsurvival/series/matters/index.html

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Course is new and being offered for the first time

• What does a new course mean for the students?• Why is it being taught?

– Context for course• Crisis Montage: courtesy of Maureen McCue, MD, PhD,

Coordinator Iowa Physicians for Social Responsibility, Adjunct Clin Prof in Public Health and Anthropology

• Why is course content important?– World Shrink– World health care worker crisis: WHO

• Unique relationship with Management Sciences for Health (MSH)

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Course Structure

Framework Provided by:1. Drug and Health

Commodity Management Cycle

2. Access and Potential Barriers

– 17 week class period schedule in syllabus

– Textbook: Managing Drug Supply, 2nd Edition• Readings• Organization of book and

chapters– Assignments

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“Underserved Populations”

International Society for Equity in Health, at its inauguralmeeting in Havana in June 2000, adopted the following

definition:Equity in health is the absence of systematic and potentially remediable differences in one or more aspects of health across socially, demographically, or geographically defined populations or population subgroups.(Conversely, inequity in health is the presence of such differences.)

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Equity

“Equity refers to the fair distribution of the costs of health services and the benefits obtained from their use among different groups in the population.”

• Horizontal equity– Equal treatment of equals

• Vertical equity– Individuals who are unequal in society should be treated

differently

International Public Health, 2nd Ed, p517.

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Equity: Financing

• Horizontal– Equal payment by those

with equal ability to pay, e.g. same insurance premium for same income group.

• Vertical– Payment in relation to

ability to pa, e.g. progressive income tax rates

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Equity: Allocating Resources

• Horizontal– Services purchased for

similar groups, e.g., the elderly, should be the same in different geographic areas

• Vertical– Services purchased should

reflect the different needs of different groups, e.g., the elderly versus children

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Equity: Providing Services

• Horizontal– Equal access for equal

need, e.g., equal waiting time for treatment for patients with similar conditions

• Vertical– Unequal treatment for

unequal need, e.g., unequal treatment of those with trivial versus serious conditions

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“Underserved Populations”

National Institutes of Health definition of health disparity:“the differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States.”

National Center on Minority Health and Health Disparities (NCMHD) http://ncmhd.nih.gov/

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Course Structure

Framework Provided by:

1. Drug and Health Commodity Management Cycle

2. Access and Potential Barriers

– 17 week class period schedule in syllabus

– Textbook: Managing Drug Supply, 2nd Edition• Readings• Organization of book

and chapters

– Assignments

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Why Manage the Drug Supply?

1. Essential drugs are critical to the success of health programs

2. Improving the management of drug supply is a high-leverage opportunity to improve health services

3. Knowledge and experience concerning effective drug management are spreading rapidly worldwide, but they remain disparate, un-synthesized and frequently unavailable to decisions-makers.

MDS-2 p x.

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Drug and health commoditymanagement cycle

Selection

Procurement

Distribution

Use

Policy and Legal Framework

Management

Support

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Drug and health commoditymanagement cycle

Selection

Procurement

Distribution

Use

Policy and Legal Framework

Management

Support

•Organization•Financing•Information Mgt •Human Resources

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• BioShield makes little progress four years after creationFour years and $5.6 billion later, the nation's BioShield effort aimed at creating stockpiles of drugs to deal with bioterrorism attacks has made little progress. The program is still months away from releasing its first plan on how it intends to buy drugs, and how many of what types of drugs it plans to stockpile. The Washington Post 

• http://www.washingtonpost.com/wp-dyn/content/article/2007/01/15/AR2007011501142.html Tuesday, January 16, 2007; Page D01

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Framework for access toessential health commodities and services

Acceptability

Geographic Accessibility

Affordability

Availabilityx

SafeEfficacious

Cost-EffectiveQuality

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The Special Importance of Drugs

• Drugs save lives and improve health• Drugs promote trust and participation in health

services• Drugs are costly• Drugs are different from other consumer products• Substantive improvements in the supply and use

of drugs are possible

25http://www.imshealth.com/vgn/images/portal/cit_40000873/3/51/79869408Drug%20Monitor%20August.pdf

26Source: WHO, 2004

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Lessons Learned in Drug Management

1. National drug policy provides a sound foundation for managing drug supply.

2. Wise drug selection underlies all other improvements.

3. Effective management saves money and improves performance.

4. Rational drug use requires more than drug information.

5. Systematic assessment and monitoring are essential.

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Assignment #1. Global Health Council

The University of Iowa is an institutional member of the Global Health Council and our students are eligible to enroll as Associate Professional members. Please follow this link: http://globalhealthcouncil.biz/ScriptContent/custom/

APEnrollment.cfmand sign up to start accessing this wonderful resource. Use your UI HawkID, select The University of Iowa GHSP as the institutional affiliation, and give your UI email address. Once you are a member, sign up for the newsletter.

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Assignment: #2 Four Questions

• Due: send to course ICON drop box by end of Sunday, January 21