Summaryobjective To assess the effectiveness of pharmaceutical systems interventions in improving the availability of essential medicines at the primary care level.methods Literature search for examples of pharmaceutical systems interventions in low and middle income countries that evaluated the impact of specific interventions on medicines' availability. Qualitative and quantitative studies were included.results Seventeen studies were included, on privatisation of drug distribution, user-fees, revolving drug funds (RDFs), supervisory visitation programmes, staff training initiatives, community-directed interventions (CDIs) and disease-specific drug programmes. We found no studies on non-monetary staff incentives or the use of national pharmacy standards. Generally, the quantity and quality of evidence was low; evidence was strongest for supervisory visitation programmes and CDIs.conclusion Several interventions have the potential for improving medicines' availability without requiring large-scale international cooperation or global policy change. The absence of evidence in this field does not prove lack of effect. There is a need for more systematic studies of multi-faceted pharmaceutical interventions to improve drug availability in the context of difficult health systems, such as structured supervision of remote health facilities, CDIs, staff training, integration of disease-specific programmes, implementation of national pharmacy standards, non-monetary staff incentives and measures to ensure cost is not a barrier to access. A standardised approach to measuring the availability of essential medicines is needed.

Background Australia's closest neighbours in the Western Pacific face many procurement, distribution and regulatory challenges providing patients with quality pharmaceuticals on limited budgets. This study tested the hypothesis that some antibiotics being used within the healthcare systems of Papua New Guinea, Vanuatu and the Solomon Islands were substandard, and through this pilot project explored challenges and constraints around collaborative regional pharmaceutical quality testing opportunities. Methods A list of 11 commonly used and ‘essential’ acute care intravenous and oral antibiotic products was compiled. A purposive sample of 20 units of each listed medicine was collected at the earliest possible point of the supply chain within the three participating nations. These samples were transported to Australia for analysis. Results All oral and intravenous product samples complied with uniformity of mass standards, except for oral amoxicillin from Country 3. Most antibiotics showed uniformity of content except for cloxacillin. Conclusion Most samples met quality standards, except for cloxacillin, which failed dramatically and this may indicate increased susceptibility to degradation in tropical settings. Although the results are reassuring compared with recent studies of pharmaceutical quality in this region, products of substandard quality were identified. The issues encountered in the timely testing of samples demonstrate the need for innovative solutions to promote pharmaceutical quality assurance, particularly in resource‐limited settings. Strategic regional cooperation could greatly increase testing capability for Small Island Nations, benefiting the most vulnerable populations and strengthening antibiotic stewardship across the region.

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Tuvalu is one of the smallest and most remote countries in the world. Due partly to its geography, the limited availability of human resources for health, infrastructure weaknesses, and the economic situation, Tuvalu faces many health systems challenges to delivering primary health care and achieving universal health coverage. Advancements in information communication technology are anticipated to change the face of health care delivery, including in developing settings. In 2020 Tuvalu commenced installation of Very Small Aperture Terminals (VSAT) at health facilities on remote outer islands to allow the digital exchange of data and information between facilities and healthcare workers. We documented the impact that the installation of VSAT has had on supporting health workers in remote locations, clinical decision-making, and delivering primary health more broadly. We found that installation of VSAT in Tuvalu has enabled regular peer-to-peer communication across facilities; supported remote clinical decision-making and reduced the number of domestic and overseas medical referrals required; and supported formal and informal staff supervision, education, and development. We also found that VSAT’s stability is dependent on access to services (such as a reliable electricity supply) for which responsibility sits outside of the health sector. We stress that digital health is not a panacea for all health service delivery challenges and should be seen as a tool (not the solution) to support health service improvement. Our research provides evidence of the impact digital connectivity offers primary health care and universal health coverage efforts in developing settings. It provides insights into factors that enable and inhibit sustainable adoption of new health technologies in low- and middle-income countries.

Objective The objective of the study was to determine if the World Health Organization's (WHO) 31 Priority Medicines for Mothers and Children are included in the Essential Medicines Lists (EML) of Pacific Island Countries (PICs). Methods EMLs from all PICs were sought. These were reviewed to determine if the priority medicines were listed in clinically appropriate doses for the age and indication in the WHO priority list. Key findings EMLs were sourced from 11 countries, representing 89% of the total PIC population. All countries had most of the priority items listed in its EML, but no country included the whole list; the overall inclusion of items listed on national EMLs ranged from 22/31 (71%) to 30/31 (97%). The average inclusion of items was 80.4%. 16 priority medicines were included in every country's EML. Conclusion The results suggest that treatment guidelines for Child and Maternal Health are not up‐to‐date in all countries or that vertical programme supply systems may not be fully incorporated into existing country mechanisms. Further support should be given to national drugs and therapeutics committees and essential medicines processes in the PICs.