ObjectivesMedicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context.MethodsSemi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data.ResultsIn total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training.ConclusionsThe situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.

Background In low-income countries breast cancer awareness (BCA) is essential to reduce the proportion of advanced stage presentations of breast cancer. There is a lack of studies using multivariable techniques to explore factors related to BCA in low-income countries. The objective of this study was to identify to what extent women in Fiji and Kashmir, India have BCA and practice breast self-examination (BSE) as well as factors associated with BCA and BSE. Methods A survey of women aged ≥18 years was conducted in Fiji and Kashmir, India to assess BCA and rates of BSE. Comparison between Fiji and Kashmir was done using student’s t-test for continuous data and chi-square for binary data. Factors associated with BCA and BSE were analysed using a multivariable logistic regression for Fiji and Kashmir separately. Results Data were collected from 399 and 1982 women in Kashmir and Fiji, respectively. Of 1968 women in Fiji 57% were deemed to have an acceptable BCA compared to only 7.3% of 395 women in Kashmir. Having some education was associated with having BCA with an odds ratio of 4.7 (1.7–13) in Fiji and 10 (1.7–59) in Kashmir. Of 1976 women in Fiji 40% had tertiary education while 40% of 392 women in Kashmir had no education at all. The marital status was similar in both samples (n = 1973 and 395) with 68–69% being married and 21–26% being single. The lack of female doctors or nurses with whom to discuss issues, was perceived as a problem in both countries. Conclusions The key finding is an association between having any level of education and BCA. This correlation was much stronger than for a family history of breast cancer and BCA. Hence, general education to illiterate women may reduce the proportion of women in low-income countries presenting with advanced-stage breast cancer.

Objective. To investigate the alignment between the course and topic outcomes of a third (course 1) and fourth (course 2) year pharmacotherapy curriculum.Methods. Each topic is categorised into subtopics and each subtopic has a set of learning outcomes.Learning outcomes for the courses and subtopics were matched to examine alignment. Cognitive levels were categorized according to the SOLO taxonomy of prestructural, unistructural, multistructural, relational or extended abstract. The types of knowledge were also categorised as declarative or functioning.Results. There were eight explicit course outcomes for each course and 140 subtopic outcomes for course 1 and 136 for course 2. Wide variations in alignment between the courses and subtopic outcomes were found. Issues identified included the use of redundant verbs, and insufficient alignment and balance of the cognitive levels and knowledge types embedded in each outcome. Conclusion.Alignment between the course and subtopic outcomes is not optimal. Using a constructive alignment analysis, learning outcome issues that need improvement for course alignment have been identified. The methodology can be applied to other courses to promote effective curriculum design.