Fighting poor-quality medicines in low- and middle-income countries: the importance of advocacy and pedagogy

Abstract

The globalization of pharmaceutical production has not been accompanied by a strengthening and harmonization of the regulatory systems worldwide. Thus, the global market is characterized today by a situation of multiple standards, and patients in low- and middle-income countries are exposed to the risk of receiving poor-quality medicines. Among those who first raised the alarm on this problem, there were pioneering humanitarian groups, who were in a privileged position to witness the gap in quality of medicines between high-income countries and low- and middle-income countries.Despite an increasing awareness of the problem and the launch of some positive initiatives, the divide in pharmaceutical quality between the North and the South remains important, and insufficiently addressed. More advocacy is needed for universal access to quality-assured medicines. It should target all those who are strongly “involved” with medicines: regulators, international organizations, journalists, purchasers, prescribers, program managers, policy makers, public health actors and the patients. Advocacy should be based on evidence from research and monitoring programs, and technical concepts should be translated in lay language through communication tools that address all the stakeholders. The fight to ensure universal access to quality medicines needs the participation of all, and can only be successful if grounded in common understanding.

An Investigation of First-Year Students' and Lecturers' Expectations of University Education

“…Current findings suggest a potential for common understanding, e.g., both students and lecturers endorsed regular lecture attendance and positive engagement during lectures as being expected when studying at university. This is in line with previous research (e.g., Crisp et al, 2009 ), but also contradictory to observed trends at university which have seen increasing rates of non-attendance at lectures (Cleary-Holdforth, 2007 ; Field, 2012 ) and a need for provisions such as online lecture repositories and increasing e-resources being requested by students. Yet, there are also quite significant differences, suggesting disparate views of what a successful academic career, or successful academic progression, means.…”

“…Longden ( 2006 ) showed that over 40% of their sample of first-year students were working alongside their studies, with 10% of the sample working more than 20 h per week. The need for students to undertake paid work has been implicated in rates of non-attendance at lectures, which is a growing problem in HE (Cleary-Holdforth, 2007 ; Field, 2012 ). This is interesting because students recognize that attendance at lectures and other teaching sessions is important for their academic performance (Crisp et al, 2009 ).…”

Quality of medicines in resource-limited settings: need for ethical guidance

“…This approach comes at the risk of practical failure due to insufficient skills and/or power to effectively change the current situation. The experience of advocates of access to medicines, however, shows that it is possible to create a powerful advocacy movement which can trigger important changes (Ravinetto et al., 2016 ).…”

The Belgian commitment to pharmaceutical quality: a model policy to improve quality assurance of medicines available through humanitarian and development programs

“…Poor-quality medicines harm individuals, who either don’t get cured or become victims of potentially serious adverse events; they harm public health, by contributing to resistances to anti-infective medicines; and they harm health systems, by eroding public trust in medicine and causing waste of resources [1, 2]. The “perfect conditions” for poor-quality medicines to penetrate the poorer, less-regulated countries are created by an unfortunate combination of globalization of production/distribution, lack of global regulatory harmonization, erratic supply, weakness of National Medicines Regulatory Authorities (NMRAs) in many low-income countries (LICs), and complexity of the supply chains [3–6].…”