Access : how do good health technologies get to poor people in poor countries?
Laura J. Frost & Michael R. Reich.
Published in the Harvard Series on Population and International Health, 2008
Available online PDF [264p.] at: http://www.accessbook.org/download/AccessBook.pdf
“…..Many bottlenecks thus block access to health technologies in developing countries. Sometimes the barriers seem to overwhelm all efforts to expand access
to beneficial health technologies.
A growing literature examines the challenges that confront efforts to address particular barriers (such as pricing or patents or end-user demand). As part of this project, we conducted a literature review on specific barriers to access and produced an annotated bibliography of 44 selected recent articles.4 But few studies have comprehensively explored the many social, economic, political, and cultural processes that shape access to health technologies in developing countries—including how such technologies are perceived differently by key players.
Despite progress with placing access to medicines on the global policy agenda, enormous problems persist in the access gap for all sorts of health technologies— not just medicines. While the most contentious debates have focused on drugs and vaccines, similar problems exist for other kinds of health technologies.
The problems with access to diagnostics, for example, have remained relatively unexplored in policy debates. And the focus on certain types of access barriers (especially pricing and patents) has tended to obscure other important barriers to access, such as distribution, delivery, and adoption problems. Too often, the assumption has been that once a medicine is included in a list of essential medicines, the problems of access are solved.
This perspective overlooks the problems of distribution, delivery, and demand. For instance, even after praziquantel (the medicine for treatment of schistosomiasis) declined in price during the 1990s, serious problems of access persisted, especially in the poorest countries of the world (where the disease existed). When patents for praziquantel expired, more producers entered the global market, but these changes alone did not produce access. In chapter 3, we explore what happened with praziquantel, why problems in access persisted, and what has recently changed to improve the situation.
This book explores the challenges and approaches to improving access to health technologies for poor people in poor countries. Our goals are to develop and illustrate a way to think systematically about the barriers to access and to identify strategies that can help improve access……”
CHAPTER 1, The Issue of Access
CHAPTER 2, The Access Framework
CHAPTER 3, Praziquantel: Access to Medicines
CHAPTER 4, Hepatitis B Vaccine: Access to Vaccines
CHAPTER 5, Malaria Rapid Diagnostic Tests: Access to Diagnostics
CHAPTER 6, Norplant: Access to Contraceptives
CHAPTER 7, Vaccine Vial Monitors: Access to Devices
CHAPTER 8, Female Condoms: Access to Dual Protection Technologies
CHAPTER 9, Synthesis: No Success Without Access
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