Maïga Fatoumata Ina, Haddad Slim, Fournier Pierre, Gauvin Lise
Groupe de Recherche Interdisciplinaire en Santé, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Qué., H3C 3J7 Montréal, Canada.
Soc Sci Med. 2003 Sep;57(5):937-48. doi: 10.1016/s0277-9536(02)00462-8.
Many African countries have introduced cost recovery mechanisms based on the sale of drugs and measures aimed at improving drug supply. This study compares prescribing and selling practices in Mali, in 3 cities where the public sector contributes differentially to the supply of drugs on the market. Multilevel models are used to analyse the content and cost of 700 medication transactions observed in 14 private and public legal points of sale. Results show that the objective of improving access to drugs seems to have been achieved in the sites studied. Costs of prescriptions were lower where public health services had been revitalized. Affordable generic drugs were accessible and widely used, even in the private sector. However, measures intended to rationalize the prescription and delivery of drugs did not always have the desired effect. While agents in the public sector tended to prescribe fewer antibiotics, injectables, or brand-name drugs, the data confirm the virtual absence of advice concerning the use or the side effects of the drugs in both public and private sectors. In addition, data supported the notion that the public and private sectors are closely intertwined. Notably, availability of drugs in the public sector contributed to diminishing the prices charged in the private sector. Similarly, the use that agents in the public sector made of the opportunities afforded by the presence of the private pharmaceutical sector provided another illustration of interrelatedness. Finally, the data showed that the presence of a private sector, which has not been affected by measures aimed at rationalizing prescription and sales practices, limits the effects of measures implemented in the public sector. More assertive policies, based on strategies encompassing actors in the private sector, are needed to increase the safety and effectiveness of prescription and sales practices.
许多非洲国家已引入基于药品销售的成本回收机制以及旨在改善药品供应的措施。本研究比较了马里3个城市的处方和销售做法，在这3个城市中，公共部门对市场药品供应的贡献各不相同。采用多层次模型分析在14个合法的公私销售点观察到的700笔药品交易的内容和成本。结果表明，在所研究的地点，改善药品可及性的目标似乎已经实现。在公共卫生服务得到振兴的地方，处方成本较低。即使在私营部门，也可获得并广泛使用价格亲民的仿制药。然而，旨在使药品处方和供应合理化的措施并非总能达到预期效果。虽然公共部门的药剂师往往较少开抗生素、注射剂或名牌药品，但数据证实，公私部门在药品使用或副作用方面几乎都没有提供相关建议。此外，数据支持了公私部门紧密交织的观点。值得注意的是，公共部门的药品供应有助于压低私营部门的收费价格。同样，公共部门的药剂师利用私营制药部门带来的机会，这是相互关联的另一个例证。最后，数据表明，未受处方和销售做法合理化措施影响的私营部门的存在，限制了公共部门实施措施的效果。需要基于涵盖私营部门行为体的战略制定更坚定有力的政策，以提高处方和销售做法的安全性和有效性。
