Department of Community Health Sciences and Women & Child Health Division, Aga Khan University, Karachi, Pakistan.
PLoS One. 2013 May 22;8(5):e63515. doi: 10.1371/journal.pone.0063515. Print 2013.
Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns.
An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable.
A synthesis of evidence found major gaps in essential medicine access in Pakistan driven by weaknesses in the health care system as well as weak pharmaceutical regulation. 7 major policy concerns and 11 emerging research concerns were identified through consultative Roundtable. These related to weaknesses in medicine registration and quality assurance systems, unclear and counterproductive pricing policies, irrational prescribing and sub-optimal drug availability. Available research, both locally and globally, fails to target most of the identified policy concerns, tending to concentrate on irrational prescriptions. It overlooks trans-disciplinary areas of policy effectiveness surveillance, consumer behavior, operational pilots and pricing interventions review.
Experience from Pakistan shows that policy concerns related to essential medicine access need integrated responses across various components of the health systems, are poorly addressed by existing evidence, and require an expanded health systems research agenda.
发展中国家普遍存在基本药物获取不足的问题。除其他因素外，政策应对受到深入的国家层面证据匮乏的限制。我们在此分享巴基斯坦获取基本药物的渠道存在的差距，以及新兴政策和研究关注点的优先级。
采用卫生系统视角，运用世卫组织公平获取基本药物框架，开展了一项探索性研究。方法包括与政策制定者、提供者、行业、非政府组织、专家和发展伙伴进行关键知情人访谈、审查已发表和灰色文献、以及在利益相关者圆桌会议上进行协商性优先级排序。
综合证据表明，巴基斯坦基本药物获取方面存在重大差距，这是由医疗保健系统的弱点以及薄弱的药品监管造成的。通过协商圆桌会议确定了 7 个主要政策关注点和 11 个新出现的研究关注点。这些问题涉及药品注册和质量保证体系薄弱、定价政策不明确和适得其反、不合理处方和药物供应不足。国内外现有的研究都未能针对大多数确定的政策关注点，往往集中于不合理处方。它忽略了政策效果监测、消费者行为、运营试点和定价干预措施审查等跨学科领域。
来自巴基斯坦的经验表明，与基本药物获取相关的政策关注点需要在卫生系统的各个组成部分之间采取综合应对措施，而现有证据对此处理不佳，需要扩大卫生系统研究议程。
