为什么千年发展目标需要良好的药品体系治理来促进全球健康。
Why the MDGs need good governance in pharmaceutical systems to promote global health.
机构信息
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto M5S 3 M2, ON, Canada.
出版信息
BMC Public Health. 2014 Jan 21;14:63. doi: 10.1186/1471-2458-14-63.
BACKGROUND
Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why.
DISCUSSION
Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward.
SUMMARY
Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and responded to with global cooperation and innovation to establish localized and evidence-based metrics for good governance to promote global pharmaceutical safety.
背景
医疗领域的腐败会损害卫生服务的成效。改善善治可反过来有助于防止与卫生相关的腐败。我们将善治定义为具有以下特征：以共识为导向、负责、透明、响应、公平和包容、有效且高效、遵循法治、参与式，理论上不易受腐败影响。我们通过关注药品体系，探索了从善治现有举措中吸取的一些关键经验教训。随着发展界开始确定 2015 年后千年发展目标的具体目标，必须对善治方案进行评估，以便巩固这些成果并建立可持续战略。对药品体系的这一讨论阐明了原因。
讨论
我们考虑了诸如世界银行、世界卫生组织和全球基金开展的药品治理举措，认为国家对善治举措的自主权至关重要，但任何举措都必须包括公正利益攸关方的参与。了解任何举措的政治背景也至关重要，这样才能发现潜在障碍，并使任何举措的设计具有足够的灵活性，以便根据需要对方案规划进行调整。最后，所有举措都面临着固有挑战，即难以充分衡量任何努力的成果。但是，公平地说，确定善治与卫生成果之间的确切关系并不总是那么简单。
总结
药品治理举措中发现的挑战根据举措的性质和结构以不同形式表现出来，但它们对基于人群的卫生的影响日益显著，这表明需要将药品治理作为 2015 年后千年发展目标的一个关键组成部分来处理。具体而言，需要通过全球合作和创新来承认和应对这些挑战，为善治建立本地化和基于证据的指标，以促进全球药品安全。
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