Faculty of Arts and Social Sciences, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK.
Department of Science, Technology, Engineering and Public Policy, University College London, London W1T 6EY, UK.
Health Policy Plan. 2018 May 1;33(4):602-610. doi: 10.1093/heapol/czy022.
The benefits of local production of pharmaceuticals in Africa for local access to medicines and to effective treatment remain contested. There is scepticism among health systems experts internationally that production of pharmaceuticals in sub-Saharan Africa (SSA) can provide competitive prices, quality and reliability of supply. Meanwhile low-income African populations continue to suffer poor access to a broad range of medicines, despite major international funding efforts. A current wave of pharmaceutical industry investment in SSA is associated with active African government promotion of pharmaceuticals as a key sector in industrialization strategies. We present evidence from interviews in 2013-15 and 2017 in East Africa that health system actors perceive these investments in local production as an opportunity to improve access to medicines and supplies. We then identify key policies that can ensure that local health systems benefit from the investments. We argue for a 'local health' policy perspective, framed by concepts of proximity and positionality, which works with local priorities and distinct policy time scales and identifies scope for incentive alignment to generate mutually beneficial health-industry linkages and strengthening of both sectors. We argue that this local health perspective represents a distinctive shift in policy framing: it is not necessarily in conflict with 'global health' frameworks but poses a challenge to some of its underlying assumptions.
非洲本地生产药品对于当地获得药品和有效治疗的好处仍存在争议。国际卫生系统专家对撒哈拉以南非洲（SSA）生产药品能否提供具有竞争力的价格、质量和供应可靠性持怀疑态度。与此同时，尽管国际上做出了重大资金投入，但非洲低收入人群仍然难以广泛获得各种药品。目前，制药业在 SSA 的投资浪潮与非洲政府积极推动制药业成为工业化战略的关键部门有关。我们提供了 2013-15 年和 2017 年在东非进行的访谈的证据，表明卫生系统行为者认为这些本地生产投资是改善药品供应和获取的机会。然后，我们确定了可以确保本地卫生系统从投资中受益的关键政策。我们主张采取“本地卫生”政策视角，该视角由接近度和定位性概念构建，与本地优先事项和独特的政策时间尺度合作，并确定激励一致性的范围，以产生互利的卫生-产业联系，并加强两个部门。我们认为，这种本地卫生视角代表了政策框架的显著转变：它不一定与“全球卫生”框架冲突，但对其一些基本假设构成了挑战。
