Joosse Iris R, van den Ham Hendrika A, Mantel-Teeuwisse Aukje K, Perumal-Pillay Velisha A, Suleman Fatima
Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
J Pharm Policy Pract. 2024 Jul 12;17(1):2372033. doi: 10.1080/20523211.2024.2372033. eCollection 2024.
We sought to identify what barriers and facilitators determine current perceived access to childhood cancer care in South Africa through in-depth interviews with stakeholders in South Africa's public and private sectors.
Qualitative semi-structured interviews were conducted with 29 key health system stakeholders, including policy-makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers and facilitators in access to medicines and broader care were structured according to the pharmaceutical value chain (PVC).
Barriers and facilitators were identified across all components of the PVC. Key barriers included (1) a lack of political commitment to childhood cancers, (2) discontinuation of essential chemotherapeutics, (3) incomplete insurance coverage for childhood cancers, (4) stock-outs of essential medicines, (5) the inability to access care, including travel to healthcare facilities and (6) low awareness on childhood cancers among primary healthcare (PHC) workers. Proposed priority interventions included pricing flexibilities, increased transparency and consistency in decision-making and healthcare spending, and improved training of PHC staff, nurses and pharmacists on childhood cancers.
This first comprehensive study of determinants of access to medicines used in childhood cancer in South Africa provides context-specific evidence for targeted policy development.
我们试图通过对南非公共和私营部门的利益相关者进行深入访谈，确定哪些障碍和促进因素决定了目前南非儿童癌症护理的可及性。
对29名关键的卫生系统利益相关者进行了定性半结构化访谈，包括政策制定者和监管者、医疗保险计划提供信息者、药品供应商、医疗服务提供者和民间社会利益相关者。根据药品价值链（PVC）对确定的药品和更广泛护理获取方面的障碍和促进因素进行了结构化分析。
在PVC的所有组成部分中都确定了障碍和促进因素。主要障碍包括：（1）对儿童癌症缺乏政治承诺；（2）基本化疗药物停产；（3）儿童癌症保险覆盖不完整；（4）基本药物缺货；（5）无法获得护理，包括前往医疗机构的交通问题；（6）初级卫生保健（PHC）工作人员对儿童癌症的认识较低。提议的优先干预措施包括定价灵活性、决策和医疗保健支出方面提高透明度和一致性，以及加强对PHC工作人员、护士和药剂师进行儿童癌症方面的培训。
这项对南非儿童癌症用药可及性决定因素的首次全面研究为针对性政策制定提供了特定背景的证据。
