• The 2012 world health report 'no health without research': the endpoint needs to go beyond publication outputs.

      Zachariah, Rony; Reid, Tony; Ford, Nathan; Van den Bergh, Rafael; Dahmane, Amine; Khogali, Mohammed; Delaunois, Paul; Harries, Anthony D; Operational Research Unit, Medical Department, Operational Centre Brussels, Medecins sans Frontieres, MSF- Luxembourg, Luxembourg, Germany; Medecins sans Frontieres, Geneva, Switzerland; Department of Molecular and Cellular Interactions, Flemish Institute of Biotechnology, Brussels, Belgium; Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium;Medecins sans Frontieres, Addis Ababa, Ethiopia; Operational Centre Brussels, Medecins sans Frontieres- Luxembourg (Direction General), Luxembourg, Germany; International Union against Tuberculosis and Lung Disease, Centre for Operational Research, Paris, France; London School of Hygiene and Tropical Medicine, London, UK. (2012-08-16)
    • 25 years of the WHO essential medicines lists: progress and challenges.

      Laing, R; Waning, B; Gray, A; Ford, N; 't Hoen, E; Boston University School of Public Health, Boston, MA 02118, USA. richardl@bu.edu <richardl@bu.edu> (Elsevier, 2003-05-17)
      The first WHO essential drugs list, published in 1977, was described as a peaceful revolution in international public health. The list helped to establish the principle that some medicines were more useful than others and that essential medicines were often inaccessible to many populations. Since then, the essential medicines list (EML) has increased in size; defining an essential medicine has moved from an experience to an evidence-based process, including criteria such as public-health relevance, efficacy, safety, and cost-effectiveness. High priced medicines such as antiretrovirals are now included. Differences exist between the WHO model EML and national EMLs since countries face varying challenges relating to costs, drug effectiveness, morbidity patterns, and rationality of prescribing. Ensuring equitable access to and rational use of essential medicines has been promoted through WHO's revised drug strategy. This approach has required an engagement by WHO on issues such as the effect of international trade agreements on access to essential medicines and research and development to ensure availability of new essential medicines.
    • Access to drugs: the case of Abbott in Thailand.

      Cawthorne, P; Ford, N; Wilson, D; Kijtiwatchakul, K; Purahong, W; Tianudom, N; Nacapew, S; Médecins Sans Frontières, 533 Mooban Nakorn Thai 14, Ladprao (2007-06)
    • Access to Essential Drugs in Poor Countries: A Lost Battle?

      Pécoul, B; Chirac, P; Trouiller, P; Pinel, J; Fondation Médecins Sans Frontières, Paris, France. office@paris.msf.org (1999-01-27)
      Drugs offer a simple, cost-effective solution to many health problems, provided they are available, affordable, and properly used. However, effective treatment is lacking in poor countries for many diseases, including African trypanosomiasis, Shigella dysentery, leishmaniasis, tuberculosis, and bacterial meningitis. Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market. Moreover, research and development in tropical diseases have come to a near standstill. This article focuses on the problems of access to quality drugs for the treatment of diseases that predominantly affect the developing world: (1) poor-quality and counterfeit drugs; (2) lack of availability of essential drugs due to fluctuating production or prohibitive cost; (3) need to develop field-based drug research to determine optimum utilization and remotivate research and development for new drugs for the developing world; and (4) potential consequences of recent World Trade Organization agreements on the availability of old and new drugs. These problems are not independent and unrelated but are a result of the fundamental nature of the pharmaceutical market and the way it is regulated.
    • Access to fluconazole in less-developed countries.

      Perez-Casas, C; Chirac, P; Berman, D; Ford, N (2000-12-16)
    • Access to Health Care for All? User Fees Plus a Health Equity Fund in Sotnikum, Cambodia.

      Hardeman, W; Van Damme, W; Van Pelt, M; Por, I; Kimvan, H; Meessen, B; Médecins sans Frontières, Phnom Penh, Cambodia. (Published by Oxford University Press, 2004-01)
      User fees in health services are a source of much debate because of their potential risk of negative effects on access to health care for the poor. A Health Equity Fund that identifies the poor and pays on their behalf may be an alternative to generally ineffective fee exemption policies. This paper presents the experience of such a Health Equity Fund, managed by a local non-governmental organization, in Sotnikum, Cambodia. It describes the results of the first 2 years of operations, investigates the constraints to equitable access to the district hospital and the effects of the Health Equity Fund on these constraints. The Health Equity Fund supported 16% of hospitalized patients. We found four major constraints to access: financial, geographical, informational and intra-household. The results of the study show that the Health Equity Fund effectively improves financial access for the poor, but that the poor continue to face many constraints for timely access. The study also found that the Health Equity Fund as set up in Sotnikum was very cost-effective, with minimal leakage to non-poor. Health Equity Funds managed by a local non-governmental organization seem to constitute a promising channel for donors who want to invest in poverty reduction. However, further research and experimentation are recommended in different contexts and with different set-ups.
    • Access to healthcare for the most vulnerable migrants: a humanitarian crisis

      Pottie, Kevin; Martin, Jorge Pedro; Cornish, Stephen; Biorklund, Linn Maria; Gayton, Ivan; Doerner, Frank; Schneider, Fabien (BioMed Central (Springer Science), 2015-05-07)
      A series of Médecins Sans Frontières projects for irregular migrants over the past decade have consistently documented high rates of 14 physical and sexual trauma, extortion and mental illness amidst severe healthcare, food, and housing limitations. Complex interventions were needed to begin to address illness and barriers to healthcare and to help restore dignity to the most vulnerable women, children and men. Promising interventions included mobile clinics, use of cultural mediators, coordination with migrant-friendly entities and NGOs and integrating advocacy programs and mental health care with medical services. Ongoing interventions, research and coordination are needed to address this neglected humanitarian crisis.
    • Access to liposomal generic formulations: beyond AmBisome and Doxil/Caelyx

      Gaspani, Sara (Pro Pharma Communications International, 2014-04-18)
      The lack of clear regulatory guidance remains a key bottleneck for securing a second quality-assured source of liposomal amphotericin B (LAmB), the WHO-recommended drug for visceral leishmaniasis. The approval of the first generic liposomal product by the US Food and Drug Administration in February 2013 could be a turning point, and serve as a basis for WHO to develop guidance for the evaluation of generic liposomal formulations.
    • Angola's suffering behind a pretence of normality.

      Stokes, C; Ford, N; Sanchez, O; Perrin, J M; Poncin, M; Joly, M; Médecins Sans Frontières, London, UK. (Elsevier, 2000-12-16)
    • Anthropology in public health emergencies:what is anthropology good for?

      Stellmach, D; Beshar, I; Bedford, J; du Cros, P; Stringer, B (BMJ Publishing Group, 2018-03-25)
      Recent outbreaks of Ebola virus disease (2013-2016) and Zika virus (2015-2016) bring renewed recognition of the need to understand social pathways of disease transmission and barriers to care. Social scientists, anthropologists in particular, have been recognised as important players in disease outbreak response because of their ability to assess social, economic and political factors in local contexts. However, in emergency public health response, as with any interdisciplinary setting, different professions may disagree over methods, ethics and the nature of evidence itself. A disease outbreak is no place to begin to negotiate disciplinary differences. Given increasing demand for anthropologists to work alongside epidemiologists, clinicians and public health professionals in health crises, this paper gives a basic introduction to anthropological methods and seeks to bridge the gap in disciplinary expectations within emergencies. It asks: 'What can anthropologists do in a public health crisis and how do they do it?' It argues for an interdisciplinary conception of emergency and the recognition that social, psychological and institutional factors influence all aspects of care.
    • Attacks on Civilians and Hospitals Must Stop

      Trelles, M; Stewart, BT; Kushner, AL (Elsevier, 2016-05-01)
      On Oct 3, 2015, a US airstrike hit Médecins Sans Frontières' (MSF's) Kunduz Trauma Centre in Afghanistan; 42 lives, including 14 MSF hospital staff, were lost.1 The 92-bed hospital was the only facility with essential trauma care capabilities for hundreds of thousands of people living in northern Afghanistan; those who continue to live amid conflict will critically miss it. The attack was a violation of international humanitarian law and the Geneva Conventions, a war crime, and an incursion on the sanctity of humanitarian action globally.
    • Attacks on Civilians and Hospitals Must Stop

      Trelles, M; Stewart, BT; Kushner, AL (Elsevier, 2016-03-21)
    • Avoiding Catastrophes: Seeking Synergies Among the Public Health, Environmental Protection, and Human Security Sectors

      Stoett, P; Daszak, P; Romanelli, C; Machalaba, C; Behringer, R; Chalk, F; Cornish, S; Dalby, S; de Souza Dias, BF; Iqbal, Z; et al. (Elsevier, 2016-10-04)
    • The battle for access--health care in Afghanistan.

      Reilley, B; Puertas, G; Coutin, A S; Médecins sans Frontières, New York, USA. (Massachusetts Medical Society, 2004-05-06)
    • Burundi: a population deprived of basic health care.

      Philips, M; Ooms, G; Hargreaves, S; Durrant, A (Royal College of General Practitioners, 2004-08)
    • Caught in Colombia's crossfire.

      Reilley, B; Morote, S; Médecins sans Frontières, New York, USA. (The Massachusetts Medical Society, 2004-12-16)
    • Clinical bacteriology in low-resource settings: today's solutions

      Ombelet, S; Ronat, JB; Walsh, T; Yansouni, CP; Cox, J; Vlieghe, E; Martiny, D; Semret, M; Vandenberg, O; Jacobs, J (Elsevier, 2018-03-05)
      Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.
    • A Comparison of Cluster and Systematic Sampling Methods for Measuring Crude Mortality.

      Rose, A; Grais, R; Coulombier, D; Ritter, H; Epicentre, Paris, France. angela.rose@epicentre.msf.org (Published by WHO, 2006-04)
      OBJECTIVE: To compare the results of two different survey sampling techniques (cluster and systematic) used to measure retrospective mortality on the same population at about the same time. METHODS: Immediately following a cluster survey to assess mortality retrospectively in a town in North Darfur, Sudan in 2005, we conducted a systematic survey on the same population and again measured mortality retrospectively. This was only possible because the geographical layout of the town, and the availability of a good previous estimate of the population size and distribution, were conducive to the systematic survey design. RESULTS: Both the cluster and the systematic survey methods gave similar results below the emergency threshold for crude mortality (0.80 versus 0.77 per 10,000/day, respectively). The results for mortality in children under 5 years old (U5MR) were different (1.16 versus 0.71 per 10,000/day), although this difference was not statistically significant. The 95% confidence intervals were wider in each case for the cluster survey, especially for the U5MR (0.15-2.18 for the cluster versus 0.09-1.33 for the systematic survey). CONCLUSION: Both methods gave similar age and sex distributions. The systematic survey, however, allowed for an estimate of the town's population size, and a smaller sample could have been used. This study was conducted in a purely operational, rather than a research context. A research study into alternative methods for measuring retrospective mortality in areas with mortality significantly above the emergency threshold is needed, and is planned for 2006.
    • A Comparison of Liposomal Amphotericin B with Sodium Stibogluconate for the Treatment of Visceral Leishmaniasis in Pregnancy in Sudan.

      Mueller, M; Balasegaram, M; Koummuki, Y; Ritmeijer, K; Santana, M R; Davidson, R N N; Médecins sans Frontières, 67-74 Saffron Hill, London EC1N 8QX, UK. (Published by Oxford University Press, 2006-10)
      OBJECTIVES: Little is known about the treatment of visceral leishmaniasis (VL) in pregnancy, especially in resource-poor settings. We present a series of pregnant women with VL treated with either sodium stibogluconate or liposomal amphotericin B (AmBisome), or both, in eastern Sudan over 16 months. METHODS: We did a retrospective analysis of all pregnant VL patients treated in the Médecins sans Frontières (MSF) Um el Kher centre between January 2004 and April 2005. We diagnosed VL with laboratory confirmation of clinical suspects, and recorded the outcomes of treatment for pregnant women and their foetuses. We carried out a manual search of relevant publications and a systematic search of the literature in the MEDLINE database. RESULTS: We treated 23 women with sodium stibogluconate, 4 with AmBisome and sodium stibogluconate and 12 with AmBisome alone. There were 13 (57%) spontaneous abortions in the sodium stibogluconate monotherapy group, and none in either of the other two groups. All spontaneous abortions occurred in the first two trimesters. All patients, except one in the sodium stibogluconate group who defaulted, were discharged as cured in good clinical condition. CONCLUSIONS: AmBisome treatment for VL appears to be safe and effective for pregnant women and their foetuses. We recommend the use of AmBisome as first-line treatment for these patients.