• 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 Treatment may be precluded because no effective drug exists, it is too expensive, or it has been withdrawn from the market.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 health services for men who have sex with men and transgender women in Beira, Mozambique: A qualitative study

      Gamariel, F; Isaakidis, P; Tarquino, IAP; Beirão, JC; O'Connell, L; Mulieca, N; Gatoma, HP; Cumbe, VFJ; Venables, E (Public Library of Science, 2020-01-30)
      OBJECTIVES: HIV prevalence and incidence are higher among key populations including Men who have Sex with Men (MSM) and transgender women in low and middle income countries, when compared to the general population. Despite World Health Organisation guidelines on the provision of services to key populations recommending an evidence-based, culturally relevant and rights-based approach, uptake of HIV services in many resource-limited and rights-constrained settings remains low. Médecins Sans Frontières (MSF) has been offering health services for MSM and transgender women in Beira, Mozambique since 2014 using a peer-educator driven model, but uptake of services has not been as high as expected. This qualitative study aimed to learn more about these key populations in Beira, their experiences of accessing MSM- and transgender-friendly services and their use of face-to-face and virtual networks, including social media, for engagement with health care. METHODS: In-depth interviews were carried out with MSM and transgender women who were 1) enrolled in, 2) disengaged from or 3) never engaged in MSF's programme. Purposive and snowball sampling were used to recruit the different groups of interviewees. Interviews were conducted in Portuguese, transcribed and translated into English before being coded and manually analysed using a thematic network framework. RESULTS: Nine transgender women and 18 cisgender MSM participated in the study. Interviewees ranged in age from 19 to 47 years, with a median age of 29. Three main themes emerged from the data: perceptions of stigma and discrimination, experiences of the peer-educator driven model and the use of face-to-face and virtual platforms for communication and engagement, including social media. Interviewees reported experiencing stigma and discrimination because of their gender or sexual identity. HIV-related stigma and health-care setting discrimination, including gossip and breach of confidentiality, were also reported. Although the presence of the peer-educators and their outreach activities were appreciated, they had limited visibility and an over-focus on health and HIV. The face-to-face networks of MSM and transgender women were small and fragmented. Virtual networks such as Facebook were mainly used for flirting, dating and informal communication. Most interviewees were at ease using social media and would consider it as a means of engaging with health messaging. CONCLUSIONS: MSM and transgender women have challenges in accessing health services due to being stigmatised because of their gender identity and their sexual behaviour, and often experience stigma at home, in health-care facilities and in their communities. Peer-driven models of engagement were appreciated but have limitations. There is an untapped potential for further expansion and engagement with face-to-face and virtual platforms to reach MSM and transgender women in settings with a high HIV burden, and to provide them with essential information about HIV and their health.
    • 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, 2016-03-21)
    • 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.
    • 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)
    • Behind the Scenes of South Africa’s Asylum Procedure: A Qualitative Study on Long-term Asylum-Seekers from the Democratic Republic of Congo

      Schockaert, L; Venables, E; Gil-Bazo, MT; Barnwell, G; Gerstenhaber, R; Whitehouse, K (Oxford University Press, 2020-02-20)
      Despite the difficulties experienced by asylum-seekers in South Africa, little research has explored long-term asylum applicants. This exploratory qualitative study describes how protracted asylum procedures and associated conditions are experienced by Congolese asylum-seekers in Tshwane, South Africa. Eighteen asylum-seekers and eight key informants participated in the study. All asylum-seekers had arrived in South Africa between 2003 and 2013, applied for asylum within a year of arrival in Tshwane, and were still in the asylum procedure at the time of the interview, with an average of 9 years since their application. Thematic analysis was used to analyse the data. The findings presented focus on the process of leaving the Democratic Republic of Congo, applying for asylum and aspirations of positive outcomes for one’s life. Subsequently, it describes the reality of prolonged periods of unfulfilled expectations and how protracted asylum procedures contribute to poor mental health. Furthermore, coping mechanisms to mitigate these negative effects are described. The findings suggest that protracted asylum procedures in South Africa cause undue psychological distress. Thus, there is both a need for adapted provision of mental health services to support asylum-seekers on arrival and during the asylum process, and systemic remediation of the implementation of asylum procedures.
    • 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.