Tuesday, January 03, 2006

SEAM : One Plus One = Progress

The Strategies for Enhancing Access to Medicines Program was created by Management Sciences for Health and funded by the Bill & Melinda Gates Foundation. It aims to improve access to and use of essential medicines, vaccines, and other health commodities in the developing world. This is because the progress that has been made by the revolutionized health care in the industrialized countries over the past 50 years that has been driven by the development of new pharmaceutical products and vaccines has barely touched developing countries, where hundreds of millions of people still lack access to basic medicines.

Each year, millions of adults and children die from conditions that could have been treated or prevented if effective and affordable medicines and vaccines had been available and properly used-when and where they were needed.

There needs to be better strategies for more efficient delivery and use of medicines, and other essential health commodities in the developing world and the SEAM Program provides technical assistance in designing and implementing those strategies in selected countries.

While the organization cannot implement this program everywhere it is needed, it is the intent of SEAM that its evolving public-private sector models also be available for adapted use in other countries throughout the developing world.

The SEAM country program development and evaluation is the result of its collaboration in December 2000 with the World Health Organization (WHO) and over 40 leading experts to develop a framework for measuring access in this area. As a result of this collaboration, SEAM identified six countries for field-testing the framework. These countries were Cambodia, El Salvador, Ghana, Tanzania, and Minas Gerais State in Brazil and Rajasthan State in India.

During February and May of 2001, staff members from SEAM visited each of the countries participating in the assessments "to explain the objectives of the SEAM Program and to gain each country's full cooperation in conducting the assessments." Later follow-up visits provided additional information needed on access to pharmaceuticals and which helped to formulate ideas for possible interventions for the improvement of access to those pharmaceuticals. In November 2001 SEAM held a Conference where the results of the assessment and the analyses of potential interventions, were presented and discussed.

As part of the efforts to create greater access to these pharmaceutical products, SEAM has also developed a franchise business model for distributing these medicines and other essential health commodities through private retail outlets in areas where the populations are underserved. Initial pilot testing of this model is taking place in Ghana , and simultaneously SEAM is working with the Sustainable Healthcare Enterprise Foundation (formerly Cry for the World Foundation) on a franchising initiative to expand and improve access to essential medicines in Kenya.

Based upon its assessments and analyses, the SEAM Program has currently implemented full-scale, countrywide programs in Ghana and Tanzania.

Some of the key findings in Ghana show that while the SEAM inventory studies indicated that the availability of essential drugs had improved there since 1993, significant gaps still remain.

Public hospitals and clinics, mission facilities, and private pharmacies all had shortfalls, as essential drugs were routinely found to be at levels below 70 percent those health care facilities. And while the Ghana National Drugs Programme has made efforts to improvements the public health sector many other factors such as financing issues cumbersome supply systems contribute to poor availability of these drugs.

There are many other items in the findings from Ghana that are posted at the SEAM web site.

In Tanzania, public and mission hospitals are the major providers of health care, especially in rural areas, where 75 percent of the population lives. 'The SEAM assessment found that a major problem is inadequate availability of drugs in the public sector, especially at the primary health care level."

Although medicines are available free of charge in the public sector, when public facilities have gaps in stock, patients generally buy prescribed medicines in the private sector, and this can impose a significant financial burden on the patient.

The rural population's access to these costly drugs is through a large network of private drug outlets, which are unregulated and provide services and products of unreliable quality.

While some professional pharmacies exist in Tanzania, they are few in number and located exclusively in the main urban centers.

Public facilities rely heavily on the government Medical Stores Department (MSD) for supplies, but the MSD can currently only meet about 65 to 70 percent of customer needs.

The SEAM assessment found that "Although the MSD is financially secure and is an experienced purchaser and distributor of essential drugs and medical supplies, demand for these commodities in the public and church-based health sectors is outpacing the MSD's supply capacity, regardless of planned improvements." And when the MSD is unable to meet demand, clients turn to local private wholesalers and distributors who often sell products of dubious quality and at less favorable prices.

Quality of service is another issue examined by the SEAM assessment. Ther are other issues as well, and they can be found at the web page for Tanzania .

While there is not a program in Kenya currently, in 2000, Sustainable Healthcare Enterprise Foundation (SHEF), {formerly Cry for the World Foundation (CFW)}, started a franchised network of essential-medicines outlets that are owned and managed by Kenyan community health workers. Since 2000, this network has grown to 28 Child and Family Wellness Shops (CFWShops®) in Kirinyaga and Mbeere provinces located in the central Region of Kenya.

SEAM provides technical assistance, tools, training materials, and managerial support to this program. And you can read more about Child and Family Wellness Shops at the following
Blog Article . SEAM says that the CFWShops Program provides a good example of how a public-private partnership can work effectively in pharmaceutical distribution.

In this healthy equation, Management Sciences for Health and the Bill & Melinda Gates Foundation together equal The Strategies for Enhancing Access to Medicines Program and it's a great example of combining efforts to make the world a better place.

You can find SEAM at this link.

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