STD-HIV intervention programme: the Sonagachi model.
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This paper presents data on the characteristics of oral contraceptive users in Honduras, obtained from a point-of-purchase survey conducted in pharmacies in 1986. The oral contraceptive Perla, provided by the Social Marketing Program, accounted for 42 percent of sales. Forty-five percent of those using Perla were considered "new" users; either they were purchasing contraceptives for the first time or had used only Perla. Almost half of those who switched to Perla previously had obtained their orals in the noncommercial sector. Brand substitution occurred among users of commercial brands at about the same rate as among Perla users (51 percent versus 55 percent). Most women switching contraceptives did so within two months of their last purchase.
Cost-benefit and cost-effectiveness analysis techniques which can be of assistance in the evaluation of innovative pharmaceutical services are reviewed. Process and outcome measures are considered, and suggested steps in a cost-benefit study are presented. Samples of pharmacy studies using these techniques are appraised. Possible measures for benefits and costs along with literature references for evaluations of innovative pharmaceutical services are presented. Areas of pharmaceutical service discussed are ambulatory patient consultation, unit dose drug distribution, drug information services, monitoring drug therapy in acute care and long-term care, parenteral admixture services, patient and therapy responsibilities, patient discharge interviews, patient drug histories and profiles, and personnel substitutions. Although there have been several encouraging reports on the cost-benefit of pharmaceutical services, more evaluative research is needed to develop programs which maximize the benefit-to-cost ratio to society.
In order to move towards rational drug use in any national or local setting the methods of inquiry have to be expanded. Both the public and private sector have to be addressed. In the latter the pharmacists might be studied using a tracer, fictitious client. One important factor influencing prescribing, drug information, has rarely been assessed scientifically. Experimental studies using group randomization are, however feasible even in developing countries. The individual human being must be in the focus of drug studies and health care and health in the foreground. The combination of qualitative and quantitative methods will assist us to achieve rational drug use that is culturally acceptable, economically feasible and pharmacologically sound.
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Price increases in the Jamaica CSM program went into effect on August 31, 1981. The program began in 1975. While the need for higher prices has been under discussion for the past 3 years, this is the 1st time the requisite approval from the Jamaica Price Commission has been obtained. The Jamaica National Family Planning Board (JNFPB) reports that the Panther 3-pack (condom) is up US$0.15 to US$0.30. Each Perle package (oral contraceptive) was increased by US$0.20. Single cycle Perle now sells for US$0.50, and 3-pack Perle sells for US$1.10. The 6-year price stagnation experienced by the CSM program resulted in a decreasing operational budget as program costs continued to rise. Marketing costs alone during this period escalated by 100-300%. For example, Panther pop-up display cartons cost the project US 16U each in 1975. By 1979 the same product cost US 49U. Newspaper advertisements have increased from the 1975 cost of US$68.00 to nearly $200.00 per placement. The overall inflation rate in Jamaica during the last 5 years has averaged more than 20% annually. In the face of these rising costs, outlet expansion for Perle has been prevented, wholesaler margins have been unavailable, and new retailer training has been discontinued. It is projected that the new prices will result in an annual increased revenues of US$80,000 which will be used to reinstate these essential marketing activities. The JNFPB is also planning to introduce a Panther 12-pack and Panther strips to the CSM product line. According to Marketing Manager Aston Evans, "We believe the public is now ready for this type of packaging" which is scheduled to be available soon. Panther is presently only available in a 3-pack, but annual sales have been steady. The new 12-pack will be stocked on supermarket shelves to provide higher product visibility and wider distribution. The selling price has been set as US$1.20 and is expected to yield a 25% increase in sales during the 1st year. A complete sales promotion and advertising campaign will accompany the 12-pack introduction. The marketing plan for Panther strips emphasizes placement in government and private sector offices and factories throughout the country. In the deep rural areas the strips will be available for sale in shops, bars, nightclubs, and other distribution points.
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Since its first mass use in 1960, oral polio vaccine ( OPV ) has largely eliminated paralytic poliomyelitis from temperate-climate and subtropical regions of the world that have good health services and a combined total population of almost 2,000 million people. The various strategies used in these countries have been highly successful even where, as in the USA, large numbers of children received no vaccine or only a single dose of OPV . During the period of 1981-1982, only 2.8 cases per 100 million total population per year were reported in the USA. The main challenge in the present era is the economically undeveloped tropical and subtropical regions with inadequate health services that are inhabited by more than half of the world population, where recent surveys for residual paralysis due to poliomyelitis have shown that the incidence of the disease has been higher than it was in the USA and other predominantly temperate-climate countries before the vaccine era. The problem in these countries is that the majority of children receive no vaccine and that the extensive year-round dissemination of virulent polioviruses requires a different strategy of vaccination from that used in the temperate-climate countries. The special point about the annual mass vaccinations with OPV for all children younger than three, four, or five years of age-which have proven highly successful in Cuba (for the past 20 years), in Brazil (during the past three years), and recently also in Mexico-is that all the children are usually vaccinated within one or two days, which quickly breaks the chain of transmission of the virulent viruses, and the annual campaigns create and maintain the maximum number of children with resistant intestinal tracts.