Academic journal article Bulletin of the World Health Organization

Priorities for Pharmaceutical Policies in Developing Countries: Results of a Delphi Survey

Academic journal article Bulletin of the World Health Organization

Priorities for Pharmaceutical Policies in Developing Countries: Results of a Delphi Survey

Article excerpt

Introduction

In the 1970s the lack of basic drugs at prices that the poor could afford became a major concern for health officials in the newly independent states of the developing world. In response, the World Health Assembly passed a resolution (WHA28.66) in 1975 that mandated the World Health Organization "to develop means by which the Organization can be of greater direct assistance to Member States in advising on the selection and procurement, at reasonable cost, of essential drugs of established quality corresponding to their national needs". WHO published the first model list of essential drugs in 1977 (1). Based on another World Health Assembly resolution in 1979 (WHA32.41), the Organization established the Action Programme on Essential Drugs and Vaccines in 1981 to develop a strategy which embraced all aspects of national drug policies.

In the 1980s, a large number of countries adopted essential drug lists with support from development agencies and nongovernmental organizations (NGOs) and began operating active programmes. Several countries, including Bangladesh (2), Philippines (3), and Nigeria (4), developed national policies and carried out major changes in the pharmaceutical sector.

Despite these efforts, however, serious problems remained in many developing countries, due in part to ad hoc, ineffective, and contradictory pharmaceutical policies. In 1988, according to WHO, more than 1300 million people had little or no regular access to the most essential drugs (5).

At the international level, the pharmaceutical industry and many developed country governments voiced strong opposition to WHO's efforts to promote policies on essential drugs. At the national level, conflicts arose over the design of pharmaceutical policy and such issues as the role of the private sector and the priority for local production. Conflicts also emerged among international development agencies over where to intervene first in the pharmaceutical sector and over which strategies were likely to be cost-effective (6).

Numerous efforts to resolve these controversies have achieved only limited success. The Conference of Experts on the Rational Use of Drugs, held in Nairobi in 1985, was a concerted attempt by MMO to create agreement on what should be done (7). Since then, conflicts of opinion have persisted on priorities for action, reflecting the divergent views and interests of the different actors (8). A new approach is therefore required to help formulate drug policies that will meet the challenges of the next decade. This article reports the use of the Delphi technique as a systematic and logical approach to establish consensus among international experts on the priorities for interventions in national drug policies.

Methods

The Delphi technique is a method for structuring communication in a process that allows a group of individuals to deal with a complex problem and reach consensus (9). The process involves the use of a series of questionnaires designed by a monitor group and then sent by mail in several rounds to a respondent group of experts who remain anonymous 10). After each round, the results are summarized and assessed by the monitor team and used to develop a questionnaire for the next round. The assessment document and new questionnaire are then sent to all members who responded. A Delphi survey is considered complete when a convergence of opinion occurs or when a point of diminishing returns is reached (11).

A major advantage of the Delphi technique is that it avoids problems commonly encountered in face-to-face group meetings. These problems include the influence of key persons on the responses of other panel members as well as the geographical constraints and costs of bringing together a group of experts. The anonymity of answers allows Delphi participants to express their personal views freely. The method is particularly useful for a subject with strong differences of opinion or high levels of uncertainty. …

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