Tracing Pharmaceuticals in South Asia

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• Tracing Pharmaceuticals in South Asia
• Overview of Project
• Nepal, 5 April 2009

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Research Problematic

• Gaps in analysis
• Sociologists/anthropologists study the meanings
  of illnesses and treatments
• Political economists study value chains
• Public health researchers study diseases, their
  epidemiology and spread
• Need to bring these three together
• Need to study from the ground up
• start from how drugs are being used
• follow drugs from cradle to grave

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Research Design

• To take oxytocin, rifampicin, and fluoxetine as
  case studies, because
• They have significant relationships to poverty
• They play important roles in key health areas,
  and they have broad implications for the MDGs
• They offer diverse insights into production,
  distribution and prescription of drugs
• They are off patent, like most medicines consumed
  by the poor

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Research Questions

• What is the evidence base for best practice for
  the use of oxytocin in augmentation of labour,
  rifampicin in active TB, and fluoxetine in
  depression in developing countries?
• What are the governmental and pharmaceutical
  companies indications for use of these medicines
  in South Asia, and how do these compare with the
  research evidence base and everyday practice?
• What are the production and distribution systems
  of oxytocin, rifampicin, and fluoxetine in South
  Asia, and how have these changed since
  liberalisation and the arrival of product patent
  protection in India?

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Research Questions (2)

• What are the marketing, medical training and
  education strategies of the pharmaceutical
  companies for these medicines, and what roles are
  played by medical representatives?
• What are the national regulatory standards for
  production, quality control, distribution and
  prescribing of medicines, how are they developed,
  and how do the enforcement mechanisms work in
  practice?
• How do the relevant health delivery programmes
  (in Safe Motherhood, TB control and Mental
  Health) interact with the pharmaceutical
  commodity chains for key medicines?

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Research Methods

• Analysis of public documents and clinical
  guidelines, etc.
• Fieldwork in six sites
• Kolkata and rural West Bengal
• Delhi, Lucknow and rural UP
• Kathmandu and rural East Nepal
• Interviews and observations of everyday practices
  of producers, distributors, retailers and
  prescribers

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Problems of regulation are compounded by complex
pharmaceutical chains

• Drugs are only sometimes produced by the
  originator
• They often travel to final users through many
  indirect ways (involving loan licenses, contract
  agreements, floating prescriptions, centralised
  procurement, resale and removal from packaging)

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Papers from the project at this workshop

• Trials and evidence in relation to health policy
  The case of Tuberculosis in Nepal and India
• Labour Management Oxytocin in the context of the
  Millennium Development Goals
• Global Burden of Disease Measures for Depression
  time for a rethink ?
• National (non-) regulation in a global
  pharmaceutical world
• Prozac on the loose Rethinking the "treatment
  gap" for depression in South Asia
• Disputing Distribution Ethics and
  pharmaceuticals in Nepal