Background
The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human
being without distinction of race, religion, political belief,
and economic or social condition [1]. Everyone has the
right to a standard of living adequate for the health of
himself and of his family, including food, clothing, housing,
necessary social services, and medical care [2]. Governments
and the international community have an
obligation to see the right to health progressively realized
which includes the responsibility for prevention, treatment
and control of disease; and the creation of conditions
to ensure access to health facilities, goods and
services [3]. Access to goods and services include of course
the provision of essential medicines necessary for the prevention
and treatment of prevalent diseases [4]. In addition,
access to essential medicines is fundamental to
human rights [5].
Pharmaceuticals have made an important contribution to
global reductions in morbidity and mortality [6]. In many
developing countries, medicines represent the largest
household health expenditure. To help save lives and
improve health by closing huge gap between the potential
that essential drugs have to offer and the reality that for
millions of people medicines are unavailable, unaffordable,
unsafe or improperly used, World Health Organization
(WHO) is already working with a wide range of
partners to achieve this aim by drugs and medicines, and
by working with countries to ensure equity to access to
drugs, drug quality and safety, and rational use of drugs
[7]. The National Drug Policy (NDP) process brings all
interested parties; legislation/regulation, quality control,
local production, education of consumers, prescribers,
dispensers, drug evaluation, selection and registration and
rational use; together to focus political improvement and
also policy guidance, management tools, and training
materials, derived from successful drug list initiatives, do
exist.
Essential drugs are one of the tools for fighting ill health.
By increasing access to essential drugs, their safety and
their rational use, we could make the pharmaceutical
potential to improve health and save development gains
[8].
Essential drugs are high-value commodities. Their availability
draws patients to health facilities, where they can
also benefit from preventive services. Moreover, if drug
procurement is efficient and transparent, the confidence
of governments and ministry in the country's health system
is increased, and provision of financial and other
resources for health system development encouraged
[7,9,10].
Since using appropriate drug list has a lot of benefits and
impact in health and economic status, it seems that evaluation
of this list could be useful for evaluation of country-adapted
policies. Iran has already adapted a National
Drug List (NDL). This list is selected by Iran Drug Selecting
Committee (IDSC). All drug supply management
including registration, procurement, inspection, quality
control and post marketing control could be done for a
drug that it is accepted to be in Iran drug list. Thinking the
drug list is one very important element of a NDP, thus
analysis and evaluation of the IDSC's decision-making is
one necessary part of the process of evaluating the NDP.
Therefore, evaluation of IDSC's decision-making during
last 5 years may be an appropriate way to evaluate drug
supply system in Iran. Actually, these kinds of studies are
necessary to assess the organizational and political determinants
of the policy process; to help explain the
strengths and weaknesses identified by the indicators; and
to assist in identifying and assessing strategies to improve
pharmaceutical policy implementation.
The main study questions discussed in the study are the
followings:
1. Are the existing basic characteristics of the pharmaceutical
system as well structures and processes within it
ensure achievement of the main NDP goals?
2. Are the criteria used for drug selection by the IDSC for
the purposes of NDL creation compatible with the
achievement of main NDP goals?
Methods
In this study, a descriptive, explanatory, and prescriptive
objectives methodology has been designed to describe the
consequences, stakeholders, interests, and networks
involved in the NDP; to help explain how and why a particular
decision was reached in the past; and to assist decision-makers
in managing the politics of formulation or
implementation.
To identify strengths and weaknesses of pharmaceutical
policy formation and implementation in Iran, four standard
questionnaires that were designed by WHO (Action
Program on Essential Drugs) was used (see table 1 for
more information). Questionnaires contained four categories
of drug policy indicators including background
information, structural indicators, process indicators, and
outcome indicators. The indicators serve two purposes in
the research: assessment of the implementation of NDP
by measuring progres
พื้นหลังความสนุกสนานของการตามมาตรฐานสูงสุดสุขภาพเป็นสิทธิขั้นพื้นฐานของมนุษย์ทุกอย่างใดอย่างหนึ่งไม่มีความแตกต่างของเชื้อชาติ ศาสนา ความ เชื่อทางการเมืองและสภาพทางเศรษฐกิจ หรือสังคม [1] ทุกคนมีการการมีมาตรฐานการครองชีพอย่างเพียงพอสำหรับสุขภาพของตัวเองและ ของ ครอบครัวของเขา รวมอาหาร เสื้อผ้า ที่อยู่อาศัยบริการสังคมที่จำเป็น และการรักษาพยาบาล [2] รัฐบาลและประชาคมระหว่างประเทศมีการหน้าที่ต้องดูสิทธิด้านสุขภาพการรับรู้ความก้าวหน้าซึ่งรวมถึงความรับผิดชอบการป้องกัน รักษาและการควบคุมโรค และการสร้างเงื่อนไขเพื่อให้เข้าถึงบริการสาธารณสุข สินค้า และบริการ [3] การเข้าถึงสินค้าและบริการรวมของหลักสูตรการจัดหายาจำเป็นที่จำเป็นในการป้องกันและรักษาโรคแพร่หลาย [4] นอกจากนี้การเข้าถึงยาจำเป็นเป็นพื้นฐานสิทธิมนุษยชน [5]ยามีผู้แจ้งเบาะแสลดระดับโลกในการเจ็บป่วยและการตาย [6] ในหลายประเทศกำลังพัฒนา ยาแทนใหญ่ที่สุดรายจ่ายสุขภาพในครัวเรือน เพื่อช่วยเหลือชีวิต และปรับปรุงสุขภาพ โดยปิดช่องว่างขนาดใหญ่ระหว่างศักยภาพว่า ยาที่จำเป็นต้องมีและความเป็นจริงว่าล้านคนยาจะไม่พร้อมใช้งาน หมากไม่ปลอดภัย หรือ ใช้ไม่ถูกต้อง องค์การอนามัยโลก(ที่) กำลัง มีหลากหลายคู่ค้าเพื่อให้บรรลุเป้าหมายนี้ โดยยาและยา และby working with countries to ensure equity to access todrugs, drug quality and safety, and rational use of drugs[7]. The National Drug Policy (NDP) process brings allinterested parties; legislation/regulation, quality control,local production, education of consumers, prescribers,dispensers, drug evaluation, selection and registration andrational use; together to focus political improvement andalso policy guidance, management tools, and trainingmaterials, derived from successful drug list initiatives, doexist.Essential drugs are one of the tools for fighting ill health.By increasing access to essential drugs, their safety andtheir rational use, we could make the pharmaceuticalpotential to improve health and save development gains[8].Essential drugs are high-value commodities. Their availabilitydraws patients to health facilities, where they canalso benefit from preventive services. Moreover, if drugprocurement is efficient and transparent, the confidenceof governments and ministry in the country's health systemis increased, and provision of financial and otherresources for health system development encouraged[7,9,10].Since using appropriate drug list has a lot of benefits andimpact in health and economic status, it seems that evaluationof this list could be useful for evaluation of country-adaptedpolicies. Iran has already adapted a NationalDrug List (NDL). This list is selected by Iran Drug SelectingCommittee (IDSC). All drug supply managementincluding registration, procurement, inspection, qualitycontrol and post marketing control could be done for adrug that it is accepted to be in Iran drug list. Thinking thedrug list is one very important element of a NDP, thusanalysis and evaluation of the IDSC's decision-making isone necessary part of the process of evaluating the NDP.Therefore, evaluation of IDSC's decision-making duringlast 5 years may be an appropriate way to evaluate drugsupply system in Iran. Actually, these kinds of studies arenecessary to assess the organizational and political determinantsof the policy process; to help explain thestrengths and weaknesses identified by the indicators; andto assist in identifying and assessing strategies to improvepharmaceutical policy implementation.The main study questions discussed in the study are thefollowings:1. Are the existing basic characteristics of the pharmaceuticalsystem as well structures and processes within itensure achievement of the main NDP goals?2. Are the criteria used for drug selection by the IDSC forthe purposes of NDL creation compatible with theachievement of main NDP goals?MethodsIn this study, a descriptive, explanatory, and prescriptiveobjectives methodology has been designed to describe theconsequences, stakeholders, interests, and networksinvolved in the NDP; to help explain how and why a particulardecision was reached in the past; and to assist decision-makersin managing the politics of formulation orimplementation.To identify strengths and weaknesses of pharmaceuticalpolicy formation and implementation in Iran, four standardquestionnaires that were designed by WHO (ActionProgram on Essential Drugs) was used (see table 1 formore information). Questionnaires contained four categoriesof drug policy indicators including backgroundinformation, structural indicators, process indicators, andoutcome indicators. The indicators serve two purposes inthe research: assessment of the implementation of NDPby measuring progres
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