Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-16T09:02:48.243Z Has data issue: false hasContentIssue false
  • English
  • Français

Mapping actions to improve access to medicines for mental disorders in low and middle income countries

Published online by Cambridge University Press:  09 January 2017

C. Barbui ,
T. Dua ,
K. Kolappa ,
B. Saraceno  and
S. Saxena
C. Barbui*
Affiliation:
Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Italy
T. Dua
Affiliation:
Department of Mental Health and Substance Abuse, World health Organization, Geneva, Switzerland
K. Kolappa
Affiliation:
Massachusetts General Hospital, McLean Psychiatry Residency, Harvard Medical School, Boston, USA
B. Saraceno
Affiliation:
Lisbon Institute of Global Mental Health, Nova University of Lisbon, Portugal
S. Saxena
Affiliation:
Department of Mental Health and Substance Abuse, World health Organization, Geneva, Switzerland
*
*Address for correspondence: Professor C. Barbui, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 Verona, Italy. (Email: corrado.barbui@univr.it)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013–2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.

Methods.

Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.

Results.

A 4 × 4 framework mapping actions as a function of the four components of access – selection, availability, affordability and appropriate use – and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.

Conclusions.

Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.

Keywords

mental disordersmedicinesaccessguidelineslow and middle income countries
Type
Special Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 5 , October 2017 , pp. 481 - 490
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akunyil, D (2005). Counterfeit and Substandard Drugs, Nigeria's Experience: Implications, Challenges, Actions and Recommendations. Talk for NAFDAC at a Meeting for Key Interest Groups on Health. The World Bank. Retrieved from http://siteresources.worldbank.org/INTAFRREGTOPHIVAIDS/Resources/717089-1113520923653/Dora_Akunyili-Good_Intentions-Bad_Drugs-MAR_10_05.doc Google Scholar
Barbui, C (2015). Access and use of psychotropic medicines in low-resource settings. Epidemiology and Psychiatric Sciences 24, 206–209.Google Scholar
Barbui, C, Bighelli, I (2013 a). Regulatory science in Europe: the case of schizophrenia trials. Lancet 382, 1234–1235.CrossRefGoogle ScholarPubMed
Barbui, C, Bighelli, I (2013 b). A new approach to psychiatric drug approval in Europe. PLoS Medicine 10, e1001530.Google Scholar
Barbui, C, Chattherjee, S (2016). Improving access to medicines for mental disorders in low-resource settings: some achievements but still a long road ahead. Epidemiology and Psychiatric Sciences 25, 1–3.Google Scholar
Barbui, C, Tansella, M (2013). Mental disorders and conditions specifically related to stress. Epidemiology and Psychiatric Sciences 22, 195–196.Google Scholar
Barbui, C, Dua, T, van Ommeren, M, Yasamy, M, Fleischmann, A, Clark, N, Thornicroft, G, Hill, S, Saxena, S (2010). Challenges in developing evidence-based recommendations using the GRADE approach: The case of mental, neurological, and substance use disorders. Plos Medicine 7, e1000322.Google Scholar
Barbui, C, Girlanda, F, Ay, E, Cipriani, A, Becker, T, Koesters, M (2014). Implementation of treatment guidelines for specialist mental health care. Cochrane Database of Systematic Reviews 1, CD009780.Google Scholar
Barbui, C, Dua, T, Harper, M, Tablante, EC, Thornicroft, G, Saxena, S (2015). Using GRADE to update WHO recommendations for MNS. Lancet Psychiatry 2, 1054–1056.CrossRefGoogle ScholarPubMed
Barbui, C, Dua, T, Kolappa, K, Saraceno, B, Saxena, S (2016). Access to psychotropic medicines in low-resource settings. Lancet Psychiatry 3, 913–915.Google Scholar
Bigdeli, M, Jacobs, B, Tomson, G, Laing, R, Ghaffar, A, Dujardin, B, Van, DW (2013). Access to medicines from a health system perspective. Health Policy and Planning 28, 692–704.Google Scholar
Bigdeli, M, Peters, DH, Wagner, A (2014). Medicines in Health Systems: advancing access, affordability and appropriate use. Retrieved from http://www.who.int/alliance-hpsr/resources/FR_webfinal_v1.pdf Google Scholar
Bigdeli, M, Laing, R, Tomson, G, Babar, ZU (2015). Medicines and universal health coverage: challenges and opportunities. Journal of Pharmacy and Policy Practice 8, 8.Google Scholar
Burns, JK (2015). Poverty, inequality and a political economy of mental health. Epidemiology and Psychiatric Sciences 24, 107–113.CrossRefGoogle Scholar
Cameron, A, Ewen, M, Ross-Degnan, D, Ball, D, Laing, R (2009). Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet 373, 240–249.CrossRefGoogle ScholarPubMed
Cameron, A, Roubos, I, Ewen, M, Mantel-Teeuwisse, AK, Leufkens, HG, Laing, RO (2011). Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bulletin of the World Health Organization 89, 412–421.Google Scholar
Cameron, A, Bansal, A, Dua, T, Hill, SR, Moshe, SL, Mantel-Teeuwisse, AK, Saxena, S (2012). Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries. Epilepsia 53, 962–969.Google Scholar
Center for Pharmaceutical Management (2000). Defining and Measuring Access to Essential Drugs, Vaccines, and Health Commodities: Report of the WHO-MSH Consultative Meeting, Ferney-Voltaire, France, December 11–13, 2000. Retrieved from http://projects.msh.org/seam/reports/measuring_access_Dec2000.pdf Google Scholar
Charlson, FJ, Baxter, AJ, Dua, T, Degenhardt, L, Whiteford, HA, Vos, T (2015). Excess mortality from mental, neurological and substance use disorders in the Global Burden of Disease Study 2010. Epidemiology and Psychiatric Sciences 24, 121–140.Google Scholar
Cockburn, R, Newton, PN, Agyarko, EK, Akunyili, D, White, NJ (2005). The global threat of counterfeit drugs: why industry and governments must communicate the dangers. PLoS Medicine 2, e100.Google Scholar
Davis, D, O'Brien, MA, Freemantle, N, Wolf, FM, Mazmanian, P, Taylor-Vaisey, A (1999). Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? Journal of the American Medical Association 282, 867–874.Google Scholar
Dua, T, Barbui, C, Clark, N, Fleischmann, A, Poznyak, V, van Ommeren, M, Yasamy, MT, Ayuso-Mateos, JL, Birbeck, GL, Drummond, C, Freeman, M, Giannakopoulos, P, Levav, I, Obot, IS, Omigbodun, O, Patel, V, Phillips, M, Prince, M, Rahimi-Movaghar, A, Rahman, A, Sander, JW, Saunders, JB, Servili, C, Rangaswamy, T, Unutzer, J, Ventevogel, P, Vijayakumar, L, Thornicroft, G, Saxena, S (2011). Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Medicine 8, e1001122.Google Scholar
Eaton, J (2008). Ensuring access to psychotropic medication in sub-Saharan Africa. African Journal of Psychiatry 11, 179–181.Google Scholar
Ensor, T, Cooper, S (2004). Overcoming barriers to health service access: influencing the demand side. Health Policy and Planning 19, 69–79.Google Scholar
Forsetlund, L, Bjorndal, A, Rashidian, A, Jamtvedt, G, O'Brien, MA, Wolf, F, Davis, D, Odgaard-Jensen, J, Oxman, AD (2009). Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 15, CD003030.Google Scholar
Grimshaw, JM, Thomas, RE, MacLennan, G, Fraser, C, Ramsay, CR, Vale, L, Whitty, P, Eccles, MP, Matowe, L, Shirran, L, Wensing, M, Dijkstra, R, Donaldson, C (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technology Assessment 8, iii–72.Google Scholar
Haynes, RB, Devereaux, PJ, Guyatt, GH (2002). Physicians’ and patients’ choices in evidence based practice. BMJ 324, 1350.Google Scholar
Horsley, T, Hyde, C, Santesso, N, Parkes, J, Milne, R, Stewart, R (2011). Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews 9, CD001270.Google Scholar
Jacobs, B, Ir, P, Bigdeli, M, Annear, PL, Van, DW (2012). Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low-income Asian countries. Health Policy and Planning 27, 288–300.Google Scholar
Kirsch, I, Moncrieff, J (2007). Clinical trials and the response rate illusion. Contemporary Clinical Trials 28, 348–351.Google Scholar
Kishore, SP, Kolappa, K, Jarvis, JD, Park, PH, Belt, R, Balasubramaniam, T, Kiddell-Monroe, R (2015). Overcoming obstacles to enable access to medicines for noncommunicable diseases in poor countries. Health Affairs (Millwood) 34, 1569–1577.Google Scholar
Lund, C (2015). Poverty, inequality and mental health in low- and middle-income countries: time to expand the research and policy agendas. Epidemiology and Psychiatric Sciences 24, 97–99.Google Scholar
Lund, C, Alem, A, Schneider, M, Hanlon, C, Ahrens, J, Bandawe, C, Bass, J, Bhana, A, Burns, J, Chibanda, D, Cowan, F, Davies, T, Dewey, M, Fekadu, A, Freeman, M, Honikman, S, Joska, J, Kagee, A, Mayston, R, Medhin, G, Musisi, S, Myer, L, Ntulo, T, Nyatsanza, M, Ofori-Atta, A, Petersen, I, Phakathi, S, Prince, M, Shibre, T, Stein, DJ, Swartz, L, Thornicroft, G, Tomlinson, M, Wissow, L, Susser, E (2015). Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM. Epidemiology and Psychiatric Sciences 24, 233–240.Google Scholar
McBain, R, Norton, DJ, Morris, J, Yasamy, MT, Betancourt, TS (2012). The role of health systems factors in facilitating access to psychotropic medicines: a cross-sectional analysis of the WHO-AIMS in 63 low- and middle-income countries. PLoS Medicine 9, e1001166.Google Scholar
Mendis, S, Fukino, K, Cameron, A, Laing, R, Filipe, A, Khatib, O, Leowski, J, Ewen, M (2007). The availability and affordability of selected essential medicines for chronic diseases in six low- and middle-income countries. Bulletin of the World Health Organization 85, 279–288.Google Scholar
Newton, PN, Amin, AA, Bird, C, Passmore, P, Dukes, G, Tomson, G, Simons, B, Bate, R, Guerin, PJ, White, NJ (2011). The primacy of public health considerations in defining poor quality medicines. PLoS Medicine 8, e1001139.Google Scholar
Nose, M, Turrini, G, Barbui, C (2015). Access to mental health services and psychotropic drug use in refugees and asylum seekers hosted in high-income countries. Epidemiology and Psychiatric Sciences 24, 379–381.Google Scholar
Padmanathan, P, Rai, D (2016). Access and rational use of psychotropic medications in low- and middle-income countries. Epidemiology and Psychiatric Sciences 25, 4–8.Google Scholar
Pankevich, D, Posey Norris, S, Wizemann, T, Altevogt, B (2014). Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Retrieved from https://www.nap.edu/read/18380/chapter/1 Google Scholar
Peters, DH, Garg, A, Bloom, G, Walker, DG, Brieger, WR, Rahman, MH (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences 1136, 161–171.Google Scholar
Saraceno, B, van Ommeren, M, Batniji, R, Cohen, A, Gureje, O, Mahoney, J, Sridhar, D, Underhill, C (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 370, 1164–1174.Google Scholar
Sorensen, H, Johnsen, S, Norgard, B (2001). Methodological issues in using prescription and other databases in pharmacoepidemiology. Norvegian Journal of Epidemiology 11, 13–18.Google Scholar
Thornicroft, G, Tansella, M (2003). What are the arguments for community-based mental health care? Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0019/74710/E82976.pdf Google Scholar
van Ommeren, M, Barbui, C, de Jong, J, Dua, T, Jones, L, Perez-Sales, P, Schilperoord, M, Ventevogel, P, Yasamy, MT, Saxena, S (2011). If you could only choose five psychotropic medicines: updating the interagency emergency health kit. PLoS Medicine 8, e1001030.CrossRefGoogle ScholarPubMed
Wagenaar, BH, Stergachis, A, Rao, D, Hoek, R, Cumbe, V, Napua, M, Sherr, K (2015). The availability of essential medicines for mental healthcare in Sofala, Mozambique. Global Health Action 8, 27942.Google Scholar
Wessells, M (2015). A reflection on the strengths and limits of a public health approach to mental health in humanitarian settings. Epidemiology and Psychiatric Sciences 24, 495–497.CrossRefGoogle ScholarPubMed
Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, Charlson, FJ, Norman, RE, Flaxman, AD, Johns, N, Burstein, R, Murray, CJ, Vos, T (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 382, 1575–1586.Google Scholar
Whitley, R (2015). Global Mental Health: concepts, conflicts and controversies. Epidemiology and Psychiatric Sciences 24, 285–291.CrossRefGoogle ScholarPubMed
World Health Organization (1985). The rational use of drugs. Report of the conference of experts. Retrieved from: http://apps.who.int/medicinedocs/documents/s17054e/s17054e.pdf Google Scholar
World Health Organization (2002). The Selection of Essential Medicines. Retrieved from http://apps.who.int/medicinedocs/pdf/s2296e/s2296e.pdf Google Scholar
World Health Organization (2004). Equitable access to essential medicines: a framework for collective action. Retrieved from: http://apps.who.int/iris/bitstream/10665/68571/1/WHO_EDM_2004.4_eng.pdf Google Scholar
World Health Organization (2005). Improving access and use of psychotropic medicines. Retrieved from: http://www.who.int/mental_health/policy/services/10_improving%20access_WEB_07.pdf Google Scholar
World Health Organization (2008). Scaling up care for mental, neurological, and substance use disorders. Retrieved from http://www.who.int/mental_health/mhgap_final_english.pdf Google Scholar
World Health Organization (2009). Improving health systems and services for mental health. Retrieved from http://apps.who.int/iris/bitstream/10665/44219/1/9789241598774_eng.pdf Google Scholar
World Health Organization (2013). Mental health action plan 2013–2020. Retrieved from http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf Google Scholar
World Health Organization (2014). Access to essential medicines. Retrieved from http://apps.who.int/medicinedocs/documents/s21453en/s21453en.pdf Google Scholar
World Health Organization (2015 a). Mental Health Atlas 2014. Retrieved from http://apps.who.int/iris/bitstream/10665/178879/1/9789241565011_eng.pdf?ua=1&ua=1 Google Scholar
World Health Organization (2015 b). mhGAP Evidence Resource Centre. Retrieved from http://www.who.int/mental_health/mhgap/evidence/en/ Google Scholar
World Health Organization (2015 c). WHO guideline on country pharmaceutical pricing policies. Retrieved from http://apps.who.int/medicinedocs/documents/s21016en/s21016en.pdf Google Scholar
World Health Organization and Calouste Gulbenkian Foundation (2016). Improving Access to and Appropriate use of Medicines for Mental Disorders. World Health Organization: Geneva, in press.Google Scholar
Xiang, YT, Ungvari, GS, Correll, CU, Chiu, HF, Shinfuku, N (2016). Trends in the access to and the use of antipsychotic medications and psychotropic co-treatments in Asian patients with schizophrenia. Epidemiology and Psychiatric Sciences 25, 9–17.Google Scholar
Young, T, Rohwer, A, Volmink, J, Clarke, M (2014). What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS ONE 9, e86706.Google Scholar
Zaidi, S, Bigdeli, M, Aleem, N, Rashidian, A (2013). Access to essential medicines in Pakistan: policy and health systems research concerns. PLoS ONE 8, e63515.Google Scholar