Please refer to my previous order number: 38500The document requires improvements which are included in the attached documents.I also need 3-5 powerpoint slides done on my topic (access to essential medicines). An example of other slides are also attached.Many thanks.
Access to Essential Medicines in Cook Islands Student Name: Student ID: Executive Summary The demographics of the populations of the Cook Islands involve several risk factors which increase the chances of non-communicable diseases in the country. The access to affordable and quality medicines is considered as a right to health in the national legislation of the Cook Islands. According to WHO, the most prevalent causes of deaths in Cook Islands have been non-communicable diseases like diabetes, poisoning, injuries, obesity, cardiac problems, hypertension and cancer. According to the Statistics of Ministry of Health in 2012, about 63% registered patients were diagnosed with hypertension. The access to essential medicines is controlled by the policies like Pharmaceutical Policy, National Good Governance Policy and National Medicines Policy which covers the selection of essential medicines, medicine financing, rational use of medicines, pricing, distribution and procurement of medicines, research and pharmaco-vigilance of medications. The Cook Islands undertook an in-depth analysis to support the financing of medicines. WHO conducted medicine surveillance and review of the pharmacy curriculum to facilitate rational use of essential medicines. Medicines Transparency Alliance (META) was established and technical support was provided in the country. However, the measures yet to be addressed more strictly are: Establishment of national policy over access to medicines, strengthening the regulatory mechanism, surveillance and minimizing the harmful and ineffective drug use practices. The Supply division of WHO involves a quality assurance system to facilitate medicine purchase only by country offices. It is done to control the expansion of unlicensed and counterfeit medicines. The Cook Islands is a signatory of UN convention against Illicit Traffic in Narcotics Drugs and Psychotropic Substances. Access to Essential Medicines Access to Essential Medicines is considered as a part of ‘Right to Health’ in the National Legislation of Cook Island (Cook Island Ministry of Health, 2013). There are legal provisions for providing patents to the medicines manufacturers which involve medical supplies, laboratory supplies, pharmaceuticals and the equipment. However, there are no licensed manufacturers and marketing authorisations of the medicines in the country. Generally, the medicines are imported from New Zealand and Australia. There are no legal provisions for the wholesalers and the distributers to follow the Goods Distribution Practices. There are no legal provisions to control the market of medicines. There are legal provisions to control the advertisement and promotion of prescription and non-prescription medicines in the Cook Islands. The access to medications is publicly a responsibility of the Pharmacy Department under the Health Ministry. A list of essential medicines is approved by the Ministry of Health Drug and Therapeutics Committee to be present in the pharmacies, clinics and hospitals. The medicines are chosen based on their effectiveness, cost and safety. The essential medicines are aimed to address the treatment of commonly found medical conditions and emergencies in the country by ensuring the equal access for the general public of these medicines. Only the medicines listed in the essential medications list are made available in the hospitals and pharmacies. The essential medicines are produced by reliable suppliers to comply with the international standards in manufacturing the medicines. The Cook Islands is characterised by the prevalence of non-communicable diseases, due to alcohol use, tobacco use, high blood pressure, physical inactivity, high level of blood glucose and cholesterol, and malnutrition (STEPS Report, 2012). The core indicators of access to essential medicines in the Cook Islands is identified by the indicators such as: Maintaining the average availability of minimum 14 essential medicines in private and public healthcare facilities, maintaining a median consumer price ratio of 14 essential medicines in private and public care facilities (WHO, 2010). The data collected is based on the national survey of availability and medicine prices of essential medicines. In 2017 the most highly demanded medicines in the Cook Islands were folic acid and iron tablets (UNICEF, 2019). Procurement There is a public sector procurement policy to ensure the quality of medicines (Cook Island Ministry of Health, 2013). The Procurement is based on the supplier’s prequalification and involves a minimum of three quotations from the chosen suppliers. The procurement is limited by the monetary value by the authoritative power. The process of quality assurance also depends on the prequalification of the products and suppliers. The public procurement process also involves tenders from international companies and direct purchasing. It is an important task to track the expiry dates of the medicines at the public Central medical Stores. There are no legal provisions for licensing the distributors and wholesalers in private sector. There are potential risks associated with procurement of essential medicines if they do not comply with the quality standards or are unsafe. Cook Island has National Structures and Policies to govern the selection of essential medicines and to encourage the rational use of drugs in the country. National Structures There is a publicly available list of essential medicines known as Essential medicines List (EML) which comprises of 430 medicines (Cook Island Ministry of Health, 2013). The medicines in the list are selected by the National Drugs and Therapeutic Committee undergoing through written consent. The country has National Standard Treatment Guidelines (NSTG) for the treatment of common illnesses. However, the mechanism to align the guidelines with the EML is under way. There are no independently funded or public national medicines information centres which could offer details about the medicines to dispensers, consumers and the prescribers. There is no regularity in public education campaigns over the topic of rational medicinal use. The National Drugs and therapeutics committee ensures the promotion of rational use of medications. The medicine education pamphlets are distributed by Pharmacy departments in collaboration with Community Health Service Directorate. The EML for the country involves medicines for children specifically chosen on the criteria of disease pattern and the medicines’ cost. There are no national strategies for identifying the antimicrobial resistance programs however the quality management department promotes the right use of antimicrobials and the prevention of infection. The epidemiological surveillance of the antimicrobial resistance across the country is coordinated by the national reference laboratory. Distribution The Pharmacy Department has a Central Medical Store (CMS) which distributes the medicines nationally (Cook Island Ministry of Health, 2013). There are specific Ministry of Health (MOH) guidelines to safeguard the goods Distribution Practices (GDP). The Central Medical Stores employ several practices like forecasting of order quantities, Requisition, preparation of picking up the medicines, reporting the stock in hand, reporting the outstanding orders, management of expiry dates and reporting the out of stock products. The medicines are distributed free of charge to certain population groups like children under 5, poor people, elderly people, pregnant women and residents of outer islands. Pharmacist Training The pharmacists are provided mandatory training for the dispensing practices of pharmacy in the Cook Islands. The curriculum of training basically involves the concept of EML and the use of STGS. The country allows substitution of generic medicines at the private and public dispensaries. The antibiotics are sometimes sold without a prescription over the counter although the injectable medicines are not sold this way. There is no professional code of conduct to direct the pharmacists’ behaviour. Sometimes the nurses prescribe the prescription only medicines at the level of primary care at the public sector facilities. Recommendations · National Medicines Policy needs to be implemented to address the incision of outstanding issues. The Drug and therapeutic Committee needs to have a strong role to monitor the Antibiotic Resistance through the implementation of National Medicines Policy (Division of Health Sector Development, n.d.). · The Pharmacovigilance capacity need to be improved to recognise and report the adverse reactions of medicines. · Drug and Therapeutic Committee should play a strong role in monitoring the antibody resistance through implementation of NMP. References Cook Island Ministry of Health (2013). Cook Islands Pharmaceutical Country Profile. Retrieved from https://www.who.int/medicines/areas/coordination/CookIslands_PSCP_NarrativeFeb18.pdf?ua=1 Division of Health Sector Development (n.d.). Essential Medicines. Retrieved from http://www.wpro.who.int/essential_medicines/documents/docs/DHSActivityReportpha_2415.pdf STEPS Report (2012). Cook Islands NSD Risk Factors. Retrieved from https://www.who.int/ncds/surveillance/steps/2003_CookIslands_STEPS_Report.pdf UNICEF (2019). Supplies and Logistics: Medicines. Retrieved from https://www.unicef.org/supply/index_ecd_drugs.html WHO (2010). Monitoring the Building Blocks of Health Systems. Switzerland: WHO Document production Services. Page 1 of 1 Page 2 of 1 Improvements required: Could you make sure that your facts in your paragraphs come with references in brackets? 1st Para: the last two sentences could be combined to one sentence with references at the end Or mention sources at the beginning of the sentences i.e. "According to (title of document) there are no...." 3 para: We need this section to be in the presentation. Could you find information about NCD's in your section to put in the presentation? In your Procurement section: could you elaborate with the third sentence? could you explain more about this particular budget? Is the government providing enough to cover this list of meds? In the second paragraph under the procurement section you started off with "Potential risks...." you could take this sentence out. The sentence following that could be moved to the beginning of the BB section because this highlights your subsections. At the end of your second paragraph under the National Structure: Was there an indicator or a census that you can refer to that gives evidence to the CHS that this is a good way to reach people? You could probably talk about this more and maybe mention a bit of health finance and education? I also need a small Powerpoint presentation done… about 6 slides on my section (access to essential medicines). Please refer to the other persons slides as an example. Page 1 of 1 Page 2 of 1 Cook Islands: background Cook Islands: background 15 islands in South Pacific Ocean Population: 17,500 Languages: English and Maori Upper-middle income country Median income of NZ $10,000-15,000 Literacy rate 95% Life expectancy Females: 78.6 Males 72.7 https://www.worldatlas.com/webimage/countrys/oceania/ck.htm The Cook Islands is a nation comprised of 15 islands within the Southern Pacific Ocean. These are divided into the northern and southern groups of islands. The nation’s capital is Avarua, on the southern island of Rarotonga. Three-quarters of the population live on Rarotonga island. There are approximately 17,500 people living in Cook Islands. The two official languages are English and Cook Islands Maori. Cook Islands is currently considered an ‘’upper middle income’’ country. The median income for residents is between $10,000 to $15,000 New Zealand dollars The literacy rate is 95%, with one in five residents having obtained tertiary education The life expectancy for females is 78.6 years, and 72.7 years for males. Cook Islands: health background - Non-communicable diseases are a significant concern Cardiovascular disease Obesity Diabetes - Inequities between main and outer islands + High rates of childhood immunisation + Low maternal and infant mortality rates Cook Islands Statistics Office, 2018 Non-communicable diseases are becoming an increasing concern for Cook Islands, causing 79% of all deaths. Of particular concern are the high rates of cardiovascular disease, obesity and diabetes The graph here shows the