29 results on '"Suleman"'
Search Results
2. Providers’ perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry
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Mootz, Jennifer J., de Vos, Lindsey, Stockton, Melissa, Sweetland, Annika C., Kann, Bianca, Seijo, Chariz, Bezuidenhout, Charl, Suleman, Antonio, Feliciano, Paulino, dos Santos, Palmira F., Shelton, Rachel, Palinkas, Lawrence A., and Wainberg, Milton L.
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- 2024
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- View/download PDF
3. Assessment of the magnitude and contributing factors of expired medicines in the public pharmaceutical supply chains of Western Ethiopia
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Diriba, Gamachu, Hasen, Gemmechu, Tefera, Yesuneh, and Suleman, Sultan
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- 2023
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4. Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district
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Hassen, Sali Suleman and Lelisho, Mesfin Esayas
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- 2022
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5. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
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Kriel, Yolandie, Milford, Cecilia, Cordero, Joanna Paula, Suleman, Fatima, Steyn, Petrus S., and Smit, Jennifer Ann
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- 2021
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6. Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa
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Mattila, Phyllis Ocran, Babar, Zaheer-Ud-Din, and Suleman, Fatima
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- 2021
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- View/download PDF
7. SDG indicator 3.b.3 – an analysis of its robustness and challenges for measuring access to medicines for children
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Joosse, I. R., primary, Wirtz, V. J., additional, van Mourik, A. T., additional, Wagner, B. A., additional, Mantel-Teeuwisse, A. K., additional, Suleman, F., additional, and van den Ham, H. A., additional
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- 2023
- Full Text
- View/download PDF
8. Evaluating the impact of the single exit price policy on a basket of originator medicines in South Africa from 1999 to 2014 using a time series analysis
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Moodley, R. and Suleman, F.
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- 2019
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9. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
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Joanna Paula Cordero, Yolandie Kriel, Jennifer A. Smit, Petrus S. Steyn, Cecilia Milford, and Fatima Suleman
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Counseling ,Health Personnel ,Health informatics ,Health administration ,South Africa ,Family planning services ,Nursing ,Qualitative research ,Health care ,Humans ,Medicine ,Quality of Health Care ,Public Sector ,business.industry ,Research ,Health Policy ,Nursing research ,Public sector ,Quality of care ,Focus Groups ,Focus group ,Contraception ,Family planning ,Female ,Thematic analysis ,Public aspects of medicine ,RA1-1270 ,business - Abstract
Background Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework. Methods This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10. Results Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use. Conclusion Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.
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- 2021
10. Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district
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Sali Suleman Hassen and Mesfin Esayas Lelisho
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Adult ,Health Knowledge, Attitudes, Practice ,Health Policy ,Infant, Newborn ,Prenatal Care ,Patient Acceptance of Health Care ,Delivery, Obstetric ,Pregnancy Complications ,Young Adult ,Cross-Sectional Studies ,Pregnancy ,Prevalence ,Humans ,Female ,Maternal Health Services ,Ethiopia - Abstract
Background Skilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia. Methods A community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model. Results This study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance. Conclusions This study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.
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- 2022
11. Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa
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Zaheer-Ud-Din Babar, Fatima Suleman, and Phyllis Ocran Mattila
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medicine.medical_specialty ,media_common.quotation_subject ,Population ,Wage ,Health Services Accessibility ,Health administration ,South Africa ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Environmental health ,medicine ,Humans ,030212 general & internal medicine ,education ,health care economics and organizations ,Cancer ,media_common ,education.field_of_study ,Public Sector ,Affordability ,Poverty ,business.industry ,Health Policy ,Public health ,Private sector ,medicine.disease ,Oncology ,030220 oncology & carcinogenesis ,Costs and Cost Analysis ,Medicine ,Private Sector ,Private healthcare ,Public aspects of medicine ,RA1-1270 ,Drugs, Essential ,business ,Pricing ,Research Article - Abstract
Background Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost needs to be assessed. Objectives To assess the prices of cancer medicines for the three most common cancers ((breast, prostate and colorectal) in the private healthcare sector of South Africa. Methods The methodology was adapted from the World Health Organization (WHO)/ Health Action International (HAI) methodology for measuring medicine prices. The Single Exit Price (SEP) variations between product types of the same medicine between the highest- and lowest-priced product and between Originator Brand (OB) and its Lowest Priced Generic (LPG) of the same medicine brand was compared, as of March 2020. The affordability of those medicines for cancer usage based on treatment affordability in relation to the daily wage of the unskilled Lowest-Paid Government Worker (LPGW) was also determined. Also, a comparison of the proportion of the population below the poverty line (PL) before (Ipre) and after (Ipost) procurement of the cancer medicines was determined. Results SEP Price differences ranged from 25.46 to 97.33% between highest- and lowest-priced products and a price variation of 72.09% more for the OB than the LPG medicine, except for one LPG that was more expensive than the OB. Affordability calculations showed that All OB treatments for all three cancers (breast, prostate and colorectal), except for paclitaxel 300 mg (0.2 days wage) and Fluorouracil (Fluroblastin) 500 mg (0.3 days wage) costs respectively were more than 1 day’s wage, with patients diagnosed with colorectal cancer needing 32.5 days wages in order to afford a standard course of treatment for a month. Conclusion There was a considerable variation in the price of different brands of cancer medicines available in the South African private sector.
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- 2021
12. Parents’ and guardians’ perceptions on availability and pricing of medicines and healthcare for children in eThekwini, South Africa – a qualitative study
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Fatima Suleman and Velisha Ann Perumal-Pillay
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Parents ,Drug Costs ,Health Services Accessibility ,Essential medicines ,Health administration ,South Africa ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Universal Health Insurance ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Qualitative Research ,Quality of Health Care ,Pharmacies ,Private sector healthcare ,Public Sector ,Affordability ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Health Policy ,Nursing research ,Public sector healthcare ,Public sector ,1. No poverty ,Availability ,lcsh:RA1-1270 ,Consumer Behavior ,Focus Groups ,Private sector ,Focus group ,Access ,3. Good health ,Snowball sampling ,Private Sector ,Drugs, Essential ,0305 other medical science ,business ,Attitude to Health ,Research Article - Abstract
Background Inadequate access to affordable essential medicines poses a challenge to achieving Universal Health Coverage. Access to essential medicines for children has been in the spotlight in recent research. However, information from the end users of medicines, i.e. patients is scarce. Obtaining information at a household level is integral to understanding how people access, obtain and use medicines. This study aimed to gather opinions and perceptions from parents/guardians on availability, affordability and quality of medicines and healthcare for children in SA. Methods Eight Focus group discussions were held with 41 individuals in eThekwini, South Africa (SA), from September–November 2016. Participants were parents/guardians of children up to 12 years from different ethnicities, ages, gender, and socio-economic backgrounds. Key informants identified by the principal researcher recruited participants using snowball sampling. Focus group discussions were recorded, transcribed verbatim, coded by the first author, verified by the second author, reconciled for consensus and imported into NVIVO for data analysis. Results Medicines and healthcare facilities are accessible in urban and peri-urban areas in eThekwini. Medicines may not always be available in public sector facilities due to medicine shortages, compelling parents to purchase medicines from private sector pharmacies. Common medicines were perceived as affordable for most socio-economic groups except the ‘Poor’ group. Quality of medicines was perceived as ‘good’ especially if obtained from the private sector but sometimes perceived as ‘poor’ and viewed with suspicion when received from public sector clinics. Quality of healthcare was perceived as ‘good’ but requires improvement for both sectors. Conclusions This is the first study in SA to report on parent/guardian perceptions on availability, affordability and quality of medicines and healthcare for children. It has the potential to be up-scaled to a country-wide investigation to paint a national picture of parents’ opinions of healthcare for children. This will allow for patient input into pharmaceutical and healthcare policy governing access to and availability of essential medicines and services within the country. The study recommends that patient input be sought to assess impact of policies on the intended target group in the country to ensure that the policy objectives are achieved. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2385-y) contains supplementary material, which is available to authorized users.
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- 2017
13. Quantitative evaluation of essential medicines lists: the South African case study
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Fatima Suleman and Velisha Ann Perumal-Pillay
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Essential medicines lists ,Pediatrics ,medicine.medical_specialty ,Standard treatment guidelines ,genetic structures ,030231 tropical medicine ,Primary health care ,Priority medicines ,Health systems research ,World Health Organization ,behavioral disciplines and activities ,World health ,Essential medicines ,03 medical and health sciences ,South Africa ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Qualitative Research ,Pharmacopoeias as Topic ,Traditional medicine ,business.industry ,Health Policy ,Hospital level ,3. Good health ,business ,Drugs, Essential ,Research Article - Abstract
Background The South African (SA) health system has employed an Essential Medicines List (EML) with Standard Treatment Guidelines (STGs) since 1996. To date no studies have reported the changes in SA STG/EMLs. This study describes these changes over time (1996–2013) and compares latest SA STG/EMLs with the latest World Health Organization (WHO) Model EMLs to assess alignment of these lists. Methods A quantitative evaluation of SA STGs/EMLs at 2 levels of healthcare was performed to assess changes in the number and ratio of molecules, dosage forms, and additions and deletions of medicines. The most recent WHO EMLs (18th list, 4th list for children) and 2012 priority life-saving medicines for women and children (PMWC) list were compared to the most recent available SA STG/EMLs (Primary Health Care (PHC 2008), Adult Hospital 2012, and Paediatric Hospital 2013) at the time of the research. Results The number of molecules over the years increased for PHC STG/EMLs but decreased slightly for Adult and Paediatric hospital STG/EMLs. The most additions and deletions over time occurred in the Adult hospital level STG/EML (27 in 2006 and 44 in 2012). A comparison between the most recent SA STG/EMLs and WHO Model EML (18th list) showed that a total of 112 medicines were absent on all SA STG/EMLs. A comparison of medicines for children between the 2013 SA Paediatric Hospital level STG/EML and PMWC indicated that these lists were somewhat aligned for most conditions as only 3 of 14 medicines and 11 of 20 vaccines were absent from SA STG/EMLs. Conclusion This is the first study in SA to investigate changes in National EMLs over time in relation to molecules, dosage forms and therapeutic classes. It is also the first to compare the latest SA STG/EMLs to the WHO Model lists. The results therefore provide insight into the trends and SA STG/EML processes over time.
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- 2016
14. Selection of essential medicines for South Africa - an analysis of in-depth interviews with national essential medicines list committee members
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Fatima Suleman and Velisha Ann Perumal-Pillay
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Adult ,Male ,Essential medicines lists ,Standard treatment guidelines ,Evidence-based practice ,Advisory Committees ,Decision Making ,Health informatics ,Selection of essential medicines ,Essential medicines ,Health administration ,Interviews as Topic ,03 medical and health sciences ,South Africa ,0302 clinical medicine ,Nursing ,Medicine ,Humans ,030212 general & internal medicine ,Decision-making ,Medical education ,Public Sector ,business.industry ,030503 health policy & services ,Nursing research ,Health Policy ,Public sector ,Monitoring and evaluation ,Middle Aged ,3. Good health ,Committee Membership ,Female ,0305 other medical science ,business ,Drugs, Essential ,Research Article - Abstract
Background The South African (SA) public health system has employed an Essential Medicines List (EML) with Standard Treatment Guidelines (STGs) in the public sector since 1996. To date no studies have reported on the process of selection of essential medicines for SA EMLs and how this may have changed over time. This study reports on the decision making process for the selection of essential medicines for SA EMLs, over the years, as described by various members of the National Essential Medicines List Committee (NEMLC) and their task teams. Methods Qualitative in-depth interviews, guided by an interview questionnaire, were conducted with 11 members of the SA NEMLC and their task teams (both past and present members) during the period January – April 2015. Interviews were recorded and transcribed verbatim. Transcripts were then coded by the first author and verified by the second author before being reconciled and input into NVIVO, a qualitative software, to facilitate analysis of the data. Results The interviews conducted suggest that the NEMLC process of medicine selection has been refined over the years. This together with the EML review process is now essentially predominantly an evidence based process where quality, safety and efficacy of a medicine is considered first followed by cost considerations which includes pharmacoeconomic evaluations, and pricing of medicines. Conclusions This is the first study in SA to report on how decisions are taken to include or exclude medicines on SA national EMLs and provides insight into the SA EML medicine selection, review and monitoring processes over time. The results show that the NEMLC has undergone tremendous transformation over the years. Whilst the membership of the committee largely remains unchanged, the committee has developed its policies and processes over the years. However there is still a need to strengthen the monitoring and evaluation aspects of the SA EML policy process.
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- 2016
15. Parents’ and guardians’ perceptions on availability and pricing of medicines and healthcare for children in eThekwini, South Africa – a qualitative study
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Perumal-Pillay, Velisha Ann, primary and Suleman, Fatima, additional
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- 2017
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16. Selection of essential medicines for South Africa - an analysis of in-depth interviews with national essential medicines list committee members
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Perumal-Pillay, Velisha Ann, primary and Suleman, Fatima, additional
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- 2017
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17. Quantitative evaluation of essential medicines lists: the South African case study
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Perumal-Pillay, Velisha Ann, primary and Suleman, Fatima, additional
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- 2016
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18. Evaluating the effect of a proposed logistics fee cap on pharmaceuticals in South Africa - a pre and post analysis
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Fatima Suleman and Varsha Bangalee
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Finance ,Policy development ,medicine.medical_specialty ,business.industry ,Health Policy ,Nursing research ,Public health ,Commerce ,Private sector ,Health informatics ,Single exit pricing ,Health administration ,South Africa ,Pharmaceutical Preparations ,Organization and Administration ,Logistics fees ,Price caps ,Costs and Cost Analysis ,Humans ,Medicine ,Private Sector ,business ,Medicine pricing ,Pre and post ,Research Article - Abstract
Background South Africa has proposed the implementation of a maximum logistics fee paid by pharmaceutical manufacturers to wholesalers and distributors. However very little knowledge exists of the effects, unintended or otherwise, of the implementation of these proposed regulations, which are required to guide further policy development and implementation. The objectives of this study was to therefore evaluate the effects of the proposed logistics fee cap on different pharmaceuticals and different dosage forms, as well as to observe the logistics fee contribution to the Single Exit Price. Methods Private sector medicine prices were sourced from the South African Medicine Price Registry as at 20 December 2013. For each medicine the maximum logistics fee was calculated based on the 2012 proposed government guidelines. The logistics fee as a percentage of the final Single Exit Price was calculated, as part of the analysis of results. Results Out of the 47 medicines in the overall sample from the current study, only 16 medicines showed a decrease in the Single Exit Price with the application of the maximum logistics fee cap. Conclusion This study reveals the need for greater transparency of the mark ups along the distribution chain as well as further research with regards to the costing of logistics fees of similar pharmaceuticals.
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- 2015
19. Evaluating the effect of a proposed logistics fee cap on pharmaceuticals in South Africa - a pre and post analysis
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Bangalee, Varsha, primary and Suleman, Fatima, additional
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- 2015
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20. Death certificate completion skills of hospital physicians in a developing country
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Haque, Ahmed Suleman, primary, Shamim, Kanza, additional, Siddiqui, Najm Hasan, additional, Irfan, Muhammad, additional, and Khan, Javaid Ahmed, additional
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- 2013
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21. Understanding medicine access strategies for innovator medicines registered in South Africa
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Thulasizwe Njabulo Qiniso Jama and Fatima Suleman
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Alternative reimbursement models ,Private sector healthcare ,Public sector healthcare ,Cost of innovator medicines ,Policies South Africa ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background South Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines. Objectives The objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry. Design This study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study. Results According to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence). Conclusion Access to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.
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- 2024
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22. Providers’ perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry
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Jennifer J. Mootz, Lindsey de Vos, Melissa Stockton, Annika C. Sweetland, Bianca Kann, Chariz Seijo, Charl Bezuidenhout, Antonio Suleman, Paulino Feliciano, Palmira F. dos Santos, Rachel Shelton, Lawrence A. Palinkas, and Milton L. Wainberg
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CFIR ,Sustainability ,Public mental healthcare ,Mozambique ,Sub-saharan Africa ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. Methods We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. Results The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. Conclusions Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.
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- 2024
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23. Death certificate completion skills of hospital physicians in a developing country
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Najm Hasan Siddiqui, Muhammad Irfan, Kanza Shamim, Ahmed Suleman Haque, and Javaid A Khan
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medicine.medical_specialty ,Health informatics ,Death Certificates ,Medical Records ,Health administration ,Hospitals, University ,Tertiary Care Centers ,Health care ,medicine ,Medical Staff, Hospital ,Humans ,Pakistan ,Developing Countries ,Health policy ,Retrospective Studies ,business.industry ,Medical record ,Public health ,Health Policy ,fungi ,food and beverages ,Public health informatics ,Family medicine ,Death certificate ,Clinical Competence ,business ,Research Article - Abstract
Background Death certificates (DC) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. Incomplete and inaccurate DC data, on the other hand, can significantly impair the precision of a national health information database. In this study we evaluated the accuracy of death certificates at a tertiary care teaching hospital in a Karachi, Pakistan. Methods A retrospective study conducted at Aga Khan University Hospital, Karachi, Pakistan for a period of six months. Medical records and death certificates of all patients who died under adult medical service were studied. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. Accuracy of this information was validated using their medical records. Errors in the death certificates were classified into six categories, from 0 to 5 according to increasing severity; a grade 0 was assigned if no errors were identified, and 5, if an incorrect cause of death was attributed or placed in an improper sequence. Results 223 deaths occurred during the study period. 9 certificates were not accessible and 12 patients had incomplete medical records. 202 certificates were finally analyzed. Most frequent errors pertaining to patients’ demographics (92%) and cause/s of death (87%) were identified. 156 (77%) certificates had 3 or more errors and 124 (62%) certificates had a combination of errors that significantly changed the death certificate interpretation. Only 1% certificates were error free. Conclusion A very high rate of errors was identified in death certificates completed at our academic institution. There is a pressing need for appropriate intervention/s to resolve this important issue.
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24. Assessment of the magnitude and contributing factors of expired medicines in the public pharmaceutical supply chains of Western Ethiopia
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Gamachu Diriba, Gemmechu Hasen, Yesuneh Tefera, and Sultan Suleman
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Expired medicine ,Magnitude ,Supply chain ,Contributing factors ,Western Ethiopia ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The magnitude of expired medicines in supply chains are increasing globally due to lack of strict control of the supply chain, poor storage management and oversupply of medicines. This situation is very serious in resource-poor countries, including Ethiopia, where the supply of medicines is limited. Therefore, this study aimed to assess the magnitude and the contributing factors of expired medicines in the Public Pharmaceutical Supply Chains of Western Ethiopia. Methods Explanatory sequential study design involving mixed quantitative and qualitative approach were employed among 62 public pharmaceutical supply chains of Western Ethiopia from July1 to August 30, 2021. An observational checklist and the self-administered questionnaire were used to review all records of the expired medicine file and to abstract secondary data on the extent, types of expired medicines and its contributing factors. The collected data was cleared, filtered, and coded using Microsoft Excel® 2010, and exported to SPSS version-23 (Amsterdam, Netherland) for statistical analysis. Bivariate logistic regression was used to check association between the outcome and independent variables. Multivariate logistic regression was analyzed when p-value is less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical at p-value
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- 2023
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25. SDG indicator 3.b.3 – an analysis of its robustness and challenges for measuring access to medicines for children
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I. R. Joosse, V. J. Wirtz, A. T. van Mourik, B. A. Wagner, A. K. Mantel-Teeuwisse, F. Suleman, and H. A. van den Ham
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Access to medicines ,Child medicines ,Child health ,Sustainable development goals ,Indicator ,Affordability ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Sustainable Development Goal (SDG) indicator 3.b.3 monitors progress in medicines’ accessibility for adults and has significant limitations when applying to medicines for children. An adapted indicator methodology was developed to fill this gap, but no proof of its robustness exists. We provide this evidence through sensitivity analyses. Methods Data on availability and prices of child medicines from ten historical datasets were combined to create datasets for analysis: Dataset 1 (medicines selected at random) and Dataset 2 (preference given to available medicines, to better capture affordability of medicines). A base case scenario and univariate sensitivity analyses were performed to test critical components of the methodology, including the new variable of number of units needed for treatment (NUNT), disease burden (DB) weighting, and the National Poverty Line (NPL) limits. Additional analyses were run on a continuously smaller basket of medicines to explore the minimum number of medicines required. Mean facility scores for access were calculated and compared. Results The mean facility score for Dataset 1 and Dataset 2 within the base case scenario was 35.5% (range 8.0–58.8%) and 76.3% (range 57.2–90.6%). Different NUNT scenarios led to limited variations in mean facility scores of + 0.1% and -0.2%, or differences of + 4.4% and -2.1% at the more critical NPL of $5.50 (Dataset 1). For Dataset 2, variations to the NUNT generated differences of + 0.0% and -0.6%, at an NPL of $5.50 the differences were + 5.0 and -2.0%. Different approaches for weighting for DB induced considerable fluctuations of 9.0% and 11.2% respectively. Stable outcomes with less than 5% change in mean facility score were observed for a medicine basket down to 12 medicines. For smaller baskets, scores increased more rapidly with a widening range. Conclusion This study has confirmed that the proposed adaptations to make SDG indicator 3.b.3 appropriate for children are robust, indicating that they could be an important addition to the official Global Indicator Framework. At least 12 child-appropriate medicines should be surveyed to obtain meaningful outcomes. General concerns that remain about the weighting of medicines for DB and the NPL should be considered at the 2025 planned review of this framework.
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- 2023
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26. Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives
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Yolandie Kriel, Cecilia Milford, Joanna Paula Cordero, Fatima Suleman, Petrus S. Steyn, and Jennifer Ann Smit
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Quality of care ,Family planning services ,Contraception ,South Africa ,Qualitative research ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Quality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework. Methods This formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10. Results Family planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use. Conclusion Using a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.
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- 2021
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27. Assessing the prices and affordability of oncology medicines for three common cancers within the private sector of South Africa
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Phyllis Ocran Mattila, Zaheer-Ud-Din Babar, and Fatima Suleman
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Oncology ,Cancer ,Medicine ,Pricing ,Affordability ,South Africa ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost needs to be assessed. Objectives To assess the prices of cancer medicines for the three most common cancers ((breast, prostate and colorectal) in the private healthcare sector of South Africa. Methods The methodology was adapted from the World Health Organization (WHO)/ Health Action International (HAI) methodology for measuring medicine prices. The Single Exit Price (SEP) variations between product types of the same medicine between the highest- and lowest-priced product and between Originator Brand (OB) and its Lowest Priced Generic (LPG) of the same medicine brand was compared, as of March 2020. The affordability of those medicines for cancer usage based on treatment affordability in relation to the daily wage of the unskilled Lowest-Paid Government Worker (LPGW) was also determined. Also, a comparison of the proportion of the population below the poverty line (PL) before (Ipre) and after (Ipost) procurement of the cancer medicines was determined. Results SEP Price differences ranged from 25.46 to 97.33% between highest- and lowest-priced products and a price variation of 72.09% more for the OB than the LPG medicine, except for one LPG that was more expensive than the OB. Affordability calculations showed that All OB treatments for all three cancers (breast, prostate and colorectal), except for paclitaxel 300 mg (0.2 days wage) and Fluorouracil (Fluroblastin) 500 mg (0.3 days wage) costs respectively were more than 1 day’s wage, with patients diagnosed with colorectal cancer needing 32.5 days wages in order to afford a standard course of treatment for a month. Conclusion There was a considerable variation in the price of different brands of cancer medicines available in the South African private sector.
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- 2021
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28. Evaluating the impact of the single exit price policy on a basket of originator medicines in South Africa from 1999 to 2014 using a time series analysis
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R. Moodley and F. Suleman
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Single exit Price ,South Africa ,Time series ,Medicine pricing policy ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Affordability and availability of quality medicines to all its citizens has been a key priority area for South Africa since democracy in 1994. In order to introduce transparency in the private market the government introduced the Single Exit Price (SEP) for medicines in 2004, for all prescription medicines, comprising of a fixed ex-factory price with a logistics fee component (and value added tax) for medicines sold to all purchasers other than the State. This is complemented with a provision for an annual regulated maximum percentage increase. The study evaluates the impact of the SEP on a basket of originator medicines, in terms of costs, immediate price reductions and projected price reductions. Method This is an analytical, quantitative study. A basket of medicines was selected, based on the WHO/HAI list, and adapted to include registered medicines in South Africa. Prices of 50 originator medicines were assessed from 1999 to 2014 in terms of the single exit price and the changes in prices in accordance with legislation using a time series analysis methodology. Results Of the 50 originator medicines investigated 35 showed a statistically significant change in level. For the Global Core list, the percentage change ranged from 2.45–39.12% (mean = 19.87%, SD = 10.62%, IQR = 10.2%). The range for the Regional Core list was 1.77–42.17% (mean = 23.38%, SD = 12.43%, IQR = 15.65%). The Supplementary list was 11.68–55.86% (mean = 22.97%, SD = 16.26%, IQR = 17.34). This study indicates that the SEP regulation had an impact on medicine pricing in South Africa in both the short and long term. Most medicines investigated showed a smaller yearly increase in price compared to before regulations due to the controlled pricing environment introduced by Government. Conclusion This study provides evidence of the impact of medicine pricing intervention from a middle–income country, and other developing countries looking at introducing medicine price controls can draw useful lessons.
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- 2019
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29. Parents’ and guardians’ perceptions on availability and pricing of medicines and healthcare for children in eThekwini, South Africa – a qualitative study
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Velisha Ann Perumal-Pillay and Fatima Suleman
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Access ,Availability ,Affordability ,Essential medicines ,Private sector healthcare ,Public sector healthcare ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Inadequate access to affordable essential medicines poses a challenge to achieving Universal Health Coverage. Access to essential medicines for children has been in the spotlight in recent research. However, information from the end users of medicines, i.e. patients is scarce. Obtaining information at a household level is integral to understanding how people access, obtain and use medicines. This study aimed to gather opinions and perceptions from parents/guardians on availability, affordability and quality of medicines and healthcare for children in SA. Methods Eight Focus group discussions were held with 41 individuals in eThekwini, South Africa (SA), from September–November 2016. Participants were parents/guardians of children up to 12 years from different ethnicities, ages, gender, and socio-economic backgrounds. Key informants identified by the principal researcher recruited participants using snowball sampling. Focus group discussions were recorded, transcribed verbatim, coded by the first author, verified by the second author, reconciled for consensus and imported into NVIVO for data analysis. Results Medicines and healthcare facilities are accessible in urban and peri-urban areas in eThekwini. Medicines may not always be available in public sector facilities due to medicine shortages, compelling parents to purchase medicines from private sector pharmacies. Common medicines were perceived as affordable for most socio-economic groups except the ‘Poor’ group. Quality of medicines was perceived as ‘good’ especially if obtained from the private sector but sometimes perceived as ‘poor’ and viewed with suspicion when received from public sector clinics. Quality of healthcare was perceived as ‘good’ but requires improvement for both sectors. Conclusions This is the first study in SA to report on parent/guardian perceptions on availability, affordability and quality of medicines and healthcare for children. It has the potential to be up-scaled to a country-wide investigation to paint a national picture of parents’ opinions of healthcare for children. This will allow for patient input into pharmaceutical and healthcare policy governing access to and availability of essential medicines and services within the country. The study recommends that patient input be sought to assess impact of policies on the intended target group in the country to ensure that the policy objectives are achieved.
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- 2017
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