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Objective: Middle-income countries are often referred to as developing or emerging economies and face multiple challenges of severe financial stresses in their health care sectors, and high disease burden. The objective of this study is to provide an overview of how health technology assessment (HTA) is used and organized in selected middle-income countries and its role in the process of pharmaceutical coverage., Methods: We selected middle-income countries where HTA activities are evident: Argentina, Brazil, China, Colombia, Israel, Mexico, Philippines, Korea, Taiwan, Thailand, and Turkey. We collected and reviewed relevant information to describe the health care and reimbursement systems and how HTA relates to coverage decision-making of pharmaceuticals. This was supplemented by information from a structured survey among professionals working in public and private health insurance, industry, regulatory authorities, ministries of health, academic units or HTA., Results: All countries require market authorization for pharmaceuticals to be sold and most countries have a national plan defining which pharmaceuticals can be reimbursed. However, the use of HTA in reimbursement decisions is still in its early stages with varying levels of HTA guidance implementation., Conclusions: The study provides evidence of the development of HTA in coverage decision-making in middle-income countries. Increased health care spending and the resulting access to modern technology give a strong impetus to HTA. However, HTA is developing with uneven speed in middle-income countries and many countries are building on the organisational and methodological experience from established HTA agencies., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

In 2003 the Thai government announced a radical shift in drug policy with the implementation of a War on Drugs. Although consequences of this controversial measure (e.g. drug dealer deaths) have received widespread attention relatively little work has evaluated changes in substance use. We used two anonymous representative samples of secondary school students to compare drug use in Northeast Thailand before (1998; n=4217) and after (2004/5; n=3489) the War on Drugs. Results indicate that reported levels of current illicit drug use reduced significantly between 1998 and 2004/5 (for methamphetamine from 4.2% to 0.9%). By examining trends in year of first methamphetamine use we identify that observed reductions in drug initiation are temporally consistent with the War on Drugs. However, while prevalence of alcohol use has also fallen, there was a three-fold increase in daily alcohol use. We suggest that this rise, combined with other negative impacts of 'wars' on drugs, means drug control requires a public health perspective that sees eliminating drug use as part of a wider strategy that has improvement in population health, not just drug prevention, as its core objective.

In Thailand, artesunate and artemether are the mainly used antimalarials for treatment of severe or multidrug resistant falciparum malaria. However, their availability (supply) and the registration requirements are the major limitations for their large-scale use. At Bangkok Hospital for Tropical Diseases, Thailand, we have studied the new artemisinin derivatives, dihydroartemisinin and arteether, and artesunate suppositories. We found that the three preparations are well tolerated, safe, and efficacious.

The paper describes the situation of drugs and drug sources found available at the village level in Thailand. It concludes, from village-survey data (N = 195) and village case studies (N = 15), that drugs are available in abundance. A vast variety of drugs, including prescription drugs, are available at various sources, of which the most common ones are grocery stores. The situation reflects the failure of the drug regulation system as well as the influence of commercial pharmaceutical sector in drug provision. This situation hampers attempts to rationalize drug use by consumers.

The ecology in northern Thailand has been affected by the lifestyle of minority groups living there and some ethnic Thai people. Since 1970 development work to improve socioeconomic conditions and national security has been under way. The highlands cover an area of 17 million hectares consisting of forest and watershed areas. A new problem has arisen with the spread of heroin abuse in the neighbouring Lao People's Democratic Republic and Myanmar, producing a negative impact on the ecology, politics and the administration of minority groups. The Government of Thailand has shown flexibility in striving to solve these problems through development work in cooperation with the private sector. This has contributed to good relationships between the countries concerned. Some of the policies and programmes introduced by the Government of Thailand are reviewed in this article.

The Government of Thailand, which has long recognized the serious threat posed by illicit drugs, has implemented stringent law enforcement measures aimed at suppressing illicit drug trafficking by dismantling clandestine laboratories, intercepting essential chemicals, effecting significant seizures and eradicating illicit crops. In addition, the Government has taken steps to initiate the enactment of legislation providing for the confiscation of proceeds derived from illicit drug trafficking activity. Furthermore, it has maintained and strengthened its already close bilateral and multilateral cooperation in the field of drug abuse control.