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      It is very difficult in this business if you want to have a good conscience”: pharmaceutical governance and on-the-ground ethical labour in Ghana

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          ABSTRACT

          The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks.

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          "Everything Is Perfect, and We Have No Problems": Detecting and Limiting Social Desirability Bias in Qualitative Research.

          Many qualitative research studies acknowledge the possibility of social desirability bias (a tendency to present reality to align with what is perceived to be socially acceptable) as a limitation that creates complexities in interpreting findings. Drawing on experiences conducting interviews and focus groups in rural Ethiopia, this article provides an empirical account of how one research team developed and employed strategies to detect and limit social desirability bias. Data collectors identified common cues for social desirability tendencies, relating to the nature of the responses given and word choice patterns. Strategies to avoid or limit bias included techniques for introducing the study, establishing rapport, and asking questions. Pre-fieldwork training with data collectors, regular debriefing sessions, and research team meetings provided opportunities to discuss social desirability tendencies and refine approaches to account for them throughout the research. Although social desirability bias in qualitative research may be intractable, it can be minimized.
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            Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa.

            Sub-Saharan Africa is facing a crisis in human health resources due to a critical shortage of health workers. The shortage is compounded by a high burden of infectious diseases; emigration of trained professionals; difficult working conditions and low motivation. In particular, the burden of HIV/AIDS has led to the concept of task shifting being increasingly promoted as a way of rapidly expanding human resource capacity. This refers to the delegation of medical and health service responsibilities from higher to lower cadres of health staff, in some cases non-professionals. This paper, drawing on Médecins Sans Frontières' experience of scaling-up antiretroviral treatment in three sub-Saharan African countries (Malawi, South Africa and Lesotho) and supplemented by a review of the literature, highlights the main opportunities and challenges posed by task shifting and proposes specific actions to tackle the challenges. The opportunities include: increasing access to life-saving treatment; improving the workforce skills mix and health-system efficiency; enhancing the role of the community; cost advantages and reducing attrition and international 'brain drain'. The challenges include: maintaining quality and safety; addressing professional and institutional resistance; sustaining motivation and performance and preventing deaths of health workers from HIV/AIDS. Task shifting should not undermine the primary objective of improving patient benefits and public health outcomes.
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              Prevalence and Estimated Economic Burden of Substandard and Falsified Medicines in Low- and Middle-Income Countries

              Key Points Question What are the prevalence and estimated economic burden of substandard and falsified medicines in low- and middle-income countries? Findings In this systematic review of 265 studies comprising 400 647 drug samples and meta-analysis of 96 studies comprising 67 839 drug samples, the prevalence of substandard and falsified medicines in low- and middle-income countries was 13.6% overall (19.1% for antimalarials and 12.4% for antibiotics). Data on the estimated economic impact were limited primarily to market size and ranged widely from $10 billion to $200 billion. Meaning Substandard and falsified medicines are a substantial health and economic problem; a concerted global effort is needed to secure the global supply chain, increase quality control capacity, and improve surveillance to better assess the problem and identify solutions.
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                Author and article information

                Journal
                Glob Bioeth
                Glob Bioeth
                Global Bioethics
                Routledge
                1128-7462
                1591-7398
                26 July 2022
                2022
                26 July 2022
                : 33
                : 1
                : 103-121
                Affiliations
                [a ] Durham University , Durham, UK
                [b ] University of Cape Coast , Cape Coast, Ghana
                [c ] University of Oxford , Oxford, UK
                Author notes
                [CONTACT ] Kate Hampshire K.R.Hampshire@ 123456durham.ac.uk Durham University , UK
                Author information
                https://orcid.org/0000-0003-4184-849X
                Article
                2103899
                10.1080/11287462.2022.2103899
                9331207
                35912379
                2de38210-5364-42b2-9650-0eac743da254
                © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 57, Pages: 19
                Categories
                Articles
                Research Article

                access to medicines,essential medicines,pharmaceutical governance,africa,ethical labour,substandard and falsified (sf) medical products

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