This research integrated sociological, public health and political
economic approaches to analyse the diverse cultural, medical, economic
and institutional factors that determine how three pharmaceuticals -
oxytocin, rifampicin, fluoxetine - reach their end users in South Asia.
The research also aimed to assist the development of effective
interventions to improve MDG and other health outcomes and thereby
contribute to poverty-reduction strategies, especially in relation to
maternal and child health, infectious diseases and mental health. We
innovatively combined detailed ethnographic interviews, semi-structured
qualitative interviews with key opinion leaders and shapers,
organisational analysis and secondary data sources using government
statistics and pharmaceutical industry data.
Our main findings show how complex pharmaceuticals' supply chains in
South Asia create continuing difficulties for the Governments of Nepal
and India in regulating how pharmaceuticals reach consumers in ways that
minimise both high prices and excessive and inappropriate consumption.
Our case studies - including disputes over 'ethical practice' in
Nepal, 'floating prescriptions' of psychiatric drugs, and
controversies over the accessibility of uterotonic drugs - have
illuminated some key areas of concern in governmental failures to
regulate producers, suppliers, retailers and prescribers. Further,
through analysing the available evidence of 'best practice' with
respect to our three selected drugs, we have shown how little is
reliably known about the 'global burden of disease' in respect of
depression, about the most appropriate methods of delivering anti-TB
drugs, and about the use of uterotonics to augment labour and
prevent/arrest post-partum haemorrhage - not only in South Asia but
elsewhere as well.
ESRC, Swindon, 8 pp.
Tracing pharmaceuticals in South Asia: regulation, distribution and consumption. ESRC End of Award Report, RES-167-25-0110