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.