Pharmaceuticals Management for Under-served Popula

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Abstract/Syllabus

Courseware/Lectures

Test/Tutorials

Pharmaceuticals Management for Under-served Populations

Spring 2006

Course

Instructors

David Peters & Alan Lyles

Offered By

Extradepartmental

Description

Students will be guided to analyze problems and develop strategies based on real world drug management issues including regulations, manufacture, procurement, distribution, safety, policy, financing and the unique aspects of international pharmaceutical trade, the role of the World Trade Organization - Trade-Related Aspects of Intellectual Property Rights (WTO-TRIPS), government, non-governmental organizations (NGOs) and individuals/programs in the selection and use of pharmaceutical products. Course materials are drawn from both developed and developing countries so that the student will be knowledgeable about the role of Essential Medicines and the formation of a National Drug Policy. The course will use a multidisciplinary approach to provide students with an operational understanding of factors influencing access to and use of pharmaceuticals and other health commodities. Collectively, these materials and approaches are intended to stimulate critical thinking on how to improve access to and the use of pharmaceutical products.

Syllabus

Course Description

Course Objectives

To develop an operational understanding of pharmaceuticals management in developing countries and underserved populations. The course will discuss factors, policies and regulations influencing drug availability and access, procurement, utilization, distribution, rational use, essential drugs, budgeting, inventory, and financing. The course will also discuss and describe the roll of government, non-governmental organizations (NGOs) and individual/program pharmaceuticals management.

Students will identify the different types of health commodities and their regulation, will understand key factors in the drug management cycle, will identify potential obstacles to and problems of access, as well as define creative solutions to these problems. Students will also understand the various factors influencing drug selection and the rational use of pharmaceuticals, and explain the relative strengths and weaknesses of alternative ways to raise revenues to pay for pharmaceuticals.

Readings

Managing Drug Supply: The Selection, Procurement, Distribution, and Use of Pharmaceuticals. 2nd edition. Management Sciences for Health in collaboration with the World Health Organization. Kumarian Press. 1997. ISBN 1-56449-047-9.

Schedule

SESSION #	TOPIC	ACTIVITIES

1	The Global Context of Pharmaceutical Products and Underserved Populations Become familiar with the key components and sequence of the Drug Management Cycle Understand the leading patient, product and pharmaceutical services management Describe the main functions of managing the pharmaceutical supply system Identify access barriers arising from globalization and the interrelationships between developed and developing countries Identify some key characteristics of underserved populations Understand the barrier to access of pharmaceuticals by underserved populations	Lecture
2	International Policy and Legal Framework Describe the main features of the World Trade Organization (WTO) and its actions regarding pharmaceutical products Discuss the main concerns regarding bilateral trade agreements Understand Orphan Drugs and be able to assess the effectiveness of policies designed to encouraged their development and marketing Explain Trade-Related Aspects of Intellectual Property (TRIPs) in relation to access and cost of pharmaceuticals	Lecture
3	Drug Manufacture, Industrial Pharmacy Considerations, Quality Assurance and Regulation Be familiar with drug manufacturing requirements and industry regulations Describe Good Manufacturing Practices (GMP) Understand requirements for developing domestic manufacturing capabilities Differentiate between brand vs generics and the conditions for interchange Become familiar with the procedures to prevent and detect counterfeit products Describe relevant drug regulations Describe the Guiding Principles for small national drug regulatory authorities Describe relevant drug regulations Understand basics of and issues relating to drug product quality assurance Understand differences relating to full-scale manufacturing, small-scale institutional/local production, and extemporaneous compounding	Lecture
4	The Drug Management Cycle: Selection Be able to apply evidence-based criteria for pharmaceutical product selection Describe approaches to developing Essential Medicines Lists, Formularies, and Standard Treatment Guidelines Recognize the challenges in implementing treatment guidelines and formulary systems and ways to overcome them	Lecture
5	Forecasting and Quantification Discuss the critical issues in forecasting and quantifying drug requirements Explain the four general methods for quantification Apply the consumption-based method to estimate actual need and costs Develop a basic spreadsheet for budget and forecasting models Become aware of the potential of MSH's Quantimed software to project drug needs	Laboratory
6	The Drug Management Cycle: Procurement Explain the factors influencing drug prices and total costs Understand different types of procurement Describe good pharmaceutical procurement practices Describe the tender process Describe the steps in the tender cycle and related critical management consideration Explain the process for developing a contract for services Identify the procurement-related determinants of drug quality and the process(es) for obtaining quality drugs	Lecture
7	Drug Donations Explain the core principles for drug donations Discuss the main concerns regarding drug donations	Lecture
8	The Drug Management Cycle: Distribution Explain the critical elements in designing a distribution system Understand the port clearing process and key documents Discuss the main considerations for managing medical stores independent of health facilities Explain inventory processes within health facilities Logistic management of drug distribution chains: transport, storage warehousing, customs and Kit System. Describe standard reports used to manage inventory Explain safety stock and service levels in determining inventory practices Apply the EOQ model for reordering	Lecture
9	The Drug Management Cycle: Use Define rational drug use Explain the main factors contributing to irrational drug use Discuss the steps in developing strategies to improve drug use Apply data and quantitative methods to identify drug interventions Evaluate drug information sources Understand drug promotion Explain the framework for improving drug prescribing - including educational, managerial and regulatory approaches Describe the steps in good dispensing practice(s) Identify the process for public education in appropriate drug use Discuss the role(s) of Medicinal Plants and Traditional Healers	Lecture
10	Budgeting and Cost Control Be able to develop a spreadsheet of: budget budget impact forecast(s) breakeven analysis	Laboratory
11	Access to Essential Drugs Explain how to appraise access to essential drugs at the community level Understand the different dimensions and determinants of access to medicines Describe different types of community participation that affect access to essential medicines Describe how to do a community needs assessment Describe recent innovations to increase access to medicines involving the private sector and communities, including participatory monitoring Explain the main factors influencing cost, use and access to pharmaceuticals	Lecture
12	Management Support Systems: Planning Cycle Explain the management cycle and implementation strategies Apply Gantt charts as a work planning tools Design a monitoring system and appropriate indicators	Lecture
13	Pharmaceutical Care and Drug Utilization in an HIV/AIDS Clinic Understand the terminology and concepts used in DUR Be able to explain models for prospective DUR and for retrospective DUR Be able to discuss DUR applications to detect inappropriate drug use in addition to fraud and abuse	Lecture
14	Financing and Sustainability Explain the different types of financing and assistance {Discuss strategic considerations in product pricing from the perspective of the manufacturer and distributor} Discuss the revolving fund concept	Planning Laboratory

Readings

Textbook

TOPIC	READINGS
Session 1: The Global Context of Pharmaceutical Products and Under-served Populations
Required	MSH Managing Drug Supply: Part 1 Introduction Toward Sustainable Supply and Rational Use of Drugs (pp. 3-16) Historical and Institutional Perspectives (pp. 17-25) Economics for Drug Management (pp.26-37) Pharmaceutical Supply System Management (pp. 38-52)
Recommended	WHO Essential Medicines Library (EMLib). Available at: http://mednet3.who.int/eml/ - contains a Model Formulary, Model list of Essential Drugs Lofland JH and Lyles A. Pharmacy Practice and Health Policy within the United States: An Introduction and Overview [Chapter 20] in Managing Pharmacy Practice: Principles, Strategies, and Systems, Andrew Peterson, Editor. CRC Press LLC. Boca Raton, Fl. 2004. Health, United States, 2004. With Chart book on Trends in the Health of Americans with Special Feature on Drugs. Available at: http://www.cdc.gov/nchs/hus.htm
Session 2: International Policy and Legal Framework
Required	MSH Managing Drug Supply Part II: Policy and Legal Framework National Drug Policies (pp. 55-67) Country Study 5.1 The Philippines Country Study 5.2 Australia Drug Supply Strategies (pp. 68-88) Country Study 6.3 Direct Delivery, Prime Vender and Mixed Supply Arrangements Pharmaceutical Legislation and Regulation (pp. 89-100) Legal Aspects of Drug Management (pp. 101-107) Explore and familiarize yourself with this resource for future use: WHO Essential Drugs and Medicines Policy. Available at: http://www.who.int/medicines/
Recommended	National Institute for Clinical Excellence (NICE). Available at: http://www.nice.org.uk Canadian Agency for Drugs and Technology in Health. Available at: http://www.cadth.ca/index.php/en/home
Session 3: Drug Manufacture, Industrial Pharmacy Considerations, Quality Assurance, and Regulation
Required	MSH Managing Drug Supply: Part 1 Introduction Pharmaceutical Production Policy (pp. 108-115) Country Study 9.3 Promoting Local Production of Essential Drugs in Bangladesh Small-scale local production (pp. 288-303) Small Scale Hospital Pharmaceutical Production 592 JE and Trueman P. 'Fourth Hurdle Reviews,' NICE and Database Applications. Pharmacoepidemiology and Drug Safety 2001;10:429-438.
Recommended	U.S. Food and Drug Administration: Good Manufacturing Practices (GMP) / Quality System (QS) Regulation. Available at: http://www.fda.gov/cdrh/devadvice/32.html
Session 4: The Drug Management Cycle: Selection
Required	MSH Managing Drug Supply Part III: Section A. Selection Managing Drug Selection (pp. 121-136) Country Study 10.1 Approaches to updates essential drugs * formulary lists Country Study 10.2 Updating the National Essential Drugs List of Kenya Treatment Guidelines and Formulary Manuals (pp. 137-149) Note Figure 11.2 Sample annotated Page from Malawi Standard Treatment Guidelines Essential Medical Supplies and Equipment (pp. 150-160) Note Box 12.1 ECHO: Nonprofit Equipment Supplier, but see Dec 2002: http://www.echohealth.org.uk/intro.html
Recommended	Lyles A. Formulary Decision-Maker Perspectives: Responding to Changing Environments [Chapter 7] in Economic Evaluation in U.S. Health Care. Jones and Bartlett Publishers, Boston. 2006. ISBN 0-7637-2746-6 Sullivan SD, Lyles A, Luce B and Gricar J. AMCP Guidance for Submission of Clinical and Economic Evaluation Data to Support Formulary Listing in United States Health Plans and Pharmacy Benefits Management Organizations. Journal of Managed Care Pharmacy 7(4):272-282,2001. The AMCP Format for Formulary Submissions,Version 2. 1 April 2005. A Format for Submission of Clinical and Economic Data in Support of Formulary Consideration by Health Care Systems in the United States. Available at: http://www.fmcpnet.org/data/resource/Format~Version_2_1~Final_Final.pdf
Session 5: Forecasting and Quantification
Required	MSH Managing Drug Supply Part III: Section B. Procurement Inventory Management (pp. 207-231) Country Study 15.1 Scheduled Purchasing in the Eastern Carribean Quantifying Drug Requirements (pp. 184-206) Use these methods to estimate actual need and Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26.
Recommended	Management Sciences for Health. International Drug Price Indicator Guide, 2004 edition. Available at: http://www.msh.org/resources/publications/IDPIG_2004.html
Session 6: The Drug Management Cycle: Procurement
Required	MSH Managing Drug Supply Part III: Section B. Procurement Managing Procurement (pp. 163-183) Country Study 13.2 Pooled Procurement through the Eastern Carribean Drug Service Country Study 13.3 Problems with Lack of Transparency in Tenders Managing the Tender Process (pp. 232-255) Note Annex 16.2 Criteria for Evaluating Current or Past Suppliers Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26. Contracting for Drugs and Services (pp. 256-270) Quality Assurance for Drug Procurement (pp. 271-287) Country Study 18.2 Quality Assurance in Selected Countries Figure 18.7 Sample Drug and Supply Evaluation Form
Session 7: Drug Donations
Required	MSH Managing Drug Supply Part III: Section B. Procurement Drug donations (pp. 304-312) Note: Country Study 19.1 The role of Private NGOs in Providing Health Care Services in Zaire WHO Guidelines for Drug Donations, revised 1999. Available at: http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.4.pdf
Session 8: The Drug Management Cycle: Distribution
Required	MSH Managing Drug Supply Part III: Section C. Distribution Managing Distribution (pp. 315-333) Importation and Port Clearing (pp. 334-340) Medical Stores Management (pp. 341-363) Drug Management for Health Facilities (pp. 364-377) Country Study 24.1 Zimbabwe Monthly Ordering System Discuss cold chain for vaccines Transport Management (pp. 393-406) Kit System Management (pp. 407-418) Country Study 27.4 Cambodia Country Study 27.5 Solomon Islands
Recommended	MSH Managing Drug Supply Planning and Building Storage Facilities (pp. 378-392) Note: Figure 25.3 Typical Elements of a Project Brief
Session 9: Drug Management Cycle: Use
Required	MSH Managing Drug Supply Part III: Section D. Use Managing for Rational Drug Use (pp. 421-429) Investigating Drug Use (pp.430-449) Drug and Therapeutics Information (pp. 450-463) Promoting Rational Drug Prescribing (pp. 464-482) Ensuring Good Dispensing Practices (pp. 483-495) Note: Figure 32.10 Sample Inspection Checklist Encouraging Appropriate Drug Use by the Public and Patients (pp. 496-512) Country Study 33.1 Mexico
Recommended	Lyles A. Direct Marketing of Pharmaceuticals to Consumers. Annual Review of Public Health 2002;23:73-91. Cabana MD, Rand CS, Powe NR, et al. Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA 1999;282(15):1458-1465.
Session 10: Budgeting and Cost Control
Required	MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability Drug Financing Strategies (pp. 607-627) Analyzing and Controlling Drug Expenditures (pp. 628-653) Financial Planning and Management (pp. 654-672)

Session 11: Management Support Systems: Planning Cycle
Required	MSH Managing Drug Supply Part IV: Section A. Organization and Management Managing Drug Programs (pp. 517-534) Country Study 34.1 Kenya Planning for Drug Management (pp. 535-552) Focus = 35.4 Monitoring and Evaluation (pp. 553-568) Country Study 36.1 Zimbabwe Country Study 36.2 Kenya Tutorial: Gantt Chart and Timeline: Available at: http://www.smartdraw.com/specials/projectchart.asp?id=3FGPhwtl%22t and http://www.smartdraw.com/tutorials/gantt/tutorial1.htm
Recommended	MSH Managing Drug Supply Force Field Analysis (pp. 527-528, 533, 544) Sample Gantt Chart (Excel). Available at: http://www.hyperion.ie/SampleGanttChart.xls
Session 12: Access to Essential Drugs
Required	MSH Managing Drug Supply Part IV: Section A. Organization and Management Community Participation (pp. 569-581) Focus = 37.5 Facilitating community participation in health programming Country Study 37.1 Canada Country Study 37.2 Thailand
Recommended	MSH. Strategies for Enhancing Access to Medicines. Available at: http://www.msh.org/programs/seam.html
Session 13: Pharmaceutical Care and Drug Utilization in an HIV/AIDS Clinic
Recommended	Lyles CA, Zuckerman IH, DeSipio SM and Fulda T. When Warnings Are Not Enough: Primary Prevention through Ambulatory Drug Use Review. Health Affairs, 17(4):175-183; 1998. Harjivan C and Lyles A. Improved Medication Use in Long Term Care: Building on the Consultant Pharmacist's Drug Regimen Review. American Journal of Managed Care 2002;8(4):318-326. Lyles A, Sleath B, Fulda TR and Collins TM. Ambulatory Drug Utilization Review: Opportunities for Improved Prescription Drug Use. [Continuing Medical Education] American Journal of Managed Care 7(1):75-81, 2001.
Session 14: Financing and Sustainability
Required	MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability Donor Financing (pp. 673-685) Revolving Drug Funds (pp. 687-710) Umenai T and Narula IS. Revolving Drug Funds: A Step Towards Health Security. Bulletin of the World Health Organization 1999;77(2):167-171
Recommended	Emmanuel Healthcare. Medicines for Overseas Programme. Available at: http://www.emms.org/support/subindex.php?type=Medicines

Webliography:

Textbook

TOPIC	READINGS

Session 1: The Global Context of Pharmaceutical Products and Under-served Populations
Required	MSH Managing Drug Supply: Part 1 Introduction Toward Sustainable Supply and Rational Use of Drugs (pp. 3-16) Historical and Institutional Perspectives (pp. 17-25) Economics for Drug Management (pp.26-37) Pharmaceutical Supply System Management (pp. 38-52)
Recommended	WHO Essential Medicines Library (EMLib). Available at: http://mednet3.who.int/eml/ - contains a Model Formulary, Model list of Essential Drugs Lofland JH and Lyles A. Pharmacy Practice and Health Policy within the United States: An Introduction and Overview [Chapter 20] in Managing Pharmacy Practice: Principles, Strategies, and Systems, Andrew Peterson, Editor. CRC Press LLC. Boca Raton, Fl. 2004. Health, United States, 2004. With Chart book on Trends in the Health of Americans with Special Feature on Drugs. Available at: http://www.cdc.gov/nchs/hus.htm

Session 2: International Policy and Legal Framework
Required	MSH Managing Drug Supply Part II: Policy and Legal Framework National Drug Policies (pp. 55-67) Country Study 5.1 The Philippines Country Study 5.2 Australia Drug Supply Strategies (pp. 68-88) Country Study 6.3 Direct Delivery, Prime Vender and Mixed Supply Arrangements Pharmaceutical Legislation and Regulation (pp. 89-100) Legal Aspects of Drug Management (pp. 101-107) Explore and familiarize yourself with this resource for future use: WHO Essential Drugs and Medicines Policy. Available at: http://www.who.int/medicines/
Recommended	National Institute for Clinical Excellence (NICE). Available at: http://www.nice.org.uk Canadian Agency for Drugs and Technology in Health. Available at: http://www.cadth.ca/index.php/en/home

Session 3: Drug Manufacture, Industrial Pharmacy Considerations, Quality Assurance, and Regulation
Required	MSH Managing Drug Supply: Part 1 Introduction Pharmaceutical Production Policy (pp. 108-115) Country Study 9.3 Promoting Local Production of Essential Drugs in Bangladesh Small-scale local production (pp. 288-303) Small Scale Hospital Pharmaceutical Production 592 JE and Trueman P. 'Fourth Hurdle Reviews,' NICE and Database Applications. Pharmacoepidemiology and Drug Safety 2001;10:429-438.
Recommended	U.S. Food and Drug Administration: Good Manufacturing Practices (GMP) / Quality System (QS) Regulation. Available at: http://www.fda.gov/cdrh/devadvice/32.html

Session 4: The Drug Management Cycle: Selection
Required	MSH Managing Drug Supply Part III: Section A. Selection Managing Drug Selection (pp. 121-136) Country Study 10.1 Approaches to updates essential drugs * formulary lists Country Study 10.2 Updating the National Essential Drugs List of Kenya Treatment Guidelines and Formulary Manuals (pp. 137-149) Note Figure 11.2 Sample annotated Page from Malawi Standard Treatment Guidelines Essential Medical Supplies and Equipment (pp. 150-160) Note Box 12.1 ECHO: Nonprofit Equipment Supplier, but see Dec 2002: http://www.echohealth.org.uk/intro.html
Recommended	Lyles A. Formulary Decision-Maker Perspectives: Responding to Changing Environments [Chapter 7] in Economic Evaluation in U.S. Health Care. Jones and Bartlett Publishers, Boston. 2006. ISBN 0-7637-2746-6 Sullivan SD, Lyles A, Luce B and Gricar J. AMCP Guidance for Submission of Clinical and Economic Evaluation Data to Support Formulary Listing in United States Health Plans and Pharmacy Benefits Management Organizations. Journal of Managed Care Pharmacy 7(4):272-282,2001. The AMCP Format for Formulary Submissions,Version 2. 1 April 2005. A Format for Submission of Clinical and Economic Data in Support of Formulary Consideration by Health Care Systems in the United States. Available at: http://www.fmcpnet.org/data/resource/Format~Version_2_1~Final_Final.pdf

Session 5: Forecasting and Quantification
Required	MSH Managing Drug Supply Part III: Section B. Procurement Inventory Management (pp. 207-231) Country Study 15.1 Scheduled Purchasing in the Eastern Carribean Quantifying Drug Requirements (pp. 184-206) Use these methods to estimate actual need and Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26.
Recommended	Management Sciences for Health. International Drug Price Indicator Guide, 2004 edition. Available at: http://www.msh.org/resources/publications/IDPIG_2004.html

Session 6: The Drug Management Cycle: Procurement
Required	MSH Managing Drug Supply Part III: Section B. Procurement Managing Procurement (pp. 163-183) Country Study 13.2 Pooled Procurement through the Eastern Carribean Drug Service Country Study 13.3 Problems with Lack of Transparency in Tenders Managing the Tender Process (pp. 232-255) Note Annex 16.2 Criteria for Evaluating Current or Past Suppliers Action Programme on Essential Drugs and Vaccines. Essential Drugs Monitor: Managing Drug Supply. 1998, No.s 25 & 26. Contracting for Drugs and Services (pp. 256-270) Quality Assurance for Drug Procurement (pp. 271-287) Country Study 18.2 Quality Assurance in Selected Countries Figure 18.7 Sample Drug and Supply Evaluation Form

Session 7: Drug Donations
Required	MSH Managing Drug Supply Part III: Section B. Procurement Drug donations (pp. 304-312) Note: Country Study 19.1 The role of Private NGOs in Providing Health Care Services in Zaire WHO Guidelines for Drug Donations, revised 1999. Available at: http://whqlibdoc.who.int/hq/1999/WHO_EDM_PAR_99.4.pdf

Session 8: The Drug Management Cycle: Distribution
Required	MSH Managing Drug Supply Part III: Section C. Distribution Managing Distribution (pp. 315-333) Importation and Port Clearing (pp. 334-340) Medical Stores Management (pp. 341-363) Drug Management for Health Facilities (pp. 364-377) Country Study 24.1 Zimbabwe Monthly Ordering System Discuss cold chain for vaccines Transport Management (pp. 393-406) Kit System Management (pp. 407-418) Country Study 27.4 Cambodia Country Study 27.5 Solomon Islands
Recommended	MSH Managing Drug Supply Planning and Building Storage Facilities (pp. 378-392) Note: Figure 25.3 Typical Elements of a Project Brief

Session 9: Drug Management Cycle: Use
Required	MSH Managing Drug Supply Part III: Section D. Use Managing for Rational Drug Use (pp. 421-429) Investigating Drug Use (pp.430-449) Drug and Therapeutics Information (pp. 450-463) Promoting Rational Drug Prescribing (pp. 464-482) Ensuring Good Dispensing Practices (pp. 483-495) Note: Figure 32.10 Sample Inspection Checklist Encouraging Appropriate Drug Use by the Public and Patients (pp. 496-512) Country Study 33.1 Mexico
Recommended	Lyles A. Direct Marketing of Pharmaceuticals to Consumers. Annual Review of Public Health 2002;23:73-91. Cabana MD, Rand CS, Powe NR, et al. Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement. JAMA 1999;282(15):1458-1465.

Session 10: Budgeting and Cost Control
Required	MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability Drug Financing Strategies (pp. 607-627) Analyzing and Controlling Drug Expenditures (pp. 628-653) Financial Planning and Management (pp. 654-672)

Session 11: Management Support Systems: Planning Cycle
Required	MSH Managing Drug Supply Part IV: Section A. Organization and Management Managing Drug Programs (pp. 517-534) Country Study 34.1 Kenya Planning for Drug Management (pp. 535-552) Focus = 35.4 Monitoring and Evaluation (pp. 553-568) Country Study 36.1 Zimbabwe Country Study 36.2 Kenya Tutorial: Gantt Chart and Timeline: Available at: http://www.smartdraw.com/specials/projectchart.asp?id=3FGPhwtl%22t and http://www.smartdraw.com/tutorials/gantt/tutorial1.htm
Recommended	MSH Managing Drug Supply Force Field Analysis (pp. 527-528, 533, 544) Sample Gantt Chart (Excel). Available at: http://www.hyperion.ie/SampleGanttChart.xls

Session 12: Access to Essential Drugs
Required	MSH Managing Drug Supply Part IV: Section A. Organization and Management Community Participation (pp. 569-581) Focus = 37.5 Facilitating community participation in health programming Country Study 37.1 Canada Country Study 37.2 Thailand
Recommended	MSH. Strategies for Enhancing Access to Medicines. Available at: http://www.msh.org/programs/seam.html

Session 13: Pharmaceutical Care and Drug Utilization in an HIV/AIDS Clinic
Recommended	Lyles CA, Zuckerman IH, DeSipio SM and Fulda T. When Warnings Are Not Enough: Primary Prevention through Ambulatory Drug Use Review. Health Affairs, 17(4):175-183; 1998. Harjivan C and Lyles A. Improved Medication Use in Long Term Care: Building on the Consultant Pharmacist's Drug Regimen Review. American Journal of Managed Care 2002;8(4):318-326. Lyles A, Sleath B, Fulda TR and Collins TM. Ambulatory Drug Utilization Review: Opportunities for Improved Prescription Drug Use. [Continuing Medical Education] American Journal of Managed Care 7(1):75-81, 2001.

Session 14: Financing and Sustainability
Required	MSH Managing Drug Supply Part IV: Section B. Financing and Sustainability Donor Financing (pp. 673-685) Revolving Drug Funds (pp. 687-710) Umenai T and Narula IS. Revolving Drug Funds: A Step Towards Health Security. Bulletin of the World Health Organization 1999;77(2):167-171
Recommended	Emmanuel Healthcare. Medicines for Overseas Programme. Available at: http://www.emms.org/support/subindex.php?type=Medicines