The Pharmaceutical Corporate Presence in Developing Countries
CONTENTS
FOREWORD
ACKNOWLEDGMENTS
INTRODUCTION
PART 1โ THE ROLE OF MULTINATIONAL PHARMACEUTICAL CORPORATIONS
Theological Ethics and the Multinational: A Changing Relationship
Can Multinational Businesses Alleviate Poverty in the Third World?
The Sort of World Mandated by the Christian Gospel
The Revelance of the Vision of Middle Axioms
Third World Health Problems and the Role of Pharmaceuticals
The State of the Dialogue Today
Notes
Pharmaceuticals and Developing Countries
Pharmaceutical Postulates
Health Needs of Developing Countries
Pharmaceuticals in Developing Countries
Note
Response
Response
Discussion Summary
Multinational Pharmaceutical Corporations and Developing Countries
Health Problems in The Third World
The Disease Pattern in the Third World
Public Health Care in the Third World
The Role of Pharmaceuticals in the Third World
Responsibilities for a Rational Use of Drugs
The National Political Responsibility
Responsibility of the Pharmaceutical Manufacturer
Ethics and Third World Business
A Pragmatic Approach to Corporate Ethics
Corporate Policies and Codes of Conduct
Personnel Policy
Management Development
Broader Measurement and Reward Systems
Ethics Makes Good Business
In Search of New Partnerships
Conclusions
Notes
Response
Response
Note
Discussion Summary
PART 2โ GLOBAL PHARMACEUTICAL ISSUES
ESSENTIAL DRUGS
Essential Drugs: Economics and Politics in International Health
Background on Who's Action Programme on Essential Drugs
Social and Political Context for Essential Drugs
Accomplishments and Remaining Issues
The Extent of Regulation
The Role of the Market
Local Production
Nairobi and Beyond
Acknowledgments
Epilogue
References
The World Health Organization Action Programme on Essential Drugs
Access to Drugs in Developing Countries
The WHO Drug Action Programme
The Potential for Multinational Pharmaceuticals
Health Services Delivery: UNICEF's Bamako Initiative
Key Components โ Focus on Community Action
The Role of Drugs
Issues in Financing
Women and Health
Initial Positive Results
Reaching Health Goals through Strengthened Services Delivery
References
Response
Response
Response
Discussion Summary
COUNTERFEIT DRUGS
Global Syndicates and the Threat to Third World Health
Counterfeiting: Modus Operandi
Substitution
Repackaging of Samples and Expired Products
Toward a Solution
Role of Governments
Professionals
Manufacturers
Public
The Ugliest Form of Medical Corruption
Why are Drugs Faked?
When is Faking at its Highest?
Who are the Victims?
Targeted Products
Consequences of Faking
Measures to Prevent and Control Counterfeiting
Response
Response
Discussion Summary
INTELLECTUAL PROPERTY RIGHTS
Intellectual Property: The U.S. Concern
The Multilateral Response
The Bilateral Response
The Unilateral Approach
Developing Country Concerns from an Industry Perspective
Discussion Summary
PART 3โ THE KENYAN EXPERIENCE FIRST WORLD MEDICINE IN A THIRD WORLD SETTING
Traditional Medicine
Concept of Causality
Diagnosis and Treatment
Ichagaki Sublocation: Murang'a District
Selected References
Modern Health Care in Kenya
Socioeconomic Context
Modern Health Care
Medical Institutions
Medical Practice
Ortum Mission Hospital
Ortum, Mutomo, and Consolata-Nyeri Hospitals
Discussion Issues
References
Pharmaceuticals in Kenyan Government Health Care
Rural Health Drug Supply System
Impact on the Pharmaceutical Industry
Drugs in the Hospitals โ District Focus and Its Implications
Cost Recovery
Overusage
Management
Church Medical Service
Summary
Note
Pharmaceuticals in Kenyan Christian Health Services
Overview of Meds
Meds History, Location, and Operations
Scope of Meds
Finance
Operating Objectives
Availability of Drugs
Global Affordability Versus Need
Shared Responsibility
Notes
Response from Africa
Response from Africa
Response from Industry
Response from Industry
Discussion Summary
Considerations for Multinational Managers
The Kenyan Situation
Kenya's Role in East Africa
Government Philosophy and Controls
Centralized Power
Indigenization
District Focus
Governmental Regulation of the Private Sector
The Pharmaceutical Delivery Systems
Government Health Care
Essential Drugs
Tendering Procedures
The Impact of District Focus
Charging for Health Care
The Private Pharmaceutical Sector
Locally Owned Manufacturers
Multinational Pharmaceutical Companies Producing Locally
Market Structure
Governmental Regulation
Systemic Tradeoffs: Price-Accessibility-Quality
Price
Accessibility
Quality
Implications for Multinational Pharmaceutical Strategy
Developmental Responsibility
Interacting with the Government
Interaction with Nongovernmental Groups
Expand or Retract Kenyan Investment?
Notes
PART 4โ MORAL COMMITMENTS AND COLLABORATION
An Activist Voice
Pharmaceutical Needs
Local Government Responses
Pharmaceutical Industry Response
An Industry Voice
The Nature of Corporate Social Responsibility
Participants