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Evaluating adoption, availability, price and affordability of essential CVD medicines and diagnostics in Mozambique and Fiji: the HAVE-CVD-MeDs
I am a specialist physician planning to subspecialise in adult cardiology. Currently, I work in the Adult Clinical and Interventional Cardiology and Rheumatic Heart Disease Departments of Cardiac Unit at the Windhoek Central Hospital Complex in the capital city of Namibia. My interests include clinical and interventional cardiovascular medicine, preventative medicine, health promotion, and research. I am really excited to be a part of the 2017 WHFEL Program and look forward to learning from and collaborating with other like-minded individuals in our goal to reduce premature mortality from cardiovascular disease globally by 25% by 2025.
Sainimere has a background in Obstetrics and Gynaecology plus Public Health Medicine both in Fiji and New Zealand. She undertook specialty training in Public Health Medicine in New Zealand which involved work roles at the local provincial, regional and national levels. She has worked as a Senior Advisor with the Rheumatic Fever Prevention Program at the New Zealand Ministry of Health and is currently working in a senior advisory role within the Fiji Rheumatic Heart Disease (RHD) Prevention and Control Program. One of Sainimere’s tasks in her current role is providing oversight over interventions aimed at improving secondary prophylaxis which includes ensuring adequate supplies of BPG to the 4000 patients currently registered on the national RHD information system.
Jose Maria (“Jojo”) E. Ferrer, MD is a Science and Medicine Advisor for the American Heart Association (AHA)’s International division and Emergency Cardiovascular Care (ECC) program. He helps develop and review CPR, ECC, and First Aid Guidelines, scientific statements, educational materials and implementation programs, including the Basic Life Support; Advanced Cardiovascular Life Support; Advanced Cardiovascular Life Support for Experienced Providers; Pediatric Emergency Assessment, Recognition, and Stabilization; and Pediatric Advanced Life Support courses. He is the staff lead for Saving Children’s Lives, AHA’s program addressing under-5 mortality in resource-limited settings around the world. The program is currently implemented in Botswana, Tanzania and India. He is also the AHA staff lead for the International Liaison Committee on Resuscitation, the global coalition of national resuscitation councils which continually evaluates resuscitation science and first aid research to publish treatment recommendations for adoption around the world. Since joining the AHA, he has served in a variety of roles, including staff scientist for Go Red for Women and managing editor for Science News and Cardiovascular Daily, AHA’s electronic news platforms for its professional members.
My name is Neusa Jessen and I was born in Mozambique. I finished medical school in 2005 and I was sent to work as a general clinician and the clinical director of the only hospital of a district in the north of Mozambique, where I worked for 2 years. There, I had the opportunity to work with an NGO to provide continuous education to health professionals and to launch HIV treatment in the district, and there started my interest in public health. After that, I did my specialization in cardiology, half in Brazil and half in Mozambique, and finished in 2015. Throughout my career at the Central Hospital of Maputo, as a resident and as a cardiologist, I collaborated in a variety of studies in the cardiology research center of my institution. In 2015, I decided to start a PhD in Public Health and was accepted at the Public Health Institute of the University of Porto, in Portugal. I am enrolled as a part-time student to be able to continue working as a cardiologist in my country, where I also intend to do my research project.
I am Ahmadou Musa Jingi, a Cameroonian, married, and father of three. I received my medical training at the Faculty of Medicine and Biomedical Sciences, University of Yaounde 1. I obtained my MD diploma (General Medi-cine) in 2007, and my Specialist Diploma (DES Internal Medicine) in October 2016. I am a member of the research group: Clinical Research, Education, Networking, and Consultancy (CRENC). I am also a member of the first batch of the African Diabetes Academy (D2A). I have special interest in the fight against Chronic Non-Communicable Diseases (NCDs). I am mainly interested in Hypertension, Diabetes, Heart failure, Pulmonary Hypertension, and Echocardiography. As a GP, I worked as the Chief Medical Officer at the Centre for the Diagnosis and Treatment of Tuberculosis in the west region (Where I noticed it was a dragnet for patients with heart disease). I also served as the West Region Focal Point for the Prevention of Mother to Child Transmission of HIV and Reproductive Health. I used this opportunity to create awareness of CVD in primary care Physicians. I also initiated field studies on sources, availability, and affordability of essential medicines. I participated in two national surveys on diabetes and hypertension. I have published over 30 articles in peer review journals. As an Emerging Leader, I am just starting. The sky is my limit.
Jennifer is a physiotherapist by training with a strong interest in preventive cardiology. Led the physical activity component of the EUROACTION trial – a multicentre cluster RCT demonstration programme of a multidisciplinary preventive cardiology programme implemented in general hospitals and general practice across eight European countries. Led the creation of the National Institute for Preventive Cardiology in Ireland. Current role:
1. Development and delivery of a wide portfolio of education and training opportunities in the area of cardiovascular health and disease prevention.
2. Development of innovative models of preventive care and service delivery.
3. Patient caseload in the area of physical activity and exercise in the prevention and management of CVD. 4. Current research cost-benefit analyses of integrated versus specialist rehabilitation service delivery models.
Abhishek Sharma is a pharmacist and researcher with over five years of experience in global health focusing on evaluating healthcare and pharmaceutical systems to improve medicine access and utilization policies. Currently, Mr. Sharma works as an Associate Health Economist at Precision Health Economics (Boston | Vancouver) where he conducts research regarding clinical and economic outcomes of novel/candidate and approved therapeutics. As an Adjunct Researcher at Boston University’s Center for Global Health and Development, Mr. Sharma’s research focus on global access to insulin and other medicines for non-communicable diseases, role of the private sector in provision of equitable access to medicines and vaccines, medicine price evaluations, and the impact of trade policies on population health.
Recently he served as a Commission on The Lancet Youth Commission on Essential Medicines Policies that aimed to provide evidence-based policy recommendations for improving medicines access and to raise the awareness regarding Essential Medicines Policies. Abhishek received a Master of Public Health with concentration in Global Health from the Boston University School of Public Health (United States) and a Bachelor of Pharmacy degree from Manipal University (India).
Equitable access to essential medicines and technologies is critical, where all people from all backgrounds can access CVD care that is effective, affordable and safe. Access to essential medicines to prevent and treat CVD is worryingly low, particularly in low- and middle-income countries. The introduction of the WHO Model List of Essential Medicines in 1977 and the establishment of the WHO / Health Action International (HAI) Project on Medicine Prices and Availability in 2003 have led to important improvements in access to essential medicines. Despite progress, a significant percentage of the world’s population is still not receiving the medicines they need. Low availability, high prices, and poor affordability represent longstanding important barriers to medicine access.
In this study, we would like to highlight and evaluate access (or the lack thereof) to essential CVD medicines and diagnostic equipment and technologies in the countries of Mozambique and Fiji. Specifically, the aims are:
The methodological approaches for each objective are:
Review medicine lists, government documents and local treatment guidelines in Mozambique and Fiji to describe the adoption of the WHO Model EML
The team will evaluate both Mozambique and Fiji’s adoption of the WHO Model EML by reviewing their respective national EMLs, pharmacopeias, or standard clinical practice guidelines. Initially, the team will do an online search for these documents. If necessary, the team will check with regional and national health ministry offices to gain access to these and similar documents. The team will highlight any gaps between treatment guidelines and national drug lists. This will serve as an internal baseline situational assessment for our studies in Mozambique and Fiji.
Compile a comprehensive list of medicines and diagnostic tools for CVD in adults (including pregnant women) and children
As mentioned earlier, the HAI core survey list contains very limited CVD medicines that are on the WHO Model EML. In this regard, the team aims to develop a comprehensive list of CVD medicines for the purpose of adapting the standard WHO/HAI survey methodology to study access to medicines for the therapeutic area of cardiovascular disease. The team will compile our list of CVD medicines upon reviewing the WHO Model EML, Priority Medicines for Children and Women list, National EML, and will identify additional medicines (such as nicotine replacement therapy, fixed-dose combinations) for ‘optional survey’ that are not listed on EML but are important for delivering rational CVD care.
Assess the availability, prices and affordability of essential CVD medicines and diagnostics in the public and private sectors in Mozambique and Fiji
The team will conduct representative surveys in Maputo City (Mozambique) and Viti Levu (Fiji) to evaluate the availability, prices and affordability of CVD diagnostics and essential medicines.