state building may carry a number of risks, from a public health ‘health for health’ perspective. These range from raising expectations among the population that cannot be met, the use of inappropriate technology, a focus on treatment rather than prevention, and the undermining of government-led reconstruction of affordable health services. Another important risk is the inequitable allocation of funds to countries, or areas within countries, that are of specific concern to foreign policymakers [10]. Overall, health professionals working in conflict-affected and fragile states may increasingly be confronted with dilemmas emanating from tensions between their primary motivation to improve health in the most equitable way and the stabilisation and state building goals of their sponsors. For instance, in the current climate, a health professional working to address the obvious health needs of the Afghan population will almost inevitably be part of efforts to legitimise a possibly illegitimate regime. Humanitarian workers have their humanitarian principles of neutrality, impartiality, and independence to guide them when confronted with similar dilemmas. While these principles may not provide ready-made solutions, they form a framework that helps them to think, discuss, and develop practical solutions [11][12]. For health professionals working in a more developmental context where the humanitarian principles do not apply, there does not seem to be an alternative framework to guide thinking about the politicisation of health. Increased awareness amongst health professionals that health is being used as a foreign policy tool, and is therefore politicised, may be needed. A framework that can guide individuals and organisations in how to deal with the dilemmas that emerge in these situations may help guard against the overt politicisation of health, and the many risks this entails. Dr. Egbert Sondorp is Senior Lecturer, Conflict and Health Programme at the London School of Hygiene and Tropical Medicine. Email: Egbert.sondorp@lshtm.ac.uk Olga Bornemisza was Research Fellow, Conflict and Health Programme, London School of Hygiene and Tropical Medicine. Email: olgamary100@hotmail.com
references [1] MacQueen G, Santa Barbara J. (2008) Mechanisms of Peace through Health. In: Arya N, Santa Barbara J, editors. Peace through Health: How health professionals can work for a less violent world Sterling, VA: Kumarian Press; 2008. p. 30-2. [2] Editor. Violent conflict: protecting the health of civilians. Lancet. 2009;373:95. [3] Bricknell M, Gadd R. (2007) Roles for international military medical services in stability operations (reconstruction and development) JR Army Med Corps. 2007;153(3):160-4. [4] OECD-DAC (2008) Service delivery in fragile situations: key concepts, findings and lessons. Paris: OECD-DAC; 2008. [5] Eldon J, Gunby D. States in Development: State Building and Service Delivery, Final Report for DfID. London: HLSP; 2009.
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[6] Petrovksy V. (2002) New Security Agenda Concepts and Instruments Zurich: 5th International Security Forum, 14-16 October 2002. [7] Ranson MK, Poletti T, Bornemisza O, Sondorp E. (2007) Promoting health equity in conflict-affected fragile states: Health Systems Knowledge Network of the World Health Organization, Commission for Social Determinants and Health; 2007. [8] Bloom JD. (2005) Lessons Learned from the Inclusion of PeaceBuilding Objectives in the Reform and Development of Healthcare Systems Emerging from Civil Conflicts. Unpublished mimeo. London: LSHTM; June 2005. [9] McInnes, C., Rushton, S. (2010) Medical Initiatives in Conflict and Peacebuilding. Centre for Health and International Relations, Aberystwyth, UK, 2010 [10] Rietveld C, Waldman R. (2006) Health in Fragile States, Country Case Study: Southern Sudan. Arlington, Virginia, USA: Basic Support for Institutionalizing Child Survival (BASICS) for the United States Agency for International Development (USAID); 2006. [11] IASC Global Health Cluster. Civil-military coordination during humanitarian health action Provisional version – February 2011 [12] Clements A, Thompson E (2009) Making the tough calls: decisionmaking in complex humanitarian environments. Humanitarian Exchange, nr 44, Sept 2009
Protection of generic drugs remains top priority for African countries
Photo: CTV News
Rangarirai Machemedze
rmachemedze@seatini.org
Deputy Director, SEATINI
background the issue
Discussions on counterfeit medicines at the World Health Organisation (WHO) have become very controversial and polarised. In particular, there has been no consensus on the definition of counterfeit medicines, first devised by the WHO in 1992, and revised by the International Medical Products Anti-counterfeiting Taskforce (IMPACT) in 2008 [1]. The issue of counterfeit medicines has included the concept of copying – which has a specific meaning in relation to intellectual property – with issues related to the quality, safety, and efficacy of medicines. African countries, in particular, have raised concerns that the current definition might erode the gains the countries have made in accessing legitimate generic drugs of assured quality to mitigate various public health problems afflicting their countries. Other large developing countries had problems with having a definition in the first place, making the discussions extremely difficult to reconcile.
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