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1 Angell SY, De Cock KM, Frieden TR. A public health approach to global management of hypertension. Lancet 2015; 385: 825–27. 2 PAHO. Plan of action for the prevention and control of noncommunicable diseases (NCDs) in the Americas 2013–2019. Washington: Pan American Health Organization, 2014. 3 Ordunez P, Martinez R, Niebylski ML, Campbell NR. Hypertension Prevention and Control in Latin America and the Caribbean. J Clin Hypertens (Greenwich) 2015; published online Feb 28. DOI:10.1111/jch.12518. 4 PAHO. PAHO strategic fund. Washington: Pan American Health Organization, 2014. http:// www.paho.org/hq/index.php?option=com_co ntentv 15: 249. 6 PAHO. Antiretroviral treatment in the spotlight: a public health analysis in Latin America and the Caribbean 2013. Washington: Pan American Health Organization, 2013. 7 WHO. A global brief on hypertension: silent killer, global public health crisis. Geneva: World Health Organization, 2013. Created in 2000, and based on PAHO’s experiences managing the Revolving Fund for vaccines, the PAHO Strategic Fund is an effective mechanism to procure drugs and medical technology at reduced prices to treat people with communicable and non-communicable diseases. As an example of its relevance in the Americas, between 2004, and 2012, the monetary value of antiretrovirals procured for HIV/AIDS through the PAHO Strategic Fund increased by more than 1500 times. Participating countries also receive technical cooperation to strengthen their capacity for planning and management of essential medical supplies. The PAHO Strategic Fund has evolved to better respond to the needs of countries and improve access to quality drugs for non-communicable diseases. As a result of an international bidding process and time-bound agreements, PAHO member states are able to procure antihypertensive drugs recommended by the GSHT Project at a unique price for each country. This mechanism also applies to drugs for cancer and diabetes. However, the success of the PAHO Strategic Fund depends on a high level of participation by member states, which allows PAHO to negotiate lower prices, thus increasing availability of drugs and providing benefi ts to larger numbers of people aff ected. Guaranteeing long-term daily treatment for a billion people with hypertension worldwide is extremely complex. Prioritisation of the availability and aff ordability of a core set of quality-assured drugs to treat hypertension, one of the pillars of the GSHT Project, is highly strategic. As such, the PAHO Strategic Fund represents a model that ensures access to a set of core drugs at competitive prices. Management and sustaining of such a fund is not without challenges— among them, the powerful competing economic interests of manufacturers. Innovative strategies will need to be adopted for advances towards as did three RCTs in the systematic review. Good RCTs are invaluable, but poor RCTs produce bad evidence. Restating conclusions based on poor evidence makes it harder to gather good evidence and sets back the progress of evidence-based medicine. |
