The United Nations (UN) classifies countries into developed (or industrial) and developing, based on their level of economic and industrial development. A sub-group of developing countries are designated as least developed countries (LDCs). These are countries with very low per capita income. Based on this classification, in 1998, of 179 countries, 50 were classified as industrial and 129 as developing of which 48 were designated as LDCs. Despite this classification, there are countries which possess some features typical of developed and other characteristics typical of developing countries. For example, countries in the Middle East, have been described as being neither exclusively developed or developing, but ‘in-between’ with wide variations of wealth (Stephen 1992).
The classification by the UN corresponds to many important national features of the political, social and economic profile of a country. These features are reflected in the resources available for health care, the provision and delivery of health services, the health status of the population, as well as the role of health professionals and patterns of drug use. Many of the poorest developing countries are hampered in their endeavours to improve the economic, social and health status of their populations, because of having to service vast debts to industrialised countries.
The World Health Organisation (WHO) has identified particular problems in developing countries in relation to the supply and use of drugs. In response to these difficulties, the WHO believes that pharmacists can make an important contribution in health care, by promoting the safe and appropriate use of medicines (World Health Organisation 1988a). Although, there are differences between developing countries, there are also many similarities which result in common issues for pharmacy services.
Health care world-wide is a mixture of public and private provision. Pharmacists may be formally integrated within a national or public system or they may exist as independent practitioners alongside other professionals or organisations providing health care. In some countries, a public or a private system predominates, in others different systems exist side by side. Even in countries in which most health care is financed by private individuals (by direct payment or voluntary insurance) and/or provided by commercial or
voluntary organisations, some public sector involvement is usual. In general, public sector provision provides at least a basic service for the poorest people in society, for whom health care would otherwise be inaccessible. Similarly, in countries with health services funded from general taxation or compulsory insurance, some health care is invariably purchased by individuals from private organisations.
In many of the poorest countries, publicly provided health care is often inadequate to meet the basic needs of the population, even though a high proportion of the population may depend on it for their care. Health insurance schemes exist in many developing countries. These are not generally comprehensive, being either private voluntary schemes in which people opt to pay a premium and in return receive specified services as required, or public sector schemes which are commonly restricted to specific sectors of the population. For example, in Egypt, the Government Health Insurance is available to public sector workers.
In many developing countries, a private health care market, funded by private individuals (or voluntary insurance contributions) and provided by private practitioners or institutions, exists independently from the public sector. As in any market, the services provided in the private sector are generally those for which purchasers are able and willing to pay. It is generally the most affluent individuals in any society who are able
and willing to purchase health care privately. Thus, the services provided in the private sector are largely geared to their perceived needs. In developing countries, urban populations tend to be wealthier. Consequently, health professionals often prefer to work in cities, and private sector health care tends to be concentrated in urban rather than rural areas.
Salam
by Umaee
source: Pharmacy practice
image: guardian.co.uk
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