A Travellerspoint blog

Public Production of Pharmaceuticals

Excerpts from Class Notes

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"Since health is a human right, we should consider drugs a social good NOT a market good."

On Monday March 18th we received a lecture from Dr. Rasheed (Researcher at the National Network of Public Laboratories) to speak on the Public Production of Medicines - I've included some excerpts below.


Within Argentinean Health Expenditure, 32% of the money is spent on medications (most other countries spend between 15-17%). Argentina is a highly medicalized society where most people look at the pathology and not the surrounding conditions. Physicians disregard the physical exam and patients seek treatment through pharmaceuticals (both under and over the counter). As Dr.Rasheed noted: "Most Argentineans think that if the doctor dosen't prescribe a drug, they must not be a real doctor." To curb this spending Argentina introduced 36 PPM (Public Production of Medicine) laboratories to curb this cost. These PPM Laboratories are registered with the ANMAT (Administracion Nacional de Medicamientos Alimentos y Techonlogia) (the equivalent of the American FDA).

How does the Private Sector promote a Pharmaceutical Culture?

1.) Pharmaceutical Companies Financially Support Medical School Education
2.) Physician Marketing and Gift-Giving
3.) Direct-to-Consumer Advertising of Symptoms (Illegal in Argentina)
4.) Campaigns Against Generic Drugs
5.) Medicalization of Emotions and Social Life (i.e. Viagra)

And they're quite successful at it. According to Dr. Rasheed the most profitable markets (in order!) are:
1.) Illegal Drugs Trade
2.) Weapons Trade
3.) Pharmaceuticals

How was the Public Production of Medicines (PPM) Established in Argentina)?

There was a latinamerican solidarity movement in the 2000s pushed for the creation of UNASUR. Within UNASUR the establishment of PPM laboratories was recommended as a way of resisting foreign pharmaceutical companies and providing cheaper medications to the people of Latin-America. While 40million Argentineans wasn't enough to support a large-scale production of generics, 440million latinamericans are enough to justify research and development independence. For once the drug market does not have to be bound to international corporations.

While many pharmaceuticals are still being brought form overseas, the Public Production of Medicine has the potential to produce essential cheap generics and improve the health of many latinamericans.

Posted by Fabian1993 13:18 Archived in Argentina Tagged pharmaceuticals

The Argentinean Health System

Procuring Health in La Argentina

"The Argentinean Health System isn't really a system - its more like a non-system"

Our lecture on the Argentinean Health System was given by Pierre de Paepe (a researcher at the Tropical Medicine Institute in Argentina).
I've included some notes from his lecture below to flesh out the health aspect of our studies.


Argentinean Medical School:

Public School - better quality since it is competitive and selective in graduation
Private School - worse quality since student pays into school and graduation is guaranteed

The Three Systems of Argentine Health:

1.) Public System (For the Poor/Indigent Population)
The quality of physicians between the public and private systems are the same hoever the technology and facilities are different. Most people have jobs in the informal economy or ar immigrants to argentina.

2.) Obras Sociales (50% of the Population)
With a job in the formal sector comes mandatory social security and a health insurance package that works at certain hospitals. There are over 300 different obras sociales (from the subway workers union to the lawyers union) and the quantity of care guaranteed to a patient often depends on the wealth of their union. Most Argentineans fall into this category.

3.) Private System (For a Wealthy Minority)
The care offered in the Private System isn't necessarily better. It's more expensive and specialized. There are no waits and there's greater trust in the system, but the cost of a single visit is $80USD. A pretty steep price to pay when your Obras Sociales could cover it.

Within these three systems people are constantly shifting. During the economic crisis of the 2000s, millions of Argentineans lost their jobs (48-60% of the population was unemployed!) and with it their Obras Sociales. They went to the Public System overburdening the healthcare that could be provided. Now that Argentina has become more economically stable, things have shifted back into place; but there's always the fear that any one of these systems could get overburdened depending on the economic prospects of the country.

Medical Specialization

In Argentina there is often prejudice against non-MD medical professionals and general practitioners. Just like the U.S., there is more money and prestige in becoming a specialized doctor at a Private Clinic. This forces a skewed workforce with lots of specialized professionals and few general attendants.
Physicians: 1/250Patients
Nurses: 1/1,000Patients
That means that there are 4 Doctors for every 1 Nurse!
(It really should be the opposite way around)

Government Social Programs

Asignacion Universal por Hijo: When children registered in school (240Pesos per child per month for food, transportation, clothing, etc.)
logo Plan nacer.jpg
Plan NACER: Maternal and Child Health Insurance Program for Poor Pregnant Women and Children Up to 6-Years Old (Insurance Provided)
REMEDIAR Program: Essential Drugs to Population (86% of Recipients have No Coverage; 94% of Recipients are Below the Poverty Line)

- Lack of Overlap Between the 3 Systems
- Fragmentation/Segmentation
- No Regulation of the Private Sector
- Under-financed Public Sector
- Inequality between the Public/Private Technology and Facilities

- Excess of Specialists, Beds, and Technology in some Areas
- Lack of Primary Care Physicians and Nurses in Urban and Rural Areas

- Quality of Healthcare is often vulnerable to Unions and Provincial Claudillos
- Coverage Rate of Social Security is lower than 40 Years Ago!

Posted by Fabian1993 12:25 Archived in Argentina Tagged argentina health nacer remediar healthsystem asignacionporhijo

Health as a Human Right in Argentina

An Excerpt from Papers

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In Argentina, a history of colonialism and violation of indigenous rights laid the backdrop for human rights abuses and social exclusion in the name of progress and economic development. Alongside (yet contrary to) this vein developed liberation theology, early government programs, and a sound public education system that promised socioeconomic rights to a growing, healthy middle class. These two perspectives on health and human rights sparked conflict in the 1900s.

In the 20th century, Argentina experienced political instability as the government wavered between staunch conservatives and radical liberals. These ideological conflicts often erupted into violent confrontations that shaped the discussion of health and human rights. From 1946-1955 Peronist Populism provided government assistance programs to build housing, expand basic healthcare coverage, improve the public education system, and allow for women’s suffrage. During this time free public hospital beds doubled and infant mortality fell by a third. (Dr. Escuerdo) After some political instability a military coup seized power. From 1976-1983 the Military Dictatorship silenced over 30,000 political dissidents, limited civil rights, and expanded the private market (including healthcare) in an effort to develop the nation economically. This was further exacerbated by Menem’s democratic presidency and his acquiescence to foreign corporations and the neoliberalist policies of the IMF/World Bank. These economic decisions had a huge toll on the health-care access of the Argentinean people.

In 2001, Argentina experienced a severe economic depression. Around 54% of the Argentinean population was unemployed and over 50% were under the poverty line. (Prof. Eisenberg) This had a profound effect on the ability of the Argentine health system to provide universal healthcare – suddenly people couldn’t afford private health-insurance, the ‘seguro social’ system (guaranteeing a health-insurance package with work) deteriorated as people lost their jobs; and the public health system became overburdened by more and more people. Struggling to stabilize the country, Argentina could not guarantee health as a human right to its people. This economic crisis was followed by the more progressive policies of Kitchener (2003-Present). As people regained economic wealth and work-associated health-insurance they were able to unburden the public healthcare system; the government also facilitated this by transferring people to private care when the public facilities were overbooked. Recently, there have been great efforts by the Union of Latin-American Nations (UNASUR) to promote solidarity in the fight for human rights to subsistence, health, and education in Argentina and across Latin America. To this end UNASUR created The South American Institute of Government in Health (iSAGS), which focuses on universal and equitable access to health services. (Sara Ardilla) Currently there is around 80% satisfaction in the Argentinean healthcare system. (Dr. Abriata)

Currently the greatest inequalities in human rights lie in the social exclusion of unregistered migrant workers and hard-to-reach indigenous communities. Walking the streets of Buenos Aires, there are hundreds of unregistered food vendors, garbage collectors, and artisans participating in the informal economy. Without employment protection and steady income they often lack formal housing, facilities, and health insurance. (Prof. Ardilla) Yet despite this, most foreigners (no matter what their status) do receive adequate healthcare through the public system as noted in our Migration and Health Pannel. (Migration and Health, Pannel) While health as a human right is guaranteed to all Argentineans, there is still difficulty reaching the rural areas where many indigenous people live. As Messer notes, “… the contradiction between constitutional guarantees to citizens and abuses against indigenous peoples highlights the continuing gap between citizen and protections…” (Messer 230) This is more evident in other Latin-American countries, but remains a problem in Argentina.

One way that Argentina addressed the health of its people is by providing programs to alleviate issues and ensure that health is a human right. To address high out-of-pocket expenditure for pharmaceuticals the government introduced the REMEDIAR Program (free medications); to address maternal/child health the government introduced Plan NACER (ante-natal coverage through pay for performance); and to address the health and wellbeing of young children the government introduced the Asignacion Universal por Hijo (providing cash transfers to pay for food, transport, clothes, and education). (Dr. Paepe) While these health services are essential, there is currently a fragmentation among these government programs and the three health-insurance systems that make sustainability an issue. (Dr. Paepe) The fracturing of the traditional healthcare workforce because of specialization and poor distribution also contributes to this lack of sustainability – there are currently only four doctors for every Argentine nurse. (Dr. Paepe) This fracturing of the healthcare system poses the largest problem currently in Argentina. Despite challenges in providing health as a human right to all members of society, Argentina has done an excellent job on behalf of its people.

Works Cited
Messer, Ellen. “Anthropology and Human Rights.” Annual Review of Anthropology. 1993. 22: 221-249.

Dr. Rasheed: National Network of Public Laboratories. “Production of Pharmaceuticals.” Buenos Aires, Argentina. March 15, 2013.

Dr. Escuerdo: Physician. “Argentinean History through the Eyes of a Physician.” Buenos Aires, Argentina. March 12, 2013.

Prof. Matias Eisenberg: Cultural Sociologist at St. Martin University. “A Brief History of Argentina.” Buenos Aires, Argentina. March 11, 2013.

Prof. Sara Ardilla: IHP Coordinator and Former Professor. “South to South Cooperation: Health as a Human Right in Latin America.” Buenos Aires, Argentina. March 12, 2013.

Dr. Abriata: Argentinean Ministry of Health. “Health Policy in Argentina – The Health and Sickness Profile.” Buenos Aires, Argentina. March 13, 2013.

Dr. Pierre de Paepe: Tropical Medicine Institute Researcher. “The Argentinean Health System.” Buenos Aires, Argentina. March 13, 2013.

Migration and Health Pannel. Buenos Aires, Argentina. March 20, 2013.

Posted by Fabian1993 12:20 Archived in Argentina Tagged history health humanrights nacer remediar

Ausencias ("Absences")

Remembering the Lost

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In Argentina, I stumbled upon this photographer, Gustavo Germano. He recreates old Argentine photographs from before the military dictatorship of the 1980s. These images speak for themselves - the horror of the disappeared and the absences still felt today.

gustavo germano ausencias 2.jpg

Mas allá de los evidentes posicionamientos políticos, ante las fotografías del álbum familiar de allá, el ciudadano de acá reflexiona, reacciona desde un universo que justo acaba de compartir. “Ausencias” trabaja con un material sensible: la fotografía que inmortaliza lo cotidiano, lo pequeño, lo propio. Un material ante el cual es imposible permanecer insensible. Por eso “Ausencias” cosecha tan calurosas acogidas, por eso convence de manera tan abrumadora. Y por eso hemos recibido tantas felicitaciones por “Ausencias”. Porque si algo ha conseguido Gustavo Germano con su apuesta conceptual es acercar el horror lo mas cotidiano. Sin estridencias. Sin espectáculo. Sin escenificaciones de impacto.

Beyond the obvious political positions, the citizen here reflects, reacts from a universe that they have just intimately shared through fading photographs and family albums. "Absences" works with sensitive material: photography that immortalizes the everyday, the small, the same. A material which is impossible to ignore. That is why "Absences" has received so many accolades. Because if theres one thing that has made Gustavo Germano's conceptual work resonate with so many, its the way he deals with everyday horror. Without fanfare. Without show. Without staging.


Posted by Fabian1993 07:25 Archived in Argentina Tagged art photography desaparecidos ausencias gustavogermano

Bleeding all over the Page

Writing from Home

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These last few months I haven't been the most diligent travel-blogger.

Writing from abroad has always posed a difficult decision - do I live in the moment or do I reflect through writing? These last few months I've chosen to do former, roaming through the city of Buenos Aires, brieing in the township of Zwelethemba, and climbing mountains in Cape Town. It was brilliant, but I want to get down what I saw, what I lived these last few months before it gets lost in the fog of memory. So for the next week I'll be posted up at home at my desk writing away.

These last few months have changed me. I'm still processing. It's my hope that in writing, I can inform others of my travels, preserve those impression, and process my experience. What was once a gesture for others has become an important part of my journey, and I want to finish it.

I look to that old bastard Hemingway for inspiration. In his travels through Europe Hemingway once wrote: "There is nothing to writing. All you do is sit at the typewriter and bleed." So here's to the hemorrhaging that is to come.


Posted by Fabian1993 06:49 Archived in Argentina Tagged writing

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