The World Health Report 2000 between resources(see Box 4.3) Some input prices are determined locally; others are set in international markets. In most countries, prices for human resources(incomes for physicians, nurses and other health are personnel)are determined nationally, and the general income level for each country or region will be an important determinant. Prices for such items as patented drugs and medical equipment, on the other hand, are determined in a global market. Although differences in income levels across countries will induce manufacturers and distributors of medicines and equipment to differentiate prices somewhat, stewards of individual country health syste are far less able to influence these prices than the prices of human resources International stewardship is needed to represent the interests of consumers in low income countries that face heavy burdens of infectious and parasitic diseases. This type of stewardship, led by agencies such as WHO and the World Bank, will assume increasing importance as globali zation of the economy continues and free trade agreements are implemented. PUBLIC AND PRIVATE PRODUCTION OF RESOURCES With the exception of skilled human resources, most inputs used for health services are produced in the private sector, with varying degrees of public stewardship over the level and mix of production, distribution, and quality. For example, local markets successfully produce most consumables and unskilled labour. Governmentintervention is needed mainly to ensure that quality and safety standards are met, that reliable information is available about the products, and that a fair competitive environment exists Other inputs, such as manufactured pharmaceuticals and specialized medical equip- ment, often face barriers to entry into the market in the form of patents and licensing requirements, manufacturing standards, large initial investment costs, expensive research, and long development periods. This gives the manufacturers of these inputs considerable market power to abuse by manipulating prices and demand. Strong policy measures are therefore needed, such as anti-trust legislation, limited formularies, generic drug policies, bulk purchasing and formal technology assessments (11-13). Furthermore, by procuring Box 4.3 A widening gap in technology use? A vast quantity of valuable of these diseases are more prevalent of HIv treatment by obliging insur- nological breakthrough would edical technologies and inno- in the poorest countries ers to cover its cost for members of also demand a new mix of re- vative clinical methods have Medicines are now available for insurance schemes sources, but only for those coun- een developed over the past Hiv/AIDS that can, at a huge cost, at Malaria transmission can be pre- tries that could afford the new decades and many more are on least postpone further development vented by means of house spraying, vaccine. he way. Unfortunately, the new of the disease. But treatment insecticide-treated nets, chloro- For tuberculosis the incidence of possibilities are not open to all terms and resource inputs for Hiv/ quine prophylaxis, and so on, but bacterial resistance to first-line income in some countries. Dis- in different countries. In poor coun- able to the people who need them concern, for example, in the Rus- eases that are treated effectively tries, HIV/AIDS is still a disease with- most. Several different projects to sian Federation. Lack of effective in rich countries by professional out treatment alternatives. The sick develop a malaria vaccine are under medical treatment and improper modern technology are mainly taken care of informally way. A breakthrough in this re- use of medicines continue to cre. d by unskilled staff or at home or in institutions with pre- search would present a tremendous ate obstacles to dealing with this at home in less devel- dominantly unskilled staff. South opportunity to improve quality of escalating problem. 2 oped countries. Moreover, some Africa has improved the availability life and prevent death Such a tech- 2 Global tuberculosis control WHO report 2000. Geneva, World Health Organization, 2000(document WHO/CDS/TB/2000.275)82 The World Health Report 2000 between resources (see Box 4.3). Some input prices are determined locally; others are set in international markets. In most countries, prices for human resources (incomes for physicians, nurses and other health care personnel) are determined nationally, and the general income level for each country or region will be an important determinant. Prices for such items as patented drugs and medical equipment, on the other hand, are determined in a global market. Although differences in income levels across countries will induce manufacturers and distributors of medicines and equipment to differentiate prices somewhat, stewards of individual country health systems are far less able to influence these prices than the prices of human resources. International stewardship is needed to represent the interests of consumers in low income countries that face heavy burdens of infectious and parasitic diseases. This type of stewardship, led by agencies such as WHO and the World Bank, will assume increasing importance as globali￾zation of the economy continues and free trade agreements are implemented. PUBLIC AND PRIVATE PRODUCTION OF RESOURCES With the exception of skilled human resources, most inputs used for health services are produced in the private sector, with varying degrees of public stewardship over the level and mix of production, distribution, and quality. For example, local markets successfully produce most consumables and unskilled labour. Government intervention is needed mainly to ensure that quality and safety standards are met, that reliable information is available about the products, and that a fair competitive environment exists. Other inputs, such as manufactured pharmaceuticals and specialized medical equip￾ment, often face barriers to entry into the market in the form of patents and licensing requirements, manufacturing standards, large initial investment costs, expensive research, and long development periods. This gives the manufacturers of these inputs considerable market power to abuse by manipulating prices and demand. Strong policy measures are therefore needed, such as anti-trust legislation, limited formularies, generic drug policies, bulk purchasing, and formal technology assessments (11–13). Furthermore, by procuring Box 4.3 A widening gap in technology use? A vast quantity of valuable medical technologies and inno￾vative clinical methods have been developed over the past decades and many more are on the way. Unfortunately, the new possibilities are not open to all because of the lack of available income in some countries. Dis￾eases that are treated effectively in rich countries by professional staff using modern technology are handled by unskilled staff or informally at home in less devel￾oped countries. Moreover, some of these diseases are more prevalent in the poorest countries. Medicines are now available for HIV/AIDS that can, at a huge cost, at least postpone further development of the disease. But treatment pat￾terns and resource inputs for HIV/ AIDS currently follow different paths in different countries. In poor coun￾tries, HIV/AIDS is still a disease with￾out treatment alternatives. The sick are mainly taken care of informally at home or in institutions with pre￾dominantly unskilled staff. South Africa has improved the availability of HIV treatment by obliging insur￾ers to cover its cost for members of insurance schemes. Malaria transmission can be pre￾vented by means of house spraying, insecticide-treated nets, chloro￾quine prophylaxis, and so on, but such measures are not always avail￾able to the people who need them most. Several different projects to develop a malaria vaccine are under way.1 A breakthrough in this re￾search would present a tremendous opportunity to improve quality of life and prevent death. Such a tech￾nological breakthrough would also demand a new mix of re￾sources, but only for those coun￾tries that could afford the new vaccine. For tuberculosis, the incidence of bacterial resistance to first-line drugs is increasing. It is of major concern, for example, in the Rus￾sian Federation. Lack of effective medical treatment and improper use of medicines continue to cre￾ate obstacles to dealing with this escalating problem.2 1 The world health report 1999 – Making a difference. Geneva, World Health Organization, 1999. 2 Global tuberculosis control: WHO report 2000. Geneva, World Health Organization, 2000 (document WHO/CDS/TB/2000.275)