: Initial considerations based on a study of the diffusion of stormwater drainage " alternatives techniques " and Sustainable Urban Drainage Systems - 1970-2010. The Cases of the Lyon Conurbation and Wales

The PREPARED Programme considers climate changes through a lens of urbanisation processes and urban water management1. It supposes that today's cities, and especially cities in industrialised countries, are not ready to face events resulting from climate changes such as increases in weather hazards (flooding, droughts) and their potential consequences (population migrations, etc.)2. This multidisciplinary research programme -including engineering and social sciences- focuses on the answers to bring forward when faced with these changes in terms of urban water management: modification of technical devices, reorganisation of services, changes in modes of government and decision-making, etc. It seeks to define new technical, organisational, and social norms and to consider possible modes for their diffusion3. The contribution of the team to the PREPARED Programme and in particular to Work Area 6, "Towards an Adaptive Water Sensitive City Future", relates to the latter aspect. It aims at better understanding possible conditions for a change in norms and paradigms in activities relative to urban water management, and thus a better understanding of favourable or unfavourable factors for planned changes. For this, it relies on an analysis of the diffusion of technical devices considered as alternatives to urban sewer systems since the 1970

Changements climatiques et résistances aux changements: Premières considérations à partir de l'étude de la diffusion des " techniques alternatives " d'assainissement - 1970-2010. Les cas de l'agglomération lyonnaise et du pays de Galles,

existe une version en anglais déposée dans HALLe programme PREPARED envisage les changements climatiques à l'aune des processus d'urbanisation et de la gestion des eaux urbaines1. Il suppose que les villes actuelles, en particulier les villes des pays industriels, ne sont pas en état de faire face aux évènements induits par les changements climatiques (multiplication des intempéries, inondations, sécheresses, déplacements de populations, etc.2). Ce programme de recherche pluridisciplinaire (sciences de l'ingénieur et SHS) porte sur les réponses à apporter à ces changements en matière de gestion des eaux urbaines : modification des dispositifs techniques, réorganisation des services, évolution des modes de gouvernement et de prises de décision, etc. Il s'attache à définir de nouvelles normes techniques, organisationnelles et sociales et à considérer les modalités possibles de leur diffusion3. La contribution de l'équipe au programme PREPARED et en particulier au Work Area 6 " Towards an Adaptative Water Sensitive City Future " intéresse ce dernier aspect. Elle vise à mieux connaître les conditions possibles d'un changement de normes et de paradigmes dans les activités relatives à la gestion des eaux urbaines et par là à mieux comprendre les facteurs favorables ou défavorables aux changements projetés. Pour cela, elle s'appuie sur l'analyse de la diffusion de techniques alternatives au réseau d'assainissement depuis les années 197

The private commercial sector distribution chain for antimalarial drugs in Benin - Findings from a rapid survey

In November 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility – malaria (AMFm). Artemisinin‐based combination therapies (ACTs) are highly‐effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.  AMFm aims to reduce significantly the price of ACTs by offering a co‐payment for ACTs purchased by eligible buyers at the top of the supply chain.    Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidized ACTs.  The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidized ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in AMFm.   The objective of the rapid supply chain survey was therefore to assist Benin, which is one of the 11 countries invited to apply to the first phase of AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients.  This report presents the findings of a series of semi‐structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain.   At the time of the survey, antimalarial products sold in the private commercial sector were procured from international and domestic manufacturers by 3 active registered wholesalers and Benin’s public sector procurement agent: the Centrale d’Achat des Médicaments Essentiels et des Consommables médicaux (CAME). Manufacturers do not have sole distributorship agreements for registered pharmaceuticals, or other special relationships with particular wholesalers. Consequently, each wholesaler regularly stocks a large proportion of the antimalarials registered in Benin. CAME is responsible for procuring the generic medicines on the National Essential Medicines List. In practice CAME procures and supplies antimalarials not included on the National Essential Medicines List, as it is currently out of date

Comparative analysis of two methods for measuring sales volumes during malaria medicine outlet surveys.

BACKGROUND: There is increased interest in using commercial providers for improving access to quality malaria treatment. Understanding their current role is an essential first step, notably in terms of the volume of diagnostics and anti-malarials they sell. Sales volume data can be used to measure the importance of different provider and product types, frequency of parasitological diagnosis and impact of interventions. Several methods for measuring sales volumes are available, yet all have methodological challenges and evidence is lacking on the comparability of different methods. METHODS: Using sales volume data on anti-malarials and rapid diagnostic tests (RDTs) for malaria collected through provider recall (RC) and retail audits (RA), this study measures the degree of agreement between the two methods at wholesale and retail commercial providers in Cambodia following the Bland-Altman approach. Relative strengths and weaknesses of the methods were also investigated through qualitative research with fieldworkers. RESULTS: A total of 67 wholesalers and 107 retailers were sampled. Wholesale sales volumes were estimated through both methods for 62 anti-malarials and 23 RDTs and retail volumes for 113 anti-malarials and 33 RDTs. At wholesale outlets, RA estimates for anti-malarial sales were on average higher than RC estimates (mean difference of four adult equivalent treatment doses (95% CI 0.6-7.2)), equivalent to 30% of mean sales volumes. For RDTs at wholesalers, the between-method mean difference was not statistically significant (one test, 95% CI -6.0-4.0). At retail outlets, between-method differences for both anti-malarials and RDTs increased with larger volumes being measured, so mean differences were not a meaningful measure of agreement between the methods. Qualitative research revealed that in Cambodia where sales volumes are small, RC had key advantages: providers were perceived to remember more easily their sales volumes and find RC less invasive; fieldworkers found it more convenient; and it was cheaper to implement than RA. DISCUSSION/CONCLUSIONS: Both RA and RC had implementation challenges and were prone to data collection errors. Choice of empirical methods is likely to have important implications for data quality depending on the study context

The private commercial sector distribution chain for antimalarial drugs in Nigeria - Findings from a rapid survey

In November of 2008, the Global Fund to Fight HIV/AIDS, TB and Malaria announced that it would administer the first phase of an ambitious scheme to increase the availability of effective treatment for malaria, the Affordable Medicines Facility-malaria (AMFm). Artemisinin-based combination therapies (ACTs) are highly effective, but remain prohibitively expensive for those who are most vulnerable to malaria infection.1 The AMFm aims to significantly reduce the price of ACTs by offering a co-payment for ACTs purchased by eligible buyers at the top of the supply chain. Recognizing that the public and private sectors are important sources of antimalarials in most endemic countries, both public and private sector buyers will be entitled to purchase subsidised ACTs. The involvement of the private sector is an innovative element of AMFm, as many countries already have experience distributing ACTs in the public sector. To ensure that subsidised ACTs reach patients at the lowest possible cost, it is necessary to gain a better understanding of the private sector supply chains for antimalarials in each country participating in the AMFm. The objective of the rapid supply chain survey was therefore to assist Nigeria, which is one of the 11 countries invited to apply to the first phase of the AMFm, in the development of an effective implementation plan by providing an understanding of the current supply chain for antimalarials, and the way in which subsidised ACTs are likely to travel through this chain to reach patients. This report presents the findings of a series of semi-structured interviews conducted with government officials and private suppliers of malaria treatment operating at the various levels of the chain. Supplemental sections include brief discussions on the Nigerian drug monitoring system, on the proposed tax exemption for subsidised ACTs under the AMFm, and also on the private sector capacity to repackage and re-label imported subsidised ACTs. In addition, data from the December 2008 report on the first round of the ACTwatch Outlet Survey in Nigeria were used to estimate key variables, such as antimalarial market shares

ACTwatch 2009 Supply Chain Survey Results, Zambia

In Zambia, as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Cambodia, Uganda, Zambia, Nigeria, Benin, Madagascar and the Democratic Republic of Congo). Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI). This report presents the results of a cross-sectional survey of antimalarial drug wholesalers conducted in Zambia between February and May 2009

ACTwatch 2009 Supply Chain Survey Results, Nigeria

In Nigeria, as in many low-income countries, private commercial providers play an important role in the treatment of malaria. To design effective interventions for improved access to accurate diagnosis and effective malaria treatment, there is a need to understand retailer behaviour and identify the factors that influence their stocking and pricing decisions. Private commercial retailers are the last link in a chain of manufacturers, importers and wholesalers and their supply sources are likely to have an important influence on the price and quality of malaria treatment that consumers can access. However, there is limited rigorous evidence on the structure and operation of the distribution chain for antimalarial drugs that serves the retail sector. The ACTwatch Supply Chain Study, one of the ACTwatch project components, aims to address this gap by conducting quantitative and qualitative studies on distribution chains for antimalarials in the ACTwatch countries (Nigeria, Cambodia, Benin, the Democratic Republic of Congo, Madagascar, Uganda and Zambia). Other elements of ACTwatch include Retail Outlet and Household Surveys led by Population Services International (PSI). This report presents the results of a cross-sectional survey of antimalarial drug wholesalers conducted in Nigeria between July and September 2009

Determinants of price setting decisions on anti-malarial drugs at retail shops in Cambodia.

BACKGROUND: In many low-income countries, the private commercial sector plays an important role in the provision of malaria treatment. However, the quality of care it provides is often poor, with artemisinin combination therapy (ACT) generally being too costly for consumers. Decreasing ACT prices is critical for improving private sector treatment outcomes and reducing the spread of artemisinin resistance. Yet limited evidence exists on the factors influencing retailers' pricing decisions. This study investigates the determinants of price mark-ups on anti-malarial drugs in retail outlets in Cambodia. METHODS: Taking an economics perspective, the study tests the hypothesis that the structure of the anti-malarial market determines the way providers set their prices. Providers facing weak competition are hypothesized to apply high mark-ups and set prices above the competitive level. To analyse the relationship between market competition and provider pricing, the study used cross-sectional data from retail outlets selling anti-malarial drugs, including outlet characteristics data (e.g. outlet type, anti-malarial sales volumes), range of anti-malarial drugs stocked (e.g. dosage form, brand status) and purchase and selling prices. Market concentration, a measure of the level of market competition, was estimated using sales volume data. Market accessibility was defined based on travel time to the closest main commercial area. Percent mark-ups were calculated using price data. The relationship between mark-ups and market concentration was explored using regression analysis. RESULTS: The anti-malarial market was on average highly concentrated, suggesting weak competition. Higher concentration was positively associated with higher mark-ups in moderately accessible markets only, with no significant relationship or a negative relationship in other markets. Other determinants of pricing included anti-malarial brand status and generic type, with higher mark-ups on cheaper products. CONCLUSIONS: The results indicate that provider pricing as well as other key elements of anti-malarial supply and demand may have played an important role in the limited access to appropriate malaria treatment in Cambodia. The potential for an ACT price subsidy at manufacturer level combined with effective communications directed at consumers and supportive private sector regulation should be explored to improve access to quality malaria treatment in Cambodia