Improving distribution of pharmaceuticals in developing countries: A case study of The Gambia project

Without sufficient sanitation, nutrition and primary health care infrastructures, developing nations must depend on pharmaceuticals as the principal defense against debilitating diseases such as malaria, schistosomiasis, river blindness, tetanus, and leprosy. Yet the distribution of pharmaceuticals within many developing countries is severely inadequate to meet the health care needs of large sectors of the population, particularly those persons living in rural areas. The result is that with 80% of the world's population, and an even greater share of the world's serious illnesses and disease, the Third World consumes only 20% of the global supply of pharmaceuticals. One of the major obstacles confronting individuals in developing countries that need pharmaceuticals is access — the drug delivery infrastructure is often inadequate. Problems exist in the entire range of drug management: Ordering, receipt, storage, distribution, and resupply. To help combat the problems, a unique collaboration began in 1981 at the initiation of several members of the Pharmaceutical Manufacturers Association (PMA), and Africare, a private voluntary organization, to improve the drug distribution and management system in The Gambia in Africa. The purpose of this article is to demonstrate the feasibility of transferring The Gambian model of cooperation between governments in developing countries, private voluntary organizations, and the international pharmaceutical industry to other Third World nations given different cultural, political and economic parameters. Last year, after observing how effectively The Gambia project had improved record keeping and management, the government of Sierra Leone invited Africare to help set up similar improvements in its drug distribution and inventory program. Although the multinational pharmaceutical corporations are often criticized by Third World governments for overpricing and dumping drugs, and excessive marketing schemes, The Gambia project demonstrates how the industry can work with health ministries to alleviate the problem of an inadequate supply and storage of pharmaceuticals particularly to poor, rural areas in Less Developed Countries.     

The Burger Court and Younger Abstention: Enhancing the Role of State Courts in Constitutional Adjudication

An important determinant of federal balance is the degree ofstate court authority to decide federal constitutional issues.This study traces the development of the Younger abstentiondoctrine, one of the primary vehicles by which the Burger Courtrestricted federal court jurisdiction and enhanced the authorityof state courts in constitutional adjudication. The Youngerdoctrine was adopted by the Supreme Court in 1971 for reasonsof comity and equitable restraint. Throughout the Burger Courtyears, Younger was expanded from an initial denial of jurisdictionto litigants seeking injunctive relief in state criminal proceedings,to litigants in cases "akin" to criminal proceedings, and thento litigants in cases "important to state interests." By relyingon Younger abstention, the Burger Court has reduced the roleof the federal courts as the primary enforcement of U.S. constitutionalrights.