All the points raised by Massimo and reechoed by Tony Waterston are very familiar and I think resonates with any health worker especially doctors in LICs. So also are the steps that have reduced Pharma inducement of doctors in the UK listed by Tony, which are all necessary for LICs.
But there is a huge hurdle in efforts to replicate these UK deterrents in LICs, for many reasons, including poor funding of health system in LICs thereby making the system dependent on Pharma support for educational activities; poor control of access to any medication; poor orientation of prescribers beginning from poor and inadequate curriculum that excludes ethics of the profession; general change in the society ( of which doctors are part of) which places more emphasis on monetary profit than patient centered and evidence based practice.
To successfully reduce Big Pharma negative influence, LICs must attack the menace on each of the various level mentioned about: fund health care better; enforce Laws that eliminate uncontrolled access to medicines; ensure pre service curriculum of training includes clinical governance ethics and ethical behaviour and attitude; make available budget for training and training to fill the gap created when Pharma leaves; etc etc.
CHIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Joseph is a member of the HIFA Steering Group. Website: www.hriwestafrica.com
jneana AT yahoo.co.uk