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Publication(Washington, DC: World Bank, 2002-09) Govindaraj, Ramesh ; Chellaraj, GnanarajThis report assesses the pharmaceutical sector in India, particularly focusing on four key issues related to the production, procurement, and distribution of drugs in India: a) availability, b) affordability; c) quality, and d) the rational use of drugs. The results of a survey of three states indicate considerable variation across states in the above four areas in both public and private sectors. The report concludes that problems with the availability, affordability, and rational use of good quality, cost-effective, essential drugs have persisted in most parts of India, and that these health-related issues need be addressed as a priority. An overarching recommendation is the need to focus on strengthening the implementation and regulation of the pharmaceutical sector at the state level, rather than on simply introducing new regulations. Adequate pharmaceutical quality assurance needs to be particularly emphasized as, in its absence, other reform measures could be rendered moot. Similarly, the rational use of drugs needs to be emphasized as it is likely to yield significant cost savings to the government and to consumers, in addition to its positive impact on health.
Publication(Washington, DC: World Bank, 2001-05) Vedeld, TrondThe study assesses the extent to which the India program, is meeting the Bank's objective of mainstreaming participatory approaches, in project preparation, and design. From a variety of social, and natural resource management sectors, ten projects were selected, appraised during 1990 and 1998, in which participation was an overall project objective. Key findings suggest that beneficiary participation was successful, contributing to participatory designs in many projects. Social assessments were used more often than before, while involvement of primary beneficiaries improved during the 1990s, reflecting a change in the ways of thinking of, both Bank staff, and Government officials. Participatory work improved significantly, showing a move from a focus on social mitigation of potentially adverse impacts, to proactive work, with broader operational frameworks for participation in project planning. Direct beneficiary participation, was less common in strategy, and policy formulation, but more common in formulating local-level project approaches, though the level of primary beneficiary participation, never went beyond information sharing, and consultation. However, there was an increased collaboration with primary stakeholders, and, capacity building, and empowerment did take place. The study stipulates the potential of beneficiaries is underutilized, and challenges participatory management, to improve processes so as to adapt to the social, and institutional context, and, to consider participation within a broader local capacity.