title: Local production of medical technologies and its effect on access in low and middle income countries: a systematic review of the literature.
abstract: OBJECTIVE
  The objective of this study was to assess the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products. Our preliminary hypothesis is that studies showing a robust relationship between local production and access to medical products are sparse, at best.
  
  
  METHODS
  An extensive literature search was conducted using a wide variety of databases and search terms intending to capture as many different aspects of this issue as possible. The results of the search were reviewed and categorized according to their relevance to the research question. The literature was also reviewed to determine the rigor used to examine the effects of local production and what implications these experiences hold for other developing countries.
  
  
  RESULTS
  Literature addressing the benefits of local production and the link between it and access to medical products is sparse, mainly descriptive and lacking empirical evidence. Of the literature we reviewed that addressed comparative economics and strategic planning of multinational and domestic firms, there are few dealing with emerging markets and lower-middle income countries and even fewer that compare local biomedical producers with multinational corporations in terms of a reasonable metric. What comparisons exist mainly relate to prices of local versus foreign/multinational produced medicines.
  
  
  CONCLUSIONS
  An assessment of the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products reveals a paucity of literature explicitly dealing with this issue. Of the literature that does exist, methods used to date are insufficient to prove a robust relationship between local production of medical products and access to these products. There are mixed messages from various studies, and although the studies may correctly depict specific situations in specific countries with reference to specific products, such evidence cannot be generalized. Our review strongly supports the need for further research in understanding the dynamic link between local production and access to medical products.
authors.affiliation: Department of International Health, Center for Global Health & Development, Boston University, School of Public Health, Boston MA.
authors.forename: Warren Allan
authors.initials: WA
authors.lastname: Kaplan
authors.forename: Lindsay Sarah
authors.initials: LS
authors.lastname: Ritz
authors.forename: Marie
authors.initials: M
authors.lastname: Vitello
keywords: Access to Medicines; Industrial Policy; Pharmaceutical Policy; Pharmaceuticals