New Initiatives
To Finance Health Care
Best Practices within the RBM Partnership
Regional Ministerial Meeting
on Financing Strategies for Health Care
Colombo, Sri Lanka
16-18 March 2009
Thomas Teuscher
Senior Advisor
rollbackmalaria.org
Achieving the MDGs
Progress on targets significantly accelerated by effective malaria control
MDG 1
Eradicate Extreme Poverty
1% GDP growth loss, 40% health spending,
30% household expenditure on illness
MDG 2
Achieve Universal Primary Education
Absenteeism, cognitive damage
MDG 4
Contained in top 3 causes of child death,
20% mortality reduction
Reduce Child Mortality
MDG 5
Improve Maternal Health
Pregnant woman at increased risk
MDG 6
Combat HIV/AIDS, Malaria, Other
GMAP promotes malaria elimination
MDG 8
PPPs and PDPs for universal access
Develop a Global Partnership for Development
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
1
Copenhagen Consensus 2008 http://www.copenhagenconsensus.com
“What would be the best ways of advancing global welfare
and particularly the welfare of the developing countries? “
Leading economists were asked to address ten key global challenges.
How to allocate an additional $75 billion over four years?
1
2
3
4
5
6
7
8
9
10
11
12
13
Micronutrient supplements for children (vitamin A and zinc)
The Doha Trade agenda
Micronutrient fortification (iron and salt iodization)
Expanded immunization coverage for children
Bio-fortification
De-worming and other nutrition programs at school
Lowering the price of schooling
Increase and improve girls’ schooling
Community‐based nutrition promotion
Provide support for women’s reproductive role
Heart attack acute management
Malaria prevention and treatment
Tuberculosis case finding and treatment
Malnutrition
Development
Malnutrition
Disease ($ 1,000 - 5.3%)
Malnutrition
Malnutrition / Education
Education ($ 5,400 – 28.8%)
Women ($ 6,000 – 32%)
Malnutrition
Women
Diseases ($ 200 – 1%)
Diseases ($ 500 - 2.6%)
Diseases ($ 419 – 2.2%)
Malaria control is 3rd most cost effective health intervention
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
2
Global Financing for Malaria Control
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
3
Increased Global Funding
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
4
Access to malaria medicines by populations at risk
Public sector
30-40%
Licensed private
sector
40-50%
Drugshops
Public Health Clinic
Financing Strategies for Health Care
Unlicensed private
sector
80-95%
Colombo, Sri Lanka 16-18 March 2009
Drug vendors
5
Market shares public & private sector
2006 Antimalarial Treatment Volumes (Million)
100%
~400
~150
Total = ~550
Other
Chloroquine (CQ)
80
SulfadoxinePyrimethamine (SP)
Chloroquine (CQ)
60
40
ACTs
20
Sulfadoxine-Pyrimethamine (SP)
Artemisinin monotherapies
0
Private
ACTs
Public
Note: "Other" includes Mefloquine, Amodiaquine and others. ACT data based on WHO estimates and supplier interviews.
Source: Biosynthetic Artemisinin Roll-Out Strategy, BCG/Institute for OneWorld Health, WHO, Dalberg.
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
6
6
Innovative Financing Mechanisms
New sources of funding
1.
Airline solidarity levy UNITAID
Subscribing countries
Benefitting countries
Maximizing benefits of new financing for health
2.
Affordable Medicines Facility for Malaria (AMFm)
Global co-payment to ensure universal access for
treatment in public and private sector
Objective:
Make available combination therapy in public & private sector at
no or low cost to end-user
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
7
UNITAID contributors (from http://www.unitaid.eu/ 14.3.2009)
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
8
Who benefits from UNITAID (from http://www.unitaid.eu/ 14.3.2009)
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
9
Pricing for ACTs in private and public sector
Under AMFm
Today
Manufacturers
Sales price 0.80 $ or
less)
Manufacturers
4$
0.80 $
Private wholesalers
5-6 $
Retail pharmacies
6-10 $
Public wholesalers
Free/
prime
Public pharmacies
Free/
prime
Patients
Patients
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
0/05$
Private wholesalers
0.2-0.4$
Retail pharmacies
0.2 – 0.5 $
Patients
USD 0.75
AMFm
0.05$
public / NGO
wholesalers
free/
prime
Public pharmacies
free/
prime
Patients
10
10
New Initiatives
To Finance Health Care
Backup Slides
rollbackmalaria.org
National Financing on Health
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
12
End user prices reflect landed costs or CIF prices (en USD):
ACTs 4 --> 8
m-ART 3 --> 6,50
SP 0.15 --> 0,50
CQ 0.08 --> 0,30
Average Prices (USD)
10.0
8.0
8.0
6.5
6.0
4.0
2.0
0.0
Range
(USD)
ACT
Artemisinin
monotherapies
6-10
5-8
0.5
0.3
SulfadoxinePyrimethamine
(Generic)
0.4-0.7
Chloroquine
(Generic)
0.2-0.4
Note: Ranges indicate variance across countries and products excluding outliers; N (observations): (ACT, 222); (AMT, 227) ; (CQ, 37) ; (SP, 118). Source: Dalberg field research
(Kenya, Uganda, BF, Cameroon), Observations by World Bank and Research International (Nigeria). Smaller pricing observations were also performed in Ghana, Rwanda,
Burundi, Niger and Zambia), but due to low n not included. SP and CQ data complemented with HAI and IOM observations
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
13
13
Objectives and principles
Objectives: increased use of ACTs
Principles
• Promote ACT use
• Offer ACTs to whole salers at CQ price
• Chase mono-therapies and ineffective
drugs
• All countries, all sectors: public, private, NGO
Through
• Eligibility of ACTs: WHO recommended
• Light secretariat
–Reduced ACT end-user price
• Eligibility of manufacturers: quality, price
–Supporting interventions
• Eligibility of wholesalers: MOH
• Eligibility of countries
• Supporting interventions for responsible
introduction and launch
• Monitoring & Evaluation – RBM 2015 Goals
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
14
14
AMFm activities: 3 packages
•
•
•
•
CORE AMFm FUNCTIONS
(Executed by Facility)
Negotiation of terms for low-cost antimalarials
Setting prices and terms for international
distribution
Processing co-payments
Transparent sharing of information and forecasts
ELIGIBILITY CRITERIA / REQUIREMENTS
(Set by RBM, applied by Facility)
• ACT treatment requirements
• Buyer eligibility requirements
• Country preparedness requirements
PARTNER / SUPPORTING INTERVENTIONS
(Ensured and facilitated by Facility)
• National policy and
• Provider training
regulatory preparedness
• National monitoring and
• Wholesaler incentives and
quality preparedness
pricing / margin control
(resistance monitoring,
mechanisms
pharmacovigilance, and
• Public education and
quality surveillance)
awareness (IEC)
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
15
AMFm Phase 1 is targeted to launch in May 2009
• Phased launch starting with a first group of countries to facilitate
learning and help guide adjustments to the AMFm design before
global implementation
• Phase 1 will launch in May 2009 and run until the end of 2010
• An independent technical evaluation will be commissioned by the
Global Fund to assess the AMFm
• Expansion from Phase 1 to full roll-out in all malaria-endemic
countries will occur unless clear failures are observed from the
evaluation findings
Resources required for launch:
• Co-payment: ~USD 212 million
• Supporting interventions: ~ USD 100-125 million
Financing Strategies for Health Care
Colombo, Sri Lanka 16-18 March 2009
16