Availability of Medicines
Anita Wagner
Harvard Medical School & WHO
Collaborating Center in
Pharmaceutical Policy
14/03/2016
Medicines Transparency Alliance
Evidence on Medicines Availability
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MeTA facility surveys
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Supply side assessment
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Average public sector generic availability 30%-55%*
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Generics in public facilities < generics in private facilities
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Generics for chronic conditions < generics for acute conditions
MeTA household surveys
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Add demand side perspective
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Consumer perceptions seem consistent with facility data
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Public facilities < private facilities
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Chronic disease medicines < acute condition medicines
Lack of public sector availability seems to impact adherence
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14/03/2016
Differently for poor, near-poor, less poor
Medicines Transparency Alliance
*Cameron et al, Lancet, 2009
Key Observations
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Appropriate, high-quality, affordable medicines must be available for health care
to improve health
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Availability is complex, multi-factorial
– International and national regulations
– Manufacturing
– Forecasting to match clinical need, guideline-based treatment, & drug lists
– Procurement, distribution, warehousing logistics
– Financing within systems, for patients
– Incentives for manufacturer, purchasers, prescribers, dispensers
– Education, training, awareness generation of all stakeholders (logistics, cost,
appropriate prescribing, dispensing, use)
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Fragmented, decentralised health care systems challenge
availability further
Multi-pronged, multi-level, multi-stakeholder approaches
essential to improving availability
14/03/2016
Medicines Transparency Alliance
Sample Interventions in
MeTA Countries
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Regulation
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Pooled procurement
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Negotiating power of volume for price, quality, availability, geographic distribution
(Jordan: Joint Procurement Department)
Centralised procurement with public tender and accountability for timely, decentralised
distribution (Peru)
Procurement from pre-qualified suppliers (Zambia)
Financing
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Generic laws (Philippines)
Legislation for price reductions to increase availability for middle class (Philippines)
“New law on medicines” (Peru)
Separate drug budgets in facilities (Ghana: NHIA reimbursement)
Basic outpatient drug package for chronic conditions & forecasting budget needs using
claims data (Kyrgyzstan)
Information generation & disclosure
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Civil society & media engagement on stock-outs => Drug Monitoring Unit (Uganda)
Availability discussion in review of national medicines policy (Zambia)
14/03/2016
Medicines Transparency Alliance
Sample Policy Suggestions
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Pharmaceutical management
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Developing & implementing formulary process related to STG (Jordan)
National formulary system implementation (Philippines)
Financing
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Differentiate policy interventions targeting poor, near-poor
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Access to care & free, high quality, appropriate drugs needed for the poor
Incentivise manufacturing, procurement, availability, prescribing, dispensing of
appropriate medicines (according to formularies)
Insure flow of funds (Ghana: NHIA reimbursement times)
Implement policies to incentivize appropriate use of generic first-line products with
patient cost-sharing for non-poor where appropriate (Kyrgyzstan)
Information generation and disclosure
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Routine online data bases of price and availability (Peru, Uganda)
Creation of regional MeTA offices (Peru)
Continued consideration of availability (and other MeTA core principles) in
Parliament (Zambia)
14/03/2016
Medicines Transparency Alliance
Information Generation
and Dissemination
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Publish processes and outcomes of MeTA pilot phase
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Build evaluation and routine monitoring of impacts into policy change
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WHO Essential Medicines Monitor:
http://www.who.int/medicines/publications/monitor/en/index.html
WHO Medicines Documentation Centre: http://apps.who.int/medicinedocs/en/
ICIUM2011: www.icium2011.org
Data
Tools
Indicators
Evaluation design/methods
Analysis
Dissemination
Share experiences and results globally
14/03/2016
Medicines Transparency Alliance
Thank you
Anita Wagner
Email: awagner@hms.harvard.edu
Skype: anita.wagner
International MeTA Secretariat: admin@metasecretariat.org
MeTA: www.MedicinesTransparency.or
14/03/2016
Medicines Transparency Alliance