Summary of key conference
findings and recommendations
Hans V. Hogerzeil, MD, PhD, FRCP Edin
Recurrent themes in the conference
We know so much more!
The place of RUM in the value chain
Prices, generics, NCDs
Adherence, soft values
The future of RUM
The Jewish Rabbi
“We have so much more data now!”

RUM indicator studies as baseline for advocacy, comparisons
and progress (Kathy Holloway, Dennis Ross-Degnan)

Very detailed quantitative country reports, routine data


Oman: AB from 60% (1995) to 15% (2010) (Batool Jaffar Suleiman)

Kenya: comprehensive report (Regina Mbindyo)
WHO/HAI price and availability surveys (Marg Ewen)



Introduction of ACTs as part of the AMfM (e.g. Tanzania)
IMS data (Peter Stevens)

Market entry of generic medicines (USA, South Africa)

Allows for truly evidence-based policy advice to MICs
ATM Index to measure commitment, transparency, business
model and behaviour of large R&D companies
Funding for essential medicines over time: Ghana
% public expenditure on medicines
100%
Colonial
times Public funding
"NHS" model
Pooled funding,
health insurance
Early
independence
time
Funding for essential medicines over time
% public expenditure on medicines
100%
Colonial
times Public funding
"NHS" model
Early
independence
Essential Medicines
policies in public sector
Pooled funding,
health insurance
Essential Medicines
policies through
reimbursement
Essential Medicines
policies impossible
time
The next generation of essential medicines:
What do countries need in the next
decade?
New Middle East: New medicine policies, good governance,
human human rights, universal access, careful public expenditure
India: Advocacy, medicine policy, democracy, human rights, care for the
poor, universal access, public funding
Africa: Democracy, transparency, carefully increasing public/pooled
expenditure, quality assurance, social marketing in middle-income group
China: Quality assurance, cost-containment (rational use)
MICs: Expand health insurance, pricing policies, cost containment, generic
policies, regulatory collaboration and harmonization
Latin America: Cost containment, generic policies, rational use, unethical
promotion, selection of expensive EMs
OECD: WHO standards/review of new EMs for NTDs, regulatory collaboration
% public/pooled expenditure on medicines
100%-
The future of essential medicines as a function of
% public/pooled expenditure on medicines over time
Colonial
times
USA/EC/Australia
Thailand
Early
independence
L.America
MICs
China
Poor Asia
Poor M.East
Africa
India
Advocacy
Rational use
Generic policies
Cost containment
Pricing policies
Public / pooled funding
Social health insurance
Social marketing
Regulation, quality
Selection
Policy
time
RUM in the value chain:
Medicine prices

Royalties are the LIC/MIC contribution to research costs (Suerie Moon)

Taxes can be OK, depending who pays, and for which medicines
(David Henry)

The level of scheduling (OTC, Pharmacy only, Prescription only) has
a large effect on price (4x) (Travor Mabugu)

Tiered prices are still higher than competitive generics (MSF)

There is no global standard for allowing differential prices to
countries/patients (GDP, LICs, HDI, high-burden, poor patients)
“The real enemy of the generics are
the doctors, not the patients”
Dr Ahmed Al Saidi, Minister of Health, Oman
RUM in the value chain: generic policies

Switching to generics saves 65% of the medicine budget of
Chinese hospitals (Sun Jing)

52% of GPs in Malaysia think that generics are less regulated
than branded products; 62% think that generic medicines
have less efficacy (Mohamed Assali) with similar results from
South Africa (Aarti Patel)

NCDs are the political argument for generic policies
“I wish I had AIDS”
Cambodian diabetes patient, quoted by Chean Men
The lack of treatment of NCDs / chronic conditions

Most treatments are cheap: <$1 per month, $12 per year

Same for depression/chronic psychosis: $4-6 per year
(Robert Sebbag)

Difference in availability of 54% for acute medication vs 36%
for chronic medication means: the system can do it
(Richard Laing)
“Let’s not only look at technical solutions,
but also improve the soft values”
Birna Trap, Uganda
Adherence
Current
drop-out rates are not to be trusted, as there is no standard!
(John Chalker)
The
new INRUD-IAA standard methodology to measure adherence
per facility is an excellent tool for intervention. This is INRUD at its
best! (all INRUD teams)
Cell-phone
methodology is very promising
There
have been many experiences and studies on adherence since
last ICIUM– do we now know what to do for scaling up?
“Promoting
RUM is support, not policing” (Batool Jaffar Suleiman)
“The right to health costs money”
Access to essential medicines as part of the right to health

In Thailand access to essential medicines is not a charity, but a
right (Suwit Wibulpolprasert)

In Pakistan women have less access to depression treatment (Anita
Wagner). But what about women and girls in Yemen, Somalia, India
and Afghanistan?

Arab Spring: Examples of good constitutional text are available.
But be modest in your constitution (Vera Pepe, Jono Quick) and plan
for an implementation programme and the necessary finances

Recommendation: Make a briefing paper for Arab spring countries,
do advocacy NOW
“Many of today’s problems are based on
yesterday’s solutions”
Irene Akua Agyepong, Minister of Health, Ghana
Evidence-based interventions:

How to involve patients/community in developing clinical
guidelines in MICs?

How to manage medicine reimbursement in MICs?

How to use reimbursement data to promote RUM?

How to achieve cost-efficiency and sustainability of cell phone
programmes for adherence?
Descriptive studies for advocacy:

Disaggregated access statistics in selected countries

The economic cost and health impact of RUM inefficiency
“The future of RUM lies with the
health insurance companies”
RUM is part of the value chain: you have to wait for the right
moment and for the right incentives
If you want to fast-forward RUM:
▼
▼

“The future of RUM lies with the
health insurance companies”
RUM is part of the value chain: you have to wait for the right
moment and for the right incentives
If you want to fast-forward RUM
▼
▼


Promote RUM as part of procurement costs; start with the GFATM,
PEPFAR, PMI and UNITAID

Make a convincing case, based on economic benefits (for funders)
and better health outcomes (for prescribers)
“Public good or private gain”?
Minister Bengzon, Philippines

Fight against the “normalization of corruption” (Richard Laing)

Advocate for the poor, against exploitation
Maimonides
Jewish scholar (1135-1204)
Rabbi, physician and philosopher
in Morocco and Egypt
Maimonides
Jewish scholar (1135-1204)
Rabbi, physician and philosopher
in Morocco and Egypt
“Everyone must always regard himself as half innocent and half guilty.
And he should regard the whole of mankind in the same way.
If he then commits one more sin, he weighs down the scale of guilt
against himself and against the whole world. And he himself causes
the destruction of all.
But if he fulfills one commandment, he turns the scale of merit in his
favor and perhaps he saves the whole world. He by himself has the
power to bring salvation to all men of the world. Everyone has this
divine opportunity. The charity you do tomorrow may save the world.”
Saving lives
with the right (to) medicines
www.who.int / medicines