Good Governance for Medicines

Program in Thailand

Dr.Chanvit Tharathep

Ministry of Public Health, Thailand

9/11/2015

Outline

� Activities before WHO GGM

� WHO GGM : Phase I, II, III and…beyond?

� Outcome, Impact

� Health Care Scandals

� Key Achievement : Operating Framework

� What’s next?

2004 WHO GGM

introduced to

Thailand.

Phase I started.

1981, 1993 :National Drug Policy

Safety, Quality, Appropriate Price, Access

1981-2005 : Essential Drugs list, Standard Price

2002 UHC - 30 Baht project

2004 : Public Good Governance Law

1997-2005 Drug management Reform in MoPH

1997

Economic

Crisis,

1997

Drug

Scandal

Activities Before WHO GGM

WHO GGM Program: Changes and Impacts

PHASE IIPHASE I PHASE III

Assessment GGM

Flamework

Situation

Analysis

Existing GGM

Infrastructure

strengthening

GGM

Networking

Thai GGM

Strategy

Available Practices,

Guidelines

GGM

Implementation

Forms,

Procedures

More

Transparency

By Information

Registration,

Selection,

Procurement,

Improvement

GGM Strategy

Socialization,

Education.

Increased

Awareness

More

Transparency

More

Efficiency

Networking

Learning

Process

Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles

2004-2005 2005-2006 Since Oct 2006-

Output

OutcomeImpacts

GGM

Policy and Implement

National Networking

and Participation

Strengthen Information

Database

Dissemination of Ethical

Practice Information

Output, Outcome, Impact

Assessment

Phase III: Strategy and implementation since 2006•GGM Framework, legislation, GGM Policy•Practice Guidelines, Medicine Promotion Practice criteria•Standard of Practice (SOP)•Declare Consent form, Conflict of interest form (ED, SP)•FDA, DHSS, DMS, Universities, Professional Councils•Hospital Pharmacy Association•Community Pharmacy Association•PReMA, •Thai Pharmaceutical Manufacturer Association•NGOs•Selection, Registration •Procurement•Drug Price, Drug Promotion Practice•Research, Study and cases•Public accessible Pharmacy Information Center•Meeting•Newsletter, Webpage of Good Governance•Best Practice•Interested Working Group•KPI for Health Inspector•Self Assessment, Assessment New tool (Promotion Practice, Inspection, Distribution?)

Publications/medias provided (cont’d)

� News Letter, Electronic data and information on CDs, Website: http://dmsic.moph.go.th

Code of Conduct for Sales and Marketing

Meeting GGM Leadership training MoPH

hospital pharmacists

� Consensus Oriented

� Participatory

� Rule of Law

� Transparent

� Accountable

� Responsive

� Effective and Efficient

� Equitable and Inclusive

GGM Framework

GGM Strategy

GGM ImplementationGGM III

Process Improvement 2006-2010

Outcome focus 2010-2015

Regional Group Purchasing Monopoly Drug Management

Compulsory Licensing

Corruption Control

Socialization (Whistle Brower)

3 Health security Schemes integration

From 2006-2015

Drug item Pack unit Average price

Regular

Separated

purchasing

Provincial

group

purchasing

Regional

group

purchasing

Diclofenac tab 25 mg 500 107.86 74.69 57.38

Insulin Human Base vial 100

IU/ml (10 ml)

1 308.99 300.63 310.30

Medroxyprogesterone amp. 50

mg/ml (3 ml)

1 16.08 12.49 13.50

Ranitidine tab 150 mg 500 200.95 201.34 177.62

Salbutamol inhaler 100 mcg (200

doses)

1 105.93 112.68 139.10

Salbutamol sol 0.5 % (20 ml) 1 91.87 102.44 85.60

Group Purchasing Outcome: More efficiency, cost

reduction

1.Antihypertensive drugs (ARB)

2.Dyslipidemia agent (Statins)

3.Proton pump inhibitor (PPI)

Monopoly Drugs Single price policy

Item Previous

Price(Baht)

Proposed

Price(Baht)

Managed

Price(Baht)

Save/

Package(Baht)

Budget

Save(Baht)

Rosuvastation

tablet 10 mg

(Crestor)

1,108.52 1,108.52 1,007.75 100.77 9,999,407

'Powerful figure' implicated in scandal over stolen

cold pills, 2012THE NATION

BANGKOK: -- At least one

very powerful figure has been

implicated in the

embezzlement of pills

containing pseudoephedrine

from state hospitals, the public

health minister's adviser, Pasit

Sakdanarong, said yesterday.

>20 Hospitals involved>20 Doctors and Pharmacists were punished

Health System Research Institution, IDRC Scandal 2014

For Appointed

the HSRI new

board members

with COI to fire

the whistle blower.

1st Case of Whistle Blower protection

The NHSO Secretary

General was investigated and moved out.

NACC investigation involved Minister and deputy

Thaihealth Scandal in 2015

Mr Krissada earlier insisted that the

foundation’s budget was spent transparently to

benefit the public. The state auditor found that

40% of its funds were diverted to political

activities instead of promoting public...

http://www.bangkokpost.com/news/general/732520/thaihealth-chief-resigns-over-spending-scandal.

Factors for Success

� Transparency (Pharmacy Information Center)

� Appropriate GGM Strategy according to situation

� Strong GGM teamwork and Network

� Focus on Output, Outcome, Impact

� Participatory Process : among public organizations,

NGO, Media, Social participation

GGM Operating Framework

National GGM Framework

Health care environment Analysis Target Priority Setting

Strategic formulation

Information System Transparency

Information Networking Socialization Guideline

Intervention Assessment

Management System Strengthening Activities

Output, Outcome Focused Activities

Challenges

� Country Context

� Health System Context : More Governance Bodies :

MoPH, NHSO, Thaihealth, National health commission, etc…

� MoPH Administrators, Structure changed : Pharmacy

Information Center weakening -> Pseudoephedrine case.

� More advanced corruption techniques : Innovative corruption in Health Sector

� Knowledge Management Gap.

People

InformationHealth

Workforce

Financing

Medical

Products

Vaccine

Technology

Service

Delivery

Leadership

and

Governance

Demographic

ChangeTechnology

ChangeProblems and

Demands

Universal Health Coverage 2002-

2004

Prevention and PromotionTreatment, Rehabilitation

MoPH130,000 staffs

800,000 Volunteers

1,202.4 Bahts/capita

Integrated InformationSystem

9,600 HC

724 CH92 RH, GH

GGM

GGM

People

InformationHealth

Workforce

Financing

Medical

Products

Vaccine

Technology

Service

Delivery

Leadership

and

Governance

Demographic

ChangeTechnology

ChangeProblems and

Demands

Universal Health Coverage 2005-

2015

Prevention and PromotionTreatment, RehabilitationNHSO, MoPH, Thaihealth, NHC

etc >300,000 staffs

>3,000 Bahts/capita

Seperated Information

>10,000 HC

784 CH>100 RH, GH

>10,000 Health Networks/Foundations

People

InformationHealth

Workforce

Financing

Medical

Products

Vaccine

Technology

Service

Delivery

Leadership

and

Governance

Demographic

ChangeTechnology

ChangeProblems and

Demands

More Health Expectancy for

Sustainable Growth

All For HealthHealth Literacy, Health in All Policy

One Health

Health for All : PHC, UHCAccess, Quality, Cost

Conclusion� GGM Framework is the national level management. We should

realize that there is different context in different country..

� Health care environment should be evaluated and priority setting

should be done at first step.

� The strategy should be formulated to support and transfer into

operation.

� Transparency is the most effective, efficient and feasible for the

first step of good governance implementation. We can achieve

transparency with the Pharmacy Information center.

� GGM team consists of related organization should be formed.

� Output, Outcome orientated activities.

� Future Strategy should be considered.