strategic directions for pharmaceutical sector work andreas seiter july 2008 first draft for review
TRANSCRIPT
Strategic Directions for Pharmaceutical Sector Work
Strategic Directions for Pharmaceutical Sector Work
Andreas Seiter
July 2008
First Draft for Review
HNP Strategy: Better Health Outcomes Through Improved Health Systems
Access to and appropriate use of medicines is an essential element of a functioning health system
Interventions
Drug Supply-Type
-Quantity
Drug Demand-Type
-Quantity
UserLocation
Drug SupplyLocation
User'sAttitudes/
Expectationsof Products
and Services
Characteristicsof Products and
Services
User's Incom eAbility to Pay
Prices of DrugProducts and
Services
Quality ofProducts
& Services
Accessibility Availability
Acceptability Affordability
Source: MSH
Availability Functioning marketProcurement, supply chain
Affordability FinancingPurchasing efficiencyPricing
AccessibilityHealthcare service infrastructureHuman resourcesTransportation
AcceptabilityTechnical StandardsRegulation & enforcementInformationTransparency of rules and decisions
UtilizationRational prescribing and use
Medicines Supporting Health Outcomes
Which of these areas should HNP support through a pharmaceuticals work program (based on skills available, leveraging potential by/for other activities or partnerships, areas not well covered by other agencies, high impact on outcomes, measurable results)?
Availability Functioning marketProcurement, supply chain
Affordability FinancingPurchasing efficiencyPricing
AccessibilityHealthcare service infrastructureHuman resourcesTransportation
AcceptabilityTechnical StandardsRegulation & enforcementInformationTransparency of rules and decisions
UtilizationRational prescribing and use
Medicines Supporting Health Outcomes
First cut – areas of interest where we may be in a good position to provide support
Areas covered by other functions or by partners, or areas with no specific skills advantage on our side
Availability Procurement, supply chain (LICs)
Affordability FinancingPurchasing efficiency (MeTA) Pricing (MeTA)
AcceptabilityRegulation (MICs)Transparency of rules and decisions (MeTA, GAC)
UtilizationRational prescribing and use (MeTA, GAC)
Medicines Supporting Health Outcomes
Areas of direct interest to operations
Areas where we can leverage partnerships
Strategy Outline
The “Pharmaceutical Expert” function in the HNP Anchor supports operations
Within the framework of general health systems development work With a focus on Good Governance and Management Practices in the
Pharmaceutical Sector (covering financing, purchasing efficiency, pricing, selection, procurement, supply chain management and rational use of medicines)
Considering public as well as private sector solutions Providing also regulatory support relevant to the above areas Assisting in establishing transparent and effective tools and processes for decision
making Guided by data and verified by measurable outcome or proxy indicators Considering viewpoints of different stakeholders (including civil society) in the sector
and aware of the strong commercial influences on policy In close collaboration with technical agencies such as WHO or procurement specialists
such as UNICEF – on which we rely in their special areas of expertise Through programmatic work, TA and policy dialogue in countries as well as through
knowledge products and training tools designed for TTLs and technical level staff in client countries
Working Effectively, Efficiently and Sustainably “Good Practice and doable” is better than “Best Practice but unrealistic” in a given
political environment Identify and work with “champions” and “early adopters” rather than trying to convince
those who are reluctant to try new things “You can only manage what you can measure” – systems to collect and analyze data
are essential for improving governance and management Learning by example – for technical experts, detailed case studies are better learning
tools than textbooks or academic overview papers Pick the best people – only hire consultants that have a track record of providing
excellent quality of work Leverage knowledge available in other institutions and networks (Bank/IFC, WHO,
other UN agencies, GFATM, academia, PPRI, PIC/s Scheme, NICE, MeTA etc) Use networks and networking tools for dissemination and learning Build critical mass and visibility to attract external funding and become independent
from BB Early prototyping and learning from pilot implementation is better than “analysis-
paralysis” Take a long term perspective – pharmaceutical sector reform is an ongoing challenge
and major changes can take years to show their full effect
How to Remain Focused
Limiting ourselves to a single issue focus such as “procurement only” or “financing only” is not an option if we want to improve complex systems
Focus has to be designed into each project – addressing key issues or bottlenecks for which informal “political economy” indicators show a solid chance for successful implementation of agreed policy changes
This contrasts with many past consulting projects that led to comprehensive analytical reports and a multitude of recommendations – sometimes overwhelming the client and leading to no change or follow-up at all
Example for focus: Ghana 2007/2008 – recommendations limited to three issues (unclear pricing rules, double-billing for subsidized “program” drugs and lack of baseline data for drug utilization) that threaten sustainability of health insurance but can be addressed in reasonable time with limited efforts; all other issues are mentioned but will not be pursued at the time
Project Selection Checklist
Why should we be doing this (demand, strategic fit, innovation, scale of impact..)?
What exactly are we doing (clear objectives, tasks and deliverables defined, realistic timelines and resource allocation..)?
How are we doing it (methodology, process, decision making, dissemination..)?
Whom are we working with (core team, TTL(s), client country champion(s), consultants, partner organization experts..)
How do we measure success (output, impact indicators, outcome measures..)?
How can we use leverage (leverage partnerships and networks, knowledge from previous projects, country-internal partners and networks; leverage opportunities from the project for future projects..)
How can we share knowledge and learnings gained during the project (training, workshops, reports, databases, expert networks, web based tools..)?
Short Term Work Program
Learning ICR India Food and Drugs Capacity Building Program DIR follow-up in India, focus on medicines procurement (certification of a state
procurement agency); contract with MSH Work with OPCPR to address procurement roadblocks Multi-country work program to improve pharmaceutical governance and management
(Ghana, Indonesia, Peru, Timor-Leste, Benin, WBG, Yemen, Zambia, Jordan, Uganda, Kyrgyzstan) in partnership with DFID, WHO and NICE; TF and EFO funded
MIC technical support as part of DPL or RTA (Bulgaria, Turkey, KSA); emerging partnership with NICE
New Flagship Module on pharmaceutical governance and management (in partnership with DFID, Harvard and WHO)
Strengths: Clear focus on core areas of competence important for health systems strengthening; high relevance to stakeholders and Bank clients; fully leveraged partnerships; growing body of competent and tested consultants
Weaknesses: not all objectives clear yet; management process not yet streamlined
Mid-Term Goals, Ideas and Options
Stronger internal partnership with OPCS and INT to address governance issues in pharmaceutical procurement and supply chain management
Providing 24/7 technical “hotline” service for TTLs and procurement staff on pharmaceuticals, medical supplies and devices through contract with specialized firm
Develop practical know-how on framework contracts for pharmaceuticals and contracting out of entire supply chains and provide TA to clients
Develop tools for rational decision making on inclusion of new drugs in reimbursement lists, in partnership with NICE
Work with IFC on public-private synergies; business environment; impact of industrial development in manufacturing and distribution on regulatory quality
Work with academia and industry on differential pricing and access programs for “new essential drugs” that are still under patent