Medicines Transparency Alliance19/04/23

Availability of Medicines

Anita WagnerHarvard Medical School & WHO Collaborating Center in Pharmaceutical Policy

Medicines Transparency Alliance

Evidence on Medicines Availability

MeTA facility surveys

– Supply side assessment

– Average public sector generic availability 30%-55%*

– Generics in public facilities < generics in private facilities

– Generics for chronic conditions < generics for acute conditions

MeTA household surveys

– Add demand side perspective

– Consumer perceptions seem consistent with facility data

Public facilities < private facilities

Chronic disease medicines < acute condition medicines

– Lack of public sector availability seems to impact adherence

Differently for poor, near-poor, less poor*Cameron et al, Lancet, 2009

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Medicines Transparency Alliance

Key Observations

Appropriate, high-quality, affordable medicines must be available for health care to improve health

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)

Fragmented, decentralised health care systems challenge availability further

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Multi-pronged, multi-level, multi-stakeholder approaches essential to improving availability

Medicines Transparency Alliance

Sample Interventions in MeTA Countries

Regulation– Generic laws (Philippines)– Legislation for price reductions to increase availability for middle class (Philippines)– “New law on medicines” (Peru)

Pooled procurement– 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– 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– Civil society & media engagement on stock-outs => Drug Monitoring Unit (Uganda)– Availability discussion in review of national medicines policy (Zambia)

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Medicines Transparency Alliance

Sample Policy Suggestions

Pharmaceutical management– Developing & implementing formulary process related to STG (Jordan)– National formulary system implementation (Philippines)

Financing– Differentiate policy interventions targeting poor, near-poor

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– 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)

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Medicines Transparency Alliance

Information Generationand Dissemination

Publish processes and outcomes of MeTA pilot phase– 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

Build evaluation and routine monitoring of impacts into policy change – Data– Tools– Indicators– Evaluation design/methods– Analysis– Dissemination

Share experiences and results globally

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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

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