Financing Essential Medicines in Low- and Middle-income Countries: Cameroon Case Study
WHO Medicines Work in Countries: The Kenya Example
description
Transcript of WHO Medicines Work in Countries: The Kenya Example
WHO/UNICEF TBS September 05 1
WHO Medicines Work in Countries: The Kenya Example
Regina M. MBINDYOEDM/NPO, WHO Kenya
KENYAKENYA
WHO/UNICEF TBS September 05 2
General and Health Indicators: Kenya
Total population, 2001…………………… 31.3 million
GDP per capita (US$), 2001……………… 453.2
Life expectancy at birth (M/F), 2002…… 47/49
Child mortality (M/F) (per 1000)………… 99/109
(probability of dying under age 5 years)
Adult mortality (M/F) (per 1000)……… 560/513
(probability of dying between 15 and 59)
Per capita total expenditure on health… 115
(in international dollars, 2000)
Total health expenditure as % of GDP… 8.3
Adult literacy rate, 2000………………… . 73.6%
WHO/UNICEF TBS September 05 3
EDM Support to Kenya (04-05)
Key Issues & Challenges• Inadequate pharmacy laws and policies• Inadequate & irregular supply of essential medicines • Weak drug regulatory mechanisms• Vibrant private pharmaceutical sector • Irrational prescribing and dispensing by health workers• Lack of policy and legal framework for integration of traditional
medicines into health care system • Increasing trends towards regional integration of pharmaceutical
services and regulatory mechanisms
WHO EDM support to Kenya focuses on 5 broad areas:Policy, Access, Quality Assurance, RUM & Traditional Medicines
WHO/UNICEF TBS September 05 4
Baseline Survey - 2003 Joint collaboration of HAI, MOH & WHO. Completed in Dec 03
Highlights of findings: Prescribing according to EDL (81% of medicines prescribed)
30% of population have access to essential medicines
50% of population have access to health facilities (within one-hour walking distance) National Medicines Policy available – last updated in 1994
However: some areas for improvement Over-prescribing common (93% of facilities) (prescribing antibiotics to 50% of patients) No medicines pricing policy, or mechanisms to monitor medicine prices No policy on traditional medicine No coordinated programs to promote rational use of medicines National QC laboratory available, but not operating optimally
WHO/UNICEF TBS September 05 5
EDM Key Activities Implemented in Kenya (2005)
Policy (P)– Formation of IP & Health Group (IPHAG) to articulate & monitor IP issues in MOH
Access (A)– Draft Report of Medicine prices survey produced & disseminated to stakeholders– Capacity Building on Drug Management for MOH procurement Agency (KEMSA)– Technical advice on drug issues to support ART roll-out in the country
Quality (Q)– Installation & training on SIAMED to improve efficiency of Drug Registration– Coordination of Tech. Audits for 2 QC labs pursuing WHO pre-qualification
Rational Use of Medicines (RUM)– Development of National Guidelines for promoting RUM– Training support for 2 nationals on RUM and DTC
Traditional Medicines (TRM)– Commemoration of Africa TRM day– MOH Participation in ongoing review of TRM policy
WHO/UNICEF TBS September 05 6
Progress of EDM Activities – Kenya (2005) EXPECTED RESULT No of Activities
C = Completed; O = Ongoing C O TOTAL
1.1 Capacity to monitor impact of trade agreements & IPR issues on access to medicines increased (P)
3 3 6
2.1 Capacity for medicines supply management in the public sector improved (A) 1 2 3
2.2 Prices and access to essential medicines monitored (A) 2 1 3
3.1 Capacity for information management in drug registration improved (Q) 3 0 3
3.2 Good QC laboratory practices promoted (Q) 1 1 2
4.1 Drug & Therapeutic Committees established in three District hospitals (RUM) 0 4 4
4.2 Training of health professionals on rational use supported (RUM) 0 2 2
4.3 National Guidelines for improving rational use of medicines developed (RUM) 1 3 4
5.1 National Policy on Traditional Medicine, a legal framework and Code of Ethics TM Practitioners developed (TRM)
1 3 4
5.2 Rational Use of TM by providers and consumers promoted (TRM) 2 0 2
TOTALS 14 19 33
WHO/UNICEF TBS September 05 7
Medicine Prices Survey – 2004
General FindingsMost public facilities use ‘course of treatment’ pricing. Lowest prices found in the public sector
Essential medicines more widely available in the mission sector compared to the public sector
Generics widely available in private retail sector – has the highest prices
High generic procurement in public sector - virtually no Innovator Brands of KEDL items
Low procurement prices in both public & mission sectors
Some Policy ImplicationsPromotion of generic prescribing
Policy to support generic substitution
Promotion of price transparency
WHO/UNICEF TBS September 05 8
Medicine Prices Survey – 2004
0
10
20
30
40
50
60
70
80
90
Public Private Mission
IB
MSG
LPG
Availability: KEDL Medicines
WHO/UNICEF TBS September 05 9
Medicine Prices Survey – 2004
0 2 4 6 8 10 12 14 16
Hypertension(atenolol)
Adult ARI(amoxicillin)
Peptic ulcer(ranitidine)
Innov. Brand Most Sold Gen. Lowest Priced Gen.
Private Retail Sector Affordability
WHO/UNICEF TBS September 05 10
WHO/HAI-Africa Joint Collaboration for Action on Medicines in Africa
Goals of the Collaboration Project– Increased access to essential medicines through improved policies and
practices
– Increased capacity & participation of NGOs & consumers in the development and implementation of medicines policy
Joint priority areas of work: medicines policy, pricing, rational use, IPR issues, operational research Project countries: Kenya, Uganda, GhanaSupported by DFID-UKCountry Working Group (CWG) at country level - MOH/HAI/WHO Develop joint work plans for country activities
Mobilize resources for implementation of agreed work plans
Coordinate implementation of joint work plans
Timely periodic reporting to the Project Management Group (PMG)
WHO/UNICEF TBS September 05 11
WHO/HAI-AfricaOverview of Collaboration
Rationale for the Collaboration Synergy of expertise & know- how for greater impact Learn from our different approaches; enhance our commonalities Enhance broad stakeholder participation in policy development and
implementation Empower CSO & build capacity in the medicines field Forge dialogue and links between consumers & MOH Improve coordination and efficient use of resources
MOHCollaborative Activities based onCountry priorities
Likelihood of sustainable impact
Added value in joint activity planning & implementation
WHO/UNICEF TBS September 05 12
WHO/HAI-Africa Collaboration Activities
Assessment of the Pharmaceutical Situation in Kenya (Baseline Survey - 2003)
A Study of Medicine Prices in Kenya (2004)
MOH capacity strengthening on IPR Issues (ongoing) Through IP & Health Advisory Group (IPHAG)
Monitoring the impact of patents on access to medicines
Development of Guidelines for Rational Use of Medicines (ongoing)
Establishment of Drug & Therapeutic Committees (DTC) at all levels (ongoing)
WHO/UNICEF TBS September 05 13
Future Activities for EDM -Kenya (2006 – 2007)
Participate in Review of the National Medicines PolicyInitiate activities to promote medicine price transparencyPromote Rational Use of Medicines in the communitySupport Incorporation of drug management and RUM in pharmacy training curriculaSupport Review of Clinical Guidelines and EDLSupport development of National Policy on Traditional Medicines (TRM), a Legal Framework and Code of Ethics for TRM practitionersCapacity building in GMP, drug management and rational use in the pharmaceutical sector
WHO/UNICEF TBS September 05 14
Asante sana!
Thank You