Pharmaceutical System Strengthening: Is There a Need for a New Paradigm?

1. Pharmaceutical System Strengthening: Is There a Need for a New Paradigm? Douglas Keene, PharmD, MHS ICIUM-3 Pre-Conference Session 14 November 2011

2. Dimensions of Drug Supply

3. From Supply Management to Medicines Access 1983 1997 2001

4. A New Paradigm FY 2000:Dimensions of Access

5. Estimated Total Annual Resources Available for AIDS, 1996 – 2005 9 000 8 000 7 000 ( US$ millions ) 6 000 5 000 PEPFAR USAID’s Millennium Challenge Account 4 000 3 000 Global Fund World Bank MAP Launch Signing of Declaration of Commitment on HIV/AIDS 2 000 Accelerating Access Initiative 1 000 Global Alliance for Vaccines and Immunization 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Source: Lancet, 2006; 368: 526–30

6. 6% Other 2% Monitoring and Evaluation 11% Infrastructure and Equipment 48%DrugsCommoditiesProductsetc... 11% Administration 11% Tuberculosis Procurement of Drugs Overshadows Human Resources, Capacity, and Systems

7. A Few Realities for Saving Lives and Improving Health • Funding is never the only constraint and is often not the major constraint • “Solving” the financing problem inevitably reveals other weaknesses • Lasting impact depends on reliable health systems: • Strengthened systems • Management tools • Human resources • Capacity building

8. Center for Pharmaceutical Management

9. Working Definition of Pharmaceutical Services Pharmaceutical services include all services rendered by pharmaceutical staff to support the provision of patient care and treatment. Beyond the supply of pharmaceutical products, pharmaceutical services include educating and training of staff, providing medicine information and counseling in support of prescribing and dispensing practices, monitoring medicine use to assure patient safety and achieve desired health outcomes, formulating policies and regulation for improved pharmaceutical care, and disseminating information and educational materials to promote public health.

10. USAID Programs • Regional Pharmaceutical Management Project [Eastern Caribbean Drug Service] • 1986 – 1990 • Rational Pharmaceutical Management Project (RPM) • 1992 – 1999 • Rational Pharmaceutical Management Plus Program (RPM Plus) • 2000 – 2007 • Supply Chain Management Systems Project (SCMS) • - 2005 – 2013 • Strengthening Pharmaceutical Systems Program (SPS) • 2007 – 2012 • Systems for Improved Access to Pharmaceuticals and Services (SIAPS) • 2011 – 2016

11. Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Pharmaceutical System Strengthening Framework Government MOH, other ministries, regulators, policy makers Governance Medical Products Service Delivery Human Resources Financing Information Sustainable Health Outcomes and Impact aligned with: Country Strategic Plans and USG/USAID Health-Specific Results Analysis International health initiatives Local context Health status Health systems Improved coverage & access of evidence-based interventions Improved health system performance Evidence-based strategy Providers public/private, NGO, commercial sector, professional associations Community patients, consumers, caregivers, civil society Monitor and Evaluate Performance

12. SIAPS Core Operating Principles • Build on and strengthen existing systems • Support integration (of other public health programs and supply systems) • Build the capacity of local organizations • Support country-led coordination • Continually monitor and evaluate • Develop improved performance metrics • Harmonize tools, approaches , and metrics • Share knowledge and information