Strategy for working with and in countries

1. Strategy for working with and in countries Dr Gilles ForteEssential Medicines and Health Product Department Policy Access and Rational Use Team (PAU)

2. Mandate and Resolutions • WHO Constitution: Article 1: “The Objective of WHO shall be the attainment by all peoples of the highest possible level of health”; Article 2: “(a) to establish and maintain effective collaboration with governmental health administrations; (b) to assist Governments upon request, in strengthening health services; (c) to furnish appropriate technical assistance and, in emergencies, necessary aid upon the request or acceptance of Governments”; • Resolutions: Rational use WHA 60.16/2007; Essential Medicines for Children WHA 60.20/2007; Pricing: WHA 54.11/2001; Availability WHA 57.14/2004; AMR 2008; UHC; SSFFC; Palliative care;

3. Key principles for collaboration with countries • Focus on country and regional needs and priorities – ownership and country led planning & implementation • Technical collaboration with individual countries: -to build evidence for policies and for monitoring progress and impact; -to provide guidance/support on policies, advocacy and best practices; -to strengthen pharmaceutical systems & build capacity; -to facilitate multi-stakeholders collaboration; • Sustainability and continuity – consolidating and expanding to new priorities • High quality technical and strategic expertise – backing up from HQ and Regional Offices • Promoting regional and subregional collaboration: -sharing information, lessons learnt and expertise -Alignment of policies, regulations, methodologies and tools e.g.medicines lists & treatments guidelines

4. WHO global approaches in support to countries • Development of norms, standards, guidelines; (e.g. Expert Committees; Advisory Committees); • Development of methodologies and tools for collection, analysis and dissemination of reliable information in the pharmaceutical sector for global advocacy and monitoring and evaluation of country policies; • Maintenance of a pool of experts & Collaborating Centers for addressing advocacy, policy guidance and capacity building in countries; • Convening power for effective collaboration, coordination and policy dialogue among national and international stakeholders;

5. WHO Country Medicines Advisers and Collaborating Centres Medicines Adviser Collaborating Centre * Burundi * Cameroon * Congo * Democratic Rep. of the Congo * Ethiopia * Ghana * Guinea-Conakry * Kenya *Zimbabwe * Zambia * Togo * Tanzania *Senegal * Mozambique * Mali * Kenya Guinea-Conakry

6. The WHO Country Medicines Advisers Network for Africa • 50 Medicines Advisers in 40 countries (15 in Africa) contribute to: • Assessing national medicines needs & priorities; • Planning, Implementing, Monitoring and Evaluate WHO interventions; • Facilitating coordination of partners; • Contribute to WHO Regional work on medicines and health systems; UEMOA Burundi Cameroon Central African Rep. Congo Democratic Rep. of the Congo Ethiopia Ghana Kenya Mali Nigeria Rwanda Senegal Uganda United Rep. of Tanzania Zambia CEMAC EAC SADC

7. EMP partners at global, regional and country levelsCoordination mechanisms for a sustainable collaboration with countries WHO/HIS EMP Department IPC WHO: HIV, MAL, TB, RH, Collaborat.Centres UN: UNICEF, UNAIDS, UNFPA, WBank, GFATM, UNITAID NGOs: MSF, HAI, MSH, MDM, JSI, etc WHO Regional Offices WHO Country Offices Private sector: IGPA, IFPMA, FIP, etc. MoH Outside MOH: Drug regulatory agencies, national procurement centres, insurance, universities, missions, NGOs, consumers National programmes with improved access to quality medicines for patients

8. Highlights on major WHO Medicines Programmes in Countries • Country Support programmes for improved access to and use of medicines: • Support to individual countries upon demand (e.g. China; India; Viet Nam etc.); • Regional (multi-country) collaboration programmes: • EU/WHO/15 African Countries Renewed Partnership (RP); • Muskoka Initiative to improve access to and use of essential medicines for mothers and children in 7 African countries & contribute to achieving MGDs 4 and 5; • Support to Transparency and Good Governance in Pharmaceutical Sector: • Good Governance for Medicines Programme • Medicines Transparency Alliance initiative • Support to countries Regulatory Authorities and sub-regional Harmonization

9. The Renewed Partnership for improving access to quality essential medicines • Partenership between the EU, WHO and 15 Countries in Africa ( negotiated through the ACP Secretariat) • Overall Objective: Contribute to the achievement of health-related MDGs (4,5,6 and 8); Contribute to Universal Health Coverage; WHR 2010 & WHA 64.9 • Purpose: Improve availability, affordability and use of safe, effective and quality assured essential medicines in 15 countries in Africa • Second phase of the EC/ACP/WHO Partnership for Pharmaceutical Policies - 2004-2010 - (PPP) • Timelines: 1st October 2012 to 30 September 2016

10. Geographical scope • The RP will support active collaboration with 15 selected countries in Africa: Burundi, Cameroon, Congo, DRC, Ethiopia, Ghana, Guinea-Conakry, Kenya, Mali, Mozambique, Senegal, Tanzania, Togo, Zambia, Zimbabwe • The RP will support medicines policies work at regional level e.g. Regional Economic Communities (RECs) & institutions e.g. ACAME, for enhancing alignment of policies, regulations and practices • The RP will support regional centres of excellence to foster inter-country collaboration within the African region e.g. Dakar University • Promote inter-country collaboration (ACP) and sharing of information and expertise

11. Result Areas of the Renewed Partnership • Result Area 1: Improved availability and supply of essential medicines in national, regional and community health facilities in countries; • Result Area 2: Reduced medicines prices and improved mechanisms for financing and for coverage of essential medicines in social protection schemes; • Result Area 3: Improved quality and safety of medicines and reduced occurrence of substandard medicines and of medicines that pose health risks; • Result Area 4: Improved medicines selection, prescribing, dispensing and use; • Result Area 5: Improved access to reliable information of pharmaceutical sector of countries; review/develop evidence based national medicines policies and plans; enhanced transparency and good governance of the pharmaceutical sector.

12. Areas of collaboration in countries in Year 1

13. Promote coordination and synergies for increasing impact in countries • Support establishment of coordination mechanism on medicines work e.g. Mali, Burundi • Synergies with other UN programmes on MDGs 4,5 and 6 e.g. Muskoka initiative; UN Commission for Life Saving Commodities • With other initiatives for improving access to medicines e.g. Medicines Transparency Alliance (MeTA) and Southern Africa, QUAMED, Regional Programme on Access to Medicines (SARPAM). • Synergies with other programmes for strengthening health systems e.g. USAID/SIAPS; EU/WHO on Policy Dialogue; • With other key partners programmes e.g. TGF, RBM, etc.

14. Medicines supply systems in TANZANIA. 2007 United Republic of Tanzania ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINES CONDOMS CONTRACEPTIVES MEDICAL SUPPLIES GOVERNMENT BILATERAL DONOR MULTILATERAL DONOR NGO/PRIVATE C O L U M B I A UN I TA I D CL I NTON GLOBAL FUND C S S C W H O S I D A N O R A D C I D A H A V A R D P E P F A R A X I O S P F I Z E R J ICA C D C G A V I C U A M M U N I C E F U S A I D W B A B B O T T GOVERNMENT Source Of Funds Procurement Agent/Body C L I N T O N H A V A R D E G P A F A X I O S U N I C E F A B B O T T C U A M M C O L U M B I A U S A I D TEC & CCT MEDICAL STORE C R S S C M S MOH & SW J I C A G A V I CROWN AGENTS T M A P C D C Point of 1st warehousing TEC &CCT MEDICAL STORE HOSPITAL CRS IMA AXIOS COLUMBIA CUAMM HEALTH FACILITY HOSPITAL Point of 2nd warehousing TEC &CCT REGIONAL/DISTRICT VACCINE STORE HEALTH FACILITY ZONAL MEDICAL STORE HOSPITAL TEC &CCT Point of Distribution ZONAL BLOOD SAFETY CENTRE DISTRICT STORE HEALTH FACILITY PRIMARY HEALTH CARE FACILITY HOSPITAL PATIENT

15. 1st Year: Example of Country activities • Price and availability survey of a basket of essential medicines using the WHO/HAI methodology in Burundi • Assessment of the National Medicines Regulatory Authorities in Senegal and Ghana • Survey on prescribing, use and dispensing of medicines in Mali and Zimbabwe • National Drug Policy 2004 Assessment in Ghana including recommendations to be considered to develop a new policy • Revision of National Standard Treatment Guidelines in Cameroon • Training of staff working at peripheral and district level on drug management using the national guidelines in Senegal and Congo • Support of the development of a new regulatory framework for health products in Kenya as part of the decentralisation process

16. 1st Year: Regional Activities • Workshop organized on the evidence-based process to update National Essential Medicines List based in Ghana with 29 representatives from Ethiopia, Ghana, Kenya, Mozambique, Tanzania, Zambia, Zimbabwe • Workshop organized in South-Africa on Blood Regulatory Systems and how to build national capacity for improving access to blood products with 19 participants from 6 countries part of the RP: first meeting organized in Africa on this topic • Visits organized in the NQCL of Tanzania and Kenya for people in charge of the QC laboratory in Burundi to share experiences/practices to become a PQ laboratory