Availability of Medicines

1. Availability of Medicines Anita Wagner Harvard Medical School & WHO Collaborating Center in Pharmaceutical Policy

2. Evidence on Medicines Availability *Cameron et al, Lancet, 2009 • 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

3. Key Observations Multi-pronged, multi-level, multi-stakeholder approaches essential to improving availability • 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

4. 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)

5. 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)

6. 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

7. Thank you Anita Wagner Email: awagner@hms.harvard.edu Skype: anita.wagner International MeTA Secretariat: admin@metasecretariat.org MeTA: www.MedicinesTransparency.or