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CAPACITY DEVELOPMENT WORKSHOP ON HEALTH SYSTEM DVEVELOPMENT MAY 24, 2007 Alexandria GROUP I Facilitator: Dr. Zafar Mirza
Participants • Dr. Werner Buehler • Dr. Ehsanullah Tarin • Dr. Ali Garraoui • Dr. Nasreen Abdul Razzak • Dr. Amal Bassili • Dr. Joumana Hermez • Dr. Nasr El Tantawy • Dr. Ali Khader • Dr. Ahmed Latif • Dr. Balgacem Sabri • Dr. Sanaa Nafa • Dr. Khushhal Khan Zaman
I. Review of the existing situation • Governance and Leadership role of the MoH • Lacks strategic vision / planning capacities • Decision making based on a single study – insufficient evidence • Dominant private sector • Equity and Ethical issues • Lack of transparency and Accountability • A National Medicine Policy and a National Essential drug list is available, however, minimal regulation of medicines, medical devices and health technologies
Review ……Cond 2. Financing • Low middle income country • No social Health Insurance System • 50 % population buys medicines out of pocket • Willingness to double the budget for buying medicines and medical devices
Review…..Continued 3. Organization and Management • A Pharmacy Directorate at the MoH - Registration department - Federal Inspectorate - Procurement department - Traditional Medicine • Two linked organizations: - National Quality Control Lab. - National Pharmacy Council • However, Irrational use of drugs does not feature as a responsibility of any of the existing authorities • Procurement and distribution of medicines/ medical devices is not needs based • Adhoc usages / non utilization
Review ……Cond 4. Information Systems • No reliable information on the extent of Irrational use of medicines / medical devices • No supervisory and / or Monitoring and Evaluation systems in Place
II. Recommendations • Establishing a Regulatory authority -Formation of a Multi stakeholder Regulatory body (MoH, Clinicians, Hospital management, Pharmaceutical companies, Medical Schools, NGOs etc) to regulate irrational drug use in the public and private sectors • Comprehensive Strategic Plan: including ethical standards, treatment / prescription guidelines, training Manuals, Procurement policies, M and E • Awareness / Education - Political Awareness / Advocacy - Consumers education- Public Health campaign - Education of doctors / prescribers on rational use of drugs - Changes in medical curricula
Recommendations • Managerial and Financial: Needs based procurement and distribution of medicines and medical equipment Transparency in the Purchase of medicines and medical devices Strengthening the evidence base – improving information systems ( preparation of a database) Establishing Monitoring and Evaluation mechanisms- monitoring Indicators
Recommendations • Enforcing essential drugs list through enhanced supervision • Preventing use of Over the Counter drugs limiting availability of drugs without prescriptions • Establishing a mechanism of Prescription audits • Applying Quality Assurance techniques • Promoting use of generic medicines