strategy for working with and in countries dr gilles forte essential medicines and health product...

Strategy for working with and in countries

Strategy for working with and in countries

Dr Gilles ForteEssential Medicines and

Health Product Department

Policy Access and Rational Use Team (PAU)

WHO-Technical Briefing Seminar | October-November 2012Gilles Forte

2 |

Mandate and ResolutionsMandate 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

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

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

WHO Country Medicines Advisers and Collaborating Centres

Collaborating CentreMedicines Adviser

* Burundi * Cameroon * Congo * Democratic Rep. of the Congo * Ethiopia * Ghana * Guinea-Conakry * Kenya

*Zimbabwe * Zambia * Togo * Tanzania *Senegal * Mozambique * Mali* KenyaGuinea-Conakry


6 |

The WHO Country Medicines Advisers Network for Africa

• 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;

50 Medicines Advisers in 40 countries (15 in Africa) contribute to:

BurundiCameroonCentral African Rep.CongoDemocratic Rep. of the CongoEthiopiaGhanaKenyaMaliNigeriaRwandaSenegalUgandaUnited Rep. of TanzaniaZambia

EAC

UEMOA

CEMAC

SADC


7 |

EMP partners at global, regional and country levelsCoordination mechanisms for a sustainable

collaboration with countries

EMP partners at global, regional and country levelsCoordination mechanisms for a sustainable

collaboration with countries

MoH Outside MOH: Drug regulatory agencies, national procurement centres, insurance, universities, missions, NGOs, consumers

WHO Regional Offices

WHO: HIV, MAL, TB, RH,Collaborat.Centres

UN:

UNICEF, UNAIDS, UNFPA, WBank, GFATM,UNITAID

WHO Country Offices

EMP Department

NGOs:

MSF, HAI, MSH, MDM, JSI, etc

National programmes with improved access to quality medicines for patients

IPC

WHO/HIS

Private sector: IGPA, IFPMA,

FIP, etc .


8 |

Highlights on major WHO Medicines Programmes in Countries

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:1. EU/WHO/15 African Countries Renewed Partnership (RP);2. 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

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


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Geographical scopeGeographical 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


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Result Areas of the Renewed PartnershipResult 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.


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Areas of collaboration in countries in Year 1 Areas of collaboration in countries in Year 1 Result areasNb countriesList of countries

1- Improved availability and supply of selected medicines

8Burundi, Congo, DRC, Kenya, Senegal, Tanzania, Togo, Zambia

2- Reduced medicines prices and improved mechanism for financing and coverage of essential medicines

3Burundi, Mali, Togo

3- Improved quality of medicines and reduced occurrence of substandard medicines

13Burundi, Cameroon, Congo, DRC, Ethiopia, Ghana, Guinea, Kenya, Mali,

Mozambique, Senegal, Tanzania, Zambia

4- Improved medicines selection, prescribing, dispensing and use

12Burundi, Cameroon, Congo, DRC, Ethiopia, Ghana, Guinea, Mali, Mozambique, Tanzania, Togo,

Zimbabwe

5- Improved access to reliable country information, NMP and plans, transparency and good governance

11Burundi, Cameroon, Congo, Ethiopia, Ghana, Guinea, Kenya, Mozambique,

Senegal, Zambia, Zimbabwe


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Promote coordination and synergies for increasing impact in countries

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.


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Source Of Funds

Procurement Agent/Body

Point of 1st warehousing

Point of 2nd warehousing

MEDICAL STORE

Medicines supply systems in TANZANIA. 2007

PRIMARY HEALTH CARE FACILITYDISTRICT STORE

ZONAL MEDICAL STORE

ESSENTIAL MEDICINES

ARVs MALARIA TB OIARVs Ped

REAGENT Blood safety

+(HIV test)VACCINES CONDOMS CONTRACEPTIVES

MEDICALSUPPLIES

REGIONAL/DISTRICT VACCINE STORE

HEALTH FACILITY

GOVERNMENT

MULTILATERAL DONOR

BILATERAL DONOR

NGO/PRIVATE

AXIOSTEC &CC

T

CRS IMA CUAMMHOSPITAL COLUMBIA HOSPITAL

TEC &CC

T

HEALTH FACILITY

HEALTH FACILITY HOSPITALTEC &CC

T

ZONAL BLOOD SAFETY CENTRE

Point of Distribution

GOVERNMENT

WBGLOBAL

FUND

SIDA

PEPFAR

USAID

UNICEF

WHO

ABBOTT

CSSC

COLUMBIA

PFIZER

JICA

CLINTON

UNITAID

CIDA

CDC

GAVI

CUAMM

HAVARD

NORAD

HOSPITAL

TEC&

CCT

CLINTON

HAVARD

MEDICALSTORE

CRS

SCMS

EGPAF

MOH &SW

AXIOS

UNICEF

JICA

CDC

COLUMBIA

ABBOTT

GAVI

CUAMM

CROWNAGENTS

USAID

TMAP

AXIOS

United Republic of Tanzania

PATIENT


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1st Year: Example of Country activities 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


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1st Year: Regional Activities1st 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

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