Corruption, a major barrier to access to medicines WHO/UNICEF Technical Briefing Seminar
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Transcript of Corruption, a major barrier to access to medicines WHO/UNICEF Technical Briefing Seminar
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 1
Corruption, a major barrier to access to medicines
WHO/UNICEF Technical Briefing Seminar21 September 2006
Dr Guitelle BaghdadiWorld Health Organization, Geneva
Department of Medicines Policy and Standards
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 2
Corruption requires two parties: the corrupter and the corruptee
"Whose is the greater blame?
She who sins for pay or he who pays for sin?"
Sor Juana Inés de la Cruz
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 3
Overview
WHO Good Governance for Medicines project
A few questions…
Corruption in the pharmaceutical sector
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 4
Overview
WHO Good Governance for Medicines project
A few questions…
Corruption in the pharmaceutical sector
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 5
Corruption identified as the single greatest obstacle to economic and social development
US$ 3 trillion spent on health services annually
Pharmaceutical expenditure: 20 to 50% of total health expenditure (dev. countries)
10 to 25% procurement spending lost into corruption (including health sector)
Some countries report that 2/3 medicines supplies lost through corruption and fraud in hospitals
Affects also donor community: GFATM suspended or terminated grant agreement because of corruption concerns
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 6
Patent
R&D and clinical trials
Manufacturing
Pricing
Distribution
Registration
Selection
Procurement & import
Promotion
Inspection
Conflict of interest
Evergreening
Counterfeit/substandards
Tax evasion
Falsification of safety/Efficacy data
Bribery
State/regulatory capture
Overinvoicing
Pressure
Unethicalpromotion
Thefts
FraudCartels
Collusion
Unethicaldonations
Potential unethical practices could be found throughout medicines chain
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 7
Unethical practices can have significant impact on the health system
Economical impact Pharma. expenditure low-income
countries: 10-40% of public health budget 20-50% of total health care
expenditures Poor most affected inequalities
Health impact Lack EM increases morbidity & mortality Unsafe medicines on the market Irrational use of medicines
Image and trust impact Reduces government capacity Reduces credibility of health profession Erodes public trust
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 8
Efforts to address corruption need application of two basic strategies: "discipline" & "values"
"Discipline approach" (top-down)
Legislative reform: establishes laws against corruption with adequate punitive consequence for violating the laws
Attempts to prevent corrupt practices through fear of punishment
"Values approach" (bottom-up)
Promotes institutional integrity through promotion moral values and ethical principles
Attempts to motivate ethical conduct of public servant
Coordinated application of both strategies
required for significant impact
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 9
Overview
A few questions…
Corruption in the pharmaceutical sector
WHO Good Governance for Medicines project
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 10
Good governance for medicines regulation and procurement
Goal
Curb corruption in the pharmaceutical public sector through promotion of ethical practices in medicines regulation and procurement by health professionals and the application of transparent administrative procedures
Objectives
Increase awareness on potential for corruption and impact on health systems functioning
Increase transparency and accountability in medicines regulatory authorities and procurement systems
Build capacity for good governance
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 11
Implemented in countries with a 3-step approach
Phase I:
National assessment of transparency & vulnerability to corruption
Phase II:
Development of national ethical framework based on consensus building
Phase III:
Socializing the national ethical framework through reflection meetings and training national officials on good governance.
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 12
Phase 1 (3 countries)
Phase 2 (4 countries)
Bottom-up approach in implementation of project and policy development
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 13
Assessment tool: measures transparency in the public pharmaceutical sector & vulnerability to corruption: diagnostic tool recommendations
Evaluation indicators (questionnaires)
Collect information and perceptions (interviews)
Analyse information collected:
rough quantificationnarrative description
(report)
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 14
Phase II: development of national ethics infrastructure based on consensus building
1. Framework of moral values and ethical principles
2. Code of conduct (CC)
3. Mechanisms for whistle-blowing
4. Control of reprehensible acts
5. Coordination, management and evaluation programmes
6. Tools for promotion and socialization of framework & CC
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 15
Phase II: development of national ethics infrastructure based on consensus building
1. Framework of moral values and ethical principles
2. Code of conduct (CC)
3. Mechanisms for whistle-blowing
4. Control of reprehensible acts
5. Coordination, management and evaluation programmes
6. Tools for promotion and socialization of framework & CC
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 16
Focus on consolidating on-going efforts in countries and possibly add few new ones
Phase 1 (4 countries)
Phase 2 (4 countries)
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 17
Overview
WHO Good Governance for Medicines project
Corruption in the pharmaceutical sector
A few questions…
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 18
A few questions for reflection…
1. Do you believe that corruption exists in your country? Isolated cases or permissive culture?
2. What are the most common forms?
3. What are the possible causes?
4. What makes the pharmaceutical sector so vulnerable to corruption?
5. What do you think needs to be done to tackle corruption in the pharmaceutical sector on the long run?
Department of Medicines Policy and StandardsApril 2006 – Corruption, barrier to access to medicines 19
"Corruption is a powerful force, but it is not inevitable or unavoidable. Diminishing its
impact restores diverted resources to their intended purpose, bringing better
health, nutrition and education to victims of corruption around the world, and with
them, opportunity and hope."
Transparency International