FINANCING ARV EXPERIENCE FROM MALAYSIA BY SHA’ARI NGADIMAN, MD, MPH, EIP, AM MINISTRY OF HEALTH...
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Transcript of FINANCING ARV EXPERIENCE FROM MALAYSIA BY SHA’ARI NGADIMAN, MD, MPH, EIP, AM MINISTRY OF HEALTH...
FINANCING ARV EXPERIENCE FROM
MALAYSIA
BY
SHA’ARI NGADIMAN, MD, MPH, EIP, AM
MINISTRY OF HEALTH MALAYSIA
Our Structure National Strategic Plan on HIV and
AIDS Activities Impacts of the activities AIDS Expenditure ARV & Logistic Cycle Conclusion
OUTLINE
OUR STRUCTURE
Deputy Minister of Health
State Health Office : 15District Health Office : 141Government Hospital : 138 Health Center : 985
Involve in process of financing, planning, procurement , distribution, monitoring etc
Director Of Disease Control
Dep. Director (Comm.
Diseases)
Sector HIV/STI
Sector VBDCP
Sector FWB&VPD
Sector Zoonotic
Sector TB/Leprosy
Dep. Director (NCD)
Dep. Director
(Surveillance)
Dep. Director
(Env. /Occp H)
OUR STRUCTURE
Director of Disease Control
Dep. Director (Comm. Disease)
Dep. Director (NCD)
Dep. Director
(Surveillance)
Dep. Director
(Env & Occp H)
Head Sector HIV/STI
SPAD Prevention
SPAD Treatment and
Care
SPAD Harm
Reduction
SPAD Monitoring
and Evaluation
SPAD Counselor
PAD Research
Head Sector VBDCP
Head Sector
Zoonotic
Head Sector
TB/Leprosy
Head Sector
FWD&WPD
SPAD State HIV/STI Officer
Target of NSP on AIDS 2011-15
80% MARPs reached prevention programmes
60% of MARPs use condoms consistently.
60% of IDUs use clean injecting equipment.
Able to eliminate vertical HIV transmission
80% ARV coverage for eligible PLHIV,
HIV NOTIFICATION IN MALAYSIA
Cumulatifve HIV = 98,279Cumulative deaths = 15,521PLHIV (end of 2012) = 82,758
NEW HIV CASE PER 100,000
YEAR
2008 2009 2010 2011 2012 2013 2014 2015
TARGET 16.0 15.3 14.6 13.9 13.2 12.5 11.7 11.0
ACHIEVED
13.3 10.8 12.8 12.2 11.7
CUMMULATIVE ON HAART AS 31 DEC 2012
15,028 on ARV in 2012
39,000 Adult Eligible for ARV in 2012 (EPP Model)
39,000 Adult Eligible for ARV in 2012 (EPP Model)
Expenditure 2008 – 2012
0
10000000
20000000
30000000
40000000
50000000
60000000
2008 2009 2010 2011 2012
Global FundDomestic
ARV : 2011 – USD 16.10 mil 2012 – USD 20.41 mil USD 16.76 1st Line ARV USD 3.65 2nd Line ARV
Exp
endi
ture
(U
SD
)
DOMESTIC FUND FOR HIV WORKS
38%
ARV in Malaysia
Eligible criteria Drugs listed in MOH Drug Formulary By specialist Available in hospitals and health centers
with specialist Also at hospitals or health centers
without specialist through follow-up by visiting specialist
Can be dispense through Integrated Dispensing Medicine System
ARV in Malaysia
PLHIV above 15 yrs 1st line – 91.7% 2nd line – 8.0% 3rd line – 0.3%
PLHIV below 15 yrs 1st line – 71.0% 2nd line – 27.0% 3rd line – 2.0%
FLOW OF MOH DRUG FORMULARY REVIEW PANEL
Director-General of Health (DG) - Chairman
Deputy DG of Medical Services
Director of Pharmaceutical Services
8 Consultants in Public Services
3 Pharmacists in Public Services
List of drugs can be used by ALL MOH institutions
Serves as guide for the selection of drug therapy
First published in October 1983 Review 2 – 3 times a year 1530 drugs are listed www.pharmacy.gov.my
Objectives
Provides the policy and administrative approach to :
• Control
• Promote
• Encourage rational, safe and cost effective drug prescribing and usage
MOH DRUG FORMULARY
PROCUREMENT PRINCIPLES
Public accountability - Procurement should obviously reflect public accountability entrusted with the Government
Transparency - All procurement regulations, conditions, procedures and processes need to be clear and transparent to facilitate better understanding among suppliers and contractors.
Best value for money - Government procurement should yield the best returns for every Malaysian Ringgit spent in terms of quality, quantity, timeliness, price and source.
Open and fair competition - Processes involving Government procurement should offer fair and equitable opportunities to all those participating or competing in any procurement.
Fair dealing - All acceptable bids will be processed fairly based on current rules, policies and procedures.
Policies on Drug Procurement
Local product (priority) Imported product : have to get approval
from Ministry of International Trade and Industry & Ministry of Finance
Value for money HOW?
Consession Company - Pharmaniaga Logistics Sdn Bhd (Approve Purchased Product List - APPL)
Central Contract (e-Tender/e-Bidding/Direct Negotiation)
Local Purchase by Quotation or Direct Purchase
41%
38%
21%Sales
APPL
Central Contract
Local Purchase
Drug Purchased in 2012
Importing Generic & Local Production
First Asian country issue Compulsory licensing in 2003
Local production of ARVs as part of our effort to confront the challenges of HIV/AIDS.
Currently, domestic pharmaceutical industry has capability to produce almost all dosage form and almost 80% of various categories in National Essential Drug List (NEDL) through the Malaysian Organization of Pharmaceutical Industries (MoPI).
Central Contract
Generic NameCategory
UnitProcurement Data (2012) Line of
TreatmentQuantity Value (USD)
1 Efavirenz 200 mg Capsule A* pack of 90's 2,388 196,389.12 First Line
2 Efavirenz 600 mg Tablet A/KK pack of 30's 89,837 5,559,544.78 First Line
3 Lamivudine 100 mg Tablet A* pack of 28's 30,478 2,000,819.74 First Line
4 Lamivudine 150 mg Tablet A/KK pack of 60's 23,077 1,152,003.84 First Line
5Stavudine 30 mg, Lamivudine 150 mg & Nevirapine 200 mg Tablet
A/KK pack of 60's 12,190 660,288.42 First Line
6Tenofovir Disoproxil Fumarate 300 mg & Emricitabine 200 mg Tablet
A* pack of 30's 20,936 1,071,923.20 First Line
7Tenofovir Disoproxil Fumarate 300 mg Tablet
A* pack of 30's 8,827 310,710.40 First Line
8Zidovudine 300 mg & Lamivudine 150 mg Tablet
A/KK Tab/Cap 4,532,491 4,400,642.77 First Line
9Indinavir Sulfate 400 mg Capsule
A* pack of 180's 1,591 214,848.64Second
Line
10Lopinavir 200 mg and Ritonavir 50 mg Tablet
A* pack of 120's 6,117 1,831,282.99Second
Line
11 Ritonavir 100 mg Capsule A* pack of 168's 1,320 225,984.00Second
Line
Total 17,624,437.90
Local Purchase No Generic Name Category Unit
Procurement Data (2012)Line of TreatmentQuantity Value (USD)
1 Stavudine 40mg (Tab/Cap) A* Tab/Cap 702 471.53 First Line
2 Nevirapine 200mg (Tab/Cap) A/KK Tab/Cap 1,828,241 439,737.40 First Line
3 Lamivudine 10mg/ml Oral Solution (Bottle) A* Bottle 4,334 321,993.28 First Line
4 Stavudine 30mg (Tab/Cap) A/KK Tab/Cap 897,181 226,621.91 First Line
5 Stavudine 1mg/ml Oral Solution (Bot) A* Bottle 33 323.39 First Line
6 Zidovudine 100mg (Tab/Cap) A/KK Tab/Cap 206,831 195,948.64 First Line
7 Zidovudine 10mg/ml Syrup (Bot) A* Bottle 4,933 88,070.40 First Line
8 Efavirenz 100mg (Tab/Cap) A* Tab/Cap 0 0.00 First Line
9 Efavirenz 50mg (Tab/Cap) A* Tab/Cap 54,333 15,209.83 First Line
10 Zidovudine 1 % Inj. (Vial) A Vial 947 44,480.21 First Line
11 Zidovudine 300mg (Tab/Cap) A* Tab/Cap 328,635 34,401.33 First Line
12 Didanosine 400mg (Tab/Cap) A* Tab/Cap 24,216 34,832.29 Second Line
13 Didanosine 100mg (Tab/Cap) A* Tab/Cap 69,851 33,137.58 Second Line
14 Didanosine 2g Oral Solution (Bot) A* Bottle 399 40,755.46 Second Line
15 Ritonavir 80mg/ml Oral Solution (Bot) A* Bottle 22 5,674.24 Second Line
16 Didanosine 25mg (Tab/Cap) A* Tab/Cap 54,041 207,517.44 Second Line
17 Didanosine 250mg (Tab/Cap) A* Tab/Cap 60,137 67,790.28 Second Line
18 Raltegravir 400mg (Tab/Cap) A* Tab/Cap 3,960 53,539.20 Second Line
19Lopinavir/ Ritonavir Oral solution 533/13.3mg -Kaletra® (Bottle)
A Bottle 2,455 712,478.75 Second Line
Total 2,522,983.16
Drugs of Special Approval
No Generic Name UnitProcurement Data (2012)
Line of TreatmentQuantity Value (USD)
1 Tenofovir DF 300 mg +Lamivudine 300mg Tab Tab 18,356 30,191.95 First Line
2 Nevirapine 50mg/5ml Oral suspension (Bot) Bottle 729 14,683.24 First Line
3 Lopinavir/ Ritonavir 100/25mg (Tab/Cap) Tab/Cap 77,842 143,620.74 Second Line
4 Abacavir 300mg (Tab/Cap) Tab/Cap 54,410 44,746.78 Second Line
5 Darunavir 300mg (Tab/Cap) Tab/Cap 3,840 16,896.00 Second Line
6
Abacavir 600mg + Lamivudine 300mg Tab (listed in MOH Drug Formulary in Nov. 2012)
Tab 7,050 12,994.56 Second Line
7 Abacavir 20 mg/ml (Bot) Bottle 18 1,301.18 Second Line
8 Atazanavir 300mg (Tab/Cap) Tab/Cap 450 974.88 Second Line
Total 265,409.34
18
Logistic Cycle of ARV’s Supply
Serving Clients
Selection of ARV
Forecasting &
Procurement
Inventory Managem
ent
LOGISTIC INFORMATION
MOH Drug Formulary Review
Physician
Ministry of Health (Pharmaceutical, Medical, Public Health)
Individual hospital, health center
Individual hospital, health center
Every level
• Central Contract• Local Purchase• Concession Company
LIST A* : Consultant/ Specialist for specific indications only
LIST A : Consultant/ Specialist LIST A/KK : Consultant/ Specialist/ Family Physician Specialist
LIST B : Medical Officer LIST C : Paramedics LIST C+ : Midwifery Paramedics
System for ARV procurement worked! Funded by Government (tax payers) Changing pattern of the epidemic Reaching 80% coverage for ARV Continue and enhance current funding
& activities New inovation? Review NSP 2011-15
CONCLUSION