Perspectives on the Health Sector: challenges and opportunities José Gomes Temporão, MD, PhD...

Perspectives on the Health Sector: challenges

and opportunities

José Gomes Temporão, MD, PhD

Former Minister of Health (2007-2010)

South American Institute of Government in Health (Isags)

THE PRESENTATION

1-BACKGROUND

2- THE TRANSITIONS

3- HEALTH AND DEVELOPMENT

4-THE NEW SOUTH AMERICAN HEALTH CONTEXT

Brazil - Economic and Institutional Scenario

• Macroeconomic stability (inflation, fiscal and monetary policies, etc.)

• Institutional strength (democracy, state organization)

• Stable growth trajectory

GDP 2010 growth: 7,5 %

Long Term Perspective: sustainable growth

Perspective: 5th position in world Economy

Brazil: Social, Demographic and Health System Changes

• Substantive improvement in social inclusion and income distribution

Social assistance programs

Expansion of middle class

GINI index decrease: 9% from 1999 to 2009 (Ipeadata, 2010)

• Universal health system consolidation (Datasus, 2009)

The primary “ Family health care program”: universal access

Infant mortality rate: the biggest decrease in the last 10 years worldwide - 5,2%/year

Life expectancy improvement (from 67 years in 1990 to 73 years in 2009)

Fonte: IBGEElaboração: Ministério da Fazenda

5

The New Middle Class and Mass Market Distribution by social class % of population

The Brazilian Health Reform The Brazilian Health Reform

and The SUS – Unified and The SUS – Unified

Health SystemHealth System

1980’s: After dictatorship’s end a new 1980’s: After dictatorship’s end a new Democratic Constitution is proclaimedDemocratic Constitution is proclaimed

Private services for those who could afford

Social Security for sectors formally employed

Public health for endemics and epidemic hazards

Health as Universal Right Health as State duty Decentralized to states and municipalitiesPublic/Private mixSocial participation at all levels

National (Unified) Health System

Fragmented system

1988198019701960… 1990 2000 2010

Democratic Constitution

SUS – Unified Health SystemSUS – Unified Health SystemSUS IndicatorsSUS Indicators

– 75%75% of the Brazilian population of the Brazilian population

depend on SUSdepend on SUS

– 6,000 hospitals6,000 hospitals

– 64,000 primary care units64,000 primary care units

– 30,000 family health care teams30,000 family health care teams

– 2,3 billion ambulatory 2,3 billion ambulatory

appointmentsappointments

– 12 million hospital admissions 12 million hospital admissions

– 9 million chemo- and 9 million chemo- and

radiotherapy proceduresradiotherapy procedures

‗ 19 thousand transplants sponsored by SUS

– 1 million CT scans and 160,000 1 million CT scans and 160,000

Magnetic RessonanceMagnetic Ressonance

– 8 million hemodialyses 8 million hemodialyses

proceduresprocedures

SUS CharacteristicsSUS Characteristics

1.1. Universality:Universality: SUS, as the SUS, as the Brazilian public system, provides Brazilian public system, provides healthcare for all, regardless of healthcare for all, regardless of distinctions and restrictions;distinctions and restrictions;

2.2. Unity:Unity: one system composed of one system composed of decentralized unities managed by decentralized unities managed by different governmental levels different governmental levels (Federal, State and (Federal, State and Local/Municipal)Local/Municipal)

More than 75% of the Brazilian population depends exclusively on SUS (150 million people) for its health needs

The other 25% has private coverture but uses also the SUS (transplants, high cost drugs, emergency care, vaccines, Aids etc)

NATIONAL HEALTH SYSTEM (SUS)

Private System: Insurance Health Plans Revenue (Brazil, 2000 to 2009)

Note: revenue growth is also the result of improved collection of information by ANS, expressing only partly real growth.

Targeting equityBRAZIL: an unequal country that chose to build

a universal health system

2- THE TRANSITIONS

Epidemiological – reduction of infectious diseases and increase of cronic and cardiovascular diseases.

Demografic

Diet Transition

• Technological • (Cultural, organizational, economic)

The Transitions

Trends in deaths patterns according to causes, Brazil 1930-2007

Legenda(Óbitos/100000)

Schmidt MI, et al Lancet, 2011

Diabetes Mortality Rates 1996 - 2007


Demografic – Increasing elderly population

Diet Transition

• Technological

The Transitions

1750 205019501850 200019001800

BRASILFecundidade

MortalidadeEUROPA

Mortalidade

Fecundidade

100 ANOS 80 ANOS

30 ANOS 60 ANOS

Ramos, Veras e Kalache, 1987 RSP

Demographic Transition: a Secular Trend

2

6.2

31.8

13.9

1950

1975

2000

2025

‘BOOM’ OF ELDERLY

IN

BRASIL

Ramos, Veras e Kalache, 1987 RSP

( millions of inhabitants 60 +)



Diet Transition

overweight : de 12% (1975) para 43% (2008) obesity: de 3% (1975) para 13% (2008).

• Technological

The Transitions

0%

20%

40%

60%

80%

100%

Poorest 2nd 3rd 4th Richest

`Hei

gh

tD

efic

it(%

)

1974/5 1989 1996 2006/7

Poorest Richest

Countdown 2008 Equity Analysis Group, Lancet 2008

Height deficit in under 5 ys. according to family income, 1974/5-

2006/7

Poorest 3 42

47,252,1

14,411,4

0

10

20

30

40

50

60

70

80

OBESITY:

16 YEARS!

OBESITY +

OVERWEIGHT: 12 YEARS!%

27.1%

64.2%

NUPENS/USP

Obesity and overweight – How long will take to be at the same level as USA today?

VIGITEL (http://portal.saude.gov.br/) BRFSS para EUA

MEN



Diet Transition- overweight, obesity

Technological

The Transitions

3-Health and Development: General

Perspective From Brasil

Health and Development(The Duality of Health)

Health as a citizenship

condition and a

proeminent area of

development

The Duality of Health

Articulation of economic logic with health logic

• Development of production base combined with

health needs Health Sector In Brasil

• About 8% GDP

• 10% of qualified work of the country

• 12 million direct and indirect jobs

• Platform for new technological paradigms (fine

chemicals, biotechnology, eletronics,

nanotechnology, new materials, etc)

Perspective of demand explosion and a strong

pressure on the productive base: a challenge and an

opportunity

28

BRAZIL: Health Industrial Complex (HIC)

Chemical and Biotechnology industries

• Pharmaceuticals• APIs• Vaccines• Blood Products• Diagnostic Reagents

Mechanic, Electronic and Materials

Industries

Hospitals AmbulatoriesDiagnosis and Therapeutic

Services

Health Services

Industrial Sectors

• Mechanical equipments• Electronic equipments• Prothesis and orthosis• Materials

Source: Gadelha, 2003

STATE..

PROMOTION+REGULATION

Informações Selecionadas

Maior base industrial da América Latina

Mercado farmacêutico de US$ 20 billion (alta tx de crescimento)

Posição no ranking: entre os 9 maiores mercados mundiais

Estrutura internacionalizada, porém com um significativo fortalecimento do capital nacional com base nos genéricos

Elevado dinamismo nas vendas de medicamentos no período recente (todos segmentos)

Produção de vacinas com elevado dinamismo (PNI e produtores públicos): R$ 900 milhões

Estratégia nacional para Hemoderivados: Hemobrás

Produção de reagentes limitada e de baixo conteúdo tecnológico

Especialização em atividades de menor conteúdo tecnológico

Papel destacado do Estado nas compras de todos segmentos

Health within a Development Context: Panorama of the Pharmaceutical Productive Chain (1)

Indústria de Equipamentos e MateriaisInformações Selecionadas

Dinamismo do segmento no período recente

Mercado em torno de R$ 8 bilhões

Predomínio de empresas de pequeno e médio porte Estrutura empresarial fragmentada

Afastamento da fronteira tecnológica

Perda de competitividade nos segmentos mais dinâmicos

Papel destacado do Estado nas vendas do setor (50%)

Health within a Development Context: Panorama of the Pharmaceutical Productive Chain (3)

Market domain for the international leaders

Specialization of the local companies in activities of smaller technological content

Permanent commercial deficit even after the depreciation

Significant role of the government purchases (politics of blood and attendance in general)

Health within a Development Context: Panorama of the Pharmaceutical Productive

Chain (4)

Reagents for Diagnosis Industry – Selected Information

HIC 2009 – Evolution of Brazilian Health Trade Balance: General Overview

(values in US$ Billions, updated by USA Inflation)

HIC 2009 - Brazilian Health Trade Deficit by Sector

Health, Innovation and Development:

policy perspectives

Institutionalization of

an integrated policy

Productive Development Policy (PDP-2008)

Mobilization Programmes in Strategic Areas

Health Industrial Complex

Nuclear Energy

Information and CommunicationTechnologies

DefenseIndustrial Complex

Nanotechnology Biotechnology

Programmes to Strengthen Competitivity

AutomobileComplex

Capital Goods Textile Woods andFurniture

Hygiene,Perfumery

and CosmeticsCivil Construction Services Complex

BiodieselNaval Industry and

Cabotage

Leathers, Footwear and

ArtifactsAgro industry Plastics OTHEROTHER

Programmes to Consolidate and Expand Leadership

AeronauticsComplex

Mining SteelCellulose and

Paper

Petroleum, Natural Gas andPetro chemistry

MeatBio ethanol

PDP: The Context - Public PDP: The Context - Public PoliciesPolicies

Programme of Growth Acceleration (PAC): in expansion and oriented to overcoming structural bottlenecks

Plan of Science, Technology and Innovation: programmes oriented to the promotion of scientific and technological development and innovation in the country

Plan for the Development of Education: quality investments applied to overcoming the greatest restriction to long-term development – training of the Brazilian people

“Mais Saúde”*: directly responds to immediate needs and builds on future capacity in the field of public health in Brazil

Structural and convergent projects are currently under way in Brazil

*Plus Health

HIC: Actions and Measures (1)HIC: Actions and Measures (1)

Use of the state purchasing power

to stimulate domestic production

Revision of regulation for governmental purchases-Pre-qualification, competitive isonomy, taxes waving and orders ofstrategic products for health innovation

Financial supportfor increased

production capacity

New Profarma: Supporting Programmes for the Development of the Health Industrial Complex

- Objective: to increase the competitiveness of the HIC, by means of disseminating innovative activities and increasing the production of devices, materials, medicines and related products, contributing to the international insertion of national firms

- Resources: US$ 2 billion between 2008 and 2012

Governmental Purchases- US$ 7,5 billion/year between 2008 and 2011

Budgetary Resources of the Ministry of Health:- US$ 582 million between 2008 and 2011

ActionsActions MeasuresMeasures

HIC: Actions and Measures (2)HIC: Actions and Measures (2)

Expansion of available resources for R&D in strategic areas

Research and Technological Development in Health Priority and the Establishment of National Centres of Toxicology and Clinical and Pre-Clinical Research (at least two networks)- US$ 700 million between 2008 and 2013

New Profarma: Sub-Programme Innovation- Objective: to support projects of firms, the construction and consolidation of infrastructure for health innovation, as well as the internalization of competences and R&D&I activities in Brazil

ActionsActions MeasuresMeasures

FUNTEC – Technological Fund: Non-reimbursable resources

- Strategic Areas 2008: Health, Renewable energies and Environment

- Active Principles and Medicines for Neglected Diseases; drugs that use of the technique of recombining DNA; construction of infrastructure for health innovation that includes bioteries, pre-clinical and clinical research

HIC: Strategic Areas for R&D&IHIC: Strategic Areas for R&D&I

3 45 6

Production of devices and materials used in health

as a response to the National Health Policy

Reactives and Diagnostic Devices for Blood Control

based on Moderns Biotechnologies

Production of medicines and active principles for pharmochemicals

Productive and Scientific-Technological Challenges

1Domestic production of

hemoderivatives (factors 8 and 9, albumine

and globulines) 2 Development of Vaccines for the National Immunization

Programme

RegulatoryRegulatorylandmarklandmark

Production of Biotechnological

Products for Health

Health R&D – The MoH’s Role (2)

• Some relevant projects in course– National Network on Cell Therapy (RNTC).– National Network on Clinical Research (RNPC).– National Network on Health Technology

Assessment HTA (REBRATS).– National Cohort on Adult’s Health – CV diseases,

diabetes, mental conditions (ELSA).– National Cancer Research Network.– Research on Neglected Diseases (~ 460 projects on

Chagas Disease, Malaria, Leishmaniasis, Schistosomiasis, etc.) .

The Brazilian Policy for the Health Industrial Complex: recent trends

• Articulation between health, industrial and S&T policy

Intergovernmental Group involving 15 ministries and agenciesagencies

• Production Development Partnership

20 public-private partnership to produce strategic productsproducts

• Use of the public purchase power to stimulate innovation in health

• Regulatory System Evolution

Executive Group of the Health Industrial Complex - Executive Group of the Health Industrial Complex - GECIS GECIS

GECISGECIS

WG TributaryWG Tributary

exemptionexemption

WG TransversalWG Transversal

Actions Actions WG WG government government

purchasepurchase

WG WG Biopharmaceutical Biopharmaceutical

regulationregulation

Articulation Forum:

22 represents of the civil society, and from the entrepreneur sector.

Participants:

MS (coordinator), MCT, MDIC, MPOG, MF, MRE, Casa Civil, ANVISA, FIOCRUZ, FINEP, BNDES, INMETRO, INPI and ABDI.



Intergovernmental Group involving 15 ministries and agencies

Convergence of incentives (investment, market, innovation)


30 public-private partnership to produce strategic products



Arrange a good balance between health access and innovation

Public and Private Development PartnershipPublic and Private Development Partnership (PPDPs)(PPDPs)

NINE PARTNERSHIP AGREEMENTS WERE

ALREADY ESTABLISHED INVOLVING :

• 9 public companies;

• 20 private companies ;

• Local development and production of 28 active principles (API`s).

• The public purchases with these API’s currently reach around R$ 1,5 billion per year.

• After full implementation, these partnerships will be able to save an estimated amount of R$ 390 million per year.

PPP’s em Andamento



Intergovernmental Group involving 15 ministries and agencies

Convergence of incentives (investment, market, innovation)


20 public-private partnership to produce strategic products



Industrial Policy – MoH (2)

• Reforming the Health Regulatory Framework.– Building a special status for the health

government purchasings (“Buy Brazilian” Act for the health products).

– Improving the purchasing processes in the health public sector (quality guarantee).

– Improving the Sanitary Surveillance regulations, together with ANVISA

A New Agenda of Cooperation in The New National Context

• From simple trade and production relationship to:

Benefits in terms of universal access

Investment in higher technological products and process

Cooperative R&D in Brazil

Partnership with local private and public producers

Enhancement of trade balance results

Main innitiatives to expand rational access to medicines and vaccines in

Brazil.

1. Pharmaceutical Assistance Programs (strategic and high costs medicines)

2. Popular Pharmacies Program.

3. Generic Drugs Consumption Program.

4. The National Immunization Program.

Expenditure in Medicines – Ministry of Health Budget

(%)

Source: SCTIE/MS

Health and Development in BrazilPolitical Context

For the first time, Brasil has na

industrial policy in health, to

strengthen its pharmaceutical

industry, having production

capacity and reduce its

dependence on this area

Health as a Window of Opportunity

Dimension of the national market (SUS and Private Sector) and high demand

Existence in Brazil of a productive tradition (the most developed in Latin America)

Scientific structure and human resources A well structured sanitary regulatory system organized on

a national basis Macroeconomic stability (investment grade) Projected Industrial GDP growth (yearly): 5% (2008/11) Reduction of income inequalities (high market impact) Priority of Health Economic-Industrial Complex within

national policy

4- The Growing Importance of Health in the Globalization Context

• Health as a central issue in the international relations:

South-south cooperation• Latin America

• Portuguese-Speaking African Countries

• Haiti

• The Union of South American Nations (UNASUR)

Global Health: The South American Institute of Government in Health (Isags)

Governance for Health

•ISAGS is a public, intergovernmental

entity within the South American Health

Council of the Union of South American

Nations (UNASUR); with permanent

headquarters in Rio de Janeiro

Governance for Health

• Its activities will be closely articulated with the Ministries of

Health of UNASUR countries in:

• knowledge management and generating innovation in policy and

governance for health,

• offering the best available practices and evidence to guide health

management;

• developing leadership on systems, services, organizations and

programs on health-related areas,

• providing technical support to government institutions in the health

sector.

Networking

ISAGS will collaborate with other institutions of

national, regional and global scope.

South America Network of National Institutes of Health (RINS);

South America Network of National Public Health Schools

(REGS);

South America Network of Technical Health Schools (RETS);

South America Network of Workshops on International Relations

in Health (ORIS);

Latin-America Network of National Institutes of Cancer (RINC).

The Unasur Strategic Agenda

2010-2015 Health Quinquennial Plan

Health Surveillance and Response;

Universal Health Systems;

Universal Access to Drugs;

Health Promotion and Action on Social Determinants of

Health;

Human Resources for Health.

Cooperação Sul-Sul e CIS

• Saúde e Desenvolvimento• Cooperação não pode olhar apenas

para a oferta de insumos, tecnologias• Compreensão mais ampla do processo

de desenvolvimento das sociedades e como a saúde se insere nele

• Inclui a gestão de tecnologias, desenvolvimento e inovação, visando a redução da dependencia

59

OBRIGADO!

[email protected]

Perspectives on the Health Sector: challenges and opportunities José Gomes Temporão, MD, PhD...

Documents

Transcript of Perspectives on the Health Sector: challenges and opportunities José Gomes Temporão, MD, PhD...