Summary of key conference findings and recommendations Hans V. Hogerzeil, MD, PhD, FRCP Edin.
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Transcript of Summary of key conference findings and recommendations Hans V. Hogerzeil, MD, PhD, FRCP Edin.
Summary of key conference
findings and recommendations
Hans V. Hogerzeil, MD, PhD, FRCP Edin
Recurrent themes in the conference
We know so much more!
The place of RUM in the value chain
Prices, generics, NCDs
Adherence, soft values
The future of RUM
The Jewish Rabbi
“We have so much more data now!”
RUM indicator studies as baseline for advocacy, comparisons and progress (Kathy Holloway, Dennis Ross-Degnan)
Very detailed quantitative country reports, routine data Oman: AB from 60% (1995) to 15% (2010) (Batool Jaffar Suleiman) Kenya: comprehensive report (Regina Mbindyo)
WHO/HAI price and availability surveys (Marg Ewen) Introduction of ACTs as part of the AMfM (e.g. Tanzania)
IMS data (Peter Stevens) Market entry of generic medicines (USA, South Africa) Allows for truly evidence-based policy advice to MICs
ATM Index to measure commitment, transparency, business model and behaviour of large R&D companies
Funding for essential medicines over time: Ghana%
pu
bli
c ex
pen
dit
ure
on
m
edic
ines
100%
time
Colonial times
Early independence
Pooled funding, health insurance
Public funding"NHS" model
Donors
Funding for essential medicines over time%
pu
bli
c ex
pen
dit
ure
on
m
edic
ines
100%
time
Colonial times
Early independence
Public funding"NHS" model
Essential Medicinespolicies in public sector
Essential Medicinespolicies through reimbursement
Essential Medicinespolicies impossible
Pooled funding, health insurance
The next generation of essential medicines:
What do countries need in the next decade?
New Middle East: New medicine policies, good governance, human human rights, universal access, careful public expenditure
India: Advocacy, medicine policy, democracy, human rights, care for the poor, universal access, public funding
Africa: Democracy, transparency, carefully increasing public/pooled expenditure, quality assurance, social marketing in middle-income group
China: Quality assurance, cost-containment (rational use)
MICs: Expand health insurance, pricing policies, cost containment, generic policies, regulatory collaboration and harmonization
Latin America: Cost containment, generic policies, rational use, unethical promotion, selection of expensive EMs
OECD: WHO standards/review of new EMs for NTDs, regulatory collaboration
Most of the New Middle East is poor(no oil in Tunisia, Egypt, Yemen, Syria)
The future of essential medicines as a function of% public/pooled expenditure on medicines over time
% p
ub
lic/
po
ole
d e
xpen
dit
ure
on
m
edic
ines
100%-
time
India
Poor M.East
Africa
L.America
China
Thailand
USA/EC/Australia
MICs
Poor Asia
Pricing policies
Regulation, quality
Selection
PolicyAdvocacy
Social health insurance
Public / pooled funding
Social marketing
Rational use
Generic policies
Cost containment
Colonial times
Early independence
RUM in the value chain:
Medicine prices
Royalties are the LIC/MIC contribution to research costs (Suerie Moon)
Taxes can be OK, depending who pays, and for which medicines (David Henry)
The level of scheduling (OTC, Pharmacy only, Prescription only) has a large effect on price (4x) (Travor Mabugu)
Tiered prices are still higher than competitive generics (MSF)
There is no global standard for allowing differential prices to countries/patients (GDP, LICs, HDI, high-burden, poor patients)
“The real enemy of the generics are the doctors, not the patients” Dr Ahmed Al Saidi, Minister of Health, Oman
RUM in the value chain: generic policiesSwitching to generics saves 65% of the medicine budget of Chinese hospitals (Sun Jing)
52% of GPs in Malaysia think that generics are less regulated than branded products; 62% think that generic medicines have less efficacy (Mohamed Assali) with similar results from South Africa (Aarti Patel)
NCDs are the political argument for generic policies
“I wish I had AIDS”
Cambodian diabetes patient, quoted by Chean Men
The lack of treatment of NCDs / chronic conditionsMost treatments are cheap: <$1 per month, $12 per year
Same for depression/chronic psychosis: $4-6 per year (Robert Sebbag)
Difference in availability of 54% for acute medication vs 36% for chronic medication means: the system can do it (Richard Laing)
“Let’s not only look at technical solutions, but also improve the soft values” Birna Trap, Uganda
AdherenceCurrent drop-out rates are not to be trusted, as there is no standard! (John Chalker)
The new INRUD-IAA standard methodology to measure adherence per facility is an excellent tool for intervention. This is INRUD at its best! (all INRUD teams)
Cell-phone methodology is very promising
There have been many experiences and studies on adherence since last ICIUM– do we now know what to do for scaling up?
“Promoting RUM is support, not policing” (Batool Jaffar Suleiman)
“The right to health costs money”
Access to essential medicines as part of the right to healthIn Thailand access to essential medicines is not a charity, but a right (Suwit Wibulpolprasert)
In Pakistan women have less access to depression treatment (Anita Wagner). But what about women and girls in Yemen, Somalia, India and Afghanistan?
Arab Spring: Examples of good constitutional text are available. But be modest in your constitution (Vera Pepe, Jono Quick) and plan for an implementation programme and the necessary finances
Recommendation: Make a briefing paper for Arab spring countries, do advocacy NOW
“Many of today’s problems are based on yesterday’s solutions” Irene Akua Agyepong, Minister of Health, Ghana
Evidence-based interventions:
How to involve patients/community in developing clinical guidelines in MICs?
How to manage medicine reimbursement in MICs?
How to use reimbursement data to promote RUM?
How to achieve cost-efficiency and sustainability of cell phone programmes for adherence?
Descriptive studies for advocacy:
Disaggregated access statistics in selected countries
The economic cost and health impact of RUM inefficiency
“The future of RUM lies with the health insurance companies”
RUM is part of the value chain: you have to wait for the right moment and for the right incentives
If you want to fast-forward RUM: ▼ ▼
“The future of RUM lies with the health insurance companies”
RUM is part of the value chain: you have to wait for the right moment and for the right incentives
If you want to fast-forward RUM
Promote RUM as part of procurement costs; start with the GFATM, PEPFAR, PMI and UNITAID
Make a convincing case, based on economic benefits (for funders) and better health outcomes (for prescribers)
▼ ▼
“Public good or private gain”? Minister Bengzon, Philippines
Fight against the “normalization of corruption” (Richard Laing)
Advocate for the poor, against exploitation
MaimonidesJewish scholar (1135-1204)Rabbi, physician and philosopher in Morocco and Egypt
“Everyone must always regard himself as half innocent and half guilty. And he should regard the whole of mankind in the same way.
If he then commits one more sin, he weighs down the scale of guilt against himself and against the whole world. And he himself causes the destruction of all.
But if he fulfills one commandment, he turns the scale of merit in his favor and perhaps he saves the whole world. He by himself has the power to bring salvation to all men of the world. Everyone has this divine opportunity. The charity you do tomorrow may save the world.”
MaimonidesJewish scholar (1135-1204)Rabbi, physician and philosopher in Morocco and Egypt
www.who.int / medicines
Saving lives with the right (to) medicines