WHO and the Global Fund harmonized tool for

Pharmaceutical Country Profiles

Richard Laing

& Enrico Cinnella,

November 2011

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ISSUESISSUES

Vast amount of information exists on the pharmaceutical sector of developing countries.

BUT this information is often not available to the public or even to the countries involved.

DUPLICATION of EFFORTS is common with multiple data collection initiatives in the same country.

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BACKGROUNDBACKGROUND

In 1999, 2003 and 2007 WHO undertook global surveys which were reported in following years

In 2009, developed country profiles for SADC

In 2010 developed pilot methodology with prefilling of data, manual and Glossary 12 countries completed

In 2011 began collecting country profiles from 192 countries

These country profiles will be incorporated into regional, global and technical profiles

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OBJECTIVEOBJECTIVE

WHO and the Global Fund decided to coordinate efforts and gather information in a harmonized and comprehensive way in order to profile countries’ systems and capacity related to the pharmaceutical sectors and make it publicly available and easy accessible.

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Global Fund GoalsGlobal Fund Goals

Move away from the existing project-based approach to a program-based approach,

Reduce the number of iterations associated with the Standard PSM Plan approval process,

Avoid the duplication of information provided to the Global Fund Minimize the Grant signing requirements of Principal Recipients

with respect to PHPM activities, and Work with Principal Recipients in prioritizing strengthening measures

thereby standardizing the Conditions included in Grant Agreements.

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WHO goals WHO goals

GOAL: Collect and disseminate reliable information on the pharmaceutical sector of 192 WHO member states.

DELIVERABLES:– Good quality information from 192 member states.– Pharmaceutical country profiles for 192 member states.– Regional and Global reports on the pharmaceutical situation.

CROSS CUTTING ISSUES:

- Ensure quality of information collected.

- Reduce burden of data collection on countries.

- Promote dissemination and visibility of information collected.

- Analyse situation and trend.

- Ensure ownership of data collected.

- Collaboration with the Global Fund

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Ensure quality of information collectedEnsure quality of information collectedEnsure quality of information collectedEnsure quality of information collected

A manual with instructions to fill in the questionnaire has been developed to guide data collection;

A glossary with definitions of key items has been produced by Harvard Collaborating Centre to make sure questions are interpreted consistently across countries and regions;

Names and contacts of respondents are collected;

Year and source of each piece of information is recorded and key documents are attached. Fields for comments are provided to allow respondents to provide more nuanced information;

Data is endorsed by an senior Official at the Ministry of Health.

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Promote dissemination and visibility of information collected

Promote dissemination and visibility of information collected

A Senior Official from the Ministry of Health will be asked to provide formal authorization to disseminate the data.

This will allow to make the data public shortly after collection. This will be done in a number of ways:

– Development of Individual Pharmaceutical Sector Country Profiles.– Display of information collected into key databases (e.g. WHO

Global Health Observatory).– Development of global and regional reports on the pharmaceutical

situation.

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CONTENT of the QUESTIONNAIRE (1)CONTENT of the QUESTIONNAIRE (1)CONTENT of the QUESTIONNAIRE (1)CONTENT of the QUESTIONNAIRE (1)

The questionnaire is divided into 9 chapters:– Health and Demographic data.– Health Services.– Policy Issues.– Medicines Trade and Production.– Medicines Regulation.– Medicines Financing.– Pharmaceutical Procurement and Distribution.– Selection and Rational Use.– Household data/access.

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CONTENT of the QUESTIONNAIRE (2)CONTENT of the QUESTIONNAIRE (2)CONTENT of the QUESTIONNAIRE (2)CONTENT of the QUESTIONNAIRE (2)

For each area of the pharmaceutical sector, the questionnaire will collect indicators on structures, processes and outcomes. These are put together to give a complete overview of the situation. For example, the questionnaire will collected data on whether there are Standard Treatment Guidelines, on whether these Guidelines are available at facility level and on whether treatment of key diseases at facility level follows national guidelines.

Data for outcome indicators come from surveys already collected at national level, usually with the support of WHO. These surveys include:

– Level II Facility and Household Surveys.

– Surveys of Medicines Prices and Availability.

– Rational Use studies conducted at country level.

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RESULTSRESULTS

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Public and private expenditure on Medicines

Public and private expenditure on Medicines

Composition of Pharmaceutical Expenditure

0%10%20%30%40%50%60%70%80%90%

100%

Low (n=4) Lower-middle(n=8)

Upper-middle(n=7)

High (n=4)

Income Level

Ph

arm

ac

eu

tic

al e

xp

en

dit

ure

(%

)

Public Pharmaceutical Expenditure Private Pharmaceutical Expenditure

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Government expenditure as % of govt budget in Africa

Government expenditure as % of govt budget in Africa

2.80%4.00%4.17%

4.75%5.13%5.20%5.27%

5.93%6.21%

6.50%6.95%7.10%

7.59%7.82%7.88%

8.27%8.86%8.89%8.95%9.07%9.25%

9.84%10.08%10.19%10.35%

10.54%10.65%

10.96%11.06%

11.54%11.60%11.65%

11.92%12.09%

12.55%13.21%

13.77%14.10%

14.73%14.76%

15.01%15.17%15.21%

16.22%16.83%

18.90%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

GuineaComoros

EritreaCôte d'Ivoire

CongoCameroonMauritania

Democratic Republic of the CongoAngolaNigeria

Equatorial GuineaKenyaGhana

Sierra LeoneLesotho

MauritiusSeychellesZimbabwe

TogoEthiopia

SwazilandCape Verde

AVERAGESouth Africa

UgandaBenin

AlgeriaCentral African Republic

NamibiaMali

GambiaBotswana

MalawiSenegal

MozambiqueSao Tome and Principe

ChadGabon

MadagascarNiger

BurundiZambia

Burkina FasoUnited Republic of Tanzania

LiberiaRwanda

Co

un

try

GGHE as a % of total government expenditure

Abuja Declaration, 15%

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Free medicines in Africa, 2003-2011Free medicines in Africa, 2003-2011

Types of free medicines

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All medicines Sexuallytransmittedinfectionsmedicines

Malariamedicines

HIV/AIDSrelated

medicines

Tuberculosismedicines

2003

2007

2011*

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TRIPS FlexibilitiesTRIPS Flexibilities

Implementation of Bolar Exception in National Legislation by Income Level

36.4% 37.5%

76.0%

51.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Low (n=22) Lower-middle (n=32) Upper-middle (n=35) High (n=25)

Income Level

Imp

lem

enta

tio

n (

%)

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Price LegislationPrice Legislation

Legal Provisions on the Pricing of Medicines by Income Level

12/29

24/42 25/41

32/38

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Low Lower-middle Upper-middle High

Income Level

Pre

sen

ce o

f le

gal

pro

vis

ion

s (

%)

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Monitoring of pricesMonitoring of prices

Medicines Price monitoring system

29.6%34.1%

46.3%

68.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Low Lower-middle Upper-middle High

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Duties on imported medicinesDuties on imported medicines

Duties on imported medicines

48.0%

53.7% 54.3%

18.2%

0%

10%

20%

30%

40%

50%

60%

Low Lower-middle Upper-middle High

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WAY FORWARDWAY FORWARD

In the course of 2011, WHO and GF have rolled out the project to 75 priority countries.

73 questionnaires have been returned and 18 profiles are available on the web.