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Implementing National Drug Policies

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Develop and implement free access to good, unbiased drug and therapeutics ... Injection safety. What knowledge do we currently have about this topic? ... – PowerPoint PPT presentation

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Title: Implementing National Drug Policies


1
Implementing National Drug Policies
2
What have we learned about this topic based on
evidence?
  • NDPs are most successful when they include
  • Implementation plan that involves all
    stakeholders,
  • capacity development.
  • Evaluation and measurement as an integral part of
    the plan.
  • Keep telling the story to all

3
Recommendations
  • Develop measurement systems (indicators/outcomes)
  • Identify small, easy and potentially
    successful targets to address in early
    interventions
  • Talk to the Minister and the media, and the
    health professionals, and the consumer.
  • Plan budgets and strategies to convert projects
    to programs
  • Plan a long term strategy to reinforce and renew
    political and professional support -

4
Key NDP research questions
  • What are the best /possible and sustainable data
    systems for measuring and monitoring policies in
    different settings?
  • What are effective strategies for converting
    policy into effective programs?
  • Using the media in NDP implementation how, what
    for, what works (best), what doesnt work?
  • Research into behaviour and attitudes of doctors,
    health professionals and consumers?
  • What strategies are effective in sustaining
    capacity development?

5
Regulation on drug quality and use
6
What have we learned about this topic?
  • Regulation without enforcement does not assure
    quality
  • There is little evidence of the impact of global
    and regional initiatives and tools (e.g. use of
    WHO Certification Scheme, GMP, GPP guidelines) on
    country efforts to assure the quality of
    essential medicines.
  • Despite having UN list of banned substances, many
    of these products are in the market.

7
Recommendations
  • Regulatory bodies, procurement agencies, and
    other national stakeholders should critically
    assess the performance of current operational
    quality assurance strategies.
  • WHO and development assistance agencies should
    support country initiatives to assure the quality
    of medicines, including strengthening
    enforcement.
  • The UN list of banned and restricted substances
    should be acted upon in all member states
  • Banning should be accompanied by suggested
    alternative treatments, be publicized, monitored
    and drugs be recalled from the market.

8
Key regulatory research questions
  • How can different strategies contribute to assure
    quality, including combating counterfeit
    products?
  • Regional surveys of what, was done in the
    different countries to follow up decisions to
    include substances in the UN list of banned
    substances and if nothing was done, why not.
  • Qualitative research as to why regulations are
    not enforced.

9
Strategies for Improving Pharmaceutical Promotion
10
What knowledge do we currently have about this
topic?
  • Inappropriate promotion continues to be very
    widespread
  • Compliance to, and awareness of WHO EC is
    generally poor
  • Voluntary guidelines and Self-regulation are
    rarely effective on their own
  • Many regulations exist that are not effectively
    enforced

11
Recommendations
  • Develop networking opportunities for regions
  • Report your research and experiences to the
    WHO/HAI drug promotion database
  • Enforce existing regulations and publicize
    enforcement actions
  • Develop and implement training/awareness programs
    for professionals and consumers

12
Recommendations (Cont.)
  • Every country needs to develop an effective and
    realistic strategy for controlling drug promotion
  • Develop and implement free access to good,
    unbiased drug and therapeutics information, both
    for professionals and the public
  • Develop funding mechanisms to monitor/enforce,
    possibly including a levy on promotional spending
    by the pharmaceutical industry
  • Educating children about medicines, and awareness
    of pharmaceutical promotion

13
Key promotion research questions
  • What is the extent and impact of drug promotion
    and regulation in developing countries?
  • What new tools are needed for improved monitoring
    and evaluation?
  • What is the impact of Internet drug
    promotion/sales? How can they be controlled?
  • What effect does drug promotion have on
    childrens perceptions of medicine taking?

14
Injection safety
15
What knowledge do we currently have about this
topic?
  • Significant progress has occurred in this area.
  • Better communication between patients and
    providers can reduce injection overuse
  • Increased access to single use injection devices
    improves injection safety
  • Managerial approaches can improve injection
    practices

16
Recommendations
  • Combine interventions using various methods to
    improve effectiveness
  • Monitor injection use and injection safety using
    standardized indicators
  • Explore ways to test the Interactive Group
    Discussion approach in various other settings
  • Empower patients to express a preference for
    oral medications and demand single use injection
    equipment
  • Ensure injection device security

17
Key injection research questions
  • What financial incentives for prescribing
    injections can be identified to show how the
    problem could be addressed?
  • How can we study "positive deviants" who
    prescribe fewer injections?
  • Will the reduction of injection use in the
    formal, public sector drive patients to use the
    informal, private sector?

18
Role of DTC in Improving Use
19
What have we learned about this topic?
  • DTCs need nurturing, members must be motivated to
    work and often need skills training (See new
    manual and existing course)
  • DTCs are an essential link between the National
    Drug Policy and the periphery
  • Process variables can show progress before
    outcome or impact effects can be detected

20
Recommendations
  • Establish clear hierarchy of responsibility for
    DTCs in the country
  • Establish national/ regional centres to support
    DTCs
  • Give DTC members protected time for their work
  • Develop institutional support for DTC, including
    influencing clinicians locally relevant data,
    incentives for DTC members food, training

21
Recommendations (Cont.)
  • Introduce culture and practice of DTCs into
    undergraduate education for medicine pharmacy
  • Establish regular training for actual and
    potential DTC members
  • Employ and recognize clinical pharmacists and
    clinical pharmacologists in health service
  • Develop DTCs in private sector in combination
    with other clinical meetings?

22
Key DTC research questions
  • What are the characteristics of a successful DTC?
    Including structure, process outcome indicators
    for DTCs?
  • Can we evaluate the impact of DTCs on drug use
    costs saved from improved use of drugs?
  • What are the influences of procurement factors,
    consumer pressure, and industry pressure on
    decisions of DTCs?

23
Encouraging Prescribing of Generic Drugs in
Hospitals
24
What have we learned about this topic?
  • Generic prescribing and substitution may be
    influenced by financing mechanisms.
  • A multi-method intervention can increase generic
    prescribing and reduce costs for the targeted
    therapeutic products.
  • Generic prescribing and generic substitution
    (generic dispensing) reduce costs but may not
    improve prescribing.
  • Drug quality must be assured to promote generic
    prescribing/substitution.

25
Recommendations
  • Disseminate findings on impact of generic
    prescribing and generic substitution policies.
  • Create incentives through the financing
    mechanisms to enable generic prescribing and
    generic substitution.
  • Every hospital should design and implement
    comprehensive approaches that include appropriate
    formulary, generic prescribing and substitution
    policies.

26
Key generic prescribing research questions
  • What works to promote generic prescribing and
    generic substitution policies?
  • What are the effects on health outcomes of
    cost-containment interventions?
  • How can the impact of educational interventions
    for generic prescribing be sustained?

27
Procurement and Hospital Economics
  • (combined)

28
What knowledge do we currently have about these
topics?
  • Knowledge must be shared with all stakeholders
    health providers, politicians, warehouse workers.
  • All procurement interventions must be
    self-sustainable.
  • Training is not the only intervention to improve
    procurement systems
  • Simple economic indicators can be developed for
    each facility. Should be used for trend
    monitoring.
  • A matrix of ABC and VED (vital, essential, and
    desirable) can be an effective monitoring and
    management tool for each facility
  • Available information technology is fine for
    performing procurement management

29
Recommendations
  • Develop case studies of effective procurement
    management
  • Develop a good procurement manual, handbook, and
    training (such as how to use ABC/VED data)
  • Need a new periodicals for procurement and supply
    management of pharmaceuticals
  • Focus on training and staffing levels, for
    effective procurement management
  • Develop financial management indicators that
    relate to health outcomes.

30
Key procurement and economics research questions
  • After supervision, what are the best
    interventions to improve procurement?
  • What financial incentives improve procurement
    performance?
  • What is the goal of Quality Control in the
    procurement system?
  • How has decentralization and the HIV/AIDS and TB
    epidemics impacted drug supply management
    systems?
  • How can forecasting be improved?
  • How do we measure and value the rational use of
    drugs in hospitals?
  • What is the impact of stock outs on rational use?

31
Innovative Public Private Sector Strategies to
Improve Drug Use in Primary Care
32
What knowledge do we currently have about this
topic?
  • Private systems need to be competitive and
    profitable to be sustainable
  • Buy-in/consensus of stakeholders is critical to
    program development

33
Recommendations
  • Develop programs/interventions based on consensus
    building of stakeholders
  • Develop information systems to support decision
    making in private care initiatives
  • Explore IT/communications strategies to support
    pharmaceutical management and improved drug use
  • Increase focus on quality of care aspects of
    private sector initiatives

34
Key public-private innovation research questions
  • What can be done using incentives to improve the
    quality of care in the private sector?
  • How can the issue of commercial competition,
    which may decrease the quality of service, be
    addressed?

35
Microeconomic Issues in Drug use User fees and
Physician incentives
36
What have we learned about this topic
  • Dispensing doctors or prescribing dispensers
    perform less well
  • Self regulation does not work
  • Fee structure influences medicines use and
    prescribing, cost, quality of care, availability,
    and cost effectiveness
  • Regulations have been effective in reducing
    antibiotic use.

37
Recommendations
  • Need for agreed indicators to monitor and
    evaluate RDU, pharmacy practices and care to
    monitor the effect of for-profit dispensing and
    other financial incentives
  • WHO should develop guidelines and take a position
    on the issue of prescribing and dispensing (for
    profit) by the same person.

38
Key microeconomics research questions
  • What are the determinants of prescriber behavior?
  • What guides the patient in their choice of
    services?
  • How do pharmacy practice and quality of care for
    dispensers and prescribing dispensers differ and
    change among countries?
  • What interventions are effective to improve use
    through changing physician fees and financial
    incentives?

39
Community RDFs, Drug Franchises and RUD
40
What have we learned about this topic?
  • Alternative drug distribution channels have a
    role in improving access and RUD
  • To be viable these alternative channels need
    active effective supervision, good financial
    management, motivated staff, active DTC
    technical training
  • In some cases financial incentives may cause
    adverse effect on RUD

41
Recommendations
  • An informed community is essential which means
    that community education and involvement are
    mandatory
  • These systems should be part of the overall
    health system and not parallel or separate
  • Regulatory and policy framework should be
    balanced with reality
  • Private providers such as itinerant drug sellers
    may be brought into system

42
Key RDF research questions
  • Can the performance of itinerant drug sellers be
    improved?
  • How do the different drug distribution schemes
    affect equity?
  • How will improved access affect use of drugs?

43
International Pharmaceutical Pricing
44
What knowledge do we currently have about this
topic?
  • An area of considerable progress since ICIUM1
  • Prices vary greatly
  • Almost all developed countries have some form of
    price mechanism
  • WHO/HAI methodology is a major advance

45
Recommendations
  • All countries should do a WHO/HAI pricing survey
    though this methodology needs to be extended.
  • A drug pricing network--involve pricing
    directorates, health insurance groups,
    researchers and activists--should be established.
    Submit a grant proposal for a 2 day meeting of
    collaborators

46
Recommendations(cont.)
  • Survey public sector procurement systems to
    evaluate efficiency, cost, best practices.
  • All countries should develop price monitoring
    systems
  • In order to encourage the uptake of generic
    medicines, develop mechanisms for QC to provide
    confidence for all

47
Key pricing research questions
  • What pricing policies and mechanisms are used and
    what are their features?
  • Impact of pricing policies on use, health
    outcomes access by level and sector

48
Impacts of Insurance Coverage on Use and Cost
49
What have we learned about this topic?
  • Health insurance scheme can be established in
    resource-poor settings.
  • HIS can use leverage with various stakeholders to
    promote rational use of medicines-- through
    reimbursement policies tied into treatment
    guidelines, provider accreditation, contracts
    with pharmaceutical companies.
  • Claims data can help us understand medication
    use, cost, and outcomes
  • USE AVAILABLE DATA NOW.

50
Recommendations
  • Start implementing drug benefits in a systematic
    manner with continuous monitoring and evaluation.
  • Develop standardized coding IT system from the
    beginning.
  • Develop capacity to enable people to routinely
    use insurance data for monitoring, evaluation,
    evidence-based decision-making.
  • Develop network to share experiences
  • Develop manual and training modules on using
    claim data for monitoring drug use and cost.

51
Key insurance research questions
  • What are the requirements for establishing and
    sustaining a drug benefit program in a HIS?
  • What are the effects of providing drug benefits
    through a HIS on (a) equity (b) affordability
    and finances (c) quality and (d) health
    outcomes?
  • What indicators and data structures are needed
    to measure these effects?
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