Transcript ภาพนิ่ง 1 - Medicines Transparency

Good Governance for
Medicines Programme: the
Thai Experience
Dr.Chanvit Tharathep.
Director of HSSD Bureau, Department of HSS
MOPH,Thailand
Medical Services in Thailand, in the year 2004
Hospitals
MoPH
Out Patient
Visits
Beds
Priority
Inpatient
Admission
Inpatient
days
Bed
occupancy
rate (%)
875
86,667
80,596,859
6,015,238
25,892,528
82
MoP
2
748
69,963
21,146
146,765
54
MoF
1
82
106,810
1,738
18,741
63
MoC
1
120
39,683
1,667
14,967
34
MoI
1
80
15,740
3,290
9,022
31
MoJ
2
550
112,100
5,655
85,233
42
MoE
15
8,556
7,532,728
335,118
2,672,621
86
MoD
63
6,987
3,884,789
181,592
1,508,211
59
Autonomous
7
737
459,393
25,661
124,285
46
Local Authority
13
2,375
2,322,571
109,233
599,207
69
Private
298
26,343
29,346,824
1,601,497
4,602,531
48
1,278
133,245
124,487,460
8,301,835
35,674,111
73
Total
Source: Bureau of Strategy and Policy, MoPH, Thailand 2006
Professional
Council
Office Of Permanent Secretary
Medical Service Cluster
MOPH
Office Of Minister
Drug Quality
Public Health Cluster
Pharmaceutical Procurement,
Department of Medicine
Department of Disease
Management control
Department of Mental
Health
Department of Health
Department of Thai
Traditional Development
and Alternative Medicine
Pharmaceutical
registration, Selection
Provincial Health Offices
Health Centers
National Health Security Committee
National Health Security Office
Health Service Support
Cluster
Department of Medical
Science
Department of Health
Service Support
FDA
Public Hospitals * Autonomous
Number of beneficiaries and percentage
of health care security by scheme in the year 2007
Benefit
Health Security
Package
Includes
Scheme
Pharmaceutical
products
UC
Number of
beneficiaries
Percentage of
coverage
46,636,899
73.49
9,060,033
14.28
CSMBS
5,119,535
8.07
Unidentified
groups
2,640,356
4.16
63,456,823
100
SSS
No Coverage,
Drug Store
Total
Source: IT Department, National Health Security Office, April, 2007
Existing GGM infrastructure: transparency and
accountability in Thailand
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National Drug Policy 1981, 1993
 Safety, Quality, Appropriate Price, Access
Essential Drugs list 1981-2008, Standard Price (2008)
Public Good Governance Law 2004
Drug management Reform 1997-2008 in MoPH hospitals
 Group purchasing of drugs and medical supplies.
 Limiting numbers of Drug items, emphasizing uses of drugs in
national essential drugs list.
 Control of Drug Inventory Level to be 3-month supply or less.
 Purchasing and Management performing under committee basis
(Pharmaceutical)
 Reporting system.
 Setting up MoPH Pharmacy Information Center.
Situation Analysis, Strategic Formulation, Transfer to
operation
Phase I: Transparency assessment
Area
Total Questions
(Sub-Questions)
Scale of 10
Degree
Registration
18 (45)
7.0
Selection
14 (29)
8.0
Procurement
22 (50)
7.1
Marginally
vulnerable
Marginally
vulnerable
Marginally
vulnerable
Rating Score
0.0-2.0
2.1-4.1
4.1-6.0
6.1-8.0
8.1-10.0
Extremely
vulnerable
Very
vulnerable
Moderately
vulnerable
Marginally
vulnerable
Minimally
vulnerable
Assess system vulnerability to unethical practices by external peers.
Phase I: Transparency assessment
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6 months interval, MoPH Inspection
FDA essential drug selection – accessible via internet
MoPH Hospitals purchasing report to the Public accessible Pharmacy
Information Center.
Hospital type
2004
2005
2006
Regional hospitals
General hospitals
21
62
24
70
25
69
Community hospitals
Total
569
659
667
765
645
742
Source: Pharmacy Information Center, MoPH, Thailand 2007
Phase II. Development of Thai GGM
Flamework and Strategic plan

Moral values and ethical principles
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A code of conduct : Civil Servant Act 1989
Socialization of an ethical framework and code of conduct : ***
Established anti-corruption legislation

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Self Sufficiency principle (King Bhumipol), Middle Path (Buddhist), Transparency
policy
Anti-corruption Act 1999, Public Good Governance Royal Decree 2004, National
Anti-corruption Organization
Established administrative procedures
MoPH Policy, Guidelines, Meeting, Conflict of interest form, Cirriculum
Mechanisms for whistle-blowing (ombudsman): Website, One Stop Service
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Sanctions on reprehensible acts
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Mechanisms for collaboration between existing anti-corruption agencies:
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National Anti-corruption organization, MoPH Disciplinary Office
Anti-corruption Act 1999, Public Good Governance Royal Decree 2004
Carbinet approved guideline and recommendation
Management, coordination and evaluation of an GGM framework
GGM Strategic Formulation
Develop Policy Guidelines
National Networking
Strengthen Information
Database
Dissemination of Ethical
Practice Information
Assessment
•Ethical Framework, legislation, Policy
•Practice Guidelines, Medicine Promotion Practice criteria
•Standard of Practice (SOP)
•Declare Consent form, Conflict of interest form
•FDA, DHSS, DMS, Universities, Professional Councils
•Hospital Pharmacy Association
•Community Pharmacy Association
•PREMA,
•Thai Pharmaceutical Manufacturer Association
•NGOs
•Selection, Registration
•Procurement
•Drug Price, Drug Promotion Practice
•Research, Study and cases
•Public accessible Pharmacy Information Center
•Meeting, News Letter
•Webpage of Good Governance
•Best Practice
•Interested Working Group
•KPI for Health Inspector
•Self Assessment, Assessment New tools
Phase III: Implementation Phase
Develop Policy Guidelines
National Networking
Strengthen Information
Database
Dissemination of Ethical
Practice Information
Assessment
•Ethical Framework, legislation, Policy
•Practice Guidelines, Medicine Promotion Practice criteria
•Standard of Practice (SOP)
•Declare Consent form, Conflict of interest form (ED, SP)
•FDA, DHSS, DMS, Universities, Professional Councils
•Hospital Pharmacy Association
•Community Pharmacy Association
•PReMA,
•Thai Pharmaceutical Manufacturer Association
•NGOs
•Selection, Registration
•Procurement
•Drug Price, Drug Promotion Practice
•Research, Study and cases
•Public accessible Pharmacy Information Center (English)
•Meeting
•Newsletter, Webpage of Good Governance
•Best Practice
•Interested Working Group
•KPI for Health Inspector
•Self Assessment, Assessment New tool
(Promotion Practice, Inspection, Distribution?)
Publications/medias provided (cont’d)

News Letter, Electronic data and information on CDs,
Website: http://dmsic.moph.go.th
Changes and Impacts
PHASE I
Assessment
2004-2005
Situation
Analysis
Existing GGM
Infrastructure
strengthening
GGM
Networking
PHASE II
GGM
Flamework
2005-2006
Thai GGM
Strategy
Available Practices,
Guidelines
Forms,
Procedures
PHASE III
GGM
Implementation
Increased
Awareness
Oct 2006-2008
More
Transparency
More
Transparency
By Information
Registration,
Selection,
Procurement
Improvement
Socialization,
Education.
More
Efficiency
Networking
Learning
Process
Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles
GGM Framework in Registration, Selection,
Procurement
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Registration : Conflict of interest form implementation,
Selection : Conflict of interest form, Guideline, Code of
Conduct, Transparency.
Procurement : Guideline, Code of Conduct, Manual,
Regulation, Transparency.
Socialization- Increase awareness, Introduction of the
GGM into Education.
More Transparent
Evidence of More Efficiency
Drug item
Pack unit
Average price
Regular
Separated
purchasing
Provincial
group
purchasing
500
107.86
74.69
57.38
Insulin Human Base vial 100
IU/ml (10 ml)
1
308.99
300.63
310.30
Medroxyprogesterone amp.
50 mg/ml (3 ml)
1
16.08
12.49
13.50
500
200.95
201.34
177.62
Salbutamol inhaler 100 mcg
(200 doses)
1
105.93
112.68
139.10
Salbutamol sol 0.5 % (20
ml)
1
91.87
102.44
85.60
Diclofenac tab 25 mg
Ranitidine tab 150 mg
Source: Pharmacy Information Center, MoPH, Thailand 2007
Regional
group
purchasing
What has worked and what should be redisign.
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Information System for Continuous Assessment and
evaluation would be helpful.
Good Governance can be achieved by committee basis for
decision making.
Conflict of Interest declaration can be implemented in the
Selection of EDL 2007-2008.
Selective Group Purchasing is a good tool to control drug
price.
Lessons learnt to date
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GGM Framework is the national level management. We should realize
that different country is different context..
Health care environment should be evaluated and priority setting
should be done at first step.
The strategy should be formulated to support and transfer into
operation.
Transparency is the most effective, efficient and feasible for the first
step of good governance implementation. We can achieve
transparency with the Pharmacy Information center.
Recommendations
First
Second
National GGM Framework development
Third
Health care environment Analysis
Target Priority Setting
Strategic formulation
Information
Networking
Socialization
Guideline
Fourth
Operation
Information System
Transparency
Intervention
Assessment
Conclusion
 Health Service System in Thailand and the MoPH structure.
 Transparency and increase accountability policy in Thailand
 The 3 phases of Good Governance for medicines programme
implementation in Thailand.
 Changes and Impacts.
 Lessons learn and recommendation.