WHO support to countries in the area of medicines

example of the African Region

WHO/EDM Drug Action Programme

Objectives of this session

 At the end participants will understand:  the WHO global strategy for working with countries  the EDM strategy for country support  how EDM work with countries is co-ordinated across WHO (country offices, regional offices, and headquarters)  the types of support to countries  how EDM works with other organisations to achieve common goal

Mission statement for country support

 Provide appropriate support to countries to build sustainable environment, capacity and develop relevant policies and programmes in order to ensure that quality, safe and effective essential medicines are available, affordable to the population and are used appropriately.

WHO Medicines Strategy 2004-2007 Objectives & Components

  Policy   Implementing & monitoring medicines policies TRM Access   Fair financing mechanisms & affordability of essential medicines Medicines supply systems

WHO Medicines Strategy 2004-2007 Cont'd

 Quality & Safety  Norms and standards for pharmaceuticals  Medicines regulation and quality assurance systems  Rational Use  Rational use by health professionals and consumers

Maximising Country Support

5 principles guiding WHO country support in medicines: 1.

Co-ordinated efforts within WHO 2.

Enhanced expertise in country offices.

3.

Demand-needs driven 4.

Evidence based planning and interventions 5.

Collaboration with partners

1-Co-ordinated efforts within WHO

Headquarters:  Strategy & policy making  Planning & monitoring  Specific technical & policy support  Strategy for development & training  Partnerships and collaboration Regional Office:  Oversee country operations  Planning and monitoring  Technical, policy and management support  Human resources development & training  Partnerships and collaborations Country Offices:  Assess needs and identify priorities for technical support  Plan & implement WHO work  Assist Coordination  Partnerships & collaborations  Feed back and report Ministries of Health:  Identify needs & priorities  Plan, implement and monitor action  Co-ordiate with bilateral and multilateral agencies and CSOs.

2-Enhanced expertise in country offices

There are 11 medicine advisors in Africa C a m e r r o o n C h a d E t t h i i o p i i a G h a n a K e n y a M a l l i i N i i g e r r i i a S e n e g a l l R w a n d a T a n z a n i i a U g a n d a Medicines Advisors to:  Assist in planning, implementation and monitoring of medicines policies  Assist in coordination of stakeholders involved in pharmaceuticals

3-Driven by country needs & priorities

Request from country Request from countries or regions   Type A: Situation analysis & monitoring a ssessment of pharmaceutical situation, identify priority needs - recommendations for interventions Type B: Specific technical support Ad hoc or regular support Usually focused on a subset of the following areas: policy; access; quality, safety & efficacy; and rational use    Type C: Comprehensive programme support Time frame may cover one or more biennia Usually involves a full time pharmaceutical adviser in the country Covers most or all of the following areas: policy; access; quality, safety & efficacy; and rational use   Type IC: Intercountry Ad hoc or regular support involving two or more countries often from the same region Usually focused on a subset of the following areas: policy; access; quality, safety & efficacy; and rational use

4-Evidence based planning and interventions

I nterventions should be implemented in coordination with partners, including bilateral and multilateral agencies, NGOs, and other stakeholders WHO has developed indicator-based tools to evaluate structures, processes, outcomes and several specific pharmaceutical components

1. Assess and Monitor 3. Implement 2. Plan

Based on assessing and monitoring the pharmaceutical situation, objectives can be established and targeted interventions planned

Rationale for seeking evidence

     Raise awareness about the realities (i.e. MOH, WHO) Provide “numbers for advocacy” to convince policy-makers Set priorities among possible areas for intervention Assess country medicines situation and trends over time Measures impact of interventions

Affordability of medicines

Affordability of Treatment of Pneumonia in 5 African Countries: Average Number of Day's Wage of Lowest Government Salary Needed to Pay for Treatment

12 10 8 6 4 2 0 10.5

5.8

1.1

1.3

1.3

1.6

1.5

0.4

1.4

1.5

1.4

3.3

0.7

Country 1 Country 2 Country 3 Country 4 Country 5 1.4

Public Health Facility Pharmacies Adults Private Pharmacies Public Health Facility Pharmacies Children Private Pharmacies

Interventions to improve affordability of medicines

 Affordability  Improve access to price information & monitoring of drug prices  Ensure inclusion of TRIPS safeguards in intellectual property legislation  Promote use of generic medicines of assured quality 1. Assess and Monitor 3. Implement 2. Plan

Ongoing Support Provided from last year

Policy Access Support Provided during the last year Train data collectors in 11 ocuntries for BLS; stakeholders workshop supported; NDPIP for Ethiopia, Mali, Senegal, Rwanda, Uganda & Nigeria 1.

2.

3.

4.

Planning & training workshops for pricing surveys in Tunis and Tanzania.

Pricing surveys underway in Cameroon, Chad, Mali, Tanzania & Uganda Training in medicines supply management (Ethiopia, Tanzania, Uganda & Nigeria) TRIPS sensitisation to Nigeria, Ghana & Uganda

Ongoing Support Provided from last year

Quality Assurance Rational Use of Medicines 1.

2.

3.

4.

1.

2.

3.

4.

5.

Drug registration in Ghana, Ethiopia, Nigeria, Tanzania, Mali &Kenya Quality analysis of TB medicines in Cameroon, Ghana,.

Procure monographs and reference standards in Cameroon and Tanzania Capacity building in quality analysis of ARV for Camroon, Nigeria.

Review of EML & STC in Chad, Ethiopia, Ghana, Kenya, Mali, Tanzania &Uganda (+ARV STG) Staff from Chad, Mali, Senegal & Rwanda to RUM in Kigali Training in Ougadougou in Nov 2004 to sent participants Support drug informations centres in Burkina Faso & Uganda Creation of DTC in Ethiopia, Kenya.

WHO policy and technical support on TRIPS to over 60 countries - health, trade and patent officials 

Meeting on TRIPS in OAPI countries (Yaounde, May 2002)



Meeting on the impact of globalization (Jakarta, May 2000)



Briefing on TRIPS (SADC), (South Africa, June 2000)



Workshop on TRIPS (Harare, August 2000)



Participants in both, South Africa and Harare meetings



Intercountry meeting on the TRIPS Agreement (Warsaw, September 2001)



Country support (15) (9) (7) (4) (11) (22) (9)

5. Collaboration with partners

HQ World Health Organization Regional Offices Country Offices Countries Ministries of Health WHO operational partners UNAIDS, bilateral and multilateral agencies, public interest NGOs in health, UNDP, UNFPA, UNCTAD Partners in Country Support WHO scientific partners WHO Collaborating Centres in pharmaceuticals, universities, research centres, international health professional associations WHO strategic partners World Bank and development banks, pharmaceutical industry, WTO, WIPO, EU

1.

2.

3.

4.

WHO/EDM-HAI Africa Regional collaboration for action on essential medicines in Africa

Increased access to essential medicines through improved policies and practices - joint priority areas of work: pricing and IPR issues Increased capacity and participation of NGOs and consumers in the development and implementation of medicines policy Expanded participation in and strengthened coordination of the HAI Africa Network Project countries: Uganda, Kenya and Ghana

Rationale for WHO-CSO collaboration in countries

       Synergy of expertise & know how Complementary mandates and approaches Enhance CSO participation in policy development & implementation Empower CSO and build capacity in the medicines field Increase impact on decision & policy makers Forge dialogue & links-changed NGO-MOH dynamics - helped close the “NGO credibility gap” Improve co-ordination and efficient use of resources

End…