WHO support to countries in the WHO support to countries in the area of medicinesarea of medicines

example of the African Regionexample of the African Region

WHO/EDM WHO/EDM Drug Action ProgrammeDrug Action Programme

Objectives of this sessionObjectives of this session

At the end participants will understand:At the end participants will understand:

the WHO global strategy for working with countriesthe WHO global strategy for working with countriesthe EDM strategy for country supportthe EDM strategy for country supporthow EDM work with countries is co-ordinated how EDM work with countries is co-ordinated

across WHO (country offices, regional offices, and across WHO (country offices, regional offices, and headquarters)headquarters)

the types of support to countries the types of support to countries how EDM works with other organisations to achieve how EDM works with other organisations to achieve

common goal common goal

Mission statement for country supportMission statement for country support

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

WHO Medicines Strategy 2004-2007WHO Medicines Strategy 2004-2007Objectives & ComponentsObjectives & Components

PolicyPolicy Implementing & monitoring medicines policiesImplementing & monitoring medicines policies TRMTRM

AccessAccess Fair financing mechanisms & affordability of Fair financing mechanisms & affordability of

essential medicinesessential medicines Medicines supply systemsMedicines supply systems

WHO Medicines Strategy 2004-2007 WHO Medicines Strategy 2004-2007 Cont'dCont'd

Quality & SafetyQuality & Safety Norms and standards for pharmaceuticalsNorms and standards for pharmaceuticals Medicines regulation and quality assurance Medicines regulation and quality assurance

systemssystems Rational UseRational Use

Rational use by health professionals and Rational use by health professionals and consumersconsumers

Maximising Country SupportMaximising Country Support5 principles guiding WHO country support in 5 principles guiding WHO country support in

medicines:medicines:

1.1. Co-ordinated efforts within WHOCo-ordinated efforts within WHO

2.2. Enhanced expertise in country offices.Enhanced expertise in country offices.

3.3. Demand-needs drivenDemand-needs driven

4.4. Evidence based planning and interventionsEvidence based planning and interventions

5.5. Collaboration with partnersCollaboration with partners

1-Co-ordinated efforts within WHO1-Co-ordinated efforts within WHO

Headquarters:Headquarters:

Strategy & policy Strategy & policy makingmaking

Planning & Planning & monitoringmonitoring

Specific technical Specific technical & policy support& policy support

Strategy for Strategy for development & development & trainingtraining

Partnerships and Partnerships and collaborationcollaboration

Regional Office:Regional Office:

Oversee country Oversee country operationsoperations

Planning and Planning and monitoringmonitoring

Technical, policy Technical, policy and management and management supportsupport

Human resources Human resources development & development & trainingtraining

Partnerships and Partnerships and collaborationscollaborations

Country Offices:Country Offices:

Assess needs Assess needs and identify and identify priorities for priorities for technical supporttechnical support

Plan & Plan & implement WHO implement WHO workwork

Assist Assist CoordinationCoordination

Partnerships & Partnerships & collaborationscollaborations

Feed back and Feed back and reportreport

Ministries of Ministries of Health:Health:

Identify needs Identify needs & priorities& priorities

Plan, Plan, implement and implement and monitor actionmonitor action

Co-ordiate Co-ordiate with bilateral with bilateral and and multilateral multilateral agencies and agencies and CSOs.CSOs.

2-Enhanced expertise in country offices2-Enhanced expertise in country offices

CCaammeerroooonn CChhaadd EEtthhiiooppiiaa GGhhaannaa KKeennyyaa MMaallii NNiiggeerriiaa SSeenneeggaall RRwwaannddaa TTaannzzaanniiaa UUggaannddaa

Medicines Advisors toMedicines Advisors to::Assist in planning, Assist in planning, implementation and implementation and monitoring of medicines monitoring of medicines policiespolicies

Assist in coordination of Assist in coordination of stakeholders involved in stakeholders involved in pharmaceuticals pharmaceuticals

There are 11 medicine advisors in AfricaThere are 11 medicine advisors in Africa

3-Driven by country needs & priorities3-Driven by country needs & priorities

Request from countryRequest from countryRequest from Request from

countries or regionscountries or regionsType A: Situation analysis & monitoringType A: Situation analysis & monitoring

assessment of pharmaceutical situation, identify ssessment of pharmaceutical situation, identify priority needs - recommendations for interventionspriority needs - recommendations for interventions

Type B: Specific Type B: Specific technicaltechnical supportsupport

Ad hoc or regular Ad hoc or regular support support

Usually focused on a Usually focused on a subset of the following subset of the following areas: policy; access; areas: policy; access; quality, safety & quality, safety & efficacy; andefficacy; and rational userational use

Type C: Comprehensive Type C: Comprehensive programme supportprogramme support

Time frame may cover Time frame may cover one or more bienniaone or more biennia

Usually involves a full-Usually involves a full-time pharmaceutical time pharmaceutical adviser in the country adviser in the country

Covers most or all of the Covers most or all of the following areas: policy; following areas: policy; access; quality, safety & access; quality, safety & efficacy; and rational useefficacy; and rational use

Type IC: IntercountryType IC: Intercountry Ad hoc or regular Ad hoc or regular

support support involving two involving two or more countries often or more countries often from the same region from the same region

Usually focused on a Usually focused on a subset of the following subset of the following areas: policy; access; areas: policy; access; quality, safety & quality, safety & efficacy; and rational efficacy; and rational useuse

4-Evidence based planning and 4-Evidence based planning and interventionsinterventions

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

Interventions nterventions should be should be implemented in implemented in coordination coordination with partners, with partners, including including bilateral and bilateral and multilateral multilateral agencies, NGOs, agencies, NGOs, and other and other stakeholdersstakeholders

WHO has developed indicator-based tools to WHO has developed indicator-based tools to evaluate structures, processes, outcomes evaluate structures, processes, outcomes and several specific pharmaceutical and several specific pharmaceutical componentscomponents

Rationale for seeking evidenceRationale for seeking evidence Raise awareness about the realities (i.e. MOH, Raise awareness about the realities (i.e. MOH,

WHO)WHO) Provide “numbers for advocacy” to convince Provide “numbers for advocacy” to convince

policy-makers policy-makers Set priorities among possible areas for Set priorities among possible areas for

interventionintervention Assess country medicines situation and trends Assess country medicines situation and trends

over timeover time Measures impact of interventionsMeasures impact of interventions

Affordability of medicinesAffordability 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

1.6 1.41.53.3

0.4 0.7

5.8

1.3 1.4

10.5

1.1 1.3 1.5 1.4

02468

1012

Public Health FacilityPharmacies

Adults

Private Pharmacies Public Health FacilityPharmacies

Children

Private Pharmacies

Country 1 Country 2 Country 3 Country 4 Country 5

AffordabilityAffordabilityImprove access to price Improve access to price

information & monitoring of information & monitoring of drug pricesdrug prices

Ensure inclusion of TRIPS Ensure inclusion of TRIPS safeguards in intellectual safeguards in intellectual property legislationproperty legislation

Promote use of generic Promote use of generic medicines of assured qualitymedicines of assured quality

Interventions to improve Interventions to improve affordability of medicinesaffordability of medicines

2. Plan2. Plan3. Implement3. Implement

1.1. AssessAssess andand MonitorMonitor

Ongoing Support Provided from last yearOngoing Support Provided from last year

Support Provided during the last yearSupport Provided during the last year

PolicyPolicy Train data collectors in 11 ocuntries for Train data collectors in 11 ocuntries for BLS; stakeholders workshop supported; BLS; stakeholders workshop supported; NDPIP for Ethiopia, Mali, Senegal, NDPIP for Ethiopia, Mali, Senegal, Rwanda, Uganda & NigeriaRwanda, Uganda & Nigeria

AccessAccess 1.1. Planning & training workshops for Planning & training workshops for pricing surveys in Tunis and pricing surveys in Tunis and Tanzania.Tanzania.

2.2. Pricing surveys underway in Pricing surveys underway in Cameroon, Chad, Mali, Tanzania & Cameroon, Chad, Mali, Tanzania & UgandaUganda

3.3. Training in medicines supply Training in medicines supply management (Ethiopia, Tanzania, management (Ethiopia, Tanzania, Uganda & Nigeria)Uganda & Nigeria)

4.4. TRIPS sensitisation to Nigeria, TRIPS sensitisation to Nigeria, Ghana & UgandaGhana & Uganda

Ongoing Support Provided from last yearOngoing Support Provided from last yearQuality AssuranceQuality Assurance 1.1. Drug registration in Ghana, Ethiopia, Drug registration in Ghana, Ethiopia,

Nigeria, Tanzania, Mali &KenyaNigeria, Tanzania, Mali &Kenya

2.2. Quality analysis of TB medicines in Quality analysis of TB medicines in Cameroon, Ghana,.Cameroon, Ghana,.

3.3. Procure monographs and reference Procure monographs and reference standards in Cameroon and Tanzaniastandards in Cameroon and Tanzania

4.4. Capacity building in quality analysis of Capacity building in quality analysis of ARV for Camroon, Nigeria.ARV for Camroon, Nigeria.

Rational Use of MedicinesRational Use of Medicines 1.1. Review of EML & STC in Chad, Ethiopia, Review of EML & STC in Chad, Ethiopia, Ghana, Kenya, Mali, Tanzania &Uganda Ghana, Kenya, Mali, Tanzania &Uganda (+ARV STG) (+ARV STG)

2.2. Staff from Chad, Mali, Senegal & Rwanda Staff from Chad, Mali, Senegal & Rwanda to RUM in Kigalito RUM in Kigali

3.3. Training in Ougadougou in Nov 2004 to Training in Ougadougou in Nov 2004 to sent participantssent participants

4.4. Support drug informations centres in Support drug informations centres in Burkina Faso & UgandaBurkina Faso & Uganda

5.5. Creation of DTC in Ethiopia, Kenya.Creation of DTC in Ethiopia, Kenya.

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

Meeting on TRIPS in OAPI countries (Yaounde, May 2002) (15)

Meeting on the impact of globalization (Jakarta, May 2000) (9)

Briefing on TRIPS (SADC), (South Africa, June 2000) (7)

Workshop on TRIPS (Harare, August 2000) (4)

Participants in both, South Africa and Harare meetings (11)

Intercountry meeting on the TRIPS Agreement (Warsaw, September 2001) (22)

Country support (9)

World Health OrganizationWorld Health OrganizationHQHQ Regional Offices Regional Offices Country OfficesCountry Offices

CountriesCountries Ministries of HealthMinistries of Health

Partners in Country SupportPartners in Country Support

WHO operational WHO operational partnerspartnersUNAIDS, bilateral UNAIDS, bilateral and multilateral and multilateral agencies, public agencies, public interest NGOs in interest NGOs in health, UNDP, health, UNDP, UNFPA, UNCTADUNFPA, UNCTAD

WHO scientific WHO scientific partnerspartnersWHO Collaborating WHO Collaborating Centres in Centres in pharmaceuticals, pharmaceuticals, universities, universities, research centres, research centres, international international health professional health professional associationsassociations

WHO strategic WHO strategic partnerspartnersWorld Bank and World Bank and development development banks, banks, pharmaceutical pharmaceutical industry, WTO, industry, WTO, WIPO, EUWIPO, EU

5. Collaboration with partners5. Collaboration with partners

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

medicines in Africamedicines in Africa1.1. Increased access to essential medicines through Increased access to essential medicines through

improved policies and practices - joint priority areas of improved policies and practices - joint priority areas of work: pricing and IPR issues work: pricing and IPR issues

2.2. Increased capacity and participation of NGOs and Increased capacity and participation of NGOs and consumers in the development and implementation of consumers in the development and implementation of medicines policymedicines policy

3.3. Expanded participation in and strengthened Expanded participation in and strengthened coordination of the HAI Africa Network coordination of the HAI Africa Network

4.4. Project countries: Uganda, Kenya and GhanaProject countries: Uganda, Kenya and Ghana

Rationale for WHO-CSO collaboration Rationale for WHO-CSO collaboration in countriesin countries

Synergy of expertise & know howSynergy of expertise & know how Complementary mandates and approaches Complementary mandates and approaches Enhance CSO participation in policy development & Enhance CSO participation in policy development &

implementationimplementation Empower CSO and build capacity in the medicines fieldEmpower CSO and build capacity in the medicines field Increase impact on decision & policy makersIncrease impact on decision & policy makers Forge dialogue & links-changed NGO-MOH dynamics - Forge dialogue & links-changed NGO-MOH dynamics -

helped close the “NGO credibility gap”helped close the “NGO credibility gap” Improve co-ordination and efficient use ofImprove co-ordination and efficient use of resources resources

End…End…