Pharmaceutical Services Unit Essential Medicines Management Zambia: Towards Sustainable Access to Essential Medicines Presented by Chikuta Mbewe Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Outline: Objectives Introduction Why Worry about Medicines Public Health Objectives and the EMs Concept Defining & Improving Access to EMs Zambia Medicines Policy Goals and elements Challenges in Pharmaceutical Management Key Lessons for Zambia in P’ceutical Management Zambia’s position on TRIPS Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Objective: To describe current issues and opportunities in access to EMs Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Introduction Interest in human health is as old as humanity In developed countries modern pharmaceuticals has eliminated or radically reduced mortality from most infections, extended lives of millions In developing countries it is estimated that 60- 80% lack regular access to EMs Lack of access is directly proportional to income Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Why Worry so much about medicines Medicines save lives and improve health Medicines promote trust and participation in Health services Medicines cost money Medicines are different from other consumer products Substantive improvements in the supply and use of medicines are possible Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Public Health Objectives and the EMs Concept Public Health Programes are concerned with using available resources to achieve maximum health improvements In 1975 WHO defined EMs indispensable and necessary for the health needs of the population that need to be available all times in proper dosage forms Guiding principle is good selection (ZEML) and use (DTCs) Procurement and distribution economically and efficiently done with the few medicines Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Defining Access to EMs Isn’t access to health care including EMs a fundamental human right 4 dimensions of Access include availability (type and quantity needed Vs provided); -affordability (Pricing Vs ability to pay) -Accessibility (location of product Vs location of user -acceptability (satisfaction Vs expectations) Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Access to Medicines Policy Environment Zambia has a National Medicines Policy that was 1st promulgated in 1996 Zambia has a generic policy on procurement of EMs Has health related goals of increasing availability and accessibility to quality EMs Has economic goals that include lower cost of EMs, sustainable financing, job creation Has national development goals that include skills in pharmacy management Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Access to Medicines Policy Environment Selection Zambia has a NEML regularly updated Zambia National Formulary Committee is appointed body to oversee formulary activities Planning & Procurement Steady increase in the medicines budget Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Planning & Procurement National Essential Medicines Budget 2013 Budget Key Strengths 112% ↑ increase of drug budget from ZMK 270 Billion (2012) to ZMK 594 billion 248% ↑ for ARVs & 20% increase for EMs, TB, Laboratory, RHCs, vaccines, Cancer, Blood Products and 540% ↑ for medical supplies . ZMK 120 Billion for ACTs (latest budget-line for GRZ Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Distribution MoH strengthening equitable distribution systems for EMs through decentralization of MSL services 6 distribution hubs will be operationalization by end of 2015 Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Use has developed key essential medicines documents to improve use of medicines New editions (2013) available of ZNF, STGs, NEML, Guidelines of Medicines and Therapeutic Committees Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Regulation Reform of Pharmaceutical regulation completed in 2013 by repealing old Pharmaceutical Act and replacing it with the new Medicines & Allied Substances Act New act will increase access through regulated health shops to the Zambian Population Zambia very active on issues of regional harmonisation of pharmaceutical regulation Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management National Challenges in Pharmaceutical Management Financing and sustainability (Public Health diseases including HIV/AIDS, TB, Malaria medicines is a high cost treatment category) Improving efficiencies in public supply system (weak distribution systems) Changing behaviours of providers and patients (irrational use of medicines) Regulating quality Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Key Lessons for Zambia in P’ceutical Management National Medicine Policy provides a sound foundation for managing pharmaceutical supply Wise selection of EMs underpins all other improvements Effective management and good governance saves resources Rational medicines is a practice issue Systematic assessment & monitoring are very essential Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management TRIPS Vs Access in Zambia (Our Stand) Medicines are sacred commodities as they improve the quality of life and human development We have a right to better and dignified health We need PERMANENT exemptions from TRIPS Pharmaceutical Services Unit

Pharmaceutical Services Unit Essential Medicines Management Thank you for listening Pharmaceutical Services Unit