Good Governance for Medicines Programme: the Thai Experience Dr.Chanvit Tharathep. Director of HSSD Bureau, Department of HSS MOPH,Thailand

HospitalsBeds Out Patient Visits Inpatient Admission Inpatient days Bed occupancy rate (%) MoPH87586,66780,596,8596,015,23825,892,52882 MoP274869,96321,146146,76554 MoF182106,8101,73818,74163 MoC112039,6831,66714,96734 MoI18015,7403,2909,02231 MoJ ,1005,65585,23342 MoE158,5567,532,728335,1182,672,62186 MoD636,9873,884,789181,5921,508,21159 Autonomous ,39325,661124,28546 Local Authority132,3752,322,571109,233599,20769 Private29826,34329,346,8241,601,4974,602,53148 Total1,278133,245124,487,4608,301,83535,674,11173 Medical Services in Thailand, in the year 2004 Source: Bureau of Strategy and Policy, MoPH, Thailand 2006 Priority

MOPHMOPH Office Of Permanent Secretary Department of Medical Science Department of Disease control Department of Medicine Department of Health Department of Mental Health Department of Thai Traditional Development and Alternative Medicine Department of Health Service Support FDAFDA Provincial Health Offices Health Centers Public Hospitals * Autonomous ProfessionalCouncil Office Of Minister National Health Security Committee Medical Service Cluster Public Health Cluster Health Service Support Cluster Cluster National Health Security Office Drug Quality Pharmaceutical registration, Selection Pharmaceutical Procurement, Management

Number of beneficiaries and percentage of health care security by scheme in the year 2007 Health Security Scheme Number of beneficiaries Percentage of coverage UC46,636, SSS9,060, CSMBS5,119, Unidentified groups 2,640, Total63,456, Source: IT Department, National Health Security Office, April, 2007 Benefit Package Includes Pharmaceutical products No Coverage, Drug Store

Existing GGM infrastructure: transparency and accountability in Thailand National Drug Policy 1981, 1993  Safety, Quality, Appropriate Price, Access Essential Drugs list , Standard Price (2008) Public Good Governance Law 2004 Drug management Reform 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

AreaTotal Questions (Sub-Questions) Scale of 10Degree Registration18 (45)7.0Marginally vulnerable Selection14 (29)8.0Marginally vulnerable Procurement22 (50)7.1Marginally vulnerable Extremely vulnerable Very vulnerable Moderately vulnerable Marginally vulnerable Minimally vulnerable Rating Score Phase I: Transparency assessment Assess system vulnerability to unethical practices by external peers.

Phase I: Transparency assessment 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 Regional hospitals General hospitals Community hospitals Total Source: Pharmacy Information Center, MoPH, Thailand 2007

Phase II. Development of Thai GGM Flamework and Strategic plan Moral values and ethical principles  Self Sufficiency principle (King Bhumipol), Middle Path (Buddhist), Transparency policy A code of conduct : Civil Servant Act 1989 Socialization of an ethical framework and code of conduct : *** Established anti-corruption legislation  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 Sanctions on reprehensible acts  National Anti-corruption organization, MoPH Disciplinary Office Mechanisms for collaboration between existing anti-corruption agencies:  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

Develop Policy Guidelines National Networking Strengthen Information Database Dissemination of Ethical Practice Information Assessment Phase III: Implementation Phase 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:

Changes and Impacts PHASE II PHASE I PHASE III Assessment GGM Flamework Situation Analysis Existing GGM Infrastructure strengthening GGM Networking Thai GGM Strategy Available Practices, Guidelines GGM Implementation Forms, Procedures More Transparency By Information Registration, Selection, Procurement Improvement Socialization, Education. Increased Awareness More Transparency More Efficiency Networking Learning Process Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles Oct

GGM Framework in Registration, Selection, Procurement 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 itemPack unit Average price Regular Separated purchasing Provincial group purchasing Regional group purchasing Diclofenac tab 25 mg Insulin Human Base vial 100 IU/ml (10 ml) Medroxyprogesterone amp. 50 mg/ml (3 ml) Ranitidine tab 150 mg Salbutamol inhaler 100 mcg (200 doses) Salbutamol sol 0.5 % (20 ml) Source: Pharmacy Information Center, MoPH, Thailand 2007

What has worked and what should be redisign.  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  Selective Group Purchasing is a good tool to control drug price.

Lessons learnt to date 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 National GGM Framework development Health care environment Analysis Target Priority Setting Strategic formulation Information SystemTransparency InformationNetworkingSocializationGuideline InterventionAssessment Operation FirstSecond Third Fourth

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.