USING WHO INDICATORS TO MONITOR THE IMPLEMENTATION OF NATIONAL DRUG POLICY Relationship between country characteristic and background, structure, process and outcome indicators Dripa Sjabana 1 & Sri Suryawati 2 1 Graduate Programme for Medicine Policy and Management 2 Centre for Clinical Pharmacology and Medicine Policy Studies Gadjah Mada University, Yogyakarta, Indonesia

Problem Statement: Many countries have used WHO indicators to evaluate the implementation of NDP, and data are available in WHO documents. It would be interesting to evaluate the currently available country data, and to see if there is a particular pattern of relationship among indicators’ values with the country characteristics. It is expected that the results will provide a rough guidance to country that already evaluated the NDP implementation in strategy to improve the country achievement. Objective: To evaluate country characteristics, to confirm the pattern of relationship between the NDP indicators’ values and the country characteristics, and to determine a rough guidance for identifying appropriate strategy. Design & Method: descriptive-analytical, retrospective data collection. Results of evaluation of 13 NDPs were analyzed. Country data were arrayed in background, structure, process, and outcome categories. Data analyzed using content analysis, literature confirmation, cluster analysis, and lambda correlation analysis. Results: Countries were classified into three characters representing their indicator values. The results showed that information and continuing education on drug use capacity was related (p<0.05) to the availabiliy of essential drug. Pricing policy implementation was influenced by drug sector status, public drug expenditure, total value of local production sold in the country and the number of pharmacist or pharmacist assistant. Conclusions: Country background, pharmaceutical capacity, NDP implementation and goal determine country character based on WHO indicators. Achievement of NDP goals were influenced by country character. The relationship pattern could be used as a rough guidance to identify the appropriate strategy to improve achievement. Funding Source: Faculty of Medicine, Airlangga University, Surabaya, Indonesia ABSTRACT

INTRODUCTION  Many countries have used WHO indicators to evaluate the implementation of NDP, and data are available in WHO documents.  It would be interesting to evaluate the currently available country data, and to see if there is a particular pattern of relationship among indicators’ values with the country characteristics.  It is expected that the results will provide a rough guidance to country that already evaluated the NDP implementation in strategy to improve the country achievement.

 To evaluate country characteristics,  To confirm the pattern of relationship between the NDP indicators’ values and the country characteristics,  To determine a rough guidance for identifying appropriate strategy. OBJECTIVE

DESIGN & METHODS  Descriptive-analytical with retrospective data collection.  Data presentation: Country data were arrayed in background, structure, process and outcome categories of NDP indicators.  Data analysis: Content analysis, literature confirmation, cluster analysis, and lambda correlation analysis.

DATA COLLECTION Chad Bulgaria ColombiaGuinea India (Andhra Pradesh) IndonesiaMali Philippines Sri Lanka Thailand Viet NamZambiaZimbabwe Published data. WHO Action Programme on Essential Drugs (1997), Comparative analysis of NDP in 12 countries,Geneva:WHO. WHO Collaboration Centre for Research and Training on Rational Drug Use (1998), Evaluation The Implementation of Indonesian NDP 1997, Yogyakarta:Gadjah Mada University.

RESULTS (1) Key Component in The Guidance 2 Key Component in Indicators 3 Indicator s Selection of essential drugs ST12-18, PR8-13 Affordability OT3-4 Drug financingDrug sector: economical data; drug allocation in the health budget BG17-22; ST19-23, PR19-26 Supply systemsPublic sector procurement procedures, distribution and logistic, pricing policy ST24-30, PR19-32 Regulation & quality assurance Legislation & regulationST1-11, PR1-7 Rational useinformation & continuing education on drug use ST42-50, PR33-38 Human resourcesHuman resources, information & continuing education on drug use BG23-24; ST42-50, PR33-38 Appropriate indicators for key component of NDP according to WHO guidance 1 1 Result of content analysis; 2 How to develop & implement NDP, WHO, 2001; 3 Indicator for monitoring NDP, WHO, 1999.

RESULTS (2) *based on political implementation through “legislation & regulation” and “drug allocation in the health budget”. **tentative classification caused by incomplete data. Accomplishment of NDP objective Higher : Colombia, Indonesia, Philippines, Zimbabwe; Bulgaria, Sri Lanka** Middle: G uinea, Viet Nam Lower: Chad, India (Andhra Pradesh); Mali, Thailand, Zambia* Objective of NDP Availability of essential drugs Affordability of essential drugs Quality of drugs Rational use of drugs Implementation of NDP* Higher: Bulgaria, Philippines, Sri Lanka, Thailand Middle: Chad, Colombia, Viet Nam, Zimbabwe Lower: Guinea, Mali, India (Andhra Pradesh), Indonesia NDP key components Legislation & regulation Essential drug selection & drug registration Drug allocation in the health budget Public sector procurement procedures Public sector distribution & logistics Pricing policy Information & continuing education on drug use Support to NDP Higher: Colombia, Thailand, Indonesia Middle: Bulgaria, Philippines, Sri Lanka, Zambia Lower: Chad, Guinea, India (Andhra Pradesh), Mali, Viet Nam, Zimbabwe Background of NDP Country Info Health Info Drug Economic & Human Resource Drug Sector Organization & Load Country character based on indicator values

RESULTS (3) Relation-pattern of indicator categories Background Country Information Average annual growth of population, GNP per capita, Average annual rate of inflation Process Implementation of “Information & Continuing Education on Drug Use” Outco me Availabili ty of Essentia l Drugs Structure Capacity of “Information & Continuing Education on Drug Use” Outco me Affordab ility of Essentia l Drugs Background Economic Data & Human Resource Total public drug expenditure, total value of local production sold in the country, total number of pharmacy assistants & pharmacist Process Implementati on of “Pricing Policy” Structure Capacity of “Pricing Policy” p<0.05, lambda correlation

DISCUSSION (1) 1 Wold Bank classification; 2 CIA World Factbook 2000 data. Country character Country income classificati on 1 Suppor t to NDP Countrie s Implementation of “information & continuing education on drug use” strategy Literac y rate 2 LowLower Zimbabw e Lower85.0% LowLowerZambia 78.2% LowLowerIndia 52.0% LowLowerChad 48.1% LowLowerGuinea 35.9% LowLowerMali 31.0% confirmed CHARACTERIZATION APPROPRIATE

RELATIONSHIP PATTERN DISCUSSION (2) Process Implementation of “Information & Continuing Education on Drug Use” Process Implementati on of “Pricing Policy” Background Country Information Economic Data & Human Resource Outcome Availability Affordability Quality of drugs Rational Use of Drugs Relation of country characters based on indicator values p<0.05, Lambda correlation Rough guidance : 1.To improve specific outcome, prioritize related strategy implementation and supporting background. 2.To evaluate of NDP implementation, compare with the achievement of other country that have similar characters.

CONCLUSIONS  Country background, pharmaceutical capacity, NDP implementation and goal determine country character.  Accomplishment of NDP goals were influenced by country character in term of country background, pharmaceutical system capacity and implementation.

RECOMMENDATIONS  Government is recommended to include “information and continuing education on drug use” policy as a one of the priorities strategies to improve access on drugs.  For maximum implementation of “pricing policy”, government should meet economical status, human resources, and capacity of pricing policy itself.  Need further study with more country data to confirm more relationship pattern.

Correspondence Dripa Sjabana, dr., M.Kes. Department of Pharmacology Faculty of Medicine Airlangga University Jalan Moestopo 47 Surabaya, Indonesia