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

WHO Medicines Strategy 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 WHO HQROs HTP clusters EDM DAP QSMPAR TRM WRs Countries collaborations with other parties supporting countries departments AFRO AMRO EMRO AFRO EURO SEARO WPRO WHO natural operational partners WHO scientific partners WHO strategic partners UNAIDS UNDP Universities, researchcentres World Bank and other World Bank and other development banks UNCTAD WHO collaborating centres in pharmaceuticals Pharmaceutical industry European union International health professional associations UNICEF UNFPA Consumer associations WTO WIPO Bilateral co-operation EDM Advisors NGOs (public interest) working in health

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 Medicines Advisors to:  Assist in planning, implementation and monitoring of medicines policies  Assist in coordination of stakeholders involved in pharmaceuticals There are 11 medicine advisors in Africa

3-Driven by country needs & priorities Request from country Request from countries or regions Type A: Situation analysis & monitoring ssessment of pharmaceutical situation, identify priority needs - recommendations for interventions 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 Based on assessing and monitoring the pharmaceutical situation, objectives can be established and targeted interventions planned nterventions should be implemented in coordination with partners, including bilateral and multilateral agencies, NGOs, and other stakeholders 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

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  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 Interventions to improve affordability of medicines 2. Plan 3. Implement 1. Assess and Monitor

Ongoing Support Provided from last year Support Provided during the last year Policy Train data collectors in 11 ocuntries for BLS; stakeholders workshop supported; NDPIP for Ethiopia, Mali, Senegal, Rwanda, Uganda & Nigeria Access 1.Planning & training workshops for pricing surveys in Tunis and Tanzania. 2.Pricing surveys underway in Cameroon, Chad, Mali, Tanzania & Uganda 3.Training in medicines supply management (Ethiopia, Tanzania, Uganda & Nigeria) 4.TRIPS sensitisation to Nigeria, Ghana & Uganda

Ongoing Support Provided from last year Quality Assurance 1.Drug registration in Ghana, Ethiopia, Nigeria, Tanzania, Mali &Kenya 2.Quality analysis of TB medicines in Cameroon, Ghana,. 3.Procure monographs and reference standards in Cameroon and Tanzania 4.Capacity building in quality analysis of ARV for Camroon, Nigeria. Rational Use of Medicines 1.Review of EML & STC in Chad, Ethiopia, Ghana, Kenya, Mali, Tanzania &Uganda (+ARV STG) 2.Staff from Chad, Mali, Senegal & Rwanda to RUM in Kigali 3.Training in Ougadougou in Nov 2004 to sent participants 4.Support drug informations centres in Burkina Faso & Uganda 5.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)(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 Organization HQ Regional Offices Country Offices Countries Ministries of Health Ministries of Health Partners in Country Support WHO operational partners UNAIDS, bilateral and multilateral agencies, public interest NGOs in health, UNDP, UNFPA, UNCTAD 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 5. Collaboration with partners

WHO/EDM-HAI Africa Regional collaboration for action on essential medicines in Africa 1.Increased access to essential medicines through improved policies and practices - joint priority areas of work: pricing and IPR issues 2.Increased capacity and participation of NGOs and consumers in the development and implementation of medicines policy 3.Expanded participation in and strengthened coordination of the HAI Africa Network 4.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

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