1. Medicines Transparency Alliance01/10/2015 Availability of Medicines Anita Wagner Harvard Medical School & WHO Collaborating Center in Pharmaceutical Policy

2. Medicines Transparency Alliance Evidence on Medicines Availability MeTA facility surveys – Supply side assessment – Average public sector generic availability 30%-55%* – Generics in public facilities < generics in private facilities – Generics for chronic conditions < generics for acute conditions MeTA household surveys – Add demand side perspective – Consumer perceptions seem consistent with facility data Public facilities < private facilities Chronic disease medicines < acute condition medicines – Lack of public sector availability seems to impact adherence Differently for poor, near-poor, less poor *Cameron et al, Lancet, 2009 01/10/2015

3. Medicines Transparency Alliance Key Observations Appropriate, high-quality, affordable medicines must be available for health care to improve health Availability is complex, multi-factorial – International and national regulations – Manufacturing – Forecasting to match clinical need, guideline-based treatment, & drug lists – Procurement, distribution, warehousing logistics – Financing within systems, for patients – Incentives for manufacturer, purchasers, prescribers, dispensers – Education, training, awareness generation of all stakeholders (logistics, cost, appropriate prescribing, dispensing, use) Fragmented, decentralised health care systems challenge availability further 01/10/2015 Multi-pronged, multi-level, multi-stakeholder approaches essential to improving availability

4. Medicines Transparency Alliance Sample Interventions in MeTA Countries Regulation – Generic laws (Philippines) – Legislation for price reductions to increase availability for middle class (Philippines) – “New law on medicines” (Peru) Pooled procurement – Negotiating power of volume for price, quality, availability, geographic distribution (Jordan: Joint Procurement Department) – Centralised procurement with public tender and accountability for timely, decentralised distribution (Peru) – Procurement from pre-qualified suppliers (Zambia) Financing – Separate drug budgets in facilities (Ghana: NHIA reimbursement) – Basic outpatient drug package for chronic conditions & forecasting budget needs using claims data (Kyrgyzstan) Information generation & disclosure – Civil society & media engagement on stock-outs => Drug Monitoring Unit (Uganda) – Availability discussion in review of national medicines policy (Zambia) 01/10/2015

5. Medicines Transparency Alliance Sample Policy Suggestions Pharmaceutical management – Developing & implementing formulary process related to STG (Jordan) – National formulary system implementation (Philippines) Financing – Differentiate policy interventions targeting poor, near-poor Access to care & free, high quality, appropriate drugs needed for the poor – Incentivise manufacturing, procurement, availability, prescribing, dispensing of appropriate medicines (according to formularies) – Insure flow of funds (Ghana: NHIA reimbursement times) – Implement policies to incentivize appropriate use of generic first-line products with patient cost-sharing for non-poor where appropriate (Kyrgyzstan) Information generation and disclosure – Routine online data bases of price and availability (Peru, Uganda) – Creation of regional MeTA offices (Peru) – Continued consideration of availability (and other MeTA core principles) in Parliament (Zambia) 01/10/2015

6. Medicines Transparency Alliance Information Generation and Dissemination Publish processes and outcomes of MeTA pilot phase – WHO Essential Medicines Monitor: http://www.who.int/medicines/publications/monitor/en/index.html – WHO Medicines Documentation Centre: http://apps.who.int/medicinedocs/en/ – ICIUM2011: www.icium2011.org Build evaluation and routine monitoring of impacts into policy change – Data – Tools – Indicators – Evaluation design/methods – Analysis – Dissemination Share experiences and results globally 01/10/2015

7. Medicines Transparency Alliance Thank you Anita Wagner Email: awagner@hms.harvard.edu Skype: anita.wagner International MeTA Secretariat: admin@metasecretariat.org MeTA: www.MedicinesTransparency.or 01/10/2015