1. BASELINE SURVEYS AND MONITORING OF PHARMACEUTICAL SITUATION IN COUNTRIES. Joseph Serutoke NPO/EDM WHO Uganda November 2002

2. 2 Rationale for assessing,monitoring and evaluating the pharmaceutical situation in countries: To get information and measure: n the access to essential medicines for the population n the safety, efficacy and quality of medicines n the appropriateness of medicines use “If you don’t keep score … in a football or tennis match … you are only practising” – Jan Leschely.

3. 3 Assessment and monitoring: a tool n Countries: policy makers and managers n to assess performance of the sector (strong and weak points) n to assess capacity (structures, strategies and resources) n to set objectives and targets and decide about interventions n to synchronize health and other policies, e.g. trade; economical Does not tell the whole story; assist to a limited extent in understanding why a policy or strategy is successful or not.

4. 4 Assessment and monitoring: a tool n International Agencies / NGOs: n to assess performance and structure of the sector for developing new projects n to assess progress of projects n to assess impact of aid and assistance to policies

5. 5 Why is it important to use indicators? n Indicators allow a standardized measurement: n to compare situations within and between countries n to measure trends over time

6. 6 Indicator-based monitoring: Challenges n Selection of indicators adapted to a country context n Establish a sustainable system (assess & monitor): n systematic process that can be repeated over time n make resources available n institute a monitoring culture

7. 7 Core indicators: rationale n To obtain most relevant information from simple survey n 3 levels of indicators to be more specific and flexible n Rapid assessments with small samples and simple survey techniques n Measure of key information to provide a comprehensive picture n Enable systematic and standardised measurement methods n Allow regular, sustainable and cost-effective monitoring of NDPs

8. 8 Core indicators to monitor National Drug Policy Level I indicators (structure & process) Level II indicators (outcome) Level III WHO & MSH NDP indicators Indicators for specific pharmaceutical components: How to investigate drug use in health facilities; Assessing regulatory capacity of countries. Access indicators  Questionnaire  Systematic survey

9. 9 Level I core indicator on country pharmaceutical situation n To assess structures and processes in a national system n Questionnaire (key informants); no field survey n comparisons among countries n Key components National drug policy Essential drug list Financing & drug procurement Rational use of drugs Legislation and Regulation Quality assurance Production

10. 10 Level I: Example n Drug financing: n national public sector expenditure for drugs (MOH) n other public sector expenditure (insurance, local budget) n value of international drug aid n % of population covered by private/public insurance n dispensing policy: drugs free; user fees n Rational use: n EDL, Formulary Committees n Drug information Centre

11. 11 Planned Interventions following assessment to address under performing areas undermining access to medicines: 1. Assess 2. Plan3.Implement 4. Monitor

12. 12 Future priorities n Strengthening National capacity of n Health systems n Human resources through partnerships and collaboration for successful NDP implementation n National EDM Managers and WHO EDM offices and staff have a critical role to play - assessing and monitoring NDP n Monitor impact, reassess and adjust plans according to needs and performance.

13. 13 THANK YOU