1. Indicators for monitoring and assessing pharmaceutical situation in countries

2. 2 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Who can use the results from assessment and monitoring? n Countries n National policy-makers n Health facilities n International agencies n Professional groups, NGO, academia

3. 3 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Indicators for monitoring and assessing pharmaceutical situation n systematic data gathering n to compare facilities, districts, regions, countries n to measure trends

4. 4 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Core indicators to monitor national drug policy http://www.who.int/medicines/strategy/policy/indicators_intro.shtml Level I indicators (structure & process) Level II indicators (outcome) Level III WHO NDP indicators Indicators for specific pharmaceutical components: How to investigate drug use in health facilities Assessing regulatory capacity of countries TRIPS, Drug pricing, Traditional medicines  Questionnaire  Systematic survey

5. 5 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Level I indicators n questionnaire (every 4 years with subset every two years) n 1999 WDS questionnaire as template, consultations and discussions with team, regional advisers, countries n mostly structure and process indicators for countries n country progress indicators for global tracking n EDM database

6. 6 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Level I indicators n Covers key components of pharmaceutical system National medicines/drug policy Access Legislation and Regulation, Quality control of pharmaceuticals Essential drug list Medicines supply system Medicines financing, production* Rational use of drugs Intellectual property rights protection and marketing

7. 7 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Operational package on level II indicators designed as a practical tool: n to assess and monitor impact and outcome (systematic survey) n to provide countries with feasible tool to monitor and assess pharmaceutical situation n to design a monitoring system and for regular monitoring of NDPs n Designed around practical/operational system of managing resources (time, people and money) n Step by step procedure administrative preparation (budget guideline, training schedules) technical requirements (training and field test, actual survey, analysis, reporting and identifying intervention

8. 8 -- (Monitoring & assessment - 12/8/2015) WHO - EDM List of indicators n on availability, stockout, record keeping and expiry of key drugs n conservation conditions and handling of medicines n affordability (child and adult moderate pneumonia and option for other disease condition n drug dispensed, labelling, patients knowledge, cost of medicines n Number of medicines prescribed, % antibiotics, % injection, ED prescribed, drugs in generic name n availability of EDL and STG n drugs prescribed for diarrhea, pneumonia, ARI

9. 9 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Sampling Recommendations n Sample n 6 regions/districts n 30 public health facilities with pharmacy/dispensary n 30 private pharmacies n 6 warehouses n Option to add private facilities, mission clinics depending on health service mix or provider

10. 10 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Clustering in Drug Supply or Drug Use Data n Geographic Characteristics n Administration and drug supply system n Epidemiologic or socio-economic differences n Health Facility Characteristics n Differences in management n Peer norms and collective habits n Provider Characteristics n Training, knowledge, clinical experience n Economic incentives n Industry pressure Result: Effective sample size is reduced

11. 11 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Countries AFRO: Cameroon, Chad, Ethiopia, Ghana, Kenya, Mali, Nigeria, Rwanda, Senegal, Tanzania, Uganda AMRO: Guatemala, Columbia (10 more countries) EMRO: Iran, Oman EURO: Bulgaria, Kyrgyzstan, SEARO: Indonesia, Nepal WPRO: China, Philippines, Malaysia

12. 12 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Monitoring if there is progress or none

13. 13 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Essential medicines are still not available and affordable to all

14. 14 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Inappropriate use of antibiotics is a common problem

15. 15 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Survey makes possible the comparison of public and private pharmacies

16. 16 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Comparing public and private pharmacies

17. 17 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Summary Values n Mean vs. median n Equivalent if data are normally distributed n Mean weighted toward skewed values n Standard deviation vs. quartiles n SDs more widely understood n Quartiles better summary of skewed data n Need to detect wild data points n Can be due to data errors or true outlier values n Can substantially bias means and SDs n Need to have standard screening procedures

18. 18 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Appropriate Standards for Indicators n Group norm n Easy for region/facilities to relate to peers n Norm might be wrong n Ideal values n Logical values exist for some indicators n Can be calculated empirically n Should ideals be stated in manual?

19. 19 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Sampling and Analysis Issues n Small sample from more facilities n Summary measure (mean/median, SD/quartiles) n Appropriate standards for indicators n Inter-country comparisons n Changes over time n Connecting results and interventions

20. 20 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Connecting Survey Results and Interventions

21. 21 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Household survey to measure access and use of medicines n currently one page survey instrument (13 questions) n information covers the the following: n health seeking behaviour leading to use or non use of drugs n if patients can afford, if they are available, where they are available, if able to get the medicine, reason why not

22. 22 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Household survey to measure access and use of medicines n Field testing n in conjunction with level II systematic survey n WHO- HAI project in AFRO n House hold survey for World Health Report n Development of questionnaire (one page with level II and option to expand with qualitative questions) n Sampling (recommended/appropriate sampling vs. resources) n Form a working group to further develop the manual and the process (questionnaire and sampling framework)

23. 23 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Lower income groups do not get all the medicines they need

24. 24 -- (Monitoring & assessment - 12/8/2015) WHO - EDM Availability and affordability are the barrier to access

25. 25 -- (Monitoring & assessment - 12/8/2015) WHO - EDM The way forward on country monitoring n Evidence through systematic but feasible data collection process is necessary in policy making and activity implementation n Should demonstrate that in the long run regular monitoring is not difficult and can be done in a cost efficient manner n Portion of country support budget and project grants should be allotted to monitoring and evaluation using indicators n Information sharing: studies and results will be available in the web