1. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Cohort III International Pain Policy Fellows Opioid Availability Action Planning Worksheet Madison, Wisconsin, USA 6 – 10 August 2012

2. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care CountryFellow(s)PPSG member(s) IEC member(s) AlbaniaKristo HutaJody Moen Snezana Bosnjak * Stephen Connor Bangladesh Rumana Dowla Farzana Khan Marty Skemp Brown Eric Krakauer India Priya Kulkarni Shalini Vallabhan Nandini Vallath David Joranson Frank Ferris M.R. Rajagopal KyrgyzstanTaalaigul SabyrbekovaMartha Maurer Henry Ddungu * Stephen Connor Sri Lanka Nadarajah Jeyakumaran Suraj Perera Jim ClearyBishnu Paudel UkraineNataliia DatsiukAsra Husain* Tom Lynch * IEC member who will not attend Training Program, but will provide follow-up technical assistance.

3. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Step 1 – Develop the Action Plan Section A: State the 3-5 problems that lead to inadequate patient access to opioid analgesics. Section B: State the objective(s) that would address the problem. (WHAT) Section C: List the action steps needed to achieve the objectives. (HOW) Section D: List those who have the authority/responsibility to take the necessary action. (WHO) Section E: Indicate an approximate timeline for completion of the action steps. (WHEN) Section F: State the assistance (technical, financial) that will be needed to achieve each objective. (HOW MUCH) Section G: Expected outputs, and how measured

4. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Medication Information Level 6. PATIENTS Level 1: International Narcotics Control Board Level 2: National Competent Authority Level 3. Importer/Manufacturers/Distributors Level 4. Hospitals/Pharmacies/Hospice/PC programs Level 5. Physicians/Pharmacists/Other Drug Distribution System Model

5. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Action Plan for: {NAME OF YOUR COUNTRY} Prepared by: {YOUR NAME} 10 August 2012

6. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1: State the 3-5 problems that lead to inadequate patient access to opioid analgesics – Be as specific as you can Problem 1: Problem 2: Problem 3: Problem 4: Problem 5:

7. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care A: State the problem that leads to inadequate patient access to opioid analgesics (What?) – Be as specific as you can in stating one problem PROBLEM 1

8. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care B: State the objective(s) that would address the problem. Which objectives are the top priorities? (What?)

9. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care C: What action steps are needed to achieve the objectives? (How?) D: List those who have the authority and/or responsibility to take the necessary action; and with whom they should collaborate. (Who?)

10. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care E: Timeline for completion of action steps. (When?) F: What assistance (technical, financial) will be needed to achieve each objective under part “B”? (How much?)

11. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care G: Expected outputs, and how measured