Technical cooperation with countries

Technical Cooperation for essential drugs and traditional medicinesSeptember 2005

Mission Statement for working with countries

………using the WHO Medicines Strategy as a framework collaborate with countries to build a sustainable environment where quality, safe and effective essential medicines, including traditional medicines, are available, affordable and used appropriately ………….

WHO Medicines Strategy 2004 – 2007: 4 objectives, 7 components, 44 expected outcomes

OBJECTIVES• Policy

• Access

• Quality and safety

• Rational use

COMPONENTS1. Implementation and monitoring of medicines policies2. Traditional and complementary medicine

3. Fair financing and affordability4. Medicines supply systems

5. Norms and standards6. Regulations and quality assurance systems

7. Rational use by health professionals and consumers

Strategic direction of TCM Department Strategic direction of TCM Department

Ethical practices

Collaboration/cooperation/Building complementarities

Values and PrinciplesKey Areas

Good governance/accountability/transparency

Support countries to attain sustainable, uninterruptible,

supply and appropriate use of affordable, quality, safe, efficacious medicines

(including TM) for public health problems

OBJECTIVEDemand/need

driven

Consistent message

from WHO: HQ, RO's, CO's

Promote appropriate use of essential medicines including traditional medicines

Guide promoting local production and innovation (R&D) of new medicines for

public health needs

Assist in strengthening Pharmaceutical HR

Provide technical guidance and support on TM

National medicine policies:Support countries to develop, implement,

evaluate & integrate NMP in health systems plan

Assist countries in developing sustainable financing mechanisms

Strengthen national capacity in drug and herbal medicines regulationto ensure quality, safety, efficacy

Assist countries to protect public health in the negotiation and implementation of

international, regional and bilateral trade agreement.

Guide pricing policiesand drug supply management

Promote appropriate and safe use of EML and traditional medicines

Guide policies on local production and innovation (R&D) of new medicines for

public health needs

Assist in strengthening Pharmaceutical Human Resources

Provide technical guidance and support on TM

Support countries to develop, implement, evaluate & integrate NMP in

health systems plan

Assist countries in developingmedicines financing mechanisms

Strengthen national capacity in drug and herbal medicines regulationto ensure quality, safety, efficacy

Guide countries to protect public health negotiation and implementation

of trade agreements.

Guide pricing policies and drug supply management

HTP

TCM

PSM

Other WHO

Clusters

Linkages with Regions & Country OfficesLinkages with Regions & Country Offices

Primary interaction

Secondary interaction

AFRO

AMRO

EMRO

EURO

SEARO

WPRO

Country Offices

NPO

NPO

NPO

NPO

Headquarters (TCM):

•Support in planning and management and collaborations

•Provide and coordinate policy and technicalsupport

• Support in HR development & training

• Assist in country assessments & monitoring

Collaborative Activities Supporting WHO Medicine StrategyCollaborative Activities Supporting WHO Medicine Strategy

Guidance, support and collaborations

Regional Offices:

• Oversee countries policies and support

• Planning and monitoring of country support

• Technical, policy and management support to countries

• Human resources development & training

• Partnerships and collaborations at regional level

Country Offices:

• Assess needs and identify priorities for technical support

• Plan & implement WHO work

•Provide technical and policy support to countries

• Assist in coordination

•Partnerships & collaborationsin countries

•Feedback and report

Ministries of Health:

• Identify needs & priorities

• Plan, implement and monitor action

• Coordinate with other Ministries and national bilateral and multilateral agencies and CSO's.

Strategic planning, implementation, monitoring

Enhanced expertise in countries

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Congo Zambia

• assessing needs and priorities• planning, implementation and

monitoring of medicines policies • coordination of stakeholders involved

in pharmaceuticals• feedback and reporting

WHO Medicines advisers in about 30 countries to assist in:

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 national programme officer• Covers most or all of the following areas: policy; access, quality, safety & efficacy, and rational use

Type A: Situation analysis & Monitoring

• Assessment of pharmaceutical situation, identify priority needs – recommendations for interventions

Type IC: Inter-country

• Ad hoc or regular support involving two or more countries often in the same region • Usually focused on a subset of the following areas: policy; access; quality, safety & efficacy; and rational use

Activities Driven by Country Needs & PrioritiesActivities Driven by Country Needs & Priorities

Initiation of most activities are in response to requests by Member States. Other activities are based on WHA Resolutions, country specific needs.

Evidence based planning and interventions

Data & evidence used, objectives and targets set, implementation plan developed, resources identified

Regional/country plans & strategies implemented in coordination with partners: bilateral and multilateral agencies, NGOs, and other stakeholders

Level I, Level II core indicators, household survey + other tools assess & monitor structures, processes, outcomes and specific pharmaceutical components

Indicators for monitoring and evaluation of pharmaceutical sector

Level I Core indicators On structures &

processes

Level II Core indicators on outcomes/impact &

household survey

Level IIIIndicator tools for specific components of the pharmaceutical sector

• Pricing• HIV/AIDS• TRIPS

• Traditional medicine• Etc, etc.

Monitoring and assessment to measure progress over time

Comparing 1995-2002 Level II indicators shows progress in some areas but that enhanced efforts needed in others

0%

20%

40%

60%

80%

100%

Availability of keydrugs

% of presc. drug inEDL

% presc. withinjection

Availability of keydrugs

% of presc. drug inEDL

% presc. withantibiotics

% patient withadequate

knowledge

% presc. withinjection

1995 2002

Bulgaria Philippines

Rationale for seeking evidence

• Raise awareness on realities and actual situation (qualitative observation with evidence)

• Provide “numbers for advocacy” to convince policy-makers, donors

• Identify problem areas and set priorities among possible areas for intervention

• Assess country medicines situation and trends over time

• Measures impact of interventions

HQHQ Regional Offices Regional Offices Country OfficesCountry Offices Ministries of HealthMinistries of Health

Partners in Country SupportPartners in Country Support

WHO operational WHO operational partnerspartners

UNAIDS, bilateral UNAIDS, bilateral and multilateral and multilateral agencies, public agencies, public interest NGOs in interest NGOs in health, UNDP, health, UNDP, UNFPA, UNCTADUNFPA, UNCTADUNICEF, EUUNICEF, EU

WHO scientific WHO scientific partnerspartners

WHO Collaborating WHO Collaborating Centres in Centres in pharmaceuticals, pharmaceuticals, universities, research universities, research centres, international centres, international health professional health professional associationsassociations

WHO strategic WHO strategic partnerspartners

World Bank and World Bank and development banks, development banks, Donor Agencies, Donor Agencies, pharmaceutical pharmaceutical industry, WTO, industry, WTO, WIPOWIPO

Links with other partners Links with other partners

WHO Countries

WHO-HAI Africa Regional collaboration for action on essential medicines in Africa

1. Increased access to quality essential medicines through improved policies and advocacy – collaboration on affordability of medicines

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