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Pharmaceutical system strengthening – Is there a need for a new paradigm?

Pharmaceutical system strengthening – Is there a need for a new paradigm?. Andreas Seiter The World Bank ICIUM 2011, Antalya. The World Bank and its clients. Financing (IDA, subsidized). Low-Income Countries. Research, analytics, policy advice. Middle-Income Countries.

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Pharmaceutical system strengthening – Is there a need for a new paradigm?

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  1. Pharmaceutical system strengthening – Is there a need for a new paradigm? Andreas Seiter The World Bank ICIUM 2011, Antalya

  2. The World Bank and its clients Financing (IDA, subsidized) Low-Income Countries Research, analytics, policy advice Middle-Income Countries Financing (market rates) Overall goal: reduce poverty, increase equity

  3. Health Systems focus Governance (laws, regulations, standards) Human Resources Medicines, supplies, infrastructure, technology Access to Quality Health Care Financing and payment systems

  4. Core challenges for policy makers Low income Middle income Equitable access Rational use Perception of quality Financial protection Affordability of innovative treatments • Availability • Quality • Affordability • Adherence • Lack of resources requires prioritization of life-saving treatments with high public health impact

  5. Systemic issues Market failure Weak governance and management Lack of accountability Outdated HR policies Fragmented decision making Corruption Lack of business skills Lack of technical skills Lack of data and transparency • Fragmented buyers • Uninformed consumers • Biased professionals • Conflict between public health and private incentives

  6. Structural variables • Public sector involvement in service delivery • Segmented insurance or financing systems • Self-dispensing doctors • Size and quality of private sector in health • Role of traditional medicine

  7. Core areas for policy innovation

  8. Supply chain integration • So far, procurement and supply chain logistics are often treated as separate system components • Fragmentation is the rule • Establish “Good Practices” for supply chain management as integral part of development cooperation?

  9. Financing systems • Public, top-down funding systems often ineffective, strangled by bureaucracy • “Money-follows-patient” principle with focus on the poor • Opening the door for more participation of private sector (combined with better regulation)

  10. Strengthen regulators • Current procurement systems potentially undermine regulators • Patients using private providers exposed to significant risks due to weak enforcement • Long-term solution has to rely on competent regulators to ensure quality of medicines in the market

  11. What about rational use? • Any evidence for successful, cost-effective, sustainable strategies to change provider and patient behavior .. • .. in the absence of a strictly managed pharmaceutical benefit provision with third party payment mechanism?

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