art program management under universal health coverage
DESCRIPTION
ART Program Management under Universal Health Coverage. Sorakij Bhakeecheep , MD . National Health Security Office, THAILAND. Outline. Overview of Thailand’s HIV/AIDS situation Financial aspect of ART program ARV supply chain management Key success factors Challenges. - PowerPoint PPT PresentationTRANSCRIPT
ART Program Managementunder
Universal Health Coverage
Sorakij Bhakeecheep, MD.National Health Security Office,
THAILAND.
National Health Security Office
Outline
• Overview of Thailand’s HIV/AIDS situation• Financial aspect of ART program• ARV supply chain management• Key success factors• Challenges
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• HIV/AIDS strategy• HIV prevention program implementation• Care and treatment related technical
guideline• Service delivery (by hospitals)
Ministry of Public Health
(Regulator and Provider)
National AIDS Control Program
National Health Security Office
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Royal Thai GovernmentNational AIDS Committee
National Health Security Office (NHSO)
(Purchaser and System manager)
Program implementation on:• HIV counseling & testing
(HCT)• HIV/AIDS care and ART• Positive prevention
Other Ministries/ governmental org
CBO & private sectors
SSSCSMBSPWHA networks
(Social security scheme) (Civil servant medical benefit scheme )
National Health Security Office
Thailand’s ART Situation
Demands Supplies
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ART centers 1,086CD4 Lab 44Viral load Lab 14Genotype Lab 16
Estimated all PWHA 475,000• # registration 363,000
Estimated ART needs 342,000
• # receiving ART 239,090 (70%)
• # UHC only 162,455
Average newly registration per year 33,000Average newly ART registration per year 20,000
National Health Security Office
•Thailand’s AIDS expenditure 330 million USD in 2011•2.4% of total health expenditure (THE) •0.09% of GDP
Thailand’s AIDS Expenditure
•73% Treatment & Care•14% Prevention•13% Others (social protection, program management, research, etc) 5
National Health Security Office
ART program budget under UHC ran steadily around 100 mUSD for years.
ART Program Budget
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ART Program Budget under UHC(2007-2013)
•58% ARV cost•27% LAB cost
•99% Domestic fund (government)•1% International fund (GF-ATM)
Unit Cost Analysis
National Health Security Office
• Cost of ARV falls to nearly 50% during past five years
• Cost for 2nd line is 4 times of the 1st line
• Central procurement and compulsory licensing play significantly role to make ARV prices more affordable
Cos
t Str
uctu
re in
201
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Unit cost-USD 1st line Protocol 2nd line Protocol RemarksARV drugs 286.6 1,103 Average cost of ARV consumption
LAB 85.2 79.3 2 CD4 + 1 VL + 2 Blood chem. + DR (allocate total DR cost to all pt) + specimen handling
Capacity building 8.5 8.5 Personnel training, Strenghten quality of care, M&E (allocate total cost to all pt)
Others 11.3 11.3 Peer group activities and facility workload (allocate total cost to all pt)
391.6 1,202.4 Average unit cost for all patients 481.7 USD
Budget Allocation under UHC
National Health Security Office
ARV Drugs
HIV/AIDS Budget
GO, NGO, CBO
LAB + HCT Capacity building
Pay for performance
Hospitals8
GO – Governmental organizationNGO – non Governmental organizationCBO – Community based organization
National ART
GuidelineTaskforce
National Committee
on Essential Drugs List
National ARV
Drugs ListApprove for:-Clinical criteria-Clinical efficacy
Approve for:- Cost effectiveness
-Long term affordability
Academic issue Financial issue
Establishing National ARV Drugs List
9National Health Security OfficeManagement issue
-Planning-Budgeting
National Health Security Office
National ARV Drugs ListFirst line:
• NRTI– Zidovudine (AZT)– Stavudine (d4T)– Lamivudine (3TC)– Didanosine (ddI)– Tenofovir (TDF)
• NNRTI– Nelvirapine (NVP)– Efavirenz (EFV)
Third line:• PI
– Darunavir (DRV)
Second line:• PI
– Lopinavir (LPV)– Ritonavir (RTV)– Atazanavir (ATV)
Remark:• Drugs indicated in blue color can be
produced domestically by GPO• Drugs indicated in red color are original
drugs• All ARV drugs are managed by GPO,
including procurement, quality control, stock management and logistic.
Original
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Abbrev:ARV Anti-retroviralUCS Universal Health Coverage SchemeSSS Social Security SchemeGPO Government Pharmaceutical
Organization
Drugs Supply Framework
National Health Security Office
Daily data transfer
-ID-Demography-Clinical-LAB-Prescription-etc
-Safety stock-ARV consumption-ARV On-hand-Amount delivered
Individual data input
Drugs supply to hospitals
Hospitals
11GPO – Government Pharmaceutical OrganizationNHSO – National Health Security Office
-Data verification-Data calculation
Real
time
data
tran
sfer
Key Success Factors1. Clear policy commitment from government2. Strong existing health system infrastructure 3. Implementation of Universal health coverage4. Effective price regulation mechanism to ensure
ART program sustainability– Centralized program management– Central procurement vs. central negotiation– Domestic manufacturing of generic ARV
5. Good collaboration among key stakeholders6. Effective HIV/AIDS information system
National Health Security Office 12
National Health Security Office 13
Challenge #1
To prevent more deaths through early diagnosis and early treatment
Finding:• > 78% of PWHA has CD4 level < 350 at first diagnosis and registration
•More than half of PWHA has CD4 level < 100 at first time of ART initiation
Challenges # 2
National Health Security Office
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To maintain quality/effectiveness despite of increasing workload
Finding:• Registered PWHA is increasing overtime (+10% each year)• Death & lost follow-up are still high, especially in non-ART group (pre-ART stage)• Increase workload could lead to poor services and poor adherence, thus aggravate
drug resistance and mortality
Challenges # 3
National Health Security Office
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To control ART program budget and ARV cost to ensure affordable financing and supply system
Finding:• 11% PWHA receiving ART are taking 2nd line protocol, and still increasing• A number of PWHA need higher than 2nd line protocol• Cost of 2nd line is 4 times higher than 1st line, but 3rd line is much higher
CL
VL
MPP
National Health Security Office
Thank you for your attention
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