goodgovernance for medicines program in … for medicines program in thailand dr.chanvittharathep...
TRANSCRIPT
Good Governance for Medicines
Program in Thailand
Dr.Chanvit Tharathep
Ministry of Public Health, Thailand
9/11/2015
Outline
� Activities before WHO GGM
� WHO GGM : Phase I, II, III and…beyond?
� Outcome, Impact
� Health Care Scandals
� Key Achievement : Operating Framework
� What’s next?
2004 WHO GGM
introduced to
Thailand.
Phase I started.
1981, 1993 :National Drug Policy
Safety, Quality, Appropriate Price, Access
1981-2005 : Essential Drugs list, Standard Price
2002 UHC - 30 Baht project
2004 : Public Good Governance Law
1997-2005 Drug management Reform in MoPH
1997
Economic
Crisis,
1997
Drug
Scandal
Activities Before WHO GGM
WHO GGM Program: Changes and Impacts
PHASE IIPHASE I PHASE III
Assessment GGM
Flamework
Situation
Analysis
Existing GGM
Infrastructure
strengthening
GGM
Networking
Thai GGM
Strategy
Available Practices,
Guidelines
GGM
Implementation
Forms,
Procedures
More
Transparency
By Information
Registration,
Selection,
Procurement,
Improvement
GGM Strategy
Socialization,
Education.
Increased
Awareness
More
Transparency
More
Efficiency
Networking
Learning
Process
Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles
2004-2005 2005-2006 Since Oct 2006-
Output
OutcomeImpacts
GGM
Policy and Implement
National Networking
and Participation
Strengthen Information
Database
Dissemination of Ethical
Practice Information
Output, Outcome, Impact
Assessment
Phase III: Strategy and implementation since 2006•GGM Framework, legislation, GGM Policy•Practice Guidelines, Medicine Promotion Practice criteria•Standard of Practice (SOP)•Declare Consent form, Conflict of interest form (ED, SP)•FDA, DHSS, DMS, Universities, Professional Councils•Hospital Pharmacy Association•Community Pharmacy Association•PReMA, •Thai Pharmaceutical Manufacturer Association•NGOs•Selection, Registration •Procurement•Drug Price, Drug Promotion Practice•Research, Study and cases•Public accessible Pharmacy Information Center•Meeting•Newsletter, Webpage of Good Governance•Best Practice•Interested Working Group•KPI for Health Inspector•Self Assessment, Assessment New tool (Promotion Practice, Inspection, Distribution?)
Publications/medias provided (cont’d)
� News Letter, Electronic data and information on CDs, Website: http://dmsic.moph.go.th
� Consensus Oriented
� Participatory
� Rule of Law
� Transparent
� Accountable
� Responsive
� Effective and Efficient
� Equitable and Inclusive
GGM Framework
GGM Strategy
GGM ImplementationGGM III
Process Improvement 2006-2010
Outcome focus 2010-2015
Regional Group Purchasing Monopoly Drug Management
Compulsory Licensing
Corruption Control
Socialization (Whistle Brower)
3 Health security Schemes integration
From 2006-2015
Drug item Pack unit Average price
Regular
Separated
purchasing
Provincial
group
purchasing
Regional
group
purchasing
Diclofenac tab 25 mg 500 107.86 74.69 57.38
Insulin Human Base vial 100
IU/ml (10 ml)
1 308.99 300.63 310.30
Medroxyprogesterone amp. 50
mg/ml (3 ml)
1 16.08 12.49 13.50
Ranitidine tab 150 mg 500 200.95 201.34 177.62
Salbutamol inhaler 100 mcg (200
doses)
1 105.93 112.68 139.10
Salbutamol sol 0.5 % (20 ml) 1 91.87 102.44 85.60
Group Purchasing Outcome: More efficiency, cost
reduction
1.Antihypertensive drugs (ARB)
2.Dyslipidemia agent (Statins)
3.Proton pump inhibitor (PPI)
Monopoly Drugs Single price policy
Item Previous
Price(Baht)
Proposed
Price(Baht)
Managed
Price(Baht)
Save/
Package(Baht)
Budget
Save(Baht)
Rosuvastation
tablet 10 mg
(Crestor)
1,108.52 1,108.52 1,007.75 100.77 9,999,407
'Powerful figure' implicated in scandal over stolen
cold pills, 2012THE NATION
BANGKOK: -- At least one
very powerful figure has been
implicated in the
embezzlement of pills
containing pseudoephedrine
from state hospitals, the public
health minister's adviser, Pasit
Sakdanarong, said yesterday.
>20 Hospitals involved>20 Doctors and Pharmacists were punished
For Appointed
the HSRI new
board members
with COI to fire
the whistle blower.
1st Case of Whistle Blower protection
The NHSO Secretary
General was investigated and moved out.
NACC investigation involved Minister and deputy
Thaihealth Scandal in 2015
Mr Krissada earlier insisted that the
foundation’s budget was spent transparently to
benefit the public. The state auditor found that
40% of its funds were diverted to political
activities instead of promoting public...
http://www.bangkokpost.com/news/general/732520/thaihealth-chief-resigns-over-spending-scandal.
Factors for Success
� Transparency (Pharmacy Information Center)
� Appropriate GGM Strategy according to situation
� Strong GGM teamwork and Network
� Focus on Output, Outcome, Impact
� Participatory Process : among public organizations,
NGO, Media, Social participation
GGM Operating Framework
National GGM Framework
Health care environment Analysis Target Priority Setting
Strategic formulation
Information System Transparency
Information Networking Socialization Guideline
Intervention Assessment
Management System Strengthening Activities
Output, Outcome Focused Activities
Challenges
� Country Context
� Health System Context : More Governance Bodies :
MoPH, NHSO, Thaihealth, National health commission, etc…
� MoPH Administrators, Structure changed : Pharmacy
Information Center weakening -> Pseudoephedrine case.
� More advanced corruption techniques : Innovative corruption in Health Sector
� Knowledge Management Gap.
People
InformationHealth
Workforce
Financing
Medical
Products
Vaccine
Technology
Service
Delivery
Leadership
and
Governance
Demographic
ChangeTechnology
ChangeProblems and
Demands
Universal Health Coverage 2002-
2004
Prevention and PromotionTreatment, Rehabilitation
MoPH130,000 staffs
800,000 Volunteers
1,202.4 Bahts/capita
Integrated InformationSystem
9,600 HC
724 CH92 RH, GH
GGM
GGM
People
InformationHealth
Workforce
Financing
Medical
Products
Vaccine
Technology
Service
Delivery
Leadership
and
Governance
Demographic
ChangeTechnology
ChangeProblems and
Demands
Universal Health Coverage 2005-
2015
Prevention and PromotionTreatment, RehabilitationNHSO, MoPH, Thaihealth, NHC
etc >300,000 staffs
>3,000 Bahts/capita
Seperated Information
>10,000 HC
784 CH>100 RH, GH
>10,000 Health Networks/Foundations
People
InformationHealth
Workforce
Financing
Medical
Products
Vaccine
Technology
Service
Delivery
Leadership
and
Governance
Demographic
ChangeTechnology
ChangeProblems and
Demands
More Health Expectancy for
Sustainable Growth
All For HealthHealth Literacy, Health in All Policy
One Health
Health for All : PHC, UHCAccess, Quality, Cost
Conclusion� GGM Framework is the national level management. We should
realize that there is different context in different country..
� Health care environment should be evaluated and priority setting
should be done at first step.
� The strategy should be formulated to support and transfer into
operation.
� Transparency is the most effective, efficient and feasible for the
first step of good governance implementation. We can achieve
transparency with the Pharmacy Information center.
� GGM team consists of related organization should be formed.
� Output, Outcome orientated activities.
� Future Strategy should be considered.