partnerships on amr and ncds mirfin mpundu

Partnerships on AMR and NCDs Ecumenical Pharmaceutical Network Mirfin Mpundu Pharm D, MBA, MPH Executive Director

www.epnetwork.org Just and compassionate quality pharmaceutical services for all

Ecumenical Pharmaceutical Network (EPN) is

a Christian, not for profit, independent organization committed to the provision of quality pharmaceutical services as a means to achieving global goals and targets on health and access to medicines

Our Network consists of

Church health associations Faith based organizations Drug supply organizations Individual members

Who we are


EPN is a worldwide network of 105 members from 37 countries who have an interest in or are involved in the delivery of just and compassionate quality pharmaceutical services

Our Network


• Faith Based Organizations (FBOs) play a major role in providing health

care globally. They provide up to 40-60% of Africa’s healthcare

• EPN works with FBOs to reach out to communities in the most marginalized and remote areas where government services are limited

• The local population feels connected to FBOs by their shared religion

therefore increasing acceptability and utilization of health care services

Faith Based Organizations


Strategic Focus Areas 2016-2020


Antimicrobial Resistance

• Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial drug that was originally effective for treatment of infections caused by it. (WHO 2014)

• AMR is a steadily increasing global public health threat • AMR is rapidly making many 1st line treatments ineffective and in some

cases, also 2nd line and 3rd line treatments • Infectious diseases kill approximately 10 million people annually, 95%

of whom live in resource-constrained countries • Sir Alexander Fleming in 1945 warned, ‘"The thoughtless person

playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."


Challenges of AMR

• Makes 1st and 2nd line antimicrobials ineffective, thus impacting efficacy and access

• Heavily diverts scarce resources impacting affordability for health systems

• Very expensive to treat, bringing affordability issues and financial risks for patients

• Makes treatment difficult and complex impacting quality and effectiveness of services

EXAMPLE: Treatment of MDR-TB:

Up to 200 times more expensive

More side effects Lower cure rates (<50%) Treatment duration 20

months or more

Only 20% of those with MDR-TB access treatment

Sources: Nugent et al. The Race Against Drug Resistance. CGD, 2010; https://www.whitehouse.gov/blog/2015/12/22/national-action-plan-combat-multidrug-resistant-tuberculosis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076529/pdf/erj-44-01-023.pdf

https://www.whitehouse.gov/blog/2015/12/22/national-action-plan-combat-multidrug-resistant-tuberculosis














http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076529/pdf/erj-44-01-023.pdf









Use - Rational and Irrational Access, quality, marketing, financing. Lack of diagnostics

Spread of resistant bacteria Poor hygiene and sanitation in hospitals and the community, travel, food

Lack of new antibiotics Scientific hurdles Low return of investment

Antibiotic resistance

What went wrong?

8 Global burden of AMR


Human behaviour



Lack of new antibiotics



AMR Burden

Deaths attributable to AMR every year compared to other major causes of death


Major surgical

procedures

Trans-plantations

Cancer treatment

Safe child deliveries

Care of preterm children

Pneumonia

Typhoid fever

Gonorrhea

Blood infections

Surgical infections

Antibiotic Resistance

Disease treatments and medical procedures under serious threat



• The cost on human life, health systems & the national economy Global spending on medicines- more than a trillion dollars a year Projected to go up by 1.4 trillion dollars a year Some countries spend up to 67% of their health budgets on

their budgets on medicines, mostly paid out out of pocket by consumers


The median overall cost to treat a resistant bacterial infection vs. an infection with bacteria sensitive to the given empiric therapy was 700 USD This corresponds to 442 daily wages for a rural male casual worker in India

Chandy, S: The Journal of Infection in Developing countries. Vol 8, sept 2014

Lack of affordability



The problem of access

• Access lies in the heart of SDGs and UHC • Global consumption of antibiotics by humans

increased 30% between 2000 and 2010 * • But this increase was not uniform and lack of access

is still a huge problem in many LMIC settings • Lack of access to treatment for pneumonia and

sepsis kills more than a million children every year * • Universal access to antibiotics can avert 75% of

deaths due to community-acquired pneumonia in children under 5 *

• At the same time, unregulated OTC availability of antimicrobials is another dimension of the problem

• So the key is to improve access, but in a regulated manner

Both lack of access and unregulated access lead to irrational antimicrobial use and contribute to AMR

OTC – Over-the-counter

* Laxminarayan et al. Lancet, November 18, 2015


Role of Poverty and Out-of-Pocket Expenses in AMR

• Poverty is a major force driving AMR • Poor access and

affordability • Incomplete courses of

treatment due to cost • Medication sharing, use

of ‘leftover’ antibiotics, purchase of poor quality products from unregulated sources

• A recently published study showed strong correlation between out-of-pocket expenses and AMR in LMICs

• This was driven by countries that had medicine co-payment policies in the public sector, possibly inducing patients to buy treatments from the less-regulated private sector

Source: Planta MB. J Am Board Fam Med 2007;20:533–539 Source: Alsan M et al. Lancet Infect Dis 2015; 15: 1203–10

These are important considerations for UHC


Medicines: 3 of the Top 10 Leading Sources of Inefficiency

and Waste 1. Medicines: underuse of generics and higher than necessary prices for medicines

6. Health-care services: inappropriate hospital admissions and length of stay

2. Medicines: use of substandard and counterfeit medicines

7. Health-care services: inappropriate hospital size (low use of infrastructure)

3. Medicines: inappropriate and ineffective use

8. Health-care services: medical errors and suboptimal quality of care

4. Health-care products and services: overuse or supply of equipment, investigations and procedures

9. Health system leakages: waste, corruption and fraud

5. Health workers: inappropriate or costly staff mix, unmotivated workers

10. Health interventions: inefficient mix/ inappropriate level of strategies

Source: WHO – World Health Report: Health Systems Financing - The Path to Universal Coverage, 2010 http://apps.who.int/iris/bitstream/10665/44371/1/9789241564021_eng.pdf

http://apps.who.int/iris/bitstream/10665/44371/1/9789241564021_eng.pdf

http://apps.who.int/iris/bitstream/10665/44371/1/9789241564021_eng.pdf


Source: 2003 World Health Report

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Global Burden of Infectious Diseases


EPN Strategy on Fighting AMR

Enhance and strengthen the capacity of FBOs in antimicrobial stewardship and infection prevention control (IPC)

Increase awareness among faith-based health providers and the public of the threat posed by AMR;

Develop and disseminate treatment guidelines for common infections;

Conduct prescription audits and other surveillance on antimicrobial use in faith-based health facilities;

Develop training courses on the rational use of antibiotics and other antimicrobials;

Establish quality assurance systems to monitor the quality of antimicrobials;


AMR Global Action Plan

AMR Global Action Plan – 5 Strategic areas 1. Increase awareness and understanding AMR 2. Strength knowledge through surveillance and

research 3. Reduce the incidence of infections 4. Optimize the use of antimicrobial agents /

medicines 5. Ensure sustainable investment National Action Plans currently in development


Containing AMR to Realize the Goals of SDGs

• Improving ACCESS to antimicrobials, vaccines and diagnostics

• OPTIMIZING SELECTION and USE of antimicrobials through UHC medicines benefit schemes

• Improving AFFORDABILITY to antimicrobials through financing mechanisms and by reducing inefficiency/waste

• Improving SAFETY and QUALITY through infection control and continual improvement programs


EPN Strategies in Fighting AMR

International Level

National Government Level

Health Facility Level

Community

Advocacy

Action

ReAct MoH-NAP

Promoting Access

Capacity building

IEC materials


Non-communicable Diseases (NCDs)

The so-called “Lifestyle diseases”


NCD Burden

Of global NCD-deaths occur in LMIC

More people in Africa die in 2025 from NCDs than from Infectious diseases, nutritional deficiencies, maternal and perinatal conditions together.

Availability of medicines for NCDs is

only 36% in public and 55% in the private sector.


Non-communicable diseases (NCDs)

EPN’s Objective: Promote awareness of NCDs and facilitate increased access and rational use of affordable quality-assured medicines for NCDs. • Procurement strategies such as Pooled Procurement • Developing and promoting standard treatment guidelines • Raising awareness and community education • Situational analysis studies that inform interventions • Advocacy activities


EPN’s Advocacy on NCDs

EPN Forum for 2016 held in May in Germany (Tübingen) had the theme “Antimicrobial Resistance (AMR) and Non- Communicable Diseases (NCDs) - Pharmaceutical Challenges in the 2030 Agenda”

• With > 90 participants • Advocating for the importance of prevention and action on NCDs in

church health facilities and constituencies .


EPN’s Action on NCDs

• Diabetes project in Zambia Capacity building of the pharmaceutical workforce on Diabetes Increasing availability of Diabetic medicines Improved rational use of Diabetic medicines


EPN’s Action on NCDs

• Baseline studies in Kenya and Tanzania To indicate the status of pharmaceutical care regarding NCDs in

Faith based Health facilities.

• Situational Analysis in Kenya, Tanzania, Nigeria and Burkina Faso To indicate the overall status of NCD care in multiple member

countries


Universal Health Coverage

The ultimate goal of EPN partnerships in containment of AMR and NCDs is to connect with global health efforts and ensure the realization of SDG Goal Number 3 which is :

“Good Health and Well-Being

-Ensure healthy lives and promote well-being for all at all ages” Without good health and wellbeing ; attainment of the other 16 SDGs remains an impractical task as good health is essential to achieve the other goals

A United Nations initiative ,successor of the Millennium Development Goals


Promoting Access – making medicines affordable


Sustainable Development Goals (SDGs)


SDG Goal 3 on Communicable Diseases & NCDs

• By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

• Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

• KEY - is in partnerships to equip communities to fight diseases & extreme poverty

Source: UN http://www.un.org/sustainabledevelopment/health/

SDGs – Sustainable Development Goals

http://www.un.org/sustainabledevelopment/health/


Thank You

partnerships on amr and ncds mirfin mpundu

Health & Medicine