pharmaceutical system strengthening – is there a need for a new paradigm? andreas seiter the world...
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Pharmaceutical system strengthening – Is there a need for a new paradigm?
Andreas SeiterThe World Bank
ICIUM 2011, Antalya
![Page 2: Pharmaceutical system strengthening – Is there a need for a new paradigm? Andreas Seiter The World Bank ICIUM 2011, Antalya 1](https://reader036.vdocuments.net/reader036/viewer/2022082818/56649eba5503460f94bc2a56/html5/thumbnails/2.jpg)
The World Bank and its clients
Slide 2
Low-Income Countries
Middle-Income Countries
Financing (IDA, subsidized)
Financing (market rates)
Research, analytics, policy advice
Overall goal: reduce poverty, increase equity
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Health Systems focus
Slide 3
Human Resources
Financing and payment systems
Governance (laws,
regulations, standards)
Medicines, supplies,
infrastructure, technology
Access to Quality Health
Care
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Core challenges for policy makers
Low income• Availability• Quality• Affordability• Adherence• Lack of resources requires
prioritization of life-saving treatments with high public health impact
Middle income• Equitable access• Rational use• Perception of quality• Financial protection• Affordability of innovative
treatments
Slide 4
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Systemic issues
Market failure
• Fragmented buyers• Uninformed consumers• Biased professionals• Conflict between public
health and private incentives
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• Lack of accountability• Outdated HR policies• Fragmented decision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
Slide 5
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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
Slide 6
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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?
Slide 8
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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)
Slide 9
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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
Slide 10
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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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