Public health in private sector

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National Drug Policy Implementation
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National Drug Policy - An essential part of a
National Health Policy

• Access -- essential drugs are available
  affordable
• Quality -- safe efficacious drugs
• Rational use -- drugs are used appropriately
  by prescribers, dispensers and patients

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National drug policy
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Key components

• Selection
• Essential drugs concept ? Traditional
  medicines
• Access
• Affordable prices ? Sustainable financing
• Reliable supply systems
• Regulatory control and quality assurance
• Legislation and regulation ? Drug regulatory
  authority
• Pharmaceutical quality assurance
• Rational use of drugs
• Public and private sector ? Professionals and
  public
• Supportive components
• Research ? Human resource development

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Formulating a national drug policy - policy
implementation begins on day 1 of policy
formulation

• 1. Organize the policy process - How does change
  happen?
• 2. Identify the main problems
• 3. Make a detailed situation analysis
• 4. Set goals and objectives for a national drug
  policy
• 5. Draft the text of the policy
• 6. Circulate and revise the draft policy -
  process is important
• 7. Secure formal endorsement of the policy -
  legal, admin
• 8. Launch the national drug policy

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How does change happen?

• The leaders - vision, commitment
• political leadership - often the engine
• professional leadership - opinion leaders
• The doers - involvement, ownership
• government - president, health other ministers
• professional bodies, NGOs, interest groups
• The outsiders - authority - expertise - money
• WHO, World Bank, UNICEF, consultants
• The process
• consultation? - consensus? - continuing
  engagement?

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Implementing a national drug policy

• 1. Determine overall responsibilities
• 2. Develop a master plan for NDP implementation /
  pharmaceutical sector development
• objectives and strategies
• expected output and target
• responsible group
• 3. Identify priorities and strategies for each
  component
• Legislative agenda - new enabling legislation
  needed?
• 4. Identify technical and financial resources

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Who is responsible?

• Ministry of Health/Health Departments
• Lead agency
• NDP expert committee-multidisciplinary,
  represented by key parties
• Working group for each component
• Should oversee and coordinate all components of
  the pharmaceutical system
• Should monitor and assess implementation and
  achievement of targets and objectives
• A unit/group within the ministry/department with
  personnel and budget

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Other groups with responsibilities

• Drug regulatory agencies
• District/provincial/regional offices
• Health facilities
• Other ministries -- finance, trade, economic
  planning, education and others
• Private sector -- industries and retailers
• Third parties -- NGO, consumer groups, academia
  and professional organizations

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Policy implementation challenges

• Technical challenges
• Ethical challenges
• Political challenges

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Policy implementation challenges

• Technical challenges
• Use experts for policy technical soundness
• Invest in people
• Ethical challenges
• Institutional conflict of interest
• Individual conflict of interest
• Underlying corruption

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Policy implementation challenges

• Political landscape - understanding key to policy
  impact
• Continuous political analysis formulation to
  implementation
• More challenging at implementation when political
  impacts are apparent
• There are controllable and uncontrollable events
• Groups will defend their own common interest
• Political tactics
• Alliance, coalitions
• Coordination and public relation
• Bargaining (compromise)
• Mobilize groups (3rd party)
• Create constituents inside and outside government

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National drug policy

• Political process
• seeks to change who gets drugs
• represents a choice of value
• consequence to distribution/redistribution of
  goods power
• allows/increase competition among groups that
  seek to influence redistribution

Monitoring evaluation
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National drug policy

• Interest groups
• Sustain participation/ consultation/coordina
  tion at all phases
• Identify substance of policy and construct a
  process that will bring people together
• Allocate resources for stakeholders

Implementation

• Formulation

Monitoring evaluation
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Basic principles

• Linked with basic health goal
• Economic goal should not sacrifice health
  objectives
• Equity -- fairness in access
• Should be concerned with efficiency that gives
  maximum level of service given the available
  resource
• Sustainability and capacity building

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Factors for success

• Political commitment at the highest levels
• Clear and specific responsibilities for directing
  the process
• Shared ownership among key groups
• Create constituencies inside and outside the
  government
• mobilize consumers, media, NGD and other key
  groups
• Technically sound policy masterplan
• Sensible priorities implementation timetable
• Adequate financial resources

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Impact and outcomes
NDP Implementation

• Political commitment
• Clear responsibilities
• Shared ownership
• Technically sound
• Priorities timetable
• Financial resources

• Access
• Rational use
• Quality drugs

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