[e-drug] Increasing availability of essential medicines for noncommunicable diseases

e-drug
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E-DRUG: Increasing availability of essential medicines for noncommunicable diseases
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[PLEASE DO NOT CLICK REPLY.
Please respond directly to Douglas Ball <douglasball@yahoo.co.uk> as requested in the message.]

Dear E-Druggers
   Noncommunicable diseases (NCDs) such as diabetes, cardiovascular
   disease, chronic respiratory disease and cancer are now the leading
   cause of death worldwide with about 80% of these deaths occurring in
   low- and middle-income countries. NCDs threaten to undermine gains
   made in the delivery of health services in these countries with a
   substantial impact on future socio-economic development.

   The 'Global Action Plan for the prevention and control of
   noncommunicable diseases 2013-2020' and its monitoring framework
  http://www.who.int/nmh/events/ncd_action_plan/en/)
have established a set of targets for countries to meet in order to stem
   the growing epidemic of NCDs. In terms of pharmaceuticals, one target
   is of "at least 80% availability of the affordable basic technologies
   and essential medicines, including generics, required to treat major
   noncommunicable diseases" to be achieved by countries.

   I am working with colleagues at the World Health Organization to look
   at whether establishing a global or regional procurement facility for
   noncommunicable disease (NCD) medicines and technologies could support
   countries in achieving this target of 80% availability of essential
   NCD medicines or if there are other mechanisms that separately or
   together with this could do the same.

   Examples of existing procurement mechanisms that it might be modeled
   on include the PAHO Strategic Fund, the Global Drug Facilty (TB), the
   Asthma Drug Facility, the Organisation of Eastern Caribbean States
   pooled procurement or the Gulf Cooperation Council group purchasing
   scheme.

   I would welcome the views of E-Druggers on this concept of having a
   global or regional procurement facility that would be available for
   countries to purchase selected NCD essential medicines.
   - Would it be effective in addressing availability of medicines in
   facilities (public or private)?
   - Would countries be willing to use such a facility ? Would they be
   willing to pay in advance for the health products ?
   - What other support would be needed to make it effective e.g.
   forecasting, MIS ?
   - What potential pitfalls or constraints would there be ?
   - Which NCD medicines would be best suited to such a facility e.g.
   limited-source vs. multi-source products ?
   - What should WHO's role be in a procurement facility of this nature?
   - What other mechanisms are there for supporting country procurement
   units to address this issue ? e.g. procurement price transparency to
   improve negotiating power

   If you have any thoughts or advice about this, I would be pleased to
   receive them to feed into the report that will examine the
   desirability and feasibility of such a mechanism.

   Please send me an e-mail to douglasball@yahoo.co.uk with your
   comments, views, insights, experiences by 28 March 2014.

   Regards

  Douglas Ball

Temporary advisor, World Health Organization
Tel: +63-2-354.7891 (Philippines)
Mobile: +63-921.500.6806 (Philippines)
E-mail: douglasball@yahoo.co.uk

References
1. http://www.who.int/nmh/events/ncd_action_plan/en/

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E-DRUG: Increasing availability of essential medicines for noncommunicable diseases (2)
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A major contribution to increased access and also to stopping incentives for companies to develop mainly new drugs with few or no advantages for patients would be value-pricing, that is paying more than the prices of existing drugs in proportion to how much better they are than existing drugs. That's how my mother (and yours?) shopped on a limited budget, and that's what rewards good research.

The senior oncologist, Hagop Kantjarian, for example, has published several articles on the unaffordable prices of new cancer drugs that usually are little or no better for patients. Yet their high prices break the budget, cause patients to use up their lifetime savings, and have nothing to do with added value. In response, companies are devoting large portions of R&D to developing as many clinically minor new cancer drugs as they can. Income from the unwarranted high prices then pays leading oncologists to tell their colleagues how great they are.

(See http://www.medscape.com/viewarticle/805503
and others at
https://www.google.it/?gfe_rd=ctrl&ei=NDotU9HcHMfW8gfchYDQAg&gws_rd=cr#q=hagop+Kantjarian )

Don Light

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E-DRUG: Availability of essential medicines and technologies for NCDs
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[PLEASE DO NOT CLICK REPLY. Respond directly to douglasball@yahoo.co.uk
as requested in the message.]

Dear colleagues

Two weeks ago I asked for feedback on the concept of a 'drug procurement
facility' for NCD essential medicines and health technologies to feed
into a report examining this issue for WHO in order to support countries
increase availability of NCDs in line with the Global Action Plan for
NCDs. I am grateful to those who responded. I am now coming back with a
follow-up question in the event that a procurement facility is not the
highest priority.

Q: What specific actions or interventions could and/or should be done to
support countries in their own procurement of NCD essential medicines
and health technologies or to spur demand or shape supply markets?

Some of the earlier responses already spoke about the need for a systems
approach and capacity building and avoiding more 'vertical' programs
that do not need repeating. But you may have views about WHO could
direct such activities or of other innovative ways to address this need
at a regional or global level. Or perhaps you have more specific ideas
or problems you have encountered that influence the availability of NCD
essential medicines and health technologies that need to be considered
e.g. EML to be updated to reflect latest/any corticosteroid asthma
inhaler, reform of procurement laws to allow purchases from
international agencies with domestic funds, scale-up capacity of
cold-chain to support insulin procurement and distribution, etc. Or how
should demand be driven, and what steps should this follow in concert
with measures to strengthen the health system for NCDs?

The focus is largely on diabetes, CVD, chronic respiratory disease and
cancer, but this should not preclude thoughts related to other NCDs
since these principles apply across the board.

If you would like to contribute your ideas to this consultation, please
e-mail me at douglasball@yahoo.co.uk.

Thanks and regards

Douglas Ball
--
Temporary advisor, World Health Organization
Tel: +63-2-354.7891 (Philippines)
Mobile: +63-921.500.6806 (Philippines)
E-mail: douglasball@yahoo.co.uk