E-DRUG: Integrating pharmaceutical systems strengthening in the current global health scenario (2)
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Dear E-Druggers,
We enjoyed reading this commentary (Hafner et al. Integrating pharmaceutical systems strengthening in the current global health scenario: three 'uncomfortable truths'. Journal of Pharmaceutical Policy and Practice 2020; 13:38;
available at
https://joppp.biomedcentral.com/articles/10.1186/s40545-020-00242-2
Hafner and colleagues reflect on the triple transition ongoing in low- and middle-income countries: a shift from development assistance to domestic resources, an epidemiological transition from communicable to noncommunicable diseases, and a reorganisation of national health systems to meet universal health coverage goals. They further note that the important challenges that remain in ensuring a population's access to and appropriate use of medicines and services, require pharmaceutical systems strengthening approaches; and that doing so requires recognition of three interrelated and 'uncomfortable truths'.
First, pharmaceutical systems strengthening is a complex process that may not align with the short time frame of donor-funded programmes; this is the case, for example, of the efforts and investments needed to strengthen the capacity of national regulatory agencies, so as to ensure that all medical products circulating in a country are safe, effective, and quality-assured.
Second, pharmaceutical systems strengthening includes strengthening governance, which in turn requires country ownership and sustained engagement with multiple stakeholders, within and outside the immediate health sector.
Third, it is not clear what systems strengthening interventions work and why, and the lack of consensus on reliable measures limits the ability to make persuasive investment cases for national governments and donors.
The WHO Global Benchmarking Tool for evaluation of national regulatory systems and the WHO Joint External Evaluation tool could serve as models for a possible approach.
Overall, it is increasingly clear that it is important to find ways to balance the short-term focus on the efficiency of disease-specific programmes and the broader, longer-term health and development objectives. Importantly, this will require a shift away from viewing medicines solely as an input commodity, or supply chain management concern, to a more holistic and comprehensive view that recognizes the various structures, processes and their interactions within the broader health system that help ensure access to and appropriate use of medicines and related services. It is also important to build the evidence base and agree on the metrics for evaluating the effectiveness of pharmaceutical systems strengthening interventions with respect to health and population outcomes.
Have a nice reading,
Raffaella Ravinetto, Public Health Department, Institute of Tropical Medicine, Antwerp
Richard Laing, Retired Professor, Department of Global Health, Boston University School of Public Health
Raffaella Ravinetto <rravinetto@itg.be>