1. Indicators for monitoring and assessing pharmaceutical situation in countries Dr. Edelisa D. Carandang Drug Action Program (DAP) Essential Drugs and Medicines Policy (EDM) World Health Organization Geneva, 30 September 2004

2. 2 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Session objectives: n The participants will have an overview and understanding of the following: n WHO hierarchical approach to monitoring and assessing country pharmaceutical situations n The main core indicator tools n Key aspects of using the tools

3. 3 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Why monitor and assessing: n To assess country capacity (infrastructures and resources) n To review implementation strategies so adjustments can be made n To measure outcome of pharmaceutical objectives (access and rational use of quality medicines)

4. 4 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Monitor and assess for evidence-based planning n Using indicator-based monitoring tools n Systematic data gathering n Enables comparisons between facilities, districts, regions, countries depending on sampling n Facilitates measuring trends n Provides evidence for prioritising planning and interventions n Raise awareness and for advocacy 1. Assess and Monitor 2. Plan 3. Implement

5. 5 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Monitor and assess for evidence-based planning n Who can use the results from assessments? n Countries n National policy-makers n Health facilities n International agencies n Professional groups, NGO, academia 1. Assess and Monitor 2. Plan 3. Implement

6. 6 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Core indicators to monitor national drug policy http://www.who.int/medicines/strategy/policy/indicators_intro.shtml Level I indicators (structure & process) Level II indicators (outcome) Level III WHO NDP indicators Indicators for specific pharmaceutical components: How to investigate drug use in health facilities; Assessing regulatory capacity of countries. TRIPS, Drug pricing, Traditional medicines  Questionnaire  Systematic survey

7. 7 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Level I indicators n 6- page questionnaire (yes or no format) n Mostly structure and process indicators for countries n Distributed to member states every 4 years with subset every two years) n country progress indicators for global tracking n Base line & target indicators for WMS 2000-2003 and 2004- 2007 indicators. n expected results (such as EC project) n indicators for EDM programme and budget planning n All the information are entered in the EDM database.

8. 8 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Level I indicators n Covers key components of pharmaceutical system National medicines/drug policy Access Legislation and Regulation, Quality control of pharmaceuticals Essential drug list Medicines supply system Medicines financing, production* Rational use of drugs Intellectual property rights protection and marketing authorization

9. 9 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Level I: Using the data to monitor the WHO Medicines Strategy

10. 10 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Level II: Operational Package for Monitoring and Assessing Country Pharmaceutical Situations n Set of 15 survey forms to assess and monitor impact and outcome of medicines interventions n Feasible tool that can be used by countries in regular monitoring n Designed around practical/operational system of managing resources (time, people and money) n Step by step procedure and guidelines administrative preparation (coordination tools, budget, training slides and schedule) technical requirements (training and field test, survey, analysis tools, reporting framework, and identifying recommendations for intervention)

11. 11 -- (Monitoring & assessment - 1/19/2016) WHO - EDM List of indicators n Availability, price, and expiry of key medicines n Affordability (child and adult moderate pneumonia and option for other disease condition) n Cost of medicines and related fees n Stockout and record keeping n Conservation conditions and handling of medicines n Number of medicines prescribed, % dispensed, % antibiotics, % injection, % on EML, % prescribed by generic name n Labelling and patient knowledge of how to take the medicines n Availability of EML and STG n Tracer cases of diarrhoea, pneumonia, ARI, and option for other disease condition treated according to STG

12. 12 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Sampling Recommendations n Sample n 6 regions/districts n From each region: 5 public health facilities with pharmacy/dispensary 5 private pharmacies 1 warehouses n Option to add private facilities, mission clinics depending on health service mix or provider

13. 13 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Level II country surveys have been implemented in: AFRO: Chad, Ethiopia, Ghana, Mali, Nigeria, Tanzania, Uganda, Camerooon, Kenya, Rwanda, Senegal, Namibia AMRO: Guatemala, Columbia, Brazil EMRO: Iran, Oman EURO: Bulgaria, Kyrgyzstan, SEARO: Indonesia, Nepal WPRO: China, Philippines, Malaysia, Cambodia, Laos

14. 14 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Monitoring and assessment can be used to see if there is progress

15. 15 -- (Monitoring & assessment - 1/19/2016) WHO - EDM To validate access estimate: if essential medicines are available and affordable

16. 16 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Profile on global issues such as inappropriate use of antibiotics: countries have planned to implement appropriate strategies

17. 17 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Survey makes possible the comparison of public and private pharmacies

18. 18 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Survey makes possible the comparison of public and private pharmacies

19. 19 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Household survey to measure access and use of medicines n One-page survey (13 questions) n Collects information on: n Health seeking behaviour leading to use or non use of drugs n Affordability, from where the medicines are obtained, and if not all are obtained the reasons why not n Field testing n in conjunction with Level II n Working group developing questionnaire, sampling framework, and manual

20. 20 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Lower income groups do not get all the medicines they need

21. 21 -- (Monitoring & assessment - 1/19/2016) WHO - EDM Household survey: Reasons households reported for not being able to obtain all prescribed medicines for most recent illness: Tanzania

22. 22 -- (Monitoring & assessment - 1/19/2016) WHO - EDM The way forward on country monitoring n Evidence through systematic but feasible data collection process is necessary in policy making and activity implementation n Should demonstrate that in the long run regular monitoring is not difficult and can be done in a cost efficient manner n Portion of country support budget and project grants should be allotted to monitoring and evaluation using indicators n Information sharing: studies and results will be available in the web