Pharmaceutical Sector Country

Profiles
Experiences and Plans

Dr Gilles Forte
Dr Richard Laing
Essential Medicines and Health
Products Department
WHO HQ
 Issues to address

 A vast amount of information exists on the

pharmaceutical sector of countries;

 BUT this information is often not available to the public

or even to decision makers in the countries involved;

 Duplication of efforts with multiple data collection

initiatives in the same country; not always endorsed;

 This information is not always reliable.

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 WHO Pharmaceutical Sector Monitoring Tools

High-level policy information (Country

Profiles), through a global survey
•Questionnaire to Ministry of Health
•Indicators on structures, policies and
outcomes;
•Carried out every four years CP
High-level information
Mostly structures and
Health facility and household surveys policies
(Level II)
•Surveys based on interviews
•Indicators on policy outcome Level II
Core outcome/impact indicators
•Upon country request & household survey

Topic-specific studies (Level III)

Level III
•More detailed indicators for monitoring
and evaluating specific areas/components Indicators for specific components of the
pharmaceutical sector:
•Upon country request
Pricing Rational use
Human Resources Assessing regulatory capacity
Procurement and Supply

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 Content of the Country Profile questionnaire

 The questionnaire is divided into 9 chapters:

– Health and Demographic data.
– Health Services.
– Policy Issues.
– Medicines Trade and Production.
– Medicines Regulation.
– Medicines Financing.
– Pharmaceutical Procurement and Distribution.
– Selection and Rational Use.
– Household data/access.

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 Rationale for Country Profiles

 Assist countries produce reliable indicators and information on structures,

processes and outcomes; using existing data e.g. pricing & availability;
 Support countries to establish a unique and reliable source of information for
identifying gaps, carrying out policy dialogue and policy formulation;
 Information available for coordination of international partners in countries;
 Global survey in 193 Member States every four years; comparisons among
large number of countries (156 in 2007; 130 in 2011), regions and income
groups;
 Systematic data collection allows comparison over time (2003,2007,2011);

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2011 Survey: ensure quality of information
 Year and source of each piece of information is recorded and key documents are provided and stored
in the WHO Medicines Library. Fields for comments are provided to allow respondents to provide more
nuanced information;
 A manual with instructions to fill in the questionnaire has been developed to guide data collection; English,
French and Spanish;
 A glossary with definitions of key items has been produced to make sure questions are interpreted
consistently across countries and regions;
 Names and contacts of respondents are collected and interactions with WHO are taking place for data
quality checking;
 Data is endorsed by a senior Official at the Ministry of Health as official country information and
authorisation for disclosure granted;
 Quality checking of information is supported by WHO at HQ and Regional Offices. This is done through:
– Checking with previous information available for the country;
– Checking for consistency within the questionnaire;
– Cross checking with other sources and profiles (for example, National Health Accounts);

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 2011 Survey: reduce
r burden of data
collection in countries
 Core and supplementary indicators defined; Mostly Yes/No questions; limited
financial and human resources needed;
 Questionnaires have been prefilled for 193 Member States with all information
available at WHO HQ. About 50% of each questionnaire has been prefilled.
Countries are asked to verify the information provided and fill in gaps; WHO support
provided for quality checking;
 The Country Profile is meant to be an official and unique source on
pharmaceutical sector information in the country for national and international
experts; It is expected that the availability of reliable information will reduce data
collection initiatives in countries;
 The questionnaire has been endorsed by The Global Fund to replace GF Health
Products Management (PHPM) Profile. In 2011, It has been an important source of
information and step for GF grant signing; Joint data collection between WHO and
GF has been carried out in countries;
 Discussions are ongoing to align the questionnaire with other International agencies
e.g. Unicef, World Bank;

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 Countries involvement and WHO support

 The survey is coordinated by the Ministry of Health in countries and involves

relevant national institutions e.g. MRA, NHA etc.;
 EMP and 6 Regional Advisers are involved in the coordination of WHO support for
country profiles completion and for collaboration with GF;;
 At country level, WHO Medicines and Health systems experts collaborate and
support the Ministry of Heath for collection of quality information, coordination with
national institutions and GF representatives and for use of data for policy dialogue
and formulation;
 Country profiles are meant to be updated and published every four years;

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 WHO: 193 Member States
6 Regional Offices
)Source: http://www.who.int/about/regions/en/index.html(

Medicines Adviser =

Collaborating Centre =

Regional Office AFRO Regional Office EMRO

Regional Office EURO Regional Office WPRO WHO HQ Geneva
Regional Office SEARO Regional Office AMRO

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 Country Profiles
http://www.who.int/medicines/areas/coordination/coordination_assessment/en/index1.html

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Regional, Global and Technical reports
 Africa, Europe, Western Pacific, Americas, Caribbean
and Eastern Mediterranean Regions

 Technical include Financing and Pricing, Selection

Rational Use & ? Regulation

 Global report

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 RESULTS

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 Global Report
 1. Introduction
2. Methods
3. Health and Demographic Results
4. Health Services
5. Medicine Policy Issues
6. Medicines Trade and Production
7. Medicines Regulation
8. Medicines Financing
9. Pharmaceutical procurement and
Distribution
10. Selection and rational use of
medicines

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Health expenditure as % of govt budget

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Table 4.1.5: Total Pharmaceutical Expenditures (2010)
Population Total Pharmaceutical Expenditure
Country
group Per
(number of Millions % Million US$ % %THE %GDP capita
countries) (US$)
WHO region
Africa (43) 819 12.1% $19,464 1.7% 23.0% 1.3% $10.59
Americas
(35) 923 13.6% $436,004 38.7% 19.8% 1.3% $87.30
Eastern
Mediterranea
n (19) 573 8.4% $20,763 1.8% 20.1% 1.2% $50.31

Europe (52) $308.4

896 13.2% $331,683 29.5% 21.5% 1.6% 8
South-East
Asia (10) 1,783 26.2% $41,157 3.5% 33.2% 1.3% $13.05
Western
Pacific (27) 1,800 26.5% $276,362 24.6% 18.7% 1.2% $37.90
World Bank income group

High-income $463.5
(49) 1,092 16.1% $775,305 68.9% 18.5% 1.4% 9
Upper-
middle-
income (55) 2,474 36.4% $283,864 25.2% 21.2% 1.3% $96.78
Lower-
middle-
income (50) 2,480 36.5% $59,580 5.3% 23.6% 1.3% $26.28
Low-income
(32) 749 11.0% $6,683 0.6% 27.7% 1.6% $8.01
Global
Global (186) 6,795   $1,125,433   20.8% 1.4% $68.78
Source: World Health Organization Global Health Observatory Database, 2013
National Health Accounts, 2013

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Median number of pharmacists per 10,000 by
WHO Region

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 Taxes on medicines
VAT on Pharmaceuticals

25%
21%
20%
20% 18% 18%
15% 15% 15%
14% 14%
15% 13%
12% 12%
10% 10% 10% 10% 10%
10% 8%
7%

5%

0%

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HIV/AIDS antiretrovirals provided free at primary
healthcare facilities over time by income group

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Global,Regional and Technical Reports
 Web Publications of Country Profiles and
Data available at:
http://www.who.int/medicines/areas/coordin
ation/coordination_assessment/en/index1.h
tml

 Regional Reports for AFRO, EURO, WPRO

produced by Regional Offices and Utrecht
University CC

 Global Report produced by HQ Team,

University of Utrecht CC, Jonny Meldrum,
Catherine Shih

 Technical Reports on
– Financing and pricing
– Selection
– Rational Use

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 Evaluation of 2011 PCP Survey
 Quantitative Evaluation
– Data from 143 responders and 54 prefilled
– Response rates over 60% for the core indicator questions
highest was Health and Demographic data, 84% and was lower
for Procurement (57%), Medicines Financing (48%) and
Household data (22%)
– 324 questions out of the 493 core and supplementary
questions were prefilled, representing a 66% average prefill
rate for the entire questionnaire.
– Of these 324 prefilled questions, 208 were changed by one or
more of the respondents, representing an average change rate
of 65% for the entire set of prefilled questions

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 Qualitative Evaluation
– 37 respondents replied with follow up in depth telephone interviews
were undertaken with 7 respondents. A conference call was also made
with the EMRO senior staff.
– Prefilling was recognized as being helpful and efficient in the validation
and completion of the questionnaire and focussed country attention on
data to be checked and/or changed.
– The length of the questionnaire was considered reasonable.
– The Instruction Manual and Glossary were not always thought to be
useful in their current format
– There was frequent criticism of the use of the Word based instrument
including problems with macros with strong support for the use of a web
based software for the next survey.

  

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Plans for 2015 Country Profile Activities
 Evaluation of 2011 Survey Quant and Qual 3 months 2 BU interns

 Meet with NPOs and Regional Advisers Sept 2013

 Revise pilot questionnaire and consult Technical units Oct 2013

 Generate and Prefill questionnaire Nov Dec 2013

 Revise manual, glossary and questionaire

 Work with RA’s and 12 Pilot countries Feb 2014

 Send out March 2014 to 12 pilot countries complete by end May 2014

 Clean, analyze and write 2 reports (Summary and Process) June-July 2014

 Revise Global questionnaire, prefill and set up instrument Aug-Dec 2014

 Send out Jan 2014 with regional and HQ support Jan-April 2015 * * * * * * *

 Clean analyze and write country reports May-July 2015 * *

 Write global, regional and technical reports Aug-Dec 2015 * *

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 Global Health Observatory

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