Transcript Corruption, a major barrier to access to medicines

Corruption, a major barrier to access
to medicines
WHO/UNICEF Technical Briefing Seminar
21 September 2006
Dr Guitelle Baghdadi
World Health Organization, Geneva
Department of Medicines Policy and Standards
Department
of Medicines Policy and
April 2006 – Corruption, barrier to access to medicines 1
Standards
Corruption requires two parties: the corrupter
and the corruptee
"Whose is the greater blame?
She who sins for pay or he
who pays for sin?"
Sor Juana Inés de la Cruz
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 2
Overview
Corruption in the pharmaceutical sector
WHO Good Governance for Medicines project
A few questions…
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 3
Overview
Corruption in the pharmaceutical sector
WHO Good Governance for Medicines project
A few questions…
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 4
Corruption identified as the single greatest
obstacle to economic and social development
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US$ 3 trillion spent on health services
annually
Pharmaceutical expenditure: 20 to 50% of
total health expenditure (dev. countries)
10 to 25% procurement spending lost into
corruption (including health sector)
Some countries report that 2/3 medicines
supplies lost through corruption and fraud
in hospitals
Affects also donor community: GFATM
suspended or terminated grant agreement
because of corruption concerns
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 5
Potential unethical practices could be found
throughout medicines chain
Evergreening
R&D and clinical trials
Bribery
Collusion
Patent
Fraud
Manufacturing
Overinvoicing
Cartels
Registration
Pricing
Falsification of
safety/Efficacy data
Selection
Conflict
of interest
State/regulatory
capture
Thefts
Counterfeit/
substandards
Unethical
donations
Procurement & import
Unethical
promotion
Pressure
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 6
Tax evasion
Distribution
Promotion
Inspection
Unethical practices can have significant
impact on the health system
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Economical impact
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Health impact
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Pharma. expenditure low-income
countries:
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10-40% of public health budget
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20-50% of total health care
expenditures
Poor most affected  inequalities
Lack EM  increases morbidity & mortality
Unsafe medicines on the market
Irrational use of medicines
Image and trust impact
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Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 7
Reduces government capacity
Reduces credibility of health profession
Erodes public trust
Efforts to address corruption need application
of two basic strategies: "discipline" & "values"
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"Discipline approach" (top-down)
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Legislative reform: establishes laws
against corruption with adequate punitive
consequence for violating the laws
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Attempts to prevent corrupt practices
through fear of punishment
"Values approach" (bottom-up)
Promotes institutional integrity through
promotion moral values and ethical
principles
Coordinated application
of both strategies
 Attempts to motivate ethical conduct of
required public
for significant
impact
servant
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Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 8
Overview
Corruption in the pharmaceutical sector
WHO Good Governance for Medicines project
A few questions…
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 9
Good governance for medicines regulation and
procurement
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Goal
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Curb corruption in the pharmaceutical public
sector through promotion of ethical practices in
medicines regulation and procurement by health
professionals and the application of transparent
administrative procedures
Objectives
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Increase awareness on potential for corruption
and impact on health systems functioning
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Increase transparency and accountability in
medicines regulatory authorities and procurement
systems
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Build capacity for good governance
Department of Medicines Policy and Standards
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Implemented in countries with a 3-step
approach
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Phase I:
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Phase II:
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National assessment of transparency &
vulnerability to corruption
Development of national ethical framework
based on consensus building
Phase III:
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Socializing the national ethical framework
through reflection meetings and training
national officials on good governance.
Department of Medicines Policy and Standards
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Bottom-up approach in implementation of
project and policy development
Phase 1 (3 countries)
Phase 2 (4 countries)
Department of Medicines Policy and Standards
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Assessment tool: measures transparency in the public
pharmaceutical sector & vulnerability to corruption:
diagnostic tool  recommendations
Evaluation indicators
(questionnaires)
Collect information and
perceptions (interviews)
Analyse information
collected:
rough quantification
narrative description
(report)
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 13
Phase II: development of national ethics
infrastructure based on consensus building
1. Framework of moral values and
ethical principles
2. Code of conduct (CC)
3. Mechanisms for whistle-blowing
4. Control of reprehensible acts
5. Coordination, management and
evaluation programmes
6. Tools for promotion and
socialization of framework & CC
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 14
Phase II: development of national ethics
infrastructure based on consensus building
1. Framework of moral values and
ethical principles
2. Code of conduct (CC)
3. Mechanisms for whistle-blowing
4. Control of reprehensible acts
5. Coordination, management and
evaluation programmes
6. Tools for promotion and
socialization of framework & CC
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 15
Focus on consolidating on-going efforts in
countries and possibly add few new ones
Phase 1 (4 countries)
Phase 2 (4 countries)
Department of Medicines Policy and Standards
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Overview
Corruption in the pharmaceutical sector
WHO Good Governance for Medicines project
A few questions…
Department of Medicines Policy and Standards
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A few questions for reflection…
1. Do you believe that corruption exists in your
country? Isolated cases or permissive culture?
2. What are the most common forms?
3. What are the possible causes?
4. What makes the pharmaceutical sector so
vulnerable to corruption?
5. What do you think needs to be done to tackle
corruption in the pharmaceutical sector on the
long run?
Department of Medicines Policy and Standards
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"Corruption is a powerful force, but it is not
inevitable or unavoidable. Diminishing its
impact restores diverted resources to
their intended purpose, bringing better
health, nutrition and education to victims
of corruption around the world, and with
them, opportunity and hope."
Transparency International
Department of Medicines Policy and Standards
April 2006 – Corruption, barrier to access to medicines 19