Transcript Title of presentation - Medicines Transparency Alliance

Towards Improving
Availability of Essential
Medicines in Jordan’s
Public Health Sector
Presenter Name
Job Title
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Medicines Transparency Alliance
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Overview of Public Health Sector

Jordan is characterized by a diverse and fragmented public
health sector. It consists of: MoH, RMS, two University Hospitals,
King Hussein Cancer Center and Prince Hamzeh Hospital

The public health sector covers about 72% of the population

Pharmaceutical expenditure as % of total health expenditure is
34.0%

Public pharmaceutical expenditure as % of total pharmaceutical
expenditure accounts for 33.3%.

Pharmaceutical expenditure is growing at 17% annually
compared to GDP growth of 3.3%

The public sector is represented at the Jordan MeTA Council by
9 members out of 18
Source: Jordan National Health Accounts (NHA) 2007
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Problem Definition

The biggest challenge in our public sector is poor
availability and certain essential drugs are consistently outof-stock.

In 2004, the WHO/HAI study of prices, availability and
affordability of essential showed that availability in the public
sector is extremely low, with a median of 28% availability
of essential medicine (this results in patients having to buy their
medicine in the private sector at higher prices).

Generics were found to be as much as 10x more expensive
in private sector than in public

Originator brands cost 2x as much as generics in private
sector
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Problem Definition cont.

Lack of national STGs and Rational Drug Use (RDU): we
cannot ensure that healthcare treatment options provided to
populations are the best and most appropriate that the country
can afford without having providers adhere to national STGs

Unethical promotion of medicines by pharmaceutical
companies to prescribers increases cost of individual treatment
courses, not allowing public sector to purchase appropriate costeffective medicines

Need to consider pharmaco-economic evidence-based
medicine (EBM) in decisions of selection of medications in the
RDL
The budget that the Government is willing to allocate for
medicines should be evaluated considering RDU, since RDU
might be one of the main reasons for high expenditure in
medicines
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Problem Definition cont.

Public Sector Supply Chain: logistics inefficiency in the MOH/
public sector is due to:
1. Insufficient space in main warehouse. The (JPD) orders are not
spaced in time - twice a year quantity of goods received often
exceeds capacity of main warehouse. This forces Supply
Department to organize ad hoc shipments to secondary
warehouses in North & South of our country
2. Warehouse equipment is not adequate in terms of racks design,
labor security, tooling, IT system… etc.
3. Poor visibility (ability to track and trace shipments) in the
Supply Chain after product is delivered to districts, interfering with
ability to create optimal stock positioning
All these issues affect medicines availability !
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How MeTA has addressed Availability
The MeTA Council identified medicines availability as a key
issue to address in the MeTA country workplan by:

Recommending that selection of medicines on RDL should be
implemented using evidence based & pharmaco-economic
concepts

Improving rational use of medicine and developing national
STGs. Poor adherence to STGs and irrational drug use makes
supply planning very difficult, leading to demand for particular
drugs, in turn leading to stock-outs, supply imbalances, and to
lower availability

Commissioning a study to analyze the supply chain to come up
with recommendations to improve efficiency
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Milestones
The following activities have been accomplished under
the MeTA initiative in Jordan:
1. UNDER Baseline pharmaceutical assessments on Price,
Availability and Use
•
Collaborating with WHO, the MeTA Council is overseeing the Baseline
Level-II Assessment and Household Survey, which also includes the
WHO/HAI Pricing Component.
This enables MeTA Jordan to have strong updated primary data & evidence to
advocate for necessary policy changes to improve availability of medicines. In
addition, the surveys provide a baseline against which to measure impact of
MeTA interventions in the future.
2. UNDER introducing Pharmaco-economic, evidence-based
medicine (EBM) in the RDL:

Organized a national workshop to raise awareness of the concepts of
evidence-based medicine (EBM), pharmaco-economics to PTCs &
RDL committees
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Milestones cont.

Reviewed classification of drugs (restricted, unrestricted,
authorized) in RDL and suggested detailed evidence based
regulations for implementation of classification of drugs
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Reviewed TORs and SOPs of various disease-related
committees involved in selection of drugs (COI declaration, and
development of COI guidelines)
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Reviewed criteria for adding and deleting drugs to and from RDL
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A workshop was conducted on use of cost effectiveness tools to
pharmacists from Local Industry and Generic Importers and to
MoH/ PTC
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NEXT STEPS: a workshop will be held to promote adherence to
RDL by prescribers in the public health institutions
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Milestones cont.
3. UNDER Rational Drug Use:
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Conducted a gap and situation analysis for availability and use of
STGs
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Developed an Essential Hypertension STG, based on best
available evidence adapted for the Jordanian setting, with
technical help from UK NICE
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Organized a workshop to promote rational use of medicines to
prescribers, dispensers and consumers
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NEXT STEPS:
–
will develop and implement a strategy to stimulate the acceptance
and use of the STG by health providers in the public sector
–
will organize a workshop to promote ethical promotion of medicines
guidelines to healthcare providers in the public sector
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Milestones cont.
4. UNDER Procurement
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Worked with JPD and its stakeholders/ public health institutions
to review procurement guidelines and to promote adherence to
good procurement guidelines and procedures
5. UNDER Supply Chain
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Commissioned the analysis of the Medicines Supply Chain in
Jordan
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Successes and Impact

The MeTA Council decided to update the 2004 WHO/HAI pricing
& availability survey by working with WHO to conduct a WHO
level 2 household, health facility and pricing surveys.
Preliminary results of the 2009 WHO/HAI Pricing
Component show a median availability of 58.8% for
lowest-priced generic essential medicines in the public sector.

The process is underway for getting official approval for the newly
developed Essential Hypertension STG from the RDU Steering
Committee, headed by the Minister of Health and the
implementation plan is being developed

Transparent Good Procurement practices have been approved
by JPD stakeholders and are being implemented
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Successes and Impact
NEXT STEPS:

Results from WHO/HAI pricing survey and WHO level 2
household and health facility surveys, will be presented to the
Minister of Health and will provide updated evidence for
discussion with the MeTA Council on potential policy
interventions that could help solving the problem of low
availability

A national workshop to build consensus with all governorate
partners, prescribers and dispensers will soon be held on the
model Essential Hypertension STG and the very first steps of
the implementation plan.
In addition, measurable indicators will be set prior to and after
the use of the STG to assess impact on availability of medicines
for essential hypertension.
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Challenges

The two year period for the MeTA pilot is too short to measure
outcomes and impact on availability of medicines in the public
sector and on Rational Drug Use
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High prices in the private sector affect the public sector,
since lack of availability of medicines in the public sector will lead
to patients buying their medicines from the private sector
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High Physician autonomy and resistance to adherence to
STGs and challenge is to obtain all health stakeholders 'buy in' to
following national STGs
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Changing patient behaviour in terms of medicine
consumption to improve Rational Use
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Powerful pharmaceutical company promotion of medicines
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Lessons learned
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UPDATED country baseline pharmaceutical data should have
been collected and available prior to deciding on interventions to
solve the main problem of lack of availability of medicines in the
public sector
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It was important to involve primary care & specialist
physicians in developing the model STG for Essential
Hypertension, in order to ensure their ‘buy in’/leadership in
helping convince their peers of benefits of implementing STGs to
improve rational use of medicines and ultimately access to
essential medicines
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More time is needed in order to measure impact of interventions
for improving availability
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A multi-stakeholder approach, with all sectors working
together, is needed to improve availability and Rational Use of
Medicines
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References
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2004 HAI/WHO Medicine prices, availability, affordability & price
components in Jordan- Rania Bader (2007)
http://www.haiweb.org/medicineprices/surveys/200405JO/survey_report.pdf
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Analysis of the Pharmaceutical Supply Chain in Jordan- Prashant Yadav,
Simon Conesa, Rania Bader (2009)
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WHO (2008) Jordan Country profile: World Health Report
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National Health Accounts of 2007 (published July 2009)
http://www.who.int/nha/country/jor/jordan_nha_2007.pdf
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Medicines Transparency Alliance: Scoping Report for Hashemite Kingdom
of Jordan - Samia Saad(2007)
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Jordan National MeTA Workplan (February 2009)
http://www.medicinestransparency.org/fileadmin/uploads/Documents/MeTAJordan-workplan.pdf
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World Bank Health Sector Reform Project Final Report- Jordan http://wwwwds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2005/06/01/000090341
_20050601121727/Rendered/PDF/31986.pdf
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Thank you

Name of presenter:

Job Title:

Email:
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Mobile number: +962
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Website: www.meta.jo
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