Publication:
Improving Transparency in Pharmaceutical Systems : Strengthening Critical Decision Points Against Corruption

Loading...
Thumbnail Image
Files in English
English PDF (1.61 MB)
1,571 downloads
English Text (329.41 KB)
165 downloads
Published
2002-10
ISSN
Date
2014-10-14
Editor(s)
Abstract
This study presents a diagnostic framework and methodology to evaluate a pharmaceutical system s vulnerability to corruption and to determine which corrupt practices can have a major impact on the system s ultimate efficiency. We thus provide: (a) a systematic and quantifiable assessment of the extent to which a country s pharmaceutical system is vulnerable to corrupt practices; and (b) the identification of potential actions to increase the system s resistance to corruption, and ultimately, improve access of the population to good quality, essential medicines. The diagnostic framework and methodology permit users to identify key decision points in the pharmaceutical supply and distribution system (registration, selection, procurement, distribution, service delivery and use); assess the extent to which a country s current policies and practices at each of these key decision points make the system vulnerable to corruption; and understand the range of options that could reduce this vulnerability. This diagnostic tool has been designed for use by World Bank health specialists involved in health lending operations that include pharmaceutical components, and their national counterparts to help them identify points of vulnerability in the pharmaceutical system, address these points, and thus help ensure that pharmaceutical expenditures are maximized. While developed in the context of the health systems of Latin America and the Caribbean (and implemented in a pilot study in Costa Rica), the methodology can be modified with ease so that it is applicable to other regions.
Link to Data Set
Citation
Cohen, Jillian Clare; Cercone, James A.; Macaya, Roman. 2002. Improving Transparency in Pharmaceutical Systems : Strengthening Critical Decision Points Against Corruption. © http://hdl.handle.net/10986/20426 License: CC BY 3.0 IGO.
Digital Object Identifier
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections

Related items

Showing items related by metadata.

  • Publication
    Financing, Pricing, and Utilization of Pharmaceuticals in China
    (Washington, DC, 2010) World Bank
    This paper examines the financing, pricing, and utilization of pharmaceuticals in China the pharmaceutical system as it has evolved, and some changes that would improve it in the context of the national health reform process. The present paper builds upon earlier critical reviews and other papers published in the series china health policy notes. The paper is divided into four parts. The first section provides an overview of the Chinese pharmaceutical market: how the sector has grown; China's position in the global market; and size, composition, and trends in the domestic market. The second section examines the evolution and status of China's system of essential medicines, an area emphasized in the government's health reform plan announced in April 2009. It shows how the use of essential medicines has evolved over the two decades since the idea was formally adopted, and discusses why practice has fallen far short of the ideal. The third section looks at the issue that dominates today's debate: managing high pharmaceutical costs. It reviews the components of drug pricing, underscoring the argument that there is considerable scope for reducing prices. It looks at government attempts to control drug prices, and suggests why they did not succeed. Finally, the fourth section suggests measures to re-chart the path to reform.
  • Publication
    Assessment of Governance and Corruption in the Pharmaceutical Sector : Lessons Learned from Low and Middle Income Countries
    (World Bank, Washington, DC, 2010-01) Diack, Aissatou; Seiter, Andreas; Hawkins, Loraine; Dweik, Imad Subhi
    Pharmaceuticals are a critical input for the health sector. At the same time, the drug business sustains many individual and corporate livelihoods and produces handsome returns for those involved in the trade. Good governance is critical for the sector to maximize returns for public health and minimize risks for patients from ineffective or contaminated drugs. Given the large financial volume of the market, the potential for corruption is significant. Vulnerable points are those at which decisions about market access and purchasing are made. This includes institutional functions such as licensing, inclusion into formularies and public procurement as well as the individual prescriber, who selects drugs for a specific patient. Given the political and institutional resistance against more transparency from the beneficiaries of the status quo, assessment of governance and corruption in the sector is not a straightforward exercise. The authors developed a more indirect approach that relies on a broader assessment of the functioning of the sector and detection of patterns that suggest governance or management problems. From a developmental perspective, the focus is on reducing the impact of bad governance (high drug prices, stock-outs, bad quality of drugs in circulation, irrational use of drugs) rather than identifying the actors and bringing them to justice. Even if the governance level cannot be touched due to political resistance, it may be possible to address the problem from a technical or management angle. For example, electronic procurement platforms and inventory management systems make manipulation more difficult and allow for a faster discovery of irregularities. The assessment framework was applied in eight countries, with adjustments based on client demand and political viability. In most cases, a follow-up after the assessment could be documented, showing that the data provided had relevance and impact in the national policy dialogue. Three of the eight countries signed up to a longer term program to increase transparency in the sector (medicines transparency alliance), others initiated specific projects to address issues that were presented as a result of the initial assessment. In summary, the authors work could demonstrate that it is possible to effectively address pharmaceutical governance issues in the context of a broader sector assessment an approach that may face less political resistance than an inquiry based on a "governance and corruption" labeled instrument.
  • Publication
    The Pharmaceutical Sector in Ghana
    (World Bank, Washington, DC, 2009-11) Gyansa-Lutterodt, Martha; Seiter, Andreas
    Main pharmaceutical policy goals in Ghana are access to essential medicines for everybody, quality assurance for all drugs on the market, a functioning and efficient supply chain as well as rational use of medicines by professionals and patients. There is also a commitment to strengthen the domestic pharmaceutical industry, outlined under health industry in the national health policy. The National Health Insurance System (NHIS) has significantly improved access to medicines for insured patients, measured in increased utilization of facilities and rapidly growing turnover of revolving drug funds. The risk is now that non-rational prescribing and fraud lead to a growing medicine bill that threatens financial sustainability of NHIS. On the other hand, National Health Insurance Authority (NHIA) has the resources and purchasing power to influence provider behavior as well as the market in terms of quality and price. The purpose of this policy note is to provide a compact overview of the situation, trends and opportunities in the pharmaceutical sector in Ghana as relevant to the strategic objectives in the five year program of work. It summarizes data from a number of recent studies and reports that were done by a range of partners inside and outside the country as well as discussions with key stakeholders in the sector. The intent is to give decision makers up-to-date background information and provide some suggestions for specific policy initiatives designed to achieve the work program objectives, with a particular focus on the role health insurance can play to stabilize and improve service delivery, increase access to quality medicines and promote rational use. The overall legal framework for the pharmaceutical sector is set by the Food and Drugs Law from 1992, amended by Act 523 in 1996. It defines the role of the food and drugs board as separate entity under control of the Ministry of Health (MOH), responsible for regulating the sector. The Food and Drugs Board (FDB) also runs the official drug quality control laboratory that is in charge of testing quality samples obtained from manufacturers, importers, distributors or other sources. The FDB is also working on an improvement of its public website in an effort to strengthen communication with the general public to increase transparency and improve governance.
  • Publication
    Turkey
    (Ankara, World Bank, 2008) Celik, Yusuf; Seiter, Andreas
    Pharmaceuticals are essential to achieve health outcomes, but are at the same time a major cost factor in every health system. From a patient perspective, access to pharmaceuticals is a proxy for the functioning of the health system. With increasing economic strength, patients become more demanding with regard to access to modern, sophisticated drugs and providers become more aggressive in marketing those drugs. This paper reflects the situation in the pharmaceutical sector in Turkey, identifies critical issues, and discusses policy options based on current trends and the overall policy objectives of the Turkish government. This paper is structured as follows: chapter one gives introduction; chapter two gives overall policy objectives in the pharmaceutical sector in Turkey; chapter three presents institutional and regulatory framework; chapter four presents reimbursement rules; chapter five focuses on governance issues in the pharmaceutical sector; chapter six gives market overview; chapter seven gives payment for pharmaceuticals in Turkey; chapter eight presents prescribing practices - rational use of medicines; and chapter nine gives conclusions and way forward.
  • Publication
    Starting from Scratch in Timor-Leste : Establishing a Pharmaceutical and Medical Supplies System in a Post-Conflict Context
    (World Bank, Washington, DC, 2009-06) Huff-Rousselle, Maggie
    This case study analyses the challenges of establishing a pharmaceutical and medical supplies system in a Timor-Leste post-conflict context. In the aftermath of its separation from Indonesia, the Timor-Leste health infrastructure was in total disarray, with more than a third of health facilities destroyed, and those remaining severely damaged. The crisis in human resources was severe, as more than 80 percent of qualified public-sector staff had returned to Indonesia. The resultant heavy dependence on expatriates was complicated by language incompatibility, and nationals were not well integrated into planning and implementation processes, as an entire public sector infrastructure was being established de nouveau. Despite the fledgling status of the public sector, a sophisticated organizational framework was envisioned for the establishment of the health sector supply system: an autonomous agency that would be a non-profit wholesaler or revolving drug fund and a public sector monopoly. The case study reviews the development of the policy and legal framework for the pharmaceutical sector, and the key phases of the commodity supply system, including: product selection through an essential drugs list; procurement hampered by use of procedures that were not appropriate for purchasing drugs for an entire country; the establishment of a centralized warehousing and distribution system; projected financing of the supply system through development of a business plan for the autonomous agency. In its exploration of the transition from post-conflict situation to health system development, the case study identifies lessons that are broadly applicable to foreign aid and external assistance in other contexts, including the tendency to 'poly-prescribe' overly ambitious and overly sophisticated solutions not pragmatically grounded in the current realities of public sector institutional and human resource constraints and capabilities.

Users also downloaded

Showing related downloaded files

  • Publication
    Doing Business 2010 : Reforming through Difficult Times - Comparing Regulation in 183 Economies
    (World Bank, 2009) International Finance Corporation; World Bank
    Doing Business 2010 is the seventh in a series of annual reports investigating the regulations that enhance business activity and those that constrain it. Doing Business presents quantitative indicators on business regulations and the protection of property rights that can be compared across 183 economies-from Afghanistan to Zimbabwe-and over time. The methodology for the employing workers indicators changed for Doing Business 2010. Research is ongoing in two new areas: getting electricity and worker protection. Initial results are presented in this report. The paper includes the following headings: overview, starting a business, dealing with construction permits, employing workers, registering property, getting credit, protecting investors, paying taxes, trading across borders, enforcing contracts, and closing a business.
  • Publication
    Implementation Know-how Briefs to Support Countries to Prioritize, Connect and Scale for a Digital-in-Health Future
    (Washington, DC: World Bank, 2023-08-18) World Bank
    Technology and data are integral to daily life. As health systems face increasing demands to deliver new, more, better, and seamless services affordable to all people, data and technology are essential. With the potential and perils of innovations like artificial intelligence the future of health care is expected to be technology-embedded and data-linked. This shift involves expanding the focus from digitization of health data to integrating digital and health as one: Digital-in-Health. The World Bank’s report, Digital-in-Health: Unlocking the Value for Everyone, calls for a new digital-in-health approach where digital technology and data are infused into every aspect of health systems management and health service delivery for better health outcomes. The report proposes ten recommendations across three priority areas for governments to invest in: prioritize, connect and scale. The Implementation Know-How Briefs serve as practical guides for countries as they implement the ten recommendations. Every Implementation Know-How Brief provides practical information to start planning and implementing how to implement the recommendations. It also contains key terminologies for those not familiar with a particular topic, provides key questions to ask, and a general orientation as to typical issues in these sectors. Topics covered are: 1.) Digital health assessments; 2.) Telemedicine and virtual health care; 3.) Private sector involvement in digital health; 4.) Interoperability in health sector; 5.) Data governance for health data; 6.) Cybersecurity for health sector; 7.) Digital health records; 8.) Determining value of digital technology in health; 9.) Certification and regulatory sandboxes for digital technologies in health; 10.) Workflow mapping for digital technology (re)design in health systems.
  • Publication
    Russian Federation Gender Assessment
    (Washington, DC, 2014-02) World Bank
    An egalitarian socialist legacy and relatively high and growing levels of income, particularly over the last decade, have translated into fairly equal gender outcomes in Russia along many dimensions. There are no significant differences in education levels between men and women, and in recent years more young women have completed post-secondary education than young men. Girls outperform boys in reading in standardized exams and do as well as them in math and science. At first glance, women do not seem to have difficulties in transitioning from school to work or remaining employed over the life cycle. And female labor force participation is significantly above the levels observed in other countries in Europe and Central Asia, as well as in the Organization for Economic Cooperation and Development, or OECD. This new assessment of gender equality issues in Russia seeks to gauge the progress in all the domains of outcomes during the last 10 years, and to further understand the main causes behind the persisting gender gaps identified in the country. This assessment builds on the analytical framework proposed by the World Development Report 2012: gender equality and development (World Bank 2012a) to provide a general overview of gender issues in Russia, and it builds on literature at the frontier in economics to go deeper in the two selected topics: adult mortality and gender gap in pay.
  • Publication
    Doing Business 2007 : How to Reform
    (Washington, DC, 2006) World Bank; International Finance Corporation
    Doing Business 2007: How to reform is the fourth in a series of annual reports investigating the regulations that enhance business activity and those that constrain it. Doing Business presents quantitative indicators on business regulations and the protection of property rights that can be compared across 175 economies-from Afghanistan to Zimbabwe-and over time. This publication points out how regulations affecting 10 areas of everyday business are measured: starting a business, dealing with licenses, employing workers, registering property, getting credit, protecting investors, paying taxes, trading across borders, enforcing contracts and closing a business. The indicators are used to analyze economic outcomes and identify what reforms have worked, where and why. The study stresses that there are 4 steps to successful reform: 1) Start simple and consider administrative reforms that don't need legislative changes; 2) Cut unnecessary procedures, reducing the number of bureaucrats entrepreneurs interact with; 3) Introduce standard application forms and publish as much regulatory information as possible; 4) And remember: many of the frustrations for businesses come from how regulations are administered. The internet alleviates these frustrations without changing the spirit of the regulation.
  • Publication
    Digital Africa
    (Washington, DC: World Bank, 2023-03-13) Begazo, Tania; Dutz, Mark Andrew; Blimpo, Moussa
    All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.