Publication: Assessment of Governance and Corruption in the Pharmaceutical Sector : Lessons Learned from Low and Middle Income Countries
Date
2010-01
ISSN
Published
2010-01
Author(s)
Abstract
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.
Citation
“Diack, Aissatou; Seiter, Andreas; Hawkins, Loraine; Dweik, Imad Subhi. 2010. Assessment of Governance and Corruption in the Pharmaceutical Sector : Lessons Learned from Low and Middle Income Countries. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank, Washington, DC. http://openknowledge.worldbank.org/entities/publication/5d30c6ae-cc25-5ccd-8d62-254ef9cfcdb2 License: CC BY 3.0 IGO.”