Publication: Pharmaceutical Reform : A Guide to
Improving Performance and Equity
Loading...
Published
2011-09-21
ISSN
Date
2012-03-19
Author(s)
Editor(s)
Abstract
This publication, which is based on the unique methodology and tools developed for the World Bank Institute/Harvard School of Public Health Flagship Course on Health System Reform and Sustainable Financing, provides a powerful set of resources to help policy makers better navigate the complicated process of reforming pharmaceutical systems. Its problem solving approach complements technical resources and training curricula available on the discrete elements of a pharmaceutical sector. The application of the flagship approach to the pharmaceutical sector is both useful and timely. Ensuring the availability of medicines and the effective management of their procurement and distribution is central to the drive to achieve coverage and access to basic health care that is both universal and financially sustainable. Together, the methodology and case materials contained in this publication provide a rich resource from which policy makers in developing countries may draw to guide their efforts to meet these challenges. This book is designed to help participants gain a better understanding of all that goes on in the pharmaceutical sector. As noted above, it uses the flagship framework that we helped develop over the past decade. The essence of that approach is not to try to tell policy makers in detail what they should do. Rather it comprises a set of analytical tools that are combined into an overall, structured methodology for developing, adopting, and implementing reform proposals. The flagship framework also includes a comprehensive review of reform alternatives and a systematic review of their strengths and weaknesses in various situations. Throughout this book the authors have used the flagship framework to structure our analysis of pharmaceutical reform, continuously and explicitly applying its methods and concepts to the pharmaceutical sector. With a few minor exceptions, all the examples and all of the reform options come directly from pharmaceutical reform efforts around the world. The authors have also given specific attention to issues in pharmaceutical policy related to reproductive health.
Link to Data Set
Citation
βRoberts, Marc J.; Reich, Michael R.. 2011. Pharmaceutical Reform : A Guide to
Improving Performance and Equity. Β© World Bank. http://hdl.handle.net/10986/2353 License: CC BY 3.0 IGO.β
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication A Practical Approach to Pharmaceutical Policy(World Bank, 2010)This book discusses the wide range of challenges faced by policy makers in the pharmaceutical sector, presents the current know-how in terms of policy measures, and provides specific examples of policy packages that can be used in defined circumstances, even if one assumes a certain degree of political resistance and capacity limits on the side of the implementing agency. This book focuses on developing countries and tries to address the issues faced by both low- and middle-income countries. The book does not cover the vaccines market and its respective policies because too many differences exist between the markets for vaccines and pharmaceuticals to cover both subsectors in one publication of this type. The book ends with an outlook on how things might evolve in the longer term. It assumes that some form of convergence will take place toward "models that work," thus reducing the fragmentation of policies and enhancing regulatory and economic efficiencies over time-one hopes to the benefit of all stakeholders in the sector and, in particular, those who, as patients, currently do not have reliable access to effective and safe medicines.Publication Financing, Pricing, and Utilization of Pharmaceuticals in China(Washington, DC, 2010)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 Accelerating Health Reforms through Collective Action : Experiences from East Africa(2014-10-08)The roots signify the origins and initial steps taken to build a coalition and the associated teething problems; the trunk represents efforts toward sustaining the organization s existence and growth; and the branches highlight the collective actions undertaken by the coalition in fulfillment of its aims and objectives. In preparing this book, and based on their unique experiences, Tanzania, Kenya, and Uganda respectively focus their chapters on the roots, trunk, and branches. To further the tree analogy, each country s chapter draws parallels or makes comparisons with what pertains in the other two countries, to show how they benefit from each other in an ongoing knowledge exchange. Chapter two (Putting Down Roots, Tanzania) has three main sections: an overview of the country context and health reform agenda; a discussion of the experiences of MSG-Pharma, Tanzania s multi-stakeholder body, in setting up a coalition, and lessons learned. These outline the reasons leading to the establishment of the multi-stakeholder group and describe how challenges met during its formation stages were overcome. Chapter three (growing a strong trunk, Kenya) provides insights into the approaches employed by Kenya s multi-stakeholder coalition, the Forum for Transparency and Accountability in Pharmaceutical Procurement (FoTAPP), in order to sustain the interest and commitment of key stakeholders. It presents a brief description of the Kenyan context in relation to the pharmaceutical sector, highlighting challenges in the sector, and the importance of a multi-stakeholder coalition amid other reform platforms. Chapter four (branching out and bearing fruits, Uganda) describes the opportunities, challenges, and rewards associated with designing and implementing a joint intervention in furtherance of the goals of the Medicines Transparency Alliance (MeTA), the coalition in Uganda. It also illustrates how the coalition has been Able to inform policy dialogue and reform efforts in the health sector.Publication The Pharmaceutical Sector in Ghana(World Bank, Washington, DC, 2009-11)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 A Generic Drug Policy as Cornerstone to Essential Medicines in China(Washington, DC, 2010-06)Compared with developed economies, health expenditure in China is not particularly high on a per capita basis or as a share of Gross Domestic Product (GDP). Similarly, pharmaceutical expenditure in comparative perspective is not particularly high on a per capita basis or as a percentage of GDP. China's exceptionally high rate of pharmaceutical expenditure has important implications for the future of a health care system that not only serves a rapidly aging population, but encourages overuse of drugs in ways that are both financially and medically inefficient. Pharmaceutical reform is therefore a high priority for China's health policymakers. Several factors are discussed for reforming this system based on lessons from recent reforms. The section following this introduction briefly reviews the expansion of basic medical insurance coverage in the 2000s and several structural features of the pharmaceutical sector in China. The related concepts of an essential medicines policy, an essential drug list, and a generic drug policy are briefly described in first section. The second section of the paper looks at several hurdles that are built into the path of essential medicines reform. The third section considers some lessons for pharmaceutical reform based on China's recent learning from regional experimentation and piloting initiatives. The fourth section considers several relevant lessons derived from reform experiences in other countries. The fifth section looks at the path forward-success factors for implementing an essential medicines program based on low-cost generic drugs.
Users also downloaded
Showing related downloaded files
Publication Morocco Economic Update, Winter 2025(Washington, DC: World Bank, 2025-04-03)Despite the drought causing a modest deceleration of overall GDP growth to 3.2 percent, the Moroccan economy has exhibited some encouraging trends in 2024. Non-agricultural growth has accelerated to an estimated 3.8 percent, driven by a revitalized industrial sector and a rebound in gross capital formation. Inflation has dropped below 1 percent, allowing Bank al-Maghrib to begin easing its monetary policy. While rural labor markets remain depressed, the economy has added close to 162,000 jobs in urban areas. Moroccoβs external position remains strong overall, with a moderate current account deficit largely financed by growing foreign direct investment inflows, underpinned by solid investor confidence indicators. Despite significant spending pressures, the debt-to-GDP ratio is slowly declining.Publication Europe and Central Asia Economic Update, Spring 2025: Accelerating Growth through Entrepreneurship, Technology Adoption, and Innovation(Washington, DC: World Bank, 2025-04-23)Business dynamism and economic growth in Europe and Central Asia have weakened since the late 2000s, with productivity growth driven largely by resource reallocation between firms and sectors rather than innovation. To move up the value chain, countries need to facilitate technology adoption, stronger domestic competition, and firm-level innovation to build a more dynamic private sector. Governments should move beyond broad support for small- and medium-sized enterprises and focus on enabling the most productive firms to expand and compete globally. Strengthening competition policies, reducing the presence of state-owned enterprises, and ensuring fair market access are crucial. Limited availability of long-term financing and risk capital hinders firm growth and innovation. Economic disruptions are a shock in the short term, but they provide an opportunity for implementing enterprise and structural reforms, all of which are essential for creating better-paying jobs and helping countries in the region to achieve high-income status.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure studentsβ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication World Development Report 2006(Washington, DC, 2005)This yearβs Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a personβs chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The reportβs main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005βΉan appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentinaβs growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentinaβs potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentinaβs context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the countryβs growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.