G ood Governance for Medicines Programme: the Thai Experience

Good Governance for Medicines Programme: the Thai Experience

Dr.Chanvit Tharathep. Director of HSSD Bureau, Department of HSSMOPH,Thailand

Hospitals BedsOut Patient

Visits

Inpatient Admissio

nInpatient

days

Bed occupancy

rate (%)

MoPH 875 86,667 80,596,859 6,015,238 25,892,528 82

MoP 2 748 69,963 21,146 146,765 54

MoF 1 82 106,810 1,738 18,741 63

MoC 1 120 39,683 1,667 14,967 34

MoI 1 80 15,740 3,290 9,022 31

MoJ 2 550 112,100 5,655 85,233 42

MoE 15 8,556 7,532,728 335,118 2,672,621 86

MoD 63 6,987 3,884,789 181,592 1,508,211 59

Autonomous 7 737 459,393 25,661 124,285 46

Local Authority 13 2,375 2,322,571 109,233 599,207 69

Private 298 26,343 29,346,824 1,601,497 4,602,531 48

Total 1,278 133,245 124,487,460 8,301,835 35,674,111 73

Medical Services in Thailand, in the year 2004

Source: Bureau of Strategy and Policy, MoPH, Thailand 2006

Priority

MOPHMOPHMOPHMOPH

Office Of Permanent SecretaryOffice Of Permanent Secretary

Department of Medical Department of Medical ScienceScience

Department of Medical Department of Medical ScienceScience

Department of Department of Disease controlDisease controlDepartment of Department of Disease controlDisease control

Department of Department of MedicineMedicine

Department of Department of MedicineMedicine

Department of HealthDepartment of HealthDepartment of HealthDepartment of HealthDepartment of Mental Department of Mental HealthHealth

Department of Mental Department of Mental HealthHealth

Department of Thai Department of Thai Traditional Traditional

Development and Development and Alternative MedicineAlternative Medicine

Department of Thai Department of Thai Traditional Traditional

Development and Development and Alternative MedicineAlternative Medicine

Department of Health Department of Health Service SupportService Support

Department of Health Department of Health Service SupportService Support

FDAFDAFDAFDA

Provincial Health OfficesProvincial Health OfficesProvincial Health OfficesProvincial Health Offices Health CentersHealth CentersHealth CentersHealth Centers Public Hospitals * AutonomousPublic Hospitals * AutonomousPublic Hospitals * AutonomousPublic Hospitals * Autonomous

ProfessionalProfessionalCouncilCouncil

ProfessionalProfessionalCouncilCouncil

Office Of MinisterOffice Of MinisterOffice Of MinisterOffice Of Minister

National Health Security CommitteeNational Health Security CommitteeNational Health Security CommitteeNational Health Security Committee

Medical Service ClusterMedical Service ClusterMedical Service ClusterMedical Service ClusterPublic Health ClusterPublic Health ClusterPublic Health ClusterPublic Health Cluster Health Service SupportHealth Service Support

ClusterCluster

Health Service SupportHealth Service SupportClusterCluster

National Health Security OfficeNational Health Security OfficeNational Health Security OfficeNational Health Security Office

Drug Quality

Pharmaceutical registration, Selection

Pharmaceutical Procurement, Management

Number of beneficiaries and percentage of health care security by scheme in the year 2007

Health Security Scheme

Number of beneficiaries

Percentage of coverage

UC 46,636,899 73.49

SSS 9,060,033 14.28

CSMBS 5,119,535 8.07

Unidentified groups

2,640,356 4.16

Total 63,456,823 100

Source: IT Department, National Health Security Office, April, 2007

BenefitPackage Includes

Pharmaceutical products

No Coverage,Drug Store

Existing GGM infrastructure: transparency and accountability in Thailand National Drug Policy 1981, 1993

Safety, Quality, Appropriate Price, Access Essential Drugs list 1981-2008, Standard Price (2008) Public Good Governance Law 2004 Drug management Reform 1997-2008 in MoPH hospitals

Group purchasing of drugs and medical supplies. Limiting numbers of Drug items, emphasizing uses of drugs

in national essential drugs list. Control of Drug Inventory Level to be 3-month supply or

less. Purchasing and Management performing under committee

basis (Pharmaceutical) Reporting system. Setting up MoPH Pharmacy Information Center.

Situation Analysis, Strategic Formulation, Transfer to operation

Area Total Questions (Sub-Questions)

Scale of 10

Degree

Registration

18 (45) 7.0 Marginally vulnerable

Selection 14 (29) 8.0 Marginally vulnerable

Procurement

22 (50) 7.1 Marginally vulnerable

0.0-2.0 2.1-4.1 4.1-6.0 6.1-8.0 8.1-10.0Extremely vulnerable

Very vulnerable

Moderately vulnerable

Marginally vulnerable

Minimally vulnerable

Rating Score

Phase I: Transparency assessment

Assess system vulnerability to unethical practices by external peers.

Phase I: Transparency assessment 6 months interval, MoPH Inspection FDA essential drug selection – accessible via internet MoPH Hospitals purchasing report to the Public accessible

Pharmacy Information Center.

Hospital type 2004 2005 2006

Regional hospitals 21 24 25

General hospitals 62 70 69

Community hospitals 569 667 645

Total 659 765 742

Source: Pharmacy Information Center, MoPH, Thailand 2007

Phase II. Development of Thai GGM Flamework and Strategic plan M oral values and ethical principles

Self Sufficiency principle (King Bhumipol), Middle Path (Buddhist), Transparency policy

A code of conduct : Civil Servant Act 1989 S ocialization of an ethical framework and code of conduct : *** Established anti- corruption legislation

Anti-corruption Act 1999, Public Good Governance Royal Decree 2004, National Anti-corruption Organization

Established administrative procedures MoPH Policy, Guidelines, Meeting, Conflict of interest form, Cirriculum

Mechanisms for whistle- blowing (ombudsman): Website, One Stop Service Sanctions on reprehensible acts

National Anti-corruption organization, MoPH Disciplinary Office Mechanisms for collaboration between existing anti- corruption agencies:

Anti-corruption Act 1999, Public Good Governance Royal Decree 2004 Carbinet approved guideline and recommendation

Management, coordination and evaluation of an GGM framework

GGM Strategic Formulation

Develop Policy Guidelines

National Networking

Strengthen Information Database

Dissemination of Ethical Practice Information

Assessment

•Ethical Framework, legislation, Policy•Practice Guidelines, Medicine Promotion Practice criteria•Standard of Practice (SOP)•Declare Consent form, Conflict of interest form•FDA, DHSS, DMS, Universities, Professional Councils•Hospital Pharmacy Association•Community Pharmacy Association•PREMA, •Thai Pharmaceutical Manufacturer Association•NGOs•Selection, Registration•Procurement•Drug Price, Drug Promotion Practice•Research, Study and cases•Public accessible Pharmacy Information Center•Meeting, News Letter•Webpage of Good Governance•Best Practice•Interested Working Group•KPI for Health Inspector•Self Assessment, Assessment New tools

Develop Policy Guidelines

National Networking

Strengthen Information Database

Dissemination of Ethical Practice Information

Assessment

Phase III: Implementation Phase •Ethical Framework, legislation, Policy

•Practice Guidelines, Medicine Promotion Practice criteria•Standard of Practice (SOP)•Declare Consent form, Conflict of interest form (ED, SP)•FDA, DHSS, DMS, Universities, Professional Councils•Hospital Pharmacy Association•Community Pharmacy Association•PReMA, •Thai Pharmaceutical Manufacturer Association•NGOs•Selection, Registration •Procurement•Drug Price, Drug Promotion Practice•Research, Study and cases•Public accessible Pharmacy Information Center (English)•Meeting•Newsletter, Webpage of Good Governance•Best Practice•Interested Working Group•KPI for Health Inspector•Self Assessment, Assessment New tool (Promotion Practice, Inspection, Distribution?)

Publications/medias provided (cont’d) News Letter, Electronic data and

information on CDs, Website: http://dmsic.moph.go.th

Changes and Impacts

PHASE IIPHASE I PHASE III

Assessment

GGM Flamework

Situation Analysis

Existing GGM

Infrastructure

strengtheningGGM

Networking

Thai GGM Strategy

Available Practices, Guidelines

GGM Implementa

tion

Forms, Procedures

More Transparenc

yBy

Information

Registration, Selection,

Procurement Improvement

Socialization,

Education.

Increased Awareness

MoreTranspare

ncy

More Efficiency

Networking

Learning Process

Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles

2004-2005 2005-2006 Oct 2006-2008

GGM Framework in Registration, Selection, Procurement

Registration : Conflict of interest form implementation,

Selection : Conflict of interest form, Guideline, Code of Conduct, Transparency.

Procurement : Guideline, Code of Conduct, Manual, Regulation, Transparency.

Socialization- Increase awareness, Introduction of the GGM into Education.

More Transparent

Evidence of More Efficiency

Drug item Pack unit Average price

RegularSeparated purchasing

Provincial group

purchasing

Regionalgroup purchasin

g

Diclofenac tab 25 mg 500 107.86 74.69 57.38

Insulin Human Base vial 100 IU/ml (10 ml)

1 308.99 300.63 310.30

Medroxyprogesterone amp. 50 mg/ml (3 ml)

1 16.08 12.49 13.50

Ranitidine tab 150 mg 500 200.95 201.34 177.62

Salbutamol inhaler 100 mcg (200 doses)

1 105.93 112.68 139.10

Salbutamol sol 0.5 % (20 ml)

1 91.87 102.44 85.60

Source: Pharmacy Information Center, MoPH, Thailand 2007

What has worked and what should be redisign. Information System for Continuous

Assessment and evaluation would be helpful. Good Governance can be achieved by

committee basis for decision making. Conflict of Interest declaration can be

implemented in the Selection of EDL 2007-2008.

Selective Group Purchasing is a good tool to control drug price.

Lessons learnt to date GGM Framework is the national level management.

We should realize that different country is different context..

Health care environment should be evaluated and priority setting should be done at first step.

The strategy should be formulated to support and transfer into operation.

Transparency is the most effective, efficient and feasible for the first step of good governance implementation. We can achieve transparency with the Pharmacy Information center.

Recommendations

National GGM Framework developmentHealth care environment AnalysisTarget Priority Setting

Strategic formulation

Information System Transparency

Information Networking Socialization Guideline

Intervention Assessment

Operation

First Second

Third

Fourth

Conclusion Health Service System in Thailand and the MoPH

structure. Transparency and increase accountability policy in

Thailand The 3 phases of Good Governance for medicines

programme implementation in Thailand. Changes and Impacts. Lessons learn and recommendation.