Corruption, a major barrier to access to medicines WHO/UNICEF Technical Briefing Seminar

1. Corruption, a major barrier to access to medicines WHO/UNICEF Technical Briefing Seminar 21 September 2006 Dr Guitelle Baghdadi World Health Organization, Geneva Department of Medicines Policy and Standards

2. Corruption requires two parties: the corrupter and the corruptee "Whose is the greater blame? She who sins for pay or he who pays for sin?" Sor Juana Inés de la Cruz

3. Overview Corruption in the pharmaceutical sector WHO Good Governance for Medicines project A few questions…

4. Corruption in the pharmaceutical sector Overview WHO Good Governance for Medicines project A few questions…

5. Corruption identified as the single greatest obstacle to economic and social development • US$ 3 trillion spent on health services annually • Pharmaceutical expenditure: 20 to 50% of total health expenditure (dev. countries) • 10 to 25% procurement spending lost into corruption (including health sector) • Some countries report that 2/3 medicines supplies lost through corruption and fraud in hospitals • Affects also donor community: GFATM suspended or terminated grant agreement because of corruption concerns

6. R&D and clinical trials Potential unethical practices could be found throughout medicines chain Patent Manufacturing Collusion Evergreening Bribery Registration Pricing Fraud Overinvoicing Cartels Selection Procurement & import Counterfeit/ substandards Falsification of safety/Efficacy data Distribution Unethical donations Promotion Conflict of interest Inspection Unethicalpromotion State/regulatory capture Pressure Tax evasion Thefts

7. Economical impact Pharma. expenditure low-income countries: 10-40% of public health budget 20-50% of total health care expenditures Poor most affected  inequalities Health impact Lack EM  increases morbidity & mortality Unsafe medicines on the market Irrational use of medicines Image and trust impact Reduces government capacity Reduces credibility of health profession Erodes public trust Unethical practices can have significant impact on the health system

8. Efforts to address corruption need application of two basic strategies: "discipline" & "values" • "Discipline approach" (top-down) • Legislative reform: establishes laws against corruption with adequate punitive consequence for violating the laws • Attempts to prevent corrupt practices through fear of punishment • "Values approach" (bottom-up) • Promotes institutional integrity through promotion moral values and ethical principles • Attempts to motivate ethical conduct of public servant  Coordinated application of both strategies required for significant impact

9. WHO Good Governance for Medicines project Overview Corruption in the pharmaceutical sector A few questions…

10. Good governance for medicines regulation and procurement • Goal • Curb corruption in the pharmaceutical public sector through promotion of ethical practices in medicines regulation and procurement by health professionals and the application of transparent administrative procedures • Objectives • Increase awareness on potential for corruption and impact on health systems functioning • Increase transparency and accountability in medicines regulatory authorities and procurement systems • Build capacity for good governance

11. Implemented in countries with a 3-step approach • Phase I: • National assessment of transparency & vulnerability to corruption • Phase II: • Development of national ethical framework based on consensus building • Phase III: • Socializing the national ethical framework through reflection meetings and training national officials on good governance.

12. Phase 1 (3 countries) Phase 2 (4 countries) Bottom-up approach in implementation of project and policy development

13. Evaluation indicators (questionnaires) Collect information and perceptions (interviews) Analyse information collected: rough quantification narrative description (report) Assessment tool: measures transparency in the public pharmaceutical sector & vulnerability to corruption: diagnostic tool  recommendations

14. Phase II: development of national ethics infrastructure based on consensus building • Framework of moral values and ethical principles • Code of conduct (CC) • Mechanisms for whistle-blowing • Control of reprehensible acts • Coordination, management and evaluation programmes • Tools for promotion and socialization of framework & CC

15. Phase II: development of national ethics infrastructure based on consensus building • Framework of moral values and ethical principles • Code of conduct (CC) • Mechanisms for whistle-blowing • Control of reprehensible acts • Coordination, management and evaluation programmes • Tools for promotion and socialization of framework & CC

16. Phase 1 (4 countries) Phase 2 (4 countries) Focus on consolidating on-going efforts in countries and possibly add few new ones

17. A few questions… Overview Corruption in the pharmaceutical sector WHO Good Governance for Medicines project

18. A few questions for reflection… • Do you believe that corruption exists in your country? Isolated cases or permissive culture? • What are the most common forms? • What are the possible causes? • What makes the pharmaceutical sector so vulnerable to corruption? • What do you think needs to be done to tackle corruption in the pharmaceutical sector on the long run?

19. "Corruption is a powerful force, but it is not inevitable or unavoidable. Diminishing its impact restores diverted resources to their intended purpose, bringing better health, nutrition and education to victims of corruption around the world, and with them, opportunity and hope." Transparency International