G ood Governance for Medicines Programme: the Thai Experience

1. Good Governance for Medicines Programme: the Thai Experience Dr.Chanvit Tharathep. Director of HSSD Bureau, Department of HSS MOPH,Thailand

2. Medical Services in Thailand, in the year 2004 Priority Source: Bureau of Strategy and Policy, MoPH, Thailand 2006

3. Professional Council MOPH National Health Security Committee Office Of Permanent Secretary Office Of Minister National Health Security Office Drug Quality Medical Service Cluster Public Health Cluster Health Service Support Cluster Pharmaceutical Procurement, Management Department of Medicine Department of Disease control Department of Medical Science Department of Mental Health Department of Health Department of Health Service Support Department of Thai Traditional Development and Alternative Medicine Pharmaceutical registration, Selection FDA Provincial Health Offices Health Centers Public Hospitals * Autonomous

4. Number of beneficiaries and percentage of health care security by scheme in the year 2007 Benefit Package Includes Pharmaceutical products No Coverage, Drug Store Source: IT Department, National Health Security Office, April, 2007

5. 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

6. Phase I: Transparency assessment Rating Score Assess system vulnerability to unethical practices by external peers.

7. 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. Source: Pharmacy Information Center, MoPH, Thailand 2007

8. Phase II. Development of Thai GGM Flamework and Strategic plan • Moral values and ethical principles • Self Sufficiency principle (King Bhumipol), Middle Path (Buddhist), Transparency policy • A code of conduct : Civil Servant Act 1989 • Socialization 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

9. 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

10. Phase III: Implementation Phase • 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 (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?)

11. Publications/medias provided(cont’d) • News Letter, Electronic data and information on CDs, Website: http://dmsic.moph.go.th

12. PHASE I PHASE II PHASE III Changes and Impacts Increased Awareness More Transparency More Efficiency Networking Learning Process Assessment GGM Flamework GGM Implementation 2004-2005 2005-2006 Oct 2006-2008 Situation Analysis Thai GGM Strategy More Transparency By Information Existing GGM Infrastructure strengthening Available Practices, Guidelines Registration, Selection, Procurement Improvement GGM Networking Forms, Procedures Socialization, Education. Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles

13. 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.

14. More Transparent

15. Evidence of More Efficiency Source: Pharmacy Information Center, MoPH, Thailand 2007

16. 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.

17. 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.

18. First Second Recommendations National GGM Framework development Third Health care environment Analysis Target Priority Setting Strategic formulation Information Networking Socialization Guideline Fourth Operation Information System Transparency Intervention Assessment

19. 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.