Strategies for Working with Countries – Regional and Sub-Regional Perspective and Experiences

1. World Health Organization Strategies for Working with Countries – Regional and Sub-Regional Perspective and Experiences Essential Drugs and Medicines Policy WHO South-East Asia Region Krisantha Weerasuriya, Regional Adviser Technical Briefing Seminar, Geneva, October 2007

2. OBJECTIVES Policy Access Quality and safety Rational use COMPONENTS Implementation and monitoring of medicines policies Traditional and complementary medicine Fair financing and affordability Medicines supply systems Norms and standards Regulations and quality assurance systems Rational use by health professionals and consumers WHO Medicines Strategy 2004 – 2007: 4 objectives, 7 components, 44 expected outcomes

3. Other WHO Clusters Country Offices NPO AFRO AMRO NPO EMRO HTP TCM PSM EURO NPO SEARO NPO WPRO Coordinated efforts between HQ Departments Regional & Country Offices Primary interaction Secondary interaction

4. Roles and responsibilities for supporting implementation of WHO Medicine Strategy Strategy, policy guidance, support and collaborations Planning, implementation, monitoring • Headquarters: • Strategy and • policy making • Planning & monitoring • Partnerships and • Collaboration • Resource Mobilisation • Provide specific • technical • & policy support • Support in HR • development & training • Regional Offices: • Oversee country • operations • Planning and • monitoring of • country support • Technical, policy • and management • support to countries • Human resources • development & • training • Partnerships and • collaborations • at regional level • Country Offices: • Assess needs and • identify priorities for • technical support • Plan & implement • WHO work • Provide technical • and policy support • to countries • Assist in coordination • Partnerships & • collaborations • in countries • Feedback and report • Ministries of Health: • Identify needs & • priorities • Plan, implement and • monitor action • Coordinate with other • Ministries and national • bilateral and • multilateral agencies • and CSO's.

5. Brief Description of South-East Asia Region • Eleven countries • Bangladesh, Bhutan, DPRK, India, Indonesia Maldives, Myanmar, Nepal, Sri Lanka, Thailand & Timor-Leste (11) • Enormous variation in medicines situationSelf sufficient --- Totally dependent on imports • One common feature – all developing countries • Country needs and regional cooperation form basis of activities

6. What is the framework for cooperation?(Common for all Regions) • Country Budget & Workplan • Decided at the beginning of the biennium after consultation between countries, Regional Office (RO) & HQ. • Based on WHO Medicines Strategy • Additional funds may become available depending on particular initiatives • Workplan – mixture of activities (workshops), specific supplies, and training (in-country and outside) • WHO is NOT a funding agency – does not fund routine service activities

7. How does specific collaboration come about ? • Country driven – they have a specific issue – Good Manufacturing Practices – how can we develop our guidelines ?Registration of Medical Devices – how can it be done, what is the experience of the other countries? • Country driven – emergency – Tsunami - donations • WHO Initiative – as part of WHA Resolution or Regional Committee Resolution. Bulk Procurement scheme for the Region • Both WHO and Country concerns (Avian influenza)

8. Examples of collaboration • Drug Donations – TsunamiIndia & Thailand – no donations pleaseSri Lanka – posted what was needed (but included non-emergency medicines)Indonesia – all donations acceptedStudies on donations done with WHO assistance in Sri Lanka and IndonesiaCountry driven – emergency – Tsunami - donations • Intellectual Property Rights and Pharmaceutical Patents (Regional Collaboration based on Inter Governmental Working Group on Public Health, Innovation & Intellectual Property.Indian Patent Legislation, Thailand Compulsory Licensing, Indonesia “Govt” use. • National Essential Medicines Lists – Regional Workshop – 30th Anniversary – WHO Initiative with country participation

9. Examples of collaboration • Counterfeits – Global Initiative – Biregional (SEARO-WPRO) Activity – learning from each otherDeveloping common definitionsDeveloping common methodsSharing informationUnderstanding how to tackle the problems • Controlled Substances (not taken up by countries) – use of opioids in pain relief in terminal illness • Pharmacovigilance – Uppsala Center, encouraging countries to be part of global scheme • Specific country activities – evaluation of the DRA as joint activity –HQ/RO/Country – Situation analysis and suggestions for improvement • Developing norms – adopt WHO ones but where necessary adapt

10. Summary • Country cooperation based on WHO Medicines Strategy • Regular workplans based on country needs • Initiatives outside the workplans are accommodated when necessary • WHO support - Technical assistance and not funding • Continuing long term work + “when needed” assistance