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Monitoring the implications of financing options

Monitoring the implications of financing options. WHO/UNAIDS Workshop on Strategic Information for Anti-Retroviral Therapy Programmes WHO, Geneva, 30 June to 2 July 2003. Jorge A. Z. Bermudez, MD, PhD Director, National School of Public Health/ FIOCRUZ

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Monitoring the implications of financing options

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  1. Monitoring the implications of financing options WHO/UNAIDS Workshop on Strategic Information for Anti-Retroviral Therapy Programmes WHO, Geneva, 30 June to 2 July 2003 Jorge A. Z. Bermudez, MD, PhD Director, National School of Public Health/ FIOCRUZ (PAHO/WHO Collaborating Centre for Pharmaceutical Policies) Rio de Janeiro, BRAZIL Bermudez (2003)

  2. ..\www.financingcare.org.br )Pagina web)\index.html Bermudez (2003)

  3. Financing Global Care Network • Moderation of the CARE discussion list (the first discussion forum on “Prices, patents and Implementation of the Doha Declaration”) • Inclusion of new country based actors and new regional and local partnerships • Website construction • Dissemination of annotated bibliography • Satellite meeting organization (Barcelona, Havana, Nairobi) • Financing framework and costs of care interventions Bermudez (2003)

  4. Learning with the work in networks • WHO Network for monitoring the impact of Globalization and TRIPS on access to medicines: we must collate lesons learned throughout a very intensive work, involving three WHO Collaborating Centres (Brazilian NSPH, LSE and Chulalongkorn University in Bangkok), yearly meetings and country surveys. Bermudez (2003)

  5. Key questions for monitoring the public health impact of TRIPS Agreement • Are newer essential drugs more expensive than they would have been if not under patent? • Is the introduction of generic drugs being slowed? • Aren more new drugs for neglected diseases being developed? • Are transfer of technology and direct foreign investment in developing countries increasing or decreasing? Bermudez (2003)

  6. TRIPS Agreement: possible effects and determinants relantionship Correlação pode ser positiva ou negativa Correlação negavita Correlação positiva Possible intermediate effects Possible effects Others Determinants Estimulo à invenção Capacidade tecnológica instalada do país Aumento das importações Capacitação tecnológica Reforma/ reorganização do sistema de saúde ou da assistência farmacêutica Technology transfer Modificação da estrutura produtiva AVAILABITITY Listas restritivas de financiamento Produção local Direct foreign investment Organização das aquisições públicas ou por outros consumidores em escala Inclusão na legislação das salvaguardas permitidas pelo TRIPS Taxa de crescimento econômico Expansão da cobertura Entrada de genéricos no mercado Affordability Inclusão dos mecanismos de extensão patentária na legislação Concentração do mercado (↓ competição) Regulação antitrust frágil AFFORDABILITY Existência de mecanismos de controle de preços Grau da consolidação da demanda para os produtos específicos Preços dos medicamentos (preço dos tratamentos) Grau de autonomia nas relações bilaterais Gastos com medicamentos Custos de litigação Bermudez (2003) Main issues monitored in this study

  7. Defining the approach • Financing HIV/AIDS Care: Insurance coverage, publicly supported sources (universal access to care), private interventions, loans • Resource allocation for HIV/AIDS programmes (the right balance) • Expenditures in HIV/AIDS programmes: measuring National Health Accounts, the extension of care, sourcing of funds • Identifying cost-containment mechanisms Bermudez (2003)

  8. Sources of information searched for financing models • Scientific papers (Medline, Lilacs, Econlit) • Mass media or opinion papers • Official documents (WHO, PAHO, UNAIDS, others) • Research reports Bermudez (2003)

  9. Main difficulties • The lack of historical series regarding financing for Health and HIV/AIDS • Therefore, impossible to identify changes and how these potential changes may affect other public health programmes • Sidalac – National Accounts in HIV/AIDS and data in 14 Latin American countries (financing sources, resource management, institutions, cost composition and population attended) Bermudez (2003)

  10. Typology of Health Systems in Latin America and HIV/AIDS Care Coverage • Socialized (Health care as a public service provided by the State) • Social Security (Health care as a service or good for protected consumers) • Plural (Health care fundamentally as a service or good for consumers • Free Market (Health care as an object of personal consuming) • Source: Figueroa, 1998. La Epidemia de VIH/SIDA en el Contexto de las Reformas del Sector Salud en América Latina. IN: El Sida en América Latina y el Caribe: una visión multidisciplinaria. Sidalac (www.sidalac.org.mx) Bermudez (2003)

  11. Sources for financing HIV/AIDS 2000 (Source: Sidalac – National Accounts) Bermudez (2003)

  12. Proposal for next steps • What are the financing options? • Building a framework (theoretical model for evaluation) or template for discussion, ammendment and utilization (may also be a guide for decision-making) • 13th ICASA Nairobi Satellite meeting • Advocacy in resource mobilization and accessing international funding (Global Fund, AAI, collating lessons with the network) • Updating sources and prices Bermudez (2003)

  13. Escola Nacional de Saúde Pública Núcleo de Assistência FarmacêuticaCentro Colaborador da OMS em Políticas Farmacêuticas Bermudez (2003)

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