CREATING POLICY CHANGE- ICIUM MESSAGES FOR POLICY MAKERS

1. CREATING POLICY CHANGE- ICIUM MESSAGES FOR POLICY MAKERS Martha Gyansa-Lutterodt GHANA

2. Access & Use • Infrastructure for rational use of medicines using indirect cost structure e’g 20 cents per dollar spending by both manufacturers as corporate responsibilities and government expenditure on medicines • ‘Think tanks’ at national/ regional and global level to address win-win situations for access to medicines

3. Access & Use…2 • The challenges around medicines access and use are very complex and pluralistic – multi‐stakeholder collaboration is urgently needed • Private sector is strategic for access and use. Appropriate regulation of the sector is essential. Private sector engagement as a ‘failed state’ is critical • Gender mainstreaming in countries should include treatments and medicine use

4. Antimicrobial Resistance (AMR) • Antimicrobial misuse occurred in the last 70years- appropriate changed and control ‘systems’ are strategic to any new product that enters the market. • ‘National champion groups’ catalytic but the ‘reactions’ must continue in a multi-stakeholder manner • Surveillance systems should be strengthened and sentinel sites to monitor AMR • DTC’s remain the vehicle to drive antimicrobial stewardship in facilities • Effective communication plan is appropriate for community involvement

5. Child Health…1 • Education on medicine use for children is essential for all stakeholders - traditional groups (i.e. health workers),and new target groups such as school children • Summarized evidences on the effectiveness and costs of strategies to improve access and use of medicines should be disseminated and also used by strategic users

6. Child Health…2 • Implement more multi‐faceted interventions including communities, CSO’s to improve treatment of childhood infections including AMR and evaluate impact • Countries should engage all stakeholders including unregulated private sector, and community based networks in the policy decision making • Countries should engage all stakeholders, including the unregulated private sector; ability to use incentives and sanctions for the unregulated private sector

7. Chronic Care • Countries should promote healthy lifestyles as a strategic adjunct to reduce treatment costs of chronic diseases • Evidence based tools which are patient focussed are required and monitoring and evaluation systems be put in place • Develop innovative approaches to sustainable access to medicines especially for chronic illnesses- they have a ‘right to health’ especially, quality of care • Networks for all stakeholders- providers , carers and patients are important support systems

8. Economic • Evidence exists that sharing of procurement prices, volumes, practices etc. and public access to such data, can lead to price reductions • Monitoring and evaluation processes are critical for documenting best practices in risk protection models and other health care financing options • Impact assessment especially with pricing policies should contextualise the entire health care system

9. HIV/AIDS , TB • International benchmarking achieves competitive prices for selected essential medicines, such as ARVs and anti‐TB medicines- countries should explore this. • Distribution of ARV’s should include community health workers BUT with appropriate supportive supervision in an integrated ‘systems’ approach • Innovative approaches to improve on adherence to treatment exist and countries should adopt and adapt these standardised tools

10. Malaria • Strengthen the enforcement of regulatory mechanisms in the implementation of treatment policies including use of RDTs. • Private sector engagement including community case management of malaria requires scaling up • Affordability and governance issues including quality assurance systems require strengthening

11. Policy • Create country knowledge portal for all stakeholders to access information to increase transparency and also, empower individuals and communities to do what can be done • Countries are encouraged to co-ordinate activities related to the promotion of rational use of medicines and also manage the pharmaceutical sector efficiently to comply with policies/laws • Externalities abound in ‘right to health’ but there is the need to find places of convergence • System strengthening using the ‘systems thinking’ is strategic in an integrated health system

12. Methods • Countries should not relegate safety issues but place them on the access platform • Pharmacovigilance systems in countries could have added benefits of measuring other issues like AMR monitoring

13. CROSS CUTTING ISSUES • Anti Microbial resistance and economic costs • Effective coordination to promote efficiency • Governance and accountability to reduce waste at all levels • Comprehensive communication plan to address knowledge gaps for all target groups • Appropriate engagement with researchers/policy makers in priority country needs/interventions • Monitoring and Evaluation systems ought to be included in the design of interventions and not as an after thought • All interventions need to be aligned nationally, regionally and globally for comparative measurement of impact

14. Conclusion • There are ‘low hanging fruits’ that could be plucked in the short term. • ‘Infrastructure’ or framework for rational use of medicines is key to sustaining actions! • Create country knowledge portal for all stakeholders to access information, empowered to do what can be done • All the actions listed when applied diligently lead to actionable policies globally • In next ICIUM, ‘5 or 7’ years on, let us all determine to improve medicines use by using informed strategies and effective policies to provide sustainable solutions