Comparative Analysis of National Drug Policies - Second Workshop Geneva, 10-13 June 1996 - EDM Research Series No. 025
(1997; 175 pages) View the PDF document
Table of Contents
View the documentExecutive summary
View the documentI. Introduction
Open this folder and view contentsII. Background on the research project
Open this folder and view contentsIII. Second workshop
Close this folderIV. Preliminary findings
Close this folder1. The methods: What has been learnt?
View the document1.1 Methods in context: How did the country teams use the methods?
View the document1.2 Methods in question: What were the main problems encountered and how to solve them?
View the document1.3 Relevance of the methods
Open this folder and view contents2. National drug policies: what has been learnt?
Open this folder and view contents3. Cross national analysis: What can be learnt at this stage?
View the document4. Broader capacity building
Open this folder and view contentsV. Conclusions of the workshop and follow-up plans
Open this folder and view contentsAnnex 1: Research proposal
View the documentAnnex 2: List of participants
View the documentAnnex 3: Agenda
View the documentAnnex 4: Questionnaire on NDP performance assessment
Open this folder and view contentsAnnex 5: Achievements of the national drug policies in the 12 countries
View the documentAnnex 6: Consolidated tables
View the documentOther documents in the DAP Research Series
 

1.1 Methods in context: How did the country teams use the methods?

The aim of the research was to use a set of standardized indicators to assess the achievement of the NDP and to use the political mapping technique to better analyse the process of policy formulation and implementation. During the first workshop it was agreed that countries had the freedom to adapt or modify the indicators to better reflect their own country context but that as large a set of common indicators as possible should be preserved given the comparative focus of the project. It was also suggested that a common mapping question related to the formulation process of the drug policy would probably further the process of comparison among countries; however it was decided that, given the different requirements of each country, they should be allowed to define their own questions for political mapping.

Methods in context: the NDP indicators

All the countries applied the indicators although some did not finalize the data collection and analysis before the workshop.

Four categories of modifications were introduced by countries in the initial list of indicators (see also Table 3):

Introduction of new indicators: only four countries added new indicators; Chad introduced a number of background, structural and process indicators already available in the health information system and six new indicators related to the level of education of prescribers and dispensers; the type of suppliers for the public and the private sectors; the number of drugs received in the private compared to the public sector, and the percentage of children under five with diarrhoea that have been prescribed ORS. Colombia introduced one additional indicator for rational use, namely the percentage of prescriptions dispensed in total by the hospital pharmacy. Guinea added eight indicators, four addressed more in detail rational use of drugs (WHO/INRUD indicators), the other four covered practices related to generics in the private sector. The Philippines added indicators on rational use (WHO/INRUD indicators) in health facilities and in drug outlets; it also created new indicators to compare the practices in the Government and in the private facilities in relation to compliance with the EDL and access to a drug formulary. Thailand added two indicators related to dispensing practices: percentage of drugs dispensed with a drug name on the label (N°1) and with instructions for use on the label (N°2). Although the team from Viet Nam did not introduce new indicators, they tried to use 24 indicators from the proposed ones to assess the implementation of the policy on traditional medicine and local production. A number of countries felt that for components that were already functioning well, more specific indicators may be needed to monitor improvements over time.

Modification of existing indicators: three countries changed some of the indicators proposed; Chad modified three indicators because of lack of data for the past three years. Colombia did the same with three indicators to adapt to the national context characterized by a decentralization of key functions such as procurement of drugs. Zimbabwe modified 18 indicators to allow comparisons over time, to simplify calculations, because no data were available or to be consistent with previous surveys.

Withdrawal of indicators because they were not relevant: a number of countries decided not to apply some indicators because they felt the indicators were not relevant to the country situation. For instance, Bulgaria did not apply the structural indicators related to the vehicles of the central procurement/distribution unit as such a unit did not exist (ST36). Colombia did not apply four structural indicators related to drug donations, centralized budget and procurement. The Philippines also excluded a few indicators, e.g. the indicator related to the provision of foreign currency to the procurement unit as all purchases are done internally (ST27). In general, the indicators which were not relevant refer to foreign exchange for buying drugs (Colombia, India, the Philippines buy internally all the drugs), to centralized structures (Colombia and the Philippines are countries where the decentralized process is very advanced); to local manufacture (Chad and Guinea have no local production), and to collection of drug samples (some countries like Zimbabwe have a policy not to collect samples on a routine basis).

• Withdrawal of indicators because data were not available: all countries encountered problems in obtaining data. India could not calculate three indicators because of the lack of data at national level on drug education or the lack of knowledge of the existence of international data (e.g. international lists of drug prices). Sri Lanka excluded some indicators such as total health expenditure (data not available) and the indicator related to banned drugs because the team felt the UN list of banned products was not appropriate for the calculation of this indicator. Viet Nam could not collect 11 data needed for process indicators on tenders, pricing, advertising and banned drugs. Guinea and the Philippines were not able to calculate some indicators as some data were not available.

Table 3: Changes introduced by countries in the proposed WHO list of indicators

Indicators

New indicators

Modified indicators

Background indicators

Structural indicators

Process indicators

Outcome indicators

Countries



NR

NA

NR

NA

NR

NA

NR

NA

Bulgaria

-

-

1

2

1

-

-

1

-

-

Chad

6

3

1

2

1

2

2

11

-

2

Colombia

1

3

-

-

4

-

-

-

-

-

Guinea

8

-

-

4

-

-

1

10

-

-

India

-

-

-

1

1

-

-

2

-

-

Mali

-

-

-

-

-

-

-

^

-

*

Philippines

5

-

-

2

2

4

-

18

-

1

Sri Lanka

-

-

-

3

-

-

1

7

-

1

Thailand

2

-

-

4

-

-

-

12**

-

**

Viet Nam

-

-

-

1

-

-

2

8

-

0

Zambia

-

-

-

-

-

-

1

*

-

-

Zimbabwe

-

18

-

-

-

-

1

1

-

-

* Data collection not yet finalized
** Did not carry out the total assessment
NR: Not relevant
NA: Not available

Methods in context: the political mapping

The subjects selected by countries for the political mapping were the following:

• Colombia: Identifying political statements considered essential for the full implementation of the NDP (prospective mapping).

• India: Explaining the changes in the formulation and implementation of the most recent NDP (1994-1995) compared to previous versions of the policy (retrospective mapping).

• Sri Lanka: Assessing the feasibility of getting a new drug pricing formula (NPF) enacted. Assisting policy advocates in designing and implementing appropriate strategies for the enactment of the NPF (prospective and prescriptive mapping).

• Thailand: Analysing the policy process in the development of the Generic Labelling and Advertising Policy (retrospective mapping).

• The Philippines: Evaluating the formulation and implementation phases of the Generics Act. Understanding the implications of the differences in the process and outcomes of these two phases of the policy for the future of the Generics Law (retrospective and prospective mapping).

• Viet Nam: Evaluating the formulation and implementation of the drug information policy (retrospective mapping).

Methods in context

NDP indicators: A high percentage of the indicators was relevant and useful to the countries situations and did not need substantial modifications. A few indicators were constructed by country teams to better cover certain components of the pharmaceutical policy (e.g. in rational use of drugs). A number of new indicators was suggested during the workshop for specific components or for additional objectives (e.g. traditional medicine). The main reasons for not applying certain indicators were the absence of data and the inconsistency in data. One country felt that some data were too sophisticated although useful for pharmaceutical systems in developing countries. However, it was agreed that data are often available but not easily accessible, mainly financial data which are collected in other departments than the pharmacy one.

Political mapping: Two countries used the political mapping to better understand what had happened in policy formulation and implementation and the reasons for successes and failures. It should be noted that the two countries in question: India and the Philippines have formulated a drug policy recently; this policy has very clear objectives and strategies, which makes a retrospective analysis easier. One country (Sri Lanka) used the political mapping to assess the chances of success of a new strategy to improve the affordability of the drugs in the private sector; the other countries looked at specific issues closely related to the components which had been assessed in the indicators exercise.

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