MeTA in Thailand
Publication date: 2008
Good Governance for Medicines Programme: the Thai Experience Dr.Chanvit Tharathep. Director of HSSD Bureau, Department of HSS MOPH,Thailand Medical Services in Thailand, in the year 2004 Source: Bureau of Strategy and Policy, MoPH, Thailand 2006 Priority Hospitals Beds Out Patient Visits Inpatient Admission Inpatient days Bed occupancy rate (%) MoPH 875 86,667 80,596,859 6,015,238 25,892,528 82 MoP 2 748 69,963 21,146 146,765 54 MoF 1 82 106,810 1,738 18,741 63 MoC 1 120 39,683 1,667 14,967 34 MoI 1 80 15,740 3,290 9,022 31 MoJ 2 550 112,100 5,655 85,233 42 MoE 15 8,556 7,532,728 335,118 2,672,621 86 MoD 63 6,987 3,884,789 181,592 1,508,211 59 Autonomous 7 737 459,393 25,661 124,285 46 Local Authority 13 2,375 2,322,571 109,233 599,207 69 Private 298 26,343 29,346,824 1,601,497 4,602,531 48 Total 1,278 133,245 124,487,460 8,301,835 35,674,111 73 MOPH Office Of Permanent Secretary Department of Medical Science Department of Disease control Department of Medicine Department of Health Department of Mental Health Department of Thai Traditional Development and Alternative Medicine Department of Health Service Support FDA Provincial Health Offices Health Centers Public Hospitals * Autonomous Professional Council Office Of Minister National Health Security Committee Medical Service Cluster Public Health Cluster Health Service Support Cluster National Health Security Office Drug Quality Pharmaceutical registration, Selection Pharmaceutical Procurement, Management Number of beneficiaries and percentage of health care security by scheme in the year 2007 Source: IT Department, National Health Security Office, April, 2007 Benefit Package Includes Pharmaceutical products No Coverage, Drug Store Health Security Scheme Number of beneficiaries Percentage of coverage UC 46,636,899 73.49 SSS 9,060,033 14.28 CSMBS 5,119,535 8.07 Unidentified groups 2,640,356 4.16 Total 63,456,823 100 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 Rating Score Phase I: Transparency assessment Assess system vulnerability to unethical practices by external peers. Area Total Questions (Sub-Questions) Scale of 10 Degree Registration 18 (45) 7.0 Marginally vulnerable Selection 14 (29) 8.0 Marginally vulnerable Procurement 22 (50) 7.1 Marginally vulnerable 0.0-2.0 2.1-4.1 4.1-6.0 6.1-8.0 8.1-10.0 Extremely vulnerable Very vulnerable Moderately vulnerable Marginally vulnerable Minimally vulnerable 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 Hospital type 2004 2005 2006 Regional hospitals 21 24 25 General hospitals 62 70 69 Community hospitals 569 667 645 Total 659 765 742 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 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 Develop Policy Guidelines National Networking Strengthen Information Database Dissemination of Ethical Practice Information Assessment Phase III: Implementation Phase 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?) Publications/medias provided (cont’d) News Letter, Electronic data and information on CDs, Website: http://dmsic.moph.go.th Changes and Impacts Assessment GGM Flamework Situation Analysis Existing GGM Infrastructure strengthening GGM Networking Thai GGM Strategy Available Practices, Guidelines GGM Implementation Forms, Procedures More Transparency By Information Registration, Selection, Procurement Improvement Socialization, Education. Increased Awareness More Transparency More Efficiency Networking Learning Process Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles 2004-2005 2005-2006 Oct 2006-2008 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. More Transparent Evidence of More Efficiency Source: Pharmacy Information Center, MoPH, Thailand 2007 Drug item Pack unit Average price Regular Separated purchasing Provincial group purchasing Regional group purchasing Diclofenac tab 25 mg 500 107.86 74.69 57.38 Insulin Human Base vial 100 IU/ml (10 ml) 1 308.99 300.63 310.30 Medroxyprogesterone amp. 50 mg/ml (3 ml) 1 16.08 12.49 13.50 Ranitidine tab 150 mg 500 200.95 201.34 177.62 Salbutamol inhaler 100 mcg (200 doses) 1 105.93 112.68 139.10 Salbutamol sol 0.5 % (20 ml) 1 91.87 102.44 85.60 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. 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. Recommendations National GGM Framework development Health care environment Analysis Target Priority Setting Strategic formulation Information System Transparency Information Networking Socialization Guideline Intervention Assessment Operation First Second Third Fourth 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. * * * * * * * * * * * * * * * * * * *
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