Good Governance for Medicines in Jordan Prof. Mohammad Rawashdeh JFDA Director General

JORDAN 10/06/09 MeTA • Jordan is a low middle – income country Population in millions: 5,894,960 10.4 % of the Jordanian GDP is spent on health with one third of this spent on medicinal drugs. One quarter of the drug expenditure is spent in the public sector with the remaining three quarter spent in the private sector. Medicines expenditure growth 17% per annum compared to GDP growth of 3.3%.

• Jordan is a low middle – income country

Population in millions: 5,894,960

10.4 % of the Jordanian GDP is spent on health with one third of this spent on medicinal drugs.

One quarter of the drug expenditure is spent in the public sector with the remaining three quarter spent in the private sector.

Medicines expenditure growth 17% per annum compared to GDP growth of 3.3%.

The problem of corruption “ The abuse of entrusted power for personal gain” • Globally more than US$ 4.4 trillion is spent on health services each year. The value of the global pharmaceutical market is estimated at over US$ 600 billion. • 10-25% of public procurement on medicine is lost because of corruption and bad governance. • Corruption is a global scourge not confined to a certain culture or country, it exists in developing and developed countries, as it exists in the public and private sectors and in different strata of society. • Corruption identified as the most important obstacle in the process of economic and social development.

• Globally more than US$ 4.4 trillion is spent on health services each year. The value of the global pharmaceutical market is estimated at over US$ 600 billion.

• 10-25% of public procurement on medicine is lost because of corruption and bad governance.

• Corruption is a global scourge not confined to a certain culture or country, it exists in developing and developed countries, as it exists in the public and private sectors and in different strata of society.

• Corruption identified as the most important obstacle in the process of economic and social development.

Efforts to address corruption need coordinated application of two basic strategies 1. "Discipline-based approach" (top-down): - Laws, policies and procedures against corruption and for pharmacy practice with adequate punitive consequence for violation - Attempts to prevent corrupt practices through fear of punishment 2 . " Values-based approach" (bottom-up) - Promotes institutional integrity through promotion moral values and ethical principles - Attempts to motivate ethical conduct of public servant

1. "Discipline-based approach" (top-down):

- Laws, policies and procedures against corruption and for pharmacy practice with adequate punitive consequence for violation

- Attempts to prevent corrupt practices through fear of punishment

2 . " Values-based approach" (bottom-up)

- Promotes institutional integrity through promotion moral values and ethical principles

- Attempts to motivate ethical conduct of public servant

Good Governance for Medicines programme • The goal of GGM Programme is to improve the situation of medicines regulation and supply. • The programme is raising awareness of potential abuse in the public pharmaceutical sector and promoting good governance. • Its ultimate aim is to ensure that essential medicines reach the people who need them. • Jordan join the program in 2007, which was established by WHO in 2004.

• The goal of GGM Programme is to improve the situation of medicines regulation and supply.

• The programme is raising awareness of potential abuse in the public pharmaceutical sector and promoting good governance.

• Its ultimate aim is to ensure that essential medicines reach the people who need them.

• Jordan join the program in 2007, which was established by WHO in 2004.

PHASE II Development national GGM framework PHASE III Implementation national GGM programme PHASE I National transparency assessment Assessment report GGM framework officially adopted GGM Strategic Plan of Action Good Governance for Medicines programme: a model process Clearance MOH

Assessment of transparency and accountability • Assesses vulnerability to corruption of systems in place • Looks at key functions of the pharmaceutical sector systems - Regulation: registration, inspection, promotion Supply: selection, procurement, distribution • Elements evaluated: - Country's regulations and official documents - Written procedures and decision-making processes - Committees, criteria for membership and conflict of interest policy - Appeals mechanisms and other monitoring systems PHASE II PHASE I PHASE III

• Assesses vulnerability to corruption of systems in place

• Looks at key functions of the pharmaceutical sector systems

- Regulation: registration, inspection, promotion

Supply: selection, procurement, distribution

• Elements evaluated:

- Country's regulations and official documents

- Written procedures and decision-making processes

- Committees, criteria for membership and conflict of interest policy

- Appeals mechanisms and other monitoring systems

Assessment of transparency in Jordan • Assessment was conducted in October - November /2007, Assessment report was published and disseminated in January 2009 • The results of the assessment and recommendations were disseminated to the stakeholders through a national workshop in february/2008 • Two committees have been nominated : GGM Steering Committee, and Task Force Committee • Some improvements occurred in the procedures of the pharmaceutical sector PHASE II PHASE I PHASE III

• Assessment was conducted in October - November /2007, Assessment report was published and disseminated in January 2009

• The results of the assessment and recommendations were disseminated to the stakeholders through a national workshop in february/2008

• Two committees have been nominated : GGM Steering Committee, and Task Force Committee

• Some improvements occurred in the procedures of the pharmaceutical sector

Areas of Improvement - Conflict of interest policy - Audit results publicly available Procurement - Conflict of interest policy - Selection criteria for members Selection - Conflict of interest policy - Clear criteria for selection of inspectors Inspection - Complete provisions to cover all Activities related to drug promotion Promotion - Conflict of interest policy - Committee composition & TOR Registration

Registration

GGM Steering Committee • Members are high level policy makers • Responsible for the overall management, adoption and evaluation of the GGM programme • Ensure implementation of recommendations made in assessment report • Ensure that the national Framework for Good Governance in the public pharmaceutical sector is officially adopted • Ensure the establishment of policies and procedures for the control of reprehensible acts • Ensure the establishment of a whistle-blowing mechanism • Ensures the establishment and implementation of a GGM programme (phase III)

• Members are high level policy makers

• Responsible for the overall management, adoption and evaluation of the GGM programme

• Ensure implementation of recommendations made in assessment report

• Ensure that the national Framework for Good Governance in the public pharmaceutical sector is officially adopted

• Ensure the establishment of policies and procedures for the control of reprehensible acts

• Ensure the establishment of a whistle-blowing mechanism

• Ensures the establishment and implementation of a GGM programme (phase III)

GGM Task Force The GGM Task Force main tasks include: 1. Manage the national consultations process necessary to: a. Share the results of the national assessments of transparency and vulnerability to corruption in the public pharmaceutical sector and b. Develop and implement the national GGM framework that approved by the steering committee 2. Follow-up and act upon the recommendations made in the national assessments report and by the steering committee. 3. Coordinate the development, adoption, and socializing the national ethical framework and the code of conduct

The GGM Task Force main tasks include:

1. Manage the national consultations process necessary to:

a. Share the results of the national assessments of transparency and vulnerability to corruption in the public pharmaceutical sector and

b. Develop and implement the national GGM framework that approved by the steering committee

2. Follow-up and act upon the recommendations made in the national assessments report and by the steering committee.

3. Coordinate the development, adoption, and socializing the national ethical framework and the code of conduct

Jordan GGM Framework Partnership • Ministry of Health. • Ministry of Public Sector Development. • Jordan Food & Drug Administration. • Anti Corruption Commission. • Royal Medical Services. • High Health Council. • Joint Procurement Department. • Jordan University Hospital. • World Health Organization.

• Ministry of Health.

• Ministry of Public Sector Development.

• Jordan Food & Drug Administration.

• Anti Corruption Commission.

• Royal Medical Services.

• High Health Council.

• Joint Procurement Department.

• Jordan University Hospital.

• World Health Organization.

Components for National GGM Frameworks • Ethical framework of moral values & ethical principles - Justice/fairness - Truth - Service to common good - Trusteeship • Code of conduct • Socialization programme • Promotion of Moral Leadership • Established anti-corruption legislation • Whistle-blowing mechanism • Sanctions on reprehensible acts • Transparent and accountable regulations and administrative procedures • Collaboration with other GG & AC initiatives • Management, coordination and evaluation of GGM programme (Steering Committee & Task Force) Discipline based approach Values based approach PHASE II PHASE I PHASE III

• Ethical framework of moral values & ethical principles

- Justice/fairness

- Truth

- Service to common good

- Trusteeship

• Code of conduct

• Socialization programme

• Promotion of Moral Leadership

Implementation of National GGM Programme • It is the phase of implementation the national program of good governance and institutionalizing it in the public pharmaceutical sector. • This phase aims to promote the framework among key pharmaceutical actors and to translate its recommendations into action through a set of strategic activities increasing awareness, strengthening integrity systems and building capabilities for leadership. • Jordan now is considered in this phase. PHASE II PHASE I PHASE III

• It is the phase of implementation the national program of good governance and institutionalizing it in the public pharmaceutical sector.

• This phase aims to promote the framework among key pharmaceutical actors and to translate its recommendations into action through a set of strategic activities increasing awareness, strengthening integrity systems and building capabilities for leadership.

• Jordan now is considered in this phase.

Suggested Activities in Jordan for Phase III • Training of the national GGM team, briefing sessions for government officials, production of advocacy materials. • Changing some procedures in the public pharmaceutical sector to make them more transparent. • Adoption of a code of conduct for pharmacist in the public sector. • Development of a COI guidelines • Introducing the GGM concept into university curricula.

• Training of the national GGM team, briefing sessions for government officials, production of advocacy materials.

• Changing some procedures in the public pharmaceutical sector to make them more transparent.

• Adoption of a code of conduct for pharmacist in the public sector.

• Development of a COI guidelines

• Introducing the GGM concept into university curricula.

Progress • In January 2009 a Phase III training workshop was held for the first time in Jordan. It focused on anti-corruption & pharmaceutical sector legal frameworks, implementation of the recommendations included in the transparency assessment (Phase I) & moral leadership capabilities. • Among 26 countries globally including 5 countries in EMR, 10 countries are in phase I, 11 countries in phase II and 5 in phase III including Jordan. • Jordan recently finalized the national GGM framework, and is the 1 st EMR country to enter the implementation phase ( phase III). .

• In January 2009 a Phase III training workshop was held for the first time in Jordan. It focused on anti-corruption & pharmaceutical sector legal frameworks, implementation of the recommendations included in the transparency assessment (Phase I) & moral leadership capabilities.

• Among 26 countries globally including 5 countries in EMR, 10 countries are in phase I, 11 countries in phase II and 5 in phase III including Jordan.

• Jordan recently finalized the national GGM framework, and is the 1 st EMR country to enter the implementation phase ( phase III). .