The document summarizes the WHO Good Governance for Medicines Program in the Eastern Mediterranean Region. It outlines that only 45% of essential medicines are available in developing countries despite high spending on medicines. The GGM program aims to increase transparency and accountability in pharmaceutical systems through national assessments and frameworks. 16 countries in the EMR have participated, developing policies on conflicts of interest, licensing, inspections, and supply chain management. Impact assessments show more transparency and efficiency, though further strengthening is needed. In Thailand, the program reduced medicine prices by up to 47% through group purchasing.

1. 9th October 2017
64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017
Good Governance
for Medicines Program
in the East Mediterranean Region

2. Presentation Outline
 The need for Good Governance for Medicines
 WHO Good Governance for Medicines
Program – GGM
 Status of implementation of GGM in the East
Mediterranean Region and the results

3. Low Access to
Medicines…
Only
45%
of 30 essential
medicines
surveyed in 40
developing countries
have shown
availability
Wastage and
corruption
…despite high %
of spending
20-60%
of MoH recurrent health
budget is spent on
medicines
60-70%
of out of pocket expense
on medicines
3/10
leading causes of health
system inefficiencies are
medicines related
2/3
of scarce medicine
supplies in hospitals are
“lost” to theft and
corruption

4. R&D
Manufacturing
Procurement
and supply
Distribution
Prescribing
Dispensing
Pharmaceutical Supply Chain
Use
Inefficiencies Malpractices

5. WHO GGM Programme
supporting policy-makers & managers in 37 countries
To contribute to health systems strengthening by
reducing/preventing vulnerability to corruption in the
pharmaceutical sector.
Specific objectives
 To increase transparency and accountability in
medicine regulatory and supply management systems
 To promote individual and institutional integrity in
pharmaceutical sector
 To institutionalize good governance in
pharmaceutical systems by building national capacity
and leadership

6. WHO Good Governance for Medicines programme
PHASE II
Development
national GGM
framework
PHASE III
Implementation
national GGM
programme
PHASE I
National
transparency
assessment
MOH
Clearance
GGM
framework
officially
adopted
Assessment
report
GGM
integrated
in MoH
plan
Regulatory Functions: Registration / Licensing / Inspection / Promotion / Clinical Trials
Supply Chain Functions: Selection / Procurement / Distribution

7. GGM Implementation in EMR
PHASE II
Development
national GGM
framework
PHASE III
Implementation
national GGM
programme
PHASE I
National
transparency
assessment
MOH
Clearance
1. Bahrain
2. Iraq
3. Morocco
4. Yemen
1. Afghanistan
2. Egypt
3. Iran
4. Kuwait
5. Pakistan
6. Palestine
7. Tunisia
8. Sudan
1. Iran
2. Jordan
3. Lebanon
4. Oman
Since 2007 – 16 countries – Financially supported by Kuwait

8. Summary of Assessment Scores in EMR Countries
Vulnerability Level
1 MS is yet to report GGM assessment results;

9. Summary Findings – areas for improvement
Registration
Conflict of interest policy
Committee composition & TOR
Licensing
Conflict of interest policy
Written guidelines for assessing applications for a license
Inspection
Conflict of interest policy
Appeals mechanisms
Promotion
Complete provisions to cover all
Establish monitoring committee
Clinical trials
Conflict of interest policy
Clinical trials inspection system
Selection
Conflict of interest policy
Selection criteria for members
Procurement
Conflict of interest policy
Audit results publicly available
Distribution
SOPs for stock management system at each level of distribution
Systematic and orderly shelving of products in warehouses

10. A glimpse of achievements
Iran regulations on drug promotion introduced, declaration
of conflict of interest forms developed for Legal Commissions,
Drug Selection committee and Clinical trials committee, platform
of the National Inspection Organization (Ombudsman)
Jordan developed Conflict of Interest guidelines, have introduced
stronger sanctions against unethical marketing of
pharmaceuticals and have adopted a code of conduct for
pharmacists
Lebanon developed a new code for medicinal drug promotion, members of
all committees have to sign Conflict of Interest forms and
guidelines and first ever “requirements for clinical trials” have
been adopted
Oman established a steering committee headed by the Minister of
health to implement GGM related reforms after adopting the
GGM framework
1. Iran
2. Jordan
3. Lebanon
4. Oman

11. Impact of Good Governance for Medicines Programme
In EMR MSs impact is yet to be assessed. The program has brought
more transparency, new instruments have been developed and more
efficiency is being achieved.
The programme in Thailand has resulted in the development of:
•A Regional Group Purchasing Strategy
•A Monopoly Drug Management Policy
•A Compulsory Licensing Law
•A Corruption Control Mechanism
•Socialization (A Whistle Brower Protection)
•Integration of 3 Health Security Schemes
11

12. Impact in Thailand
Item Pack
Unit
Price USD
(pre-GGM)
Price USD
(Post-GGM)
% Cost
Reduction
Diclofenac tab 25 mg
500 3.2 1.7 47
Medroxyprogesterone amp 50 mg/ml
(3 ml)
1 0.48 0.4 16
Ranitidine tab 150 mg
500 6.0 5.3 12
Salbutamol sol 0.5 % (20 ml)
1 2.8 2.6 7
Regional Group Purchasing

13. Key Messages
1. Good Governance in Medicines is essential
for addressing inefficiencies and
malpractices
2. The Program needs to be strengthened and
expanded in the region
3. We seek Member States guidance and
support