Progress on Good Governance in the

pharmaceutical sector in Thailand

Dr.Chanvit Tharathep MD., FRCST, Fam. Med., Prev. Med.

Universal Health Coverage inThailandHealth

Security Scheme

Number of beneficiaries

Percentage of coverage

30 Baht 46,636,899 73.49

Social Security

9,060,033 14.28

Civil Servant Medical Benefit

5,119,535 8.07

Unidentified groups

2,640,356 4.16

Total 63,456,823 100

Health Care Environment in ThailandHospit

als BedsOut Patient

Visits

Inpatient Admissio

nInpatient

days

Bed occupancy rate (%)

MoPH 87586,66

7 80,596,859 6,015,238 25,892,528 82

PM office 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 Authorit

y 13 2,375 2,322,571 109,233 599,207 69

Private 29826,34

3 29,346,824 1,601,497 4,602,531 48

Total 1,278133,2

45124,487,46

0 8,301,835 35,674,111 73

2004 GGM introduced to improve and enhance process of Drug Management

2004 GGM introduced to improve and enhance process of Drug Management

1981, 1993 :National Drug PolicySafety, Quality, Appropriate Price, Access

1981-2005 : Essential Drugs list, Standard Price

2004 : Public Good Governance Law

1997-2005 Drug management Reform in MoPH

1997 Economic Crisis,

1997 Economic Crisis,

1997 Drug Scandal

1997 Drug Scandal

Activities Before WHO GGM

WHO GGM Program: Changes and Impacts

PHASE IIPHASE I PHASE III

Assessment

GGM Flamework

Situation Analysis

Existing GGM

Infrastructure

strengtheningGGM

Networking

Thai GGM Strategy

Available Practices, Guidelines

GGM Implementa

tion

Forms, Procedures

More Transparenc

yBy

Information

Registration, Selection,

Procurement Improvement

Socialization,

Education.

Increased Awareness

MoreTranspare

ncy

More Efficiency

Networking

Learning Process

Strengthening Anti-Corruption Laws, Agency and Mechanism, Moral Value and Ethical Principles

2004-2005 2005-2006 Oct 2006-209

OutputOutcome Impacts

Develop Policy Guidelines

National Networking

Strengthen Information Database

Dissemination of Ethical Practice Information

Assessment

Phase III: Strategy and implementation 2006-2009•GGM 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 •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

Code of Conduct for Sales and Marketing

Meeting 2009 GGM Leadership training MoPH hospital

pharmacists

GGM head of MoPH hospital pharmacists Meeting 2010 group discussion

Key achievements 2005-2013GGM Components Achievements GGM Activities

Consensus Oriented GGM Framework : SubsetGGM Strategy

GGM ImplementationCOI

Code of Conduct

Participatory

Rule of Law

Transparent Pharmacy Information Center

Accountable Group PurchasingMonopoly Drug Management

Compulsory LicensingCorruption Control

SocializationRational Use of Drugs

3 Health Security Schemes Harmonization

Responsive

Effective and Efficient

Equitable and Inclusive

Key achievements 2011-2013 GGM Framework : Subset :The National Ethical

Framework on Drug Promotion : (National Drug Policy B.E.2554 (2011) on March 14, 2011)

Rational Use of Drugs : Glucosamine, Antimicrobial Guideline

Corruption Control, Socialization Pharmacy Information Center strengthening (Pseudoephedrine case 14 hospitals : 5 Hospital Pharmacists were fired 2012)

Monopoly Drug Management (continuing) Single Price policy

Pharmaceutical Logistic Improvement: Regional Stock for all hospitals (ongoing process)

3 Health Security Schemes Harmonization : Emergency Service Integration, ARV, Hemodialysis, CA

Reasons for Success

Strong National Good Governance Policy by Government and MoPH

Participatory Process : among public organizations, NGO, Media

GGM Strategy Transparency (Pharmacy Information

Center) GGM teamwork Focus on Output, Outcome, Impact

Drug item Pack unit Average price

RegularSeparated purchasing

Provincial group

purchasing

Regionalgroup purchasin

g

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

Group Purchasing Outcome: More efficiency, cost reduction

1.Antihypertensive drugs (ARB)

2.Dyslipidemia agent (Statins)

3.Proton pump inhibitor (PPI)

Monopoly Drugs Single price policy

Item Previous Price(Baht)

Proposed

Price(Baht)

Managed Price(Baht)

Save/Packag

e(Baht)

Budget Save

(Baht)

Rosuvastation tablet 10 mg (Crestor)

11,08.52

11,08.52

10,07.75

10

07.7

99,99,40

7

GGM Operating Framework

National GGM FrameworkHealth care environment AnalysisTarget Priority Setting

Strategic formulation

Information System Transparency

Information Networking Socialization Guideline

Intervention Assessment

Management System Strengthening Activities

Output, Outcome Focused Activities

Activities and ImplementationGGM 2010-2013 Continue System Analysis (GGM

Framework, Existing System, Context change ), Priority Setting

Strategic Formulation (Selective Implementation)

Re-Design Evaluation, Re-Assessment

Challenges

MoPH Structure changed : Pharmacy Information Center weakening -> Pseudoephedrine case.

Seperated Operation among organizations

Unlinkage between Government Anticorruption Policy and GGM program

Knowledge Management Gap.

Conclusion 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.

GGM team consists of related organization should be formed.

Output, Outcome orientated activities