Tuesday, September 04, 2012

Socialized Healthcare 7: Degnan and Wagner on ICIUM and UHC

Healthcare is a very important issue for many people around the planet. That is why emotional arguments are often linked with quantitative and political discourses. The belief or motto that "health is a right and an entitlement from the state" often clouds if not erases the other side of the equation that health is also a personal and parental/guardian/civil society responsibility.

Yesterday, I attended a seminar at the Asian Institute of Management (AIM) by two eminent speakers from Harvard Medical School (HMS) and World Health Organization (WHO) consultants.

Dr. Ross-Degnan, Sc.D. (left photo), an Associate Professor at the Department of Ambulatory Care and Prevention (DACP) at HMS and Director of Research at Harvard Pilgrim Health Care, spoke on Improving Medicines Access and Use: Highlights from the International Conference on
Improving Use of Medicines (ICIUM 2011).

Dr. DegNan co-founded the International Network for Rational Use of Drugs (INRUD) in 1990, a global network of academics, health managers, and policymakers involved in developing and testing interdisciplinary interventions to improve use of medicines. He is a consultant at the WHO on issues related to access to and appropriate use of medicines, and pharmaceutical sector monitoring and evaluation. 

The second speaker was Dr. Anita Wagner (above, right photo), an Assistant Professor in the Department of Ambulatory Care and Prevention (DACP) at HMS and Harvard Pilgrim Health Care. She has a doctorate in epidemiology from Harvard School of Public Health and a doctorate in clinical pharmacy from the Massachusetts College of Pharmacy and Allied Health Sciences. For the WHO Collaborating Center in Pharmaceutical Policy, she leads the global Medicines and Insurance Coverage (MedIC) Initiative. Yesterday, she spoke on Universal Coverage and Medicines: Why Focus on Value?

A staff of Dr. Kenneth Hartigan-Go of AIM, David Teh, sent me the powerpoints today. Thanks David. Dr. Degnan's presentation is about 30 slides, I will show only about half of them below.


Improving use of medicines (IUM) I think is the other term for rational use of medicines (RUM). The latter is used here by the DOH and even by WHO Philippine Office. Right, even if medicines are heavily subsidized by the government, or even freely available, a patient should not over-dose or over-extend taking the medicines simply because they are cheap or free. There are serious long term adverse effects like anti-microbial resistance (AMR) where the body or a disease has gotten used to certain medicines and treatment and simply multiply or evolve into more dangerous diseases even if the patient is taking the necessary medications. The chart on supply and demand of medicines by Dr. Degnan is nice. I think it's simple enough.

Dr. Degnan gave a background about the ICIUM, it holds the conference every seven years. So the next conference would be sometime in 2018. And from 2003 to 2007, there was marginal improvement in policies and implementation of countries to improve use of medicines.


Below are the series of recommendations for each sector or stakeholder. I like the one mentioning the role of think tanks. We don't have much of such stuff here in the Philippines. We instead have dozens or hundreds of advocacy NGOs and people's organizations and cooperatives with definite positions on certain issues that are often not refined or updated with the changing times.

Then I like the mention or emphasis on multi-stakeholder collaboration, the unintended adverse effects of government intervention in pricing of medicines, like the current drug price control and mandatory 20 percent discount to senior citizens and persons with disabilities (PWDs).

The healthcare providers, health insurance companies, private and government, also have their share of ways to improve access and use of medicines. Policing of unethical marketing should be done at the source as much as possible, via industry associations, CSR and related practices.


The recommendations on the role of civil society is nice, but not cool enough. For me, the role of civil society is to empower the people towards self-reliance and responsible citizenship, free from mendicant thinking that almost everything especially in healthcare, should be government responsibility. Because there is bigger role for personal and parental or guardian responsibility in healthcare, like doing healthy lifestyle and having a clean house and environment.


The summary is brief and direct enough. Progress has been slow, but new strategies and schemes are discovered. I do not know how receptive or skeptical the WHO and the participants of the ICIUM are in having more role for market players, in having less government intervention, in some aspects of healthcare. Not everything can be planned and foreseen by government, whether at the local or national or multilateral/WHO/foreign aid levels.

The next slides after the summary are supporting presentations, especially the role of the Medicines Transparency Alliance (MeTA). 


The world is indeed moving towards more generics, especially among the emerging (aka "pharmerging") markets and economies.


I will discuss the presentation by Dr. Wagner next. Meanwhile, here are some photos that I took last night. Dr. Klara Tisocki of the WHO asking some questions. On a side note, I am thankful to her for inviting me to the first MeTA CSO mapping in January 2009. It opened a lot of discussion venues for me after that. Lower photo, I caught her discussing some points with Reiner Gloor, the Executive Director of the Pharmaceutical and Healthcare Association of the Philippines (PHAP).


Below, a group picture that I instigated :-) From left: Ross Degnan, Pricess Nemenzo of WomanHealth, Art Catli of PHAP, Normita Leyesa of PPhA, Cecile Sison of MeTA-Philippines, Anita Wagner, Leonie Ocampo, current President of PPhA, Klara Tisocki, Yolly Robles of PPhA and Reiner Gloor.


Lower photo left, DOH Assistant Secretary Madz Valera adding a comment to a question. To his right was Joey Ochave of Unilab who raised a number of good points on healthcare, that we need to focus more on the local government and community levels in health data gathering and HC delivery.
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See also:



Socialized Healthcare 6: Student Debates, Charity Beds and UHC, August 22, 2012

2 comments:

Leonie Ocampo said...

59AHi Nonoy!
Thank you for this post, yes the activity on that night was really very good and I agree with the 2 speakers on several points. The PPhA had always been in a position to improve the use of medicines and be responsible while in the use of it. Once again, emphasis was placed not only on the prices but on the medicines quality and responsible use and everyone has his role to play. The PPhA, with its limited resources but with officers and some members equipped with a wide experience on this, is doing its share of the responsibility to promote rational and responsible use of medicines. We need to work together to let the public know that while a medicine may heal the people's ailments, it can also harm that one using it but be responsible enough to seek the proper advise from authorities of it, the health professionals especially the Pharmacists who are widely distributed and available in the community setting.The model, Indonesia, Anita was giving as an example is an initiative I am familiar with as this was presented in FIP and I had the chance to talk to the project proponent. It SUCCEEDS because it is stongly supported by the government. I am positive now that we will get the same support from our DOH. More can be done and the private sector is ready and available to work with and support the government too. Let us therefore all work together in a COLLABORATIVE manner if we want something different especially in the patients' health outcomes, to happen.Again thank you for always upodating people with your blog.

Nonoy Oplas said...

Thanks for the kind words Leonie. Being a non-health professional but a keen observer of public health policies and health conditions, this is the least that I can do -- to write and provide as much information that I can gather to my readers. And to emphasize the real role of civil society, which is citizen empowerment towards self reliance and more volunteerism, not towards more dependence on government subsidies and intervention.