new initiatives to finance health care best practices within the rbm partnership

New Initiatives To Finance Health Care

Best Practices within the RBM Partnership

Regional Ministerial Meeting on Financing Strategies for Health Care Colombo, Sri Lanka16-18 March 2009

Thomas TeuscherSenior Advisor

rollbackmalaria.org

2Financing Strategies for Health Care Colombo, Sri Lanka 16-18 March 2009

Achieving the MDGs

Progress on targets significantly accelerated by effective malaria control

MDG 1 1% GDP growth loss, 40% health spending, Eradicate Extreme Poverty 30% household expenditure on illness

MDG 2 Absenteeism, cognitive damageAchieve Universal Primary Education

MDG 4 Contained in top 3 causes of child death,Reduce Child Mortality 20% mortality reduction

MDG 5 Pregnant woman at increased riskImprove Maternal Health

MDG 6 GMAP promotes malaria eliminationCombat HIV/AIDS, Malaria, Other

MDG 8 PPPs and PDPs for universal access Develop a Global Partnership for Development


Copenhagen Consensus 2008 http://www.copenhagenconsensus.com

“What would be the best ways of advancing global welfare

and particularly the welfare of the developing countries? “

Leading economists were asked to address ten key global challenges.How to allocate an additional $75 billion over four years?

1 Micronutrient supplements for children (vitamin A and zinc) Malnutrition2 The Doha Trade agenda Development3 Micronutrient fortification (iron and salt iodization) Malnutrition4 Expanded immunization coverage for children Disease ($ 1,000 - 5.3%)5 Bio-fortification Malnutrition6 De-worming and other nutrition programs at school Malnutrition / Education7 Lowering the price of schooling Education ($ 5,400 – 28.8%)8 Increase and improve girls’ schooling Women ($ 6,000 – 32%)9 Community‐based nutrition promotion Malnutrition10 Provide support for women’s reproductive role Women11 Heart attack acute management Diseases ($ 200 – 1%)12 Malaria prevention and treatment Diseases ($ 500 - 2.6%)13 Tuberculosis case finding and treatment Diseases ($ 419 – 2.2%)

Malaria control is 3rd most cost effective health intervention


Global Financing for Malaria Control


Increased Global Funding


Access to malaria medicines by populations at risk

Public Health Clinic Drugshops

Public sector30-40%

Public sector30-40%

Licensed private sector40-50%

Licensed private sector40-50%

Unlicensed private sector80-95%

Unlicensed private sector80-95%

Drug vendors

7Financing Strategies for Health Care Colombo, Sri Lanka 16-18 March 2009 7

Market shares public & private sector

Chloroquine (CQ)

Sulfadoxine-Pyrimethamine (SP)

Artemisinin monotherapies

ACTs

Other

Chloroquine (CQ)

Sulfadoxine-Pyrimethamine (SP)

ACTs

Private Public

~400 ~150Total = ~550

0

20

40

60

80

100%

2006 Antimalarial Treatment Volumes (Million)

Note: "Other" includes Mefloquine, Amodiaquine and others. ACT data based on WHO estimates and supplier interviews. Source: Biosynthetic Artemisinin Roll-Out Strategy, BCG/Institute for OneWorld Health, WHO, Dalberg.


Innovative Financing Mechanisms

New sources of funding

1. Airline solidarity levy UNITAID

Subscribing countries

Benefitting countries

Maximizing benefits of new financing for health

2. Affordable Medicines Facility for Malaria (AMFm)

Global co-payment to ensure universal access for treatment in public and private sector

Objective:

Make available combination therapy in public & private sector at no or low cost to end-user


UNITAID contributors (from http://www.unitaid.eu/ 14.3.2009)


Who benefits from UNITAID (from http://www.unitaid.eu/ 14.3.2009)


Pricing for ACTs in private and public sector

Manufacturers

Today

Private wholesalers Public wholesalers

Retail pharmacies Public pharmacies

Patients Patients

4 $ 0.80 $

5-6 $ Free/ prime

6-10 $ Free/ prime

ManufacturersSales price 0.80 $ or

less)

Under AMFm

Private wholesalers public / NGO wholesalers

Retail pharmacies Public pharmacies

Patients Patients

0/05$ 0.05$

0.2-0.4$ free/ prime

0.2 – 0.5 $ free/ prime

AMFm

USD 0.75

New Initiatives To Finance Health Care

Backup Slides

rollbackmalaria.org


National Financing on Health


End user prices reflect landed costs or CIF prices (en USD):

ACTs 4 --> 8 m-ART 3 --> 6,50 SP 0.15 --> 0,50 CQ 0.08 --> 0,30

ACT Artemisininmonotherapies

Sulfadoxine-Pyrimethamine

(Generic)

Chloroquine (Generic)

8.0

6.5

0.5 0.30.0

2.0

4.0

6.0

8.0

10.0

Average Prices (USD)

Range(USD) 6-10 5-8 0.4-0.7 0.2-0.4

Note: Ranges indicate variance across countries and products excluding outliers; N (observations): (ACT, 222); (AMT, 227) ; (CQ, 37) ; (SP, 118). Source: Dalberg field research (Kenya, Uganda, BF, Cameroon), Observations by World Bank and Research International (Nigeria). Smaller pricing observations were also performed in Ghana, Rwanda, Burundi, Niger and Zambia), but due to low n not included. SP and CQ data complemented with HAI and IOM observations


Objectives and principles

Objectives: increased use of ACTs

• Promote ACT use

• Chase mono-therapies and ineffective drugs

Through

–Reduced ACT end-user price

–Supporting interventions

Objectives: increased use of ACTs

• Promote ACT use

• Chase mono-therapies and ineffective drugs

Through

–Reduced ACT end-user price

–Supporting interventions

Principles

• Offer ACTs to whole salers at CQ price

• All countries, all sectors: public, private, NGO

• Light secretariat

• Eligibility of ACTs: WHO recommended

• Eligibility of manufacturers: quality, price

• Eligibility of wholesalers: MOH

• Eligibility of countries

• Supporting interventions for responsible introduction and launch

• Monitoring & Evaluation – RBM 2015 Goals

Principles

• Offer ACTs to whole salers at CQ price

• All countries, all sectors: public, private, NGO

• Light secretariat

• Eligibility of ACTs: WHO recommended

• Eligibility of manufacturers: quality, price

• Eligibility of wholesalers: MOH

• Eligibility of countries

• Supporting interventions for responsible introduction and launch

• Monitoring & Evaluation – RBM 2015 Goals


AMFm activities: 3 packages CORE AMFm FUNCTIONS

(Executed by Facility)• Negotiation of terms for low-cost antimalarials • Setting prices and terms for international

distribution• Processing co-payments • Transparent sharing of information and forecasts

ELIGIBILITY CRITERIA / REQUIREMENTS(Set by RBM, applied by Facility)

PARTNER / SUPPORTING INTERVENTIONS(Ensured and facilitated by Facility)

• ACT treatment requirements• Buyer eligibility requirements• Country preparedness requirements

• National policy and regulatory preparedness

• Wholesaler incentives and pricing / margin control mechanisms

• Public education and awareness (IEC)

• Provider training• National monitoring and

quality preparedness (resistance monitoring, pharmacovigilance, and quality surveillance)


AMFm Phase 1 is targeted to launch in May 2009

• Phased launch starting with a first group of countries to facilitate learning and help guide adjustments to the AMFm design before global implementation

• Phase 1 will launch in May 2009 and run until the end of 2010

• An independent technical evaluation will be commissioned by the Global Fund to assess the AMFm

• Expansion from Phase 1 to full roll-out in all malaria-endemic countries will occur unless clear failures are observed from the evaluation findings

Resources required for launch:• Co-payment: ~USD 212 million

• Supporting interventions: ~ USD 100-125 million

new initiatives to finance health care best practices within the rbm partnership

Documents

health care colombo

financing strategies

global financing

health spending

oneworld health

malaria medicines

benefits of new financing

malaria prevention