Assessment of Governance and Corruption in the Pharmaceutical Sector : Lessons Learned from Low and Middle Income Countries
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World Bank, Washington, DC
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Pharmaceuticals are a critical input for
the health sector. At the same time, the drug business
sustains many individual and corporate livelihoods and
produces handsome returns for those involved in the trade.
Good governance is critical for the sector to maximize
returns for public health and minimize risks for patients
from ineffective or contaminated drugs. Given the large
financial volume of the market, the potential for corruption
is significant. Vulnerable points are those at which
decisions about market access and purchasing are made. This
includes institutional functions such as licensing,
inclusion into formularies and public procurement as well as
the individual prescriber, who selects drugs for a specific
patient. Given the political and institutional resistance
against more transparency from the beneficiaries of the
status quo, assessment of governance and corruption in the
sector is not a straightforward exercise. The authors
developed a more indirect approach that relies on a broader
assessment of the functioning of the sector and detection of
patterns that suggest governance or management problems.
From a developmental perspective, the focus is on reducing
the impact of bad governance (high drug prices, stock-outs,
bad quality of drugs in circulation, irrational use of
drugs) rather than identifying the actors and bringing them
to justice. Even if the governance level cannot be touched
due to political resistance, it may be possible to address
the problem from a technical or management angle. For
example, electronic procurement platforms and inventory
management systems make manipulation more difficult and
allow for a faster discovery of irregularities. The
assessment framework was applied in eight countries, with
adjustments based on client demand and political viability.
In most cases, a follow-up after the assessment could be
documented, showing that the data provided had relevance and
impact in the national policy dialogue. Three of the eight
countries signed up to a longer term program to increase
transparency in the sector (medicines transparency
alliance), others initiated specific projects to address
issues that were presented as a result of the initial
assessment. In summary, the authors work could demonstrate
that it is possible to effectively address pharmaceutical
governance issues in the context of a broader sector
assessment an approach that may face less political
resistance than an inquiry based on a "governance and
corruption" labeled instrument.
Palabras clave
ABUSE, ACCESS TO PHARMACEUTICALS, ACCOUNTABILITY, ANTIBIOTICS, ASSASSINATION, AUTHORITY, BIDDING, BRAND, BRANDS, BUDGETING, CAPACITY BUILDING, CASH FLOW, CENTRAL GOVERNMENT, CENTRAL GOVERNMENT AUTHORITIES, CENTRAL MEDICAL STORES, CITIZENS, CLINICS, COMMODITIES, COMMUNICABLE DISEASES, COMMUNITY HEALTH, CONTRACEPTIVES, CONTRACTING OUT, CORRUPTION, CRIME, DECISION MAKERS, DECISION-MAKING, DECREE, DEVELOPMENT GOALS, DIABETES, DIET, DISPENSING FEES, DISTRICTS, DRUG FINANCING, DRUG FORMULARIES, DRUG PRESCRIBING, DRUG PRICES, DRUG TESTING, DRUG UTILIZATION, DRUGS, EFFECTIVE GOVERNANCE, EFFICIENT MARKET, ENFORCEMENT ACTION, ESSENTIAL DRUGS, ESSENTIAL MEDICINES, EXPENDITURE EXPENDITURE, EXPENDITURE MANAGEMENT, EXPENDITURES, FEASIBILITY, FEASIBILITY STUDY, FIELD TESTING, FINANCIAL INCENTIVES, FINANCIAL MANAGEMENT, FINANCIAL RESOURCES, FRAUD, GENERIC DRUGS, GENERIC PRODUCTS, GMP, GOOD GOVERNANCE, GOVERNMENT DECISION, GOVERNMENT PROGRAMS, GOVERNMENTAL ORGANIZATION, HEALTH CARE, HEALTH CARE WORKERS, HEALTH FACILITIES, HEALTH INSURANCE, HEALTH MANAGEMENT, HEALTH OUTCOMES, HEALTH SECTOR, HEALTH SERVICES, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HEALTHCARE PROVIDERS, HORMONES, HOSPITALS, HUMAN DEVELOPMENT, HUMAN DEVELOPMENT NETWORK, IMPORTED DRUGS, INDICATOR DRUGS, INFORMAL SECTOR, INSTITUTIONAL CAPACITY, INSURANCE SCHEMES, INTERVENTION, INVENTORY, INVENTORY CONTROL, INVENTORY MANAGEMENT, IRRATIONAL USE, LABORATORIES, LACK OF COMPETITION, LAWS, LEGAL ACTION, LEGAL SYSTEM, LEGISLATION, LOCAL AUTHORITIES, LOCAL GOVERNMENT, LOCAL GOVERNMENTS, LOCAL MANUFACTURERS, LOW-INCOME COUNTRIES, LOW-INCOME COUNTRY, MALARIA, MANAGEMENT SYSTEMS, MARKET ACCESS, MARKET FAILURE, MARKET FAILURES, MARKET SEGMENTS, MARKET SHARE, MARKETING, MARKETIZATION, MARKETPLACE, MEDICAL STORES, MEDICATION, MEDICINE, MEDICINES, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MONOPOLY, NATIONAL DRUG, NATIONAL POLICY, NATIONS, NUTRITION, PATENTS, PATIENT, PATIENTS, PAYMENT TERMS, PERIPHERAL HEALTH FACILITIES, PHARMACEUTICAL, PHARMACEUTICAL EXPENDITURE, PHARMACEUTICAL INDUSTRY, PHARMACEUTICAL INSPECTORS, PHARMACEUTICAL LAW, PHARMACEUTICAL MANAGEMENT, PHARMACEUTICAL POLICY, PHARMACEUTICAL PRICING, PHARMACEUTICAL PRICING POLICIES, PHARMACEUTICAL PRODUCTS, PHARMACEUTICAL SECTOR, PHARMACEUTICAL SUPPLY, PHARMACEUTICAL SUPPLY CHAINS, PHARMACEUTICALS, PHARMACEUTICALS MANAGEMENT, PHARMACEUTICALS REGULATION, PHARMACIES, PHARMACISTS, PHARMACY, POLICY DECISIONS, POLICY DIALOGUE, POLICY LEVEL, POLICY MAKERS, POLITICAL SUPPORT, POOLED PROCUREMENT, POOR GOVERNANCE, PRESCRIPTIONS, PRICE CEILINGS, PRICE COMPARISONS, PRICE COMPETITION, PRICE CONTROL, PRICE LEVELS, PRICE LISTS, PRICING MECHANISMS, PRICING POLICY, PRIVATE PHARMACIES, PRIVATE SECTOR INVESTMENT, PROCUREMENT, PRODUCT QUALITY, PROGRESS, PUBLIC EDUCATION, PUBLIC EXPENDITURE, PUBLIC EXPENDITURES, PUBLIC FUNDING, PUBLIC FUNDS, PUBLIC HEALTH, PUBLIC HOSPITALS, PUBLIC OFFICIALS, PUBLIC PROCUREMENT, PUBLIC RESOURCES, PUBLIC SECTOR, PUBLIC SERVICE, PUBLIC SPENDING, PUBLIC SYSTEM, PURCHASING, PURCHASING POWER, QUALITY ASSURANCE, QUALITY CONTROL, RATIONAL DRUG USE, RATIONAL USE OF DRUGS, REBATES, REFUGEES, REGULATORY AGENCIES, REGULATORY AGENCY, REGULATORY AUTHORITIES, REGULATORY AUTHORITY, REGULATORY FRAMEWORK, REGULATORY OVERSIGHT, REGULATORY SYSTEM, REPRESENTATIVES, RETAIL, RETAIL PHARMACIES, RULE OF LAW, SALE, SALES, SECURE SUPPLY, SERVICE DELIVERY, SKILLED STAFF, SMOKING, SOCIAL DEVELOPMENT, SOCIAL HEALTH INSURANCE, SOCIAL INSURANCE, STANDARD TREATMENT GUIDELINES, STOCKS, SUBSTITUTION, SUPPLIER, SUPPLIERS, SUPPLY CHAIN, SUPPLY CHAIN MANAGEMENT, SUPPLY SYSTEMS, TECHNICAL ASSISTANCE, TENDERING, THERAPIES, TRADITIONAL MEDICINES, TRANSPARENCY, TRANSPORT COSTS, VACCINES, VULNERABILITY, WAREHOUSES, WASTE, WHOLESALER, WHOLESALERS, WORKERS