Improving Transparency in Pharmaceutical Systems : Strengthening Critical Decision Points Against Corruption
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World Bank, Washington, DC
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This study presents a diagnostic
framework and methodology to evaluate a pharmaceutical
system s vulnerability to corruption and to determine which
corrupt practices can have a major impact on the system s
ultimate efficiency. We thus provide: (a) a systematic and
quantifiable assessment of the extent to which a country s
pharmaceutical system is vulnerable to corrupt practices;
and (b) the identification of potential actions to increase
the system s resistance to corruption, and ultimately,
improve access of the population to good quality, essential
medicines. The diagnostic framework and methodology permit
users to identify key decision points in the pharmaceutical
supply and distribution system (registration, selection,
procurement, distribution, service delivery and use); assess
the extent to which a country s current policies and
practices at each of these key decision points make the
system vulnerable to corruption; and understand the range of
options that could reduce this vulnerability. This
diagnostic tool has been designed for use by World Bank
health specialists involved in health lending operations
that include pharmaceutical components, and their national
counterparts to help them identify points of vulnerability
in the pharmaceutical system, address these points, and thus
help ensure that pharmaceutical expenditures are maximized.
While developed in the context of the health systems of
Latin America and the Caribbean (and implemented in a pilot
study in Costa Rica), the methodology can be modified with
ease so that it is applicable to other regions.
Palabras clave
ABUSES, ACCESS TO PHARMACEUTICALS, ACCOUNTABILITY, ACTIVE INGREDIENTS, ADJUDICATION, ALLOCATION OF RESOURCES, ANALGESICS, ANTIBIOTICS, ANTICORRUPTION, ANTICORRUPTION POLICIES, AUDITOR, AUDITS, BASIC SERVICES, BEST PRACTICES, BRIBE, BRIBES, BUSINESS TRANSACTIONS, CASH FLOW, CERTIFICATION, CITIZENS, CIVIL SERVANT, CLINICS, COLLUSION, COMPETITIVE BIDDING, CONFIDENCE, CORRUPT, CORRUPT PRACTICES, CORRUPTION, COUNTERFEIT DRUGS, CRIME, CULTURAL PRACTICES, DECISION MAKING, DEVELOPING COUNTRIES, DISCLOSURE, DISCRETION, DISTRIBUTION OF PHARMACEUTICALS, DISTRIBUTION SYSTEMS, DOCTORS, DOSAGE FORMS, DRUG CONSUMPTION, DRUG PRESCRIBING, DRUG PRICES, DRUG SELECTION, DRUG STORAGE, DRUG TESTING, DRUG UTILIZATION, DRUGS, ECONOMIC GROWTH, ECONOMIC POLICY, EMPLOYMENT, ENFORCEMENT OF LAWS, EPIDEMIC, EPIDEMIOLOGICAL SURVEILLANCE, EQUILIBRIUM, ESSENTIAL DRUGS, ESSENTIAL MEDICINES, EXPENDITURES, FEASIBILITY, FINANCIAL MANAGEMENT, FOCUS GROUP DISCUSSIONS, FOREIGN CORRUPT PRACTICES, FOREIGN CORRUPT PRACTICES ACT, FOREIGN DIRECT INVESTMENT, GLOBAL POPULATION, GOOD GOVERNANCE, GOVERNMENT OFFICIALS, GROUP DISCUSSIONS, HEALTH CARE, HEALTH CARE PROFESSIONALS, HEALTH CARE PROVIDER, HEALTH CARE PROVIDERS, HEALTH CARE PROVISION, HEALTH CARE SYSTEM, HEALTH CARE SYSTEMS, HEALTH COSTS, HEALTH FACILITIES, HEALTH INITIATIVES, HEALTH INSURANCE, HEALTH OFFICIALS, HEALTH ORGANIZATION, HEALTH POLICY, HEALTH PROBLEMS, HEALTH PROFESSIONALS, HEALTH RESEARCH, HEALTH SECTOR, HEALTH SECTOR REFORM, HEALTH SERVICES, HEALTH SYSTEM, HEALTH SYSTEMS, HIDDEN COSTS, HIV/AIDS, HOSPITAL, HOSPITAL MANAGEMENT, HOSPITAL RECORDS, HOSPITALS, HOUSEHOLD INCOME, HUMAN DEVELOPMENT, ILLNESSES, INCOME, INDIVIDUAL HEALTH, INDUCED DEMAND, INFECTIOUS DISEASES, INFORMATION SYSTEM, INFORMATION SYSTEMS, INTEGRITY, INVENTORY CONTROL, INVENTORY MANAGEMENT, LAWS, LEADERSHIP, LIMITED RESOURCES, MARKETING, MEDIA, MEDICAL CARE, MEDICAL SPECIALTIES, MEDICAL STORES, MEDICAL SUPPLIES, MEDICINE, MEDICINES, MINISTER, MINISTRY OF HEALTH, MONOPOLIES, MONOPOLY, MORAL HAZARD, MORBIDITY, MULTINATIONAL, NATIONAL DRUG, NATIONAL HEALTH INSURANCE, NATIONAL HEALTH SYSTEM, NDP, NURSES, NUTRITION, OPERATING COSTS, PACKAGING, PATIENT, PATIENT CARE, PATIENT COMPLIANCE, PATIENTS, PENALTY, PERCEPTION OF CORRUPTION, PHARMACEUTICAL, PHARMACEUTICAL COMPANIES, PHARMACEUTICAL DISTRIBUTION, PHARMACEUTICAL INDUSTRY, PHARMACEUTICAL LEGISLATION, PHARMACEUTICAL POLICIES, PHARMACEUTICAL PRICING, PHARMACEUTICAL PROCUREMENT, PHARMACEUTICAL PRODUCTS, PHARMACEUTICAL RESEARCH, PHARMACEUTICAL SECTOR, PHARMACEUTICAL SUPPLIES, PHARMACEUTICAL SUPPLY, PHARMACEUTICAL SYSTEMS, PHARMACEUTICALS, PHARMACISTS, PHARMACY, PHYSICIAN, PHYSICIANS, POLICY DECISIONS, POLICY DEVELOPMENT, POLICY MAKERS, POLITICAL APPOINTEES, POLLUTION, PRESCRIPTIONS, PRIMARY CARE, PRIVATE PHARMACIES, PROBABILITY, PROCUREMENT, PROCUREMENT OFFICES, PROCUREMENTS, PSYCHOTROPIC DRUGS, PUBLIC FUNDS, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC HEALTH CARE SERVICES, PUBLIC HEALTH EXPENDITURES, PUBLIC HOSPITALS, PUBLIC INFORMATION, PUBLIC OFFICIAL, PUBLIC OFFICIALS, PUBLIC PHARMACIES, PUBLIC POLICIES, PUBLIC POLICY, PUBLIC SERVICES, PURCHASING, QUALITY ASSURANCE, QUALITY CONTROL, QUANTITATIVE DATA, RESOURCE ALLOCATION, SAFETY STOCK, SANCTIONS, SANITATION, SERVICE DELIVERY, SOCIAL SECURITY, SPECIFIC INCENTIVES, SUPPLY CHAINS, SUPPLY SYSTEMS, SUSTAINABLE DEVELOPMENT, TECHNICAL SKILLS, TENDERING, THEFT, THERAPEUTICS, TRANSPARENCY, TRANSPORTATION, TREATMENT GUIDELINES, USER FEES, VACCINATION, VULNERABILITY, WASTE, WORKERS, WORKING CONDITIONS, WORLD HEALTH ORGANIZATION