Smart Governance for Medicines under Universal Health Coverage

Smart Governance for Medicines under Universal Health Coverage

 {Photo credit: MSH/Paula Champagne}Constance Addo-Quaye, Deputy Director of Quality Insurance at National Health Insurance Authority, Ghana.Photo credit: MSH/Paula Champagne

Universal health coverage (UHC) is the ultimate accomplishment in health systems strengthening: UHC is achieved when a health system is strong enough to deliver high-quality products and services in a reliable, comprehensive and affordable way to its entire population. For the leaders who govern health systems, UHC is an ambitious and worthy goal. And as MSH President and CEO Jonathan Quick explains, success starts with their vision.

But what comes next? UHC carries unique governance challenges and can exacerbate existing challenges surrounding healthcare financing and service delivery. To overcome these challenges, leaders and managers will benefit greatly from sharing lessons from other health systems that are pursuing UHC or have achieved it already.

Sharing these lessons was the purpose of a recent meeting, Medicines as Part of UHC: Starting a Dialogue, hosted by MSH in collaboration with Harvard Medical School and the Rockefeller Foundation, with additional support from USAID and PAHO. The meeting focused on the role of medicines in UHC. At the global level, attention to UHC has focused on financing mechanisms and patients’ access to services. But much of the financing for UHC goes towards medicines, and medicines constitute an essential component of service delivery. To improve lives on a large scale, countries must succeed in managing drug supply.

[Governing the Many Facets of Pharma in UHC. Slide by MSH] Governing the Many Facets of Pharma in UHC. Slide by MSHThe UHC and medicines meeting brought together representatives from ministries of health, country insurance schemes, international development agencies, the donor community, academia, and the private sector—in other words, key players in medicines management for countries pursuing or considering UHC. Their discussions identified the factors, based on their own experience, that frustrate and facilitate governance around UHC design, financing and pharmaceutical supply chain.

Takeways: key factors in UHC and medicines governance

According to the participants, effective UHC design depends on political will and government investment in experienced leaders. These leaders need the right resources, including case studies and best practices, along with information systems for modeling the cost implications of coverage decisions. Changing epidemiology of diseases can further complicate these decisions. Other stakeholders, including pharmaceutical industry and the media, must be engaged early and effectively. Investments in regulation and enforcement are worthwhile, since the regulatory environment must be sound enough to provide adequate oversight.

Governance for UHC financing requires clear, transparent processes and open dialogue among stakeholders. In particular, the pharmaceutical industry should be included in designing financing processes and the private sector must be brought on board. Providers and suppliers must commit to affordable systems. Stable leadership and long-term political will facilitate strong financing mechanisms, while corruption at various levels is an ongoing risk to be managed. Efficient payment is essential to keep the system running smoothly.

Supply chains rely on effective regulatory oversight. With regulators responsible for ensuring quality and identifying corruption, they need resources like information systems to capture and generate better data. Transparency, especially surrounding procurement and tendering processes and drug prices, is key to good governance. While it is tempting to focus only on cost, leaders must pay equal attention to quality, appropriate use and long-term value. Again, engagement of multiple stakeholders, including multinational companies, is necessary to design a sustainable supply chain.

Towards better governance for UHC

These observations fit the framework of good health systems governance developed by MSH’s Center for Leadership and Management. This framework organizes around cultivating accountability, engaging stakeholders, setting a shared direction and stewarding resources. In addition to fostering dialogue, MSH will continue to partner with health systems working to strengthen governance towards broader coverage and better services.

James (Jim) A. Rice, PhD, is project director of USAID's Leadership, Management, & Governance (LMG) project and global technical lead on governance at MSH. Jonathan Jay is a senior writer at MSH.

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