ࡱ> vu( / 0DTimes New RomanH0bbv 0b( 0DArialNew RomanH0bbv 0b( 0v" DMonotype SortsH0bbv 0b( 0x ` .  @n?" dd@  @@``  `|    c $@8, g49d9dv 0bppp@ g4BdBdv 0btp@ pp<4BdBd` 0b41buʚ;2Nʚ;<4!d!d4b{ 0 bb<4dddd4b{ 0 bb:2___PPT9/ 0? %O =+UK Policy considerations on increasing access to medicines for the poor in developing countries. DEPARTMENT FOR INTERNATIONAL DEVELOPMENT&c( !International Development Targets""$Poverty: Reduce by 50% the proportion of people living in extreme poverty by 2015 Health and Health Systems Reduce maternal mortality rate by by 2015 Reduce infant mortality rate by 2/3 by 2015 Universal access to reproductive health care through primary health systems no later than 2015 Disease Specific 25% reduction in HIV infection among 15-24 year olds in worst affected countries Malaria, TB: Reduce burden by 50% by 2010 ZIZZZZ|Z I3|   Commitment@To poverty reduction, to health, to access to essential commodities Large Development Budget from 0.21 - 0.32% of GDP total FY 1999 2.53 billion Health spend 13% Health systems development Increasingly direct support to Poverty Reduction Strategies and Budget Support. Untied as of 2001 Leadership in Secretary of StateB]ZZ3Z]3Other influencesuLarge effective NGO and advocacy community Large pharmaceutical industry Large publicly financed health service (NHS)CLack of Access to medicines: a key impediment to reducing povertyDD$Important focus Addressing through: Working with other partners internationally to consider approaches Priminister Initiative through the Cabinet office Variety of policy measures considered to increase access End of April bgZZ3ZFZZh3G,,Front runners in terms of impact seem to be 2-!   Differential pricing International fund for HIV/AIDs, TB, Malaria, childhood illnesses& to support: essential drugs and health commodities or funds for the purchase of drugs and commodities Health systems (procurement, delivery, logistics support, quality control, training, drug policy) Others include: Tax measures R&D, tax measures around donations that meet criteria as set out by WHO BeZZgZeg4 $~ On Differential Pricing6Support from UK government departments (DTI, DOH, DFID, CO, $). Need: limit parallel re-importation at no increased cost to NHS drug bill considerations for middle income countries Framework International support (not just UK, or EC) Identify DP at what level: country or global? In country targeting the poor or  trickle down keep it simple support systems development procurement, transparent tendering etc.tFZoZ ZZ(ZFo (  6U Mix of Strategies CrucialWhat potential and limits of differential pricing Patents and/or Generics Those only with large markets What diseases HIV/AIDs TB? Malaria, Diarrheoal diseases, respiratory infections? Need for a mix of strategies and dramatic Increase in Scale Look to leadership from WHO 2Z6ZZCZZYZ26CZ/  " ` .T3f` T3f3f` 999MMM` lff3f3޲` eoHff33Ҷ` ff!>?" dd@,?nFd@  d " @ ` n?" dd@   @@``@n?" dd@  @@``PP   @ ` ` p>> ph(  bF   T  C# Z  BCEF @` o   BpC=E$F =pp @  ` 5   BpC=EFh=pp @ `;    BpCrE0F" 5EhrrpEp5HP,5@   ` ~   BpC=E$F h==pp* @  `= c    BpCE0F" `Xpp@   `=     BxCjE<F&-=0j==`=8jx=x- -h----@    `: u    BpC=E$F =pp @  `     BpC=EFh=pp @ ` A     BpCrE0F" 5EhrrpEp5HP,5@   `   BpC=E$F h==pp* @  `     BpCE0F" `Xpp@   `     BxCjE<F&-=0j==`=8jx=x- -h----@    `    BpC=E$F =pp @  `R    BpC=EFh=pp @ `    BpCrE0F" 5EhrrpEp5HP,5@   `   B#CqEFp#q#'p @ `]   BpCE0F" `Xpp@   `_   BxCjE<F&-=0j==`=8jx=x- -h----@    `[ B  Z0e0e     ?BCEFvvv d @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?||] @ ` B  Z0e0e     ?BCEFvvv  @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?||k @ `  s * q    T Click to edit Master title style! !   c $s   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S  c $x k  \* 2  c $<~ `   ^*(2  c $ `@  ^*(2Z  B޽h))? ? T3f3f Dads Tie1   _(   F    T   C#    BCEF @` o    BpC=E$F =pp @  ` 5    BpC=EFh=pp @ `;     BpCrE0F" 5EhrrpEp5HP,5@   ` ~    BpC=E$F h==pp* @  `= c    BpCE0F" `Xpp@   `=     BxCjE<F&-=0j==`=8jx=x- -h----@    `: u    BpC=E$F =pp @  `     BpC=EFh=pp @ ` A     BpCrE0F" 5EhrrpEp5HP,5@   `    BpC=E$F h==pp* @  `      BpCE0F" `Xpp@   `      BxCjE<F&-=0j==`=8jx=x- -h----@    `     BpC=E$F =pp @  `R     BpC=EFh=pp @ `     BpCrE0F" 5EhrrpEp5HP,5@   `    B#CqEFp#q#'p @ `]    BpCE0F" `Xpp@   `_    BxCjE<F&-=0j==`=8jx=x- -h----@    `[  B c d0e0e     ?BCEFvvv d @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?||] @ `|  B # L0e0e     ?BCEFvvv  @ 5% 8c8c     ?1 d0u0@Ty2 NP'p<'p@A)BCD|E?||k @ `  s *p M  T Click to edit Master title style! !  c $C     W#Click to edit Master subtitle style$ $  c $PQ `  `* 2  c $U `   b*(2  c $D[ `@  b*(2Z  B޽h))? ? T3f3f0 zrP, (  , , 0` P    P*   , 0`     R*  d , c $ ?   , 0Th  @  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S , 6m `P   P*   , 6q `   R*  H , 0޽h ? ̙33@ X(  X X 0h P    X*  X 0xl     Z*  X 6p `P   X*  X 68t `   Z* H X 0޽h ? ̙33d   0(  l  C       H  0޽h ? T3f3f  `(  l  C P`   l  C    H  0޽h ? T3f3f  (  l  C l0   l  C   H  0޽h ? T3f3f  (  l  C     l  C   H  0޽h ? T3f3f   (   l  C `    l  C   H  0޽h ? T3f3f  D(  Dl D C }p`   l D C P~0@  H D 0޽h ? T3f3f   $(  $l $ C <    l $ C    H $ 0޽h ? T3f3f   ((  (l ( C 8`0   l ( C 0P   H ( 0޽h ? T3f3f 0 0p(  0R 0 3 ,    0 C , @   ~DThere are other influences which keep  access to medicines as a key agenda item for the UK government -Large Effective NGO and advocacy community - Large pharmaceutical industry -Large publicly financed health service (which I will say a little more about later) in how this influences. "#H 0 0޽h ? ̙33j0 *"4(  4R 4 3 ,   ( 4 C , @   lCommitment and Background to our interest in this area Large Development budget which has seen a year on year increase for the last 4 years. Up to 0.32% of GDP Still not up to 0.7% UN target that some of our Nordic counterparts -- but growing Important. We feel that a move to supporting  sectors as opposed to project, Increasingly even a move to  budgetary support link to PRS. This builds cabablity and ownership of governments& More effective and moves us away from  flag waving These factors are important, as we consider HERE strategies around DP and policy measures to increase access to medicines. We need to consider their implementation Completely untied as 2001 Stance and Leadership of Secretary of State. Development Minister who has come out strongly to  Make Globalisation Work for the poor@7 T #   H 4 0޽h ? ̙33p 0 0 ( p8 (  8R 8 3 ,   .  8 C 0, @   r I won t go over total poverty numbers. Nor will I review the burden of disease, these were discussed in passing yesterday and Maria mentioned then again today. But we should keep them at the forefront of our minds. In the UK the overall government response to international development is guided by the international development targets The overarching target is& To achieve poverty reduction we need action in the health sector. We need to strengthen systems, and support countries as they reduce their disease burdens. We have seen how malaria and maternal mortality, etc are intimately linked to poverty We have more evidence on this emerging through the CMH Through dialogue with our partners in developing countries, we get a sense of which specific areas are a priority. -indications of the priority and shortage of essential medicines and other commodities. This consultation is crucial and we could and should do more of it. It is unacceptable, but it is something that often gets neglected in the whirlwind of policy development at an international level.:: $H 8 0޽h ? ̙330 @<9( $ <R < 3 ,    < C |, @   G3The good thing about speaking near the end is that most people have made the points that you wanted to make. Take this from a slightly different perspective of European Country government engaged in external development assistance I was asked to speak on incentives for UK government around Differential pricing It seems best though to discuss DP in the context of other policy measures which are being considered by the UK government as ways to dramatically increase access to medicines To do this I will provide you a bit of context that we are working in.H < 0޽h ? ̙330 @$( = @R @ 3 ,    @ C t6, @   2There has been G8 commitment at Okinawa in July and December A broadening of the consolation around appropriate action subsequently EC, multilateral Looking for evidence as to the strategies that can have the biggest impact - commission for macro economics - examining country governments health policies and strategies that identify priorities and gaps Recently 6 month priministers Office initiative to look at package of policy measures to increase availability and affordability of essential medicines. - we hope to see is reletive weight of various measures - tax incentives around R&d -tax credits for donation programmes in line with international guidelines -differential pricing -international fund -advanced purchase fund*  @ H @ 0޽h ? ̙33 0 | t H (  HR H 3 ,   z  H C ̜, @    V Differential pricing and a International Fund seem to be the front runners in terms of impact In analysis considerations has always been balance  Access toady and  Incentives for R&D . -a huge range of policy options were considered These can also be seen as a package not in isolation. Recognise that there is not ONE SOLUTION The International Fund for HIV/AIDs, TB and malaria in particular has received significant attention -A commitment to pursue this was made recently at the Child Poverty Confernece -And has been taken up by the Italian government who next host the G8 summit in July. -discussion merits with WHO, UNAIDS, EC etc However there are some important distrinctions that need to be made from this discussion versus some of the things mentioned yesterday around a  procurement fund, commodity fund -Great benefit to link diseases together. Ease of transaction costs for developing country governments to access. Reduces  competition amongst diseases. Allows support to be given based on countries health priorities. Enables systems development overall, not just for isolated diseases. Variation in the type of support important for long term capacity development and to ensure that it does not undermine, existing systems capacity, OR EXISTING PRIVATE SECTOR (I,E, FOR BEDNETS IN TANZANIA) -z.       9  H H 0޽h ? ̙330 tl0L(  d LR L 3 ,   r L C , @   The response of the UK government departments on this is predictable. But illustrates the considerations that - Department for Internaitonal Dev -Department of Health -Department of Trade and Industry -Treasury -Cabinet Office Need to: limit parallel re-importation ensure no increased cost to NHS drug bill In general there is not a problem with increased subsidisation and funding. We know there needs a massive scale up but need to ensure, well develop strategy for DP that ensures we can subsidies increased cost from development budget or treasury and not a  creeping up of drug costs borne by the NHS&vvH L 0޽h ? ̙330 x@P(  PR P 3 ,   ~ P C , @    H P 0޽h ? ̙33rXPQ<dfigk`o@qZ sHw2m#ßL` G Oh+'0t hpt    UK Policy considerations on increasing access to medicines for the poor in developing countries. DEPARTMENT FOR INTERNATIONAL DEVELOPMENT Carol MedlinsidNC:\Program Files\Microsoft Office\Templates\Presentation Designs\Dads Tie.potelCarl Sorensenes17lMicrosoft PowerPointoso@0a\@@5@5Gg  @& &&#TNPPh2OMi & TNPP &&TNPP    & "--- !- "----- !---&&r&o&n--$mmm--&&o-T-2$mmmmmmmmmmm`UJA1% m--&&o--$ mmeZM? m--&&o0-T-4$mm+i,d,X-I.9.).-, ,+ !-4=OX`gm--&&go--.$mgmidXI9) ghh-i<iIiSh]hmg--&&Gov-3f-2$mGmHmImNmUm^mfmmmrmtmtbqYpPoEo>o6p%rs ttGmG--&&)oL-3f-<$m,mIfK]KQJEI>I5J#KKK JI, +*#*0*>+J+U,],b,f,i,j,l,m,--&&n-T-2$lllllllllll_TI@0$ l--&&sn--$ lsldYL>sls--&&n-3f-4$llhcWH8(   ,3<NW_fl--&&Snx--.$lSlrhsctWuHv8w(vu tsrSTT,U<UHUST\TlS--&&3nb-3f-4$l3l4l5l:lAlJlRlYl^l`l`b]Y\P[J[D[=[5\$^_ ``3l3--&&n8--<$ll5f7]7Q6D5=546"777 65 "/=IT\bfhjkl--&& o:--2$m m m mmm m(m0m5m7m7`6U5J5A515%789 97 m --&&o-3f-$ mm eZM?    m--&&Snt--4$lXlohpcpWqHr8r(rq ppoX UT T,T3T<UNVWV_WfXlX--&&n--$ ll,<HS\l--&&n-3f-4$lllllllllllbYPJD=5$ l--&&ln-3f-<$lolf]QD=4" o nm"m/m=nInTo\obofohojokolo--&&&0&--&&- $ - $  - $- $((vvv- $(00(&&& "- &:$#(%,H.j/.-+)&9%N$c#z"! <^ !"#&w8b&-&& &&-&&:$#(%,H.j/.-+)&9%N$c#z"! <^ !"#&&- $ - $  - $- $((vvv- $(00(&- --&&&Pr&--&&- $PZZP- $ZddZ- $dnnd- $nrrn&&&- &@$UU TT*T=UQUfU}VVWXZ6[p\\\\.\F[]ZsYXVTRPppU&w8b&-&& &&-&&@$UU TT*T=UQUfU}VVWXZ6[p\\\\.\F[]ZsYXVTRPppU&&- $PZZP- $ZddZ- $dnnd- $nrrn&- --&&&&zD& - &w& --!0p-- @Times New Roman- 3f.12 UK Policy considerations on +)!. 3f.<2 }#increasing access to medicines for /. 3f.92 *!the poor in developing countries..@Times New Roman- 3f.32 DEPARTMENT FOR INTERNATIONAL    . 3f.2  DEVELOPMENT.--"System-&TNPP & ՜.+,0H     On-screen Show UCSF-PSG Sh˨  Times New RomanArialMonotype Sorts Dads TieUK Policy considerations on increasing access to medicines for the poor in developing countries. DEPARTMENT FOR INTERNATIONAL DEVELOPMENT"International Development Targets CommitmentOther influencesDLack of Access to medicines: a key impediment to reducing poverty-Front runners in terms of impact seem to be On Differential PricingMix of Strategies Crucial  Fonts UsedDesign Template Slide Titles%_㧨 Carl SorensenCarl Sorensen  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTVWXYZ[\]^_`abcdfghijklnopqrstwRoot EntrydO)Current UsermSummaryInformation(UPowerPoint Document(˨DocumentSummaryInformation8e