Defining and Measuring Pharmaceutical Systems Strengthening: Report of the SIAPS Partners’ Consultative Meeting

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The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program convened a consultative meeting of its partners to identify definitions of a pharmaceutical system and pharmaceutical systems strengthening and components to be included in a measurement framework for systems strengthening. The meeting held on September 11-12, 2014, brought together SIAPS core and resource partners, experts from the US Agency for International Development (USAID), the Pan American Health Organization (PAHO) (representing the World Health Organization), and Boston University School of Public Health. The discussions were guided by a background discussion paper prepared by SIAPS staff (page 18) and presentations given at the beginning of each session.

More than 30 participants, who represented 13 different organizations working to improve access and use of pharmaceuticals in low- and middle-income countries, agreed on the following working definitions of a pharmaceutical system and pharmaceutical systems strengthening:

  • A pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes.
  • Pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to enhance responsive and resilient system performance for achieving better health outcomes. The critical components of a pharmaceutical system are its core functions, structures, the supporting health system resources, and an enabling policy, legal, and governance framework.

Participants also identified the pharmaceutical system components to be included as part of a measurement framework for systems strengthening: policy, law and governance; regulatory systems; pharmaceutical products and services; human resources; financing; information; innovation, research and development, manufacturing, and trade. In addition, for each of these system components, participants proposed critical elements to guide SIAPS in the selection of indicators for a measurement framework. Recommendations were also made to inform the use of composite indicators as an approach for measuring and ranking the performance of national pharmaceutical systems.

Key next steps include developing the measurement framework for pharmaceutical systems strengthening. In addition, indicators and tools to measure progress made in strengthening systems must be identified and piloted. The framework and indicators will help guide health system planners and donors that are considering investing scarce resources in ways that will have lasting results.