Strengthening Governance in Pharmaceutical Systems: A Compendium of Country Case Studies

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Poor governance in pharmaceutical systems can reduce access to pharmaceutical products, inflate medicine prices, and waste scarce health system resources. SIAPS and its predecessor programs have assisted numerous countries to strengthen governance to promote robust decision making, enhance accountability, reduce opportunities for corruption, and improve efficiencies to enable better access to and use of quality-assured medicines. This compendium draws on these experiences and provides a collection of eight case studies that provide examples of strategies and approaches for strengthening governance in pharmaceutical systems.

The case studies describe SIAPS’ support/technical assistance for the:

  • Development and enactment of legislation in Swaziland to improve the control of medicines
  • Strengthening of key pharmaceutical governing and decision-making bodies in Sierra Leone after the Ebola epidemic
  • Implementation of governance-related interventions to strengthen medicines registration in the Democratic Republic of the Congo (DRC)
  • Improvement of transparency and accountability in pharmaceutical service delivery in Ethiopia
  • Harmonization of medicines lists used to guide procurement and establishment of a robust medicines selection process in Ukraine
  • Use of information technology to improve governance in procurement and supply management in Bangladesh
  • Bolstering of leadership, management, and governance capacity at regional and facility levels in Cameroon to reduce antiretroviral (ARV) stock-outs at HIV clinics
  • Strengthening the tuberculosis (TB) control program in poor urban areas in Quezon City in the Philippines by establishing community health management councils

The compendium highlights accumulated insights into factors that may have enabled or constrained the success of governance improvement initiatives and closes with some reflections on lessons learned. Governance can be a sensitive subject, and various challenges may impede the startup or implementation of improvement initiatives and reforms that target issues related to governance in pharmaceutical systems. Common challenges encountered include:

  • Resistance due to sensitivities, competing interests, or reluctance to changing long-standing processes and behaviors
  • Lengthy policy and legislative procedures and protracted bureaucratic processes that hinder implementation of governance-improvement initiatives
  • Insufficient capacity to implement or sustain reforms or initiatives SIAPS has found the following strategies effective for initiating, implementing, and sustaining governance strengthening initiatives:
  • Conducting situational analyses, targeting inefficiencies, and including a governance-related component in country pharmaceutical system assessments—whatever the scope—have proven to be effective ways for gaining entry and implementing and sustaining initiatives.
  • Aligning technical assistance activities with government priorities to create a shared vision and priorities can help generate trust and secure political support.
  • Embedding reforms in legislation helps to institutionalize and sustain initiatives.
  • Designing a combination of interventions that target governance, management, and leadership practices can improve institutional and individual capacity, a common constraint for exercising and institutionalizing good governance.