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Analysis of Medicine Entitlement Programs for NCDs in the Philippines.

Author(s) Raoul Bermejo1, Beverly Lorraine Ho2, Wim Van Damme3
Affiliation(s) 1Department of Public Health, Institute of Tropical Medicine -Antwerp, Manila, Philippines, 2Health Unit, Philippine Institute of Development Studies, Manila, Philippines, 3Department of Public Health, Institute of Tropical Medicine -Antwerp, Antwerp, Belgium.
Country - ies of focus Philippines
Relevant to the conference tracks Governance and Policies
Summary In response to rising non-communicable disease prevalence and access to medicines challenges for the worst-off, the national government has launched three medicines access programs. Data were collected from informant interviews, site visits and document reviews. These were analyzed by first creating a chronology of events. Then, using a health policy framework, strategies and actions used along with the results were examined. Findings revealed that the rapid roll out of the NCD access programs exhibited strong political commitment towards UHC. However, weak policy processes have failed to ensure equitable access to quality and cost-effective medicines and implementation success.
Background As more Filipinos continue to be exposed to non-communicable disease risk factors such as tobacco and alcohol use, unhealthy diets and physical inactivity, prevalence for hypertension and diabetes mellitus have risen to 21% and 7.7 % respectively in 2008, and are expected to increase further. Cardiovascular disease and diabetes, along with cancer and chronic respiratory disease account for 57% of total deaths during the same year. According to the National Health Accounts, 52.7% of health expenditures are out-of-pocket. Of these, pharmaceuticals – accounting for 65.75% of household spending – are the single largest item of health care expenditures for households. Republic Act 9502, a law providing for cheaper and quality medicines was enacted in 2009.The Department of Health’s National Center for Pharmaceutical Access and Management launched three medicine access programs, namely DOH Complete Treatment Pack (ComPack), Valsartan (VAP) and Insulin Access Programs (IAP). ComPack provides complete (monthly) treatment regimens at no cost to the poorest families identified under the NHTS who are diagnosed to have diabetes and hypertension. VAP and IAP make available patent-protected Valsartan and Insulin at 60% lower cost than market prices.
Objectives The paper aims to document the policy process of three NCD medicine acces programs in the Philippines using a health policy analytical framework. Specifically, the paper seeks to understand the interaction of strategies that were employed and the factors that contributed greatly to policy advancement.
Methodology A qualitative, case study methodology using an in-depth longitudinal, prospective examination of events was employed for each of the three programs. Primary and secondary data were collected from (1) interviews with key policy and programme stakeholders; (2) visits to programme implementation sites; and (3) review of government documents, development partner reports, meeting records, conference proceedings and media clips. Representatives from government, academic institutions, nongovernment organizations, multilateral and bilateral agencies were interviewed. The interview guide reflected the three themes of emergence, formulation and implementation as described in the analytical framework by Lemieux (2002). A chronology of events was developed and process tracing was conducted. Triangulation of multiple data sources and discussion/verification with key actors supported interpretation and minimized bias.
Results Emergence: Our analysis shows that the following were critical in moving the access programs forward: (1) political commitment to achieve Universal Health Coverage by 2016, (2) availability of national health budget, (3) strong NCD policy community and access to medicines alliances, (4) increasing focus for the worst-off population and (5) strong industry lobbying.Formulation: The policy unit responsible for the programs was operational for less than 3 years when the policies were conceptualized and launched, and did not receive full technical support as was required. A relatively participative process was undertaken to define the contents but there was minimal integration into the health system.Implementation: Full subsidy of $15 million/annum and $400,000 are allocated for the ComPack and VAP. IAP has no subsidy since it is procured on a supply now-pay later (or consignment scheme). Information activities, implementation and evaluation support were constrained for all three programs largely due to funding limitations. The non-uniformity of information across health workers and patients resulted in a varied application of the policy in different implementation sites. Implementation was compromised by immediate national roll-out and devolved set-up for ComPack and the limited access sites for IAP and VAP. Availability of an efficient means for monitoring and responding to stock-outs remained a major challenge. To date, no plans for program evaluation have been articulated. IAP and VAP were also unable to address access challenges especially for the worst-off.
Conclusion The rapid roll out of the NCD access programs exhibit strong political commitment towards UHC. However, weak policy processes have failed to ensure equitable access to quality and cost-effective medicines and implementation success. Findings indicate that that rapid rollout of access to medicines programs is possible only if strategies employed are purposeful and contextually sensitive. Favorable conditions for the emergence of a policy may not always exist but can be created.

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