Designup

Category: Transition and Sustainabuility

  • Big Pharma Greed and Artificial Prices – Knocking on Door to Limit Access to HIV Medicines in Georgia

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    • Respect for human dignity and human rights is the ethical foundation of everything we do.[1]
    • We are inspired by the opportunity to address unmet medical needs for patients living with life-threatening diseases around the world.[2]
    • We aspire to improve the health and wellness of people worldwide and to expand access to our medicines and vaccines.[3]
    • We are passionate about transforming patients’ lives. We commit ourselves to scientific rigor, unassailable ethics, and access to medical innovations.[4]
    • We do more than treat diseases—we aim to make a remarkable impact on people’s lives.[5]

    These are excerpts from the values of pharmaceutical companies that are global leaders in inventing and producing many essential medicines, including HIV / AIDS antiretroviral drugs.

    With these values, the companies position and introduce themselves to the world.

    They produce medicines that can save lives and at the same time artificially restrict access to these drugs for financially deprived people and for countries that fall outside their commercial interests.

    “We did not develop this medicine for Indians.”

    We developed it for Western patients who can afford it ‘

    Marijn Dekkers – Bayer CEO in 2010 – 2016

    Thanks to the decades-long existence of effective antiretroviral medicines, HIV/AIDS is no longer considered to be a fatal disease. A timely and regular administration of these drugs ensures that a human life is not endangered.

    However, despite the inspiring values on websites, artificial barriers created by these pharmaceutical companies are one of the main reasons that millions of people die every year worldwide, because of HIV / AIDS only because they have no access to medications.

    Why?

    Because a human’s life costs less than a medicine which can save his or her life.

    Pharmaceutical companies are artificially maintaining high prices for essential drugs. The barriers created by them are mainly related to the establishment of monopolies on the market and the restriction of production of generic medicines and their access to the market through protecting patent rights and extending them as much as possible.

    What is happening in Georgia?

    HIV / AIDS treatment in Georgia has been available since 2004 with the financial support of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, whereby treatment is provided free of charge to all people who are diagnosed and registered in the national program.

    The procurement of medications within the programs is carried out by the Global Fund’s Pooled Procurement Mechanism (PPM).

    PPM is a strategy designed to create an economically favorable and efficient mechanism for procuring essential medicines.

    Due to the volumes of procurements proceeded by the Global Fund, PPM creates opportunities for financial savings and a significant decrease of prices of medications.[6]

    The key principle of this mechanism lies on ‘’Framework Agreements’’ with ARV manufacturing pharmaceutical companies that defines pre-negotiated favorable prices within procurement carried out by the Global Fund. While using this mechanism, a country can avoid the patent rights of pharmaceutical companies and the restrictions imposed by them.

    However, due to the recent developments, Georgia faces significant challenges, which can cause significant barriers to the access of HIV treatment.

    As a result of the renewal of the countries’ classification system according to their income level by the World Bank[7] in 2014; as well as the introduction of a new funding model (NFM) [8] by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Georgia belongs to so-called transitioning countries in terms of funding[9]. This entails the gradual reduction in funding by the Global Fund and the need to increase state allocations, including for procurement of HIV / AIDS ARV medicines.

    Under the framework of state funding, the issue related to procurement mechanisms of medications comes to the agenda. In particular, through which mechanism and, most importantly, at what price the medications will be procured.

    Georgian legislation in the field of state procurement, regulation of intellectual property rights and patent rights is not sufficiently flexible to ensure the procurement of quality drugs at favorable prices, to promote market competition and to open access to generic medications as well as to create opportunities for using international mechanisms for reducing drug prices.

    This challenge is accompanied by the commitments under the Association Agreement (AA)[10] signed between Georgia and the European Union in 2014, which obliges the country to carry out the relevant legislative amendments directly aimed at creating favorable conditions for the brand pharmaceutical industry.

    These legislative amendments include additional measures to protect patent rights on pharmaceutical products, in particular, to extend patent terms and to ensure so-called data exclusivity to guarantee the confidentiality of information and to prevent its usage by third parties thus directly limiting access to the local market for the generic manufacturers.

    Most of the legislative amendments relating to the commitments undertaken within the AA were implemented in 2017[11]. These amendments pose a significant threat to the availability of drugs, including HIV antiretroviral medications, especially under state procurements.

    What reality may we face?

    HIV antiretroviral medications have been procured by allocations from the state budget since 2016.

    The procurement of drugs with state budgetary sources is also carried out by using the Global Fund’s mechanism which, temporarily allows a country to avoid potential challenges. However, the main remaining questions are:

    • whether this mechanism will remain available for the use after the country’s transition from the Global Fund
    • and whether the country will be able to use the same benefits, including, to evade patent rights

    Georgia, as a country with a low disease burden of HIV infection and, accordingly, with a low purchase power is not commercially interesting for pharmaceutical companies. Therefore, they will try to set the highest possible prices for medications to maximize their profits.

    Taking into consideration that the incidence of HIV infection in the country is rising over years, this can become a quite heavy burden for the state budget.

    To illustrate, we can compare prices of drugs procured by the Global Fund mechanism in Georgia with prices of the same drugs in other countries purchased under state procurement:

    Georgia (Global Fund Mechanism) Poland

    (State Procurement)

    		 Latvia

    (State Procurement)
    Unit Cost

    $

    		 Package Cost

    $

    		 Unit Cost

    $

    		 Package Cost

    $

    		 Unit Cost

    $

    		 Package Cost

    $
    Abacavir 300mg tablet 0.1832 10.99 3.8125 228.75 3.4702 208.21
    Abacavir + Lamivudine (combined drug) 600/300mg tablet 0.4163 12.49 14.1667 425 11.619 348.57
    Atazanavir 300mg capsule 0.6 18 15.4167 462.5 14.8337 445.01
    Darunavir 600mg tablet 1.667 70 11.025 661.5 11.6655 699.93[12]

     

    This data is a clear illustration of what realities we may face and how big the rise in the level of expenditures we will have to deal with.

    In countries indicated in the table as examples (Poland, Latvia) high prices on medications are exactly due to monopolies of pharmaceutical companies and patent restrictions which limit the availability of generic medicines on the market, restrict competition and decrease in prices of drugs.

    To avoid similar developments in the country, it is important to immediately start working on changes in local legislation to create a favorable environment in terms of the availability of drugs and to establish a legal framework which will allow for making use of internationally recognized mechanisms for reducing prices of medications.

    Health is a fundamental human right, that also covers access to essential lifesaving medicines. The invention of the medication and its physical existence does not mean access to it. We live in an environment where human life is in danger due to the greed of the pharmaceutical industry, where a human life depends on how much money an individual has. The state is obliged to provide a person with the right to health!

     

     

    [1] https://www.bayer.com/en/our-values.aspx

    [2] http://www.gilead.com/about/ethics

    [3] http://www.merck.com/about/home.html

    [4] https://www.roche.com/about/our_purpose.htm

    [5] https://www.abbvie.com/our-company/about-abbvie.html

    [6] https://www.theglobalfund.org/en/sourcing-management/health-products/

    [7] https://datahelpdesk.worldbank.org/knowledgebase/articles/378834-how-does-the-world-bank-classify-countries

    [8] https://www.theglobalfund.org/en/funding-model/

    [9]https://www.theglobalfund.org/media/5641/core_projectedtransitionsby2025_list_en.pdf?u=636649300140000000

    [10] http://www.parliament.ge/uploads/other/34/34754.pdf

    [11] http://www.sakpatenti.gov.ge/media/page_files/patent_law_2017_Iy62qmS.pdf

    [12] http://arv.ecuo.org/[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][ultimate_spacer height=”30″][/vc_column][/vc_row]

  • Technical Assistance for evaluation of transition readiness and preparation of Transition and Sustainability Plan for Global Fund-supported programs in Tajikistan

    Introduction and Overview

    In June 2018 CIF initiated a new project with the financial support of The Global Fund. The overall goal of the CIF assignment is to support the Country Coordination Mechanism of Tajikistan (CCM) in assessing country preparedness for Transition and developing the Transition and Sustainability Plan based on this assessment and key steps identified.

    Donors and Partners
    The Global Fund, Country Coordination Mechanism (CCM) of Tajikistan
    Project objectives and Contributions

    The following activities are planned to fulfill within the scope of the project frame:

    • In collaboration with the Tajikistan CCMs and Global Fund Secretariat, plan the key steps and dates in the process of the Transition Preparedness Assessment;
    • Undertake a comprehensive desk review of documents, literature, qualitative and quantitative data and research relevant to the national TB and HIV responses of Tajikistan;
    • Conduct a series of interviews and country dialogue with stakeholders and other actors in Tajikistan, and collect input for the HIV and TB Transition preparedness assessment;
    • Develop a Transition Preparedness Assessment report for Tajikistan based on the desk review and interviews;
    • Develop HIV and TB Transition Plan;
    • Develop HIV and TB Monitoring plan with a set of indicators to monitor Transition Plan implementation;
    • Conduct a workshop with the key HIV and TB stakeholders in Tajikistan on the finding of the Transition Preparedness Assessment and Transition Plan.

    By November 2018 CIF will deliver Transition Preparedness Assessment Report for HIV & TB and Draft Transition and Sustainability Plan for HIV & TB. The documents will be shared on CIF website by the end of the project.

  • Technical Assistance for the preparation of Transition and Sustainability Plan for HIV program in Philippines

    Introduction and Overview

    Since May 2018 Curatio International Foundation implements a technical assistance for the Philippines to prepare  Transition and Sustainability Plan for HIV program. The overall goal of the given assignment is to support the Department of Health and the Philippine National AIDS Council to develop the Transition and Financial Sustainability Plan based on the evaluation of remaining steps required to strengthen transition preparedness. The project is to complete by June 2018.

     

    Project objectives and Contributions

    Specific objectives of the assignment are following:

    • In collaboration with UNAIDS Philippines, plan the key steps and dates in the process of the Transition and Financial Sustainability Plan elaboration;
    • Ensure application of the participatory approach to ensure national ownership of the Transition and Financial Sustainability Plan;
    • Propose, facilitate and guide national counterparts and stakeholders on the most effective approach for the Transition and Financial Sustainability Plan development;
    • Provide technical support as appropriate during the FSP development process
    • Ensure production of the final FSP by the Technical Working Group (TWG) based on the validation exercise.
    CIF’s Deliverables:
    • Work Plan for Technical Working Group
    • TWG workshop: WHAT should be done?
    • TWG workshop: Transition and Financial Sustainability Plan Budget & Monitoring and Evaluation plan
    • Draft Transition and Financial Sustainability Plan

  • Assessing impact of donor co-financing and transition policies on TB Commodity Procurement

    Introduction and Overview

    Curatio International Foundation recently started implementation of the project entitled: Assessing impact of donor co-financing and transition policies on TB Commodity Procurement. The project is financially supported by Stop TB partnership and UNOPS, initiated by Global Drug Facility (GDF).

    The assignment will last 10 months and aims to assess positive and negative implications of The Global Fund’s (TGF) Sustainability, Transition and Co-Financing Policy (STCP) that may have on TB commodity procurement practices on a country level in EECA region.

    Based on the goal of the assignment the project has the following objectives:

    • Develop a methodological approach necessary for systematically documenting and assessing challenges and opportunities related to the TB commodity procurement practices arising from TGF’s STCP;
    • Using the methodological approach and standard tools, systematically assess and document experiences related to TB commodity procurement practices during and after the transition in the countries that have graduated from TGF support or are already implementing STCP and paying for parts of TB commodity purchase.
    Expected Results

    After the successful completion of the project scientific article describing the key findings from the all assessed EECA region countries will be published in peer reviewed international journal.

    The project findings will support countries to be aware of existing gaps and take appropriate actions for change.

  • Network Coordination Partner: The Learning Network for Countries in Transition

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    Introduction and Overview

    According to a new Gavi strategy for 2016-­2020 one of the strategic goals for Gavi is to assure that EPI programs are sustainable in a long-term, especially within the group of countries transitioning out of Gavi financial support during the next five-­year period. A large number of countries receiving support from Gavi, are transitioning or expected to transition out of support in the next few years.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text]

    Visit the project website 

    [/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]As transition is a new challenge middle-­income countries are faced, it is crucial to capture experiences of countries go through the transition process and utilize country-­to-­country peer learning to address common challenges in immunization financing and programming. For this purposes a new initiative, the Learning Network for Countries in Transition was launched in May 2017. Results for Development (R4D) is leading network coordination and technical facilitation, drawing on partners and experts as needed.

    Specific objectives of the project are following:

    1. Facilitate knowledge exchange on technical topics;
    2. Build community and sustain the collaborative process;
    3. Co-develop clear and agreed output(s) related to priority technical topics;
    4. Support LNCT country core groups;
    5. Help with broader dissemination of LNCT messages, approaches, and lessons.
    Organizations Involved in the Research

    Project is implemented by Results for Development Institute, Inc. “R4D” in partnership with Learning Network for Countries in Transition, middle-income countries in transition from GAVI support.

    The project is funded by Bill&Melinda Gates Foundation.

    Expected Results

    CIF will support R4D in conducting scoping literature review and interviews with partner organizations and country stakeholders to a) better understand current country processes, b) identify other country experiences regionally/ globally that would provide good learning opportunities; c) explore existing approaches, tools, and resources on identified technical topics; d) refine identified topics through understanding of country demand, experiences, and gaps in knowledge.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][/vc_column][/vc_row]

  • Transition Preparedness Assessment

    Sustainability of national HIV and TB programs gains importance in light of recent changes in the global health landscape when external funders are redirecting resources to poorer states while phasing out from middle-income countries.

    Objectively evaluation of the country transition readiness is a key in the transition process. With this aim in 2015, Curatio International Foundation developed a Transition Preparedness Assessment (TPA) Framework with the Global Fund financial support and piloted in four Eastern European countries Belarus, Bulgaria, Georgia, Ukraine.

    The country Case Studies present findings in a standardized way that enable country stakeholders to prioritize areas that need most attention during transition planning and implementation. In addition, the assessment findings are useful for the donors to guide the country in the transition process. These countries share important similarities that are presented in the Synthesis Report. The three countries case studies are also downloadable below.

    Synthesis report – 4 countries
    Ukraine-case study
    Georgia-case study
    Belarus – case study

  • Assessment of GAVI Alliance HSS support to Tajikistan

    In August 2014, Curatio International Foundation conducted an assessment of GAVI Alliance HSS support to Tajikstan to provide solid evidence of to what extent the support achieved its objectives and contributed to strengthen the health system of the country.

    The assessment aimed to identify successes, key challenges and lessons learned that may help GAVI Alliance to improve the design and implementation of future HSS support to Tajikistan and other countries. The assessment covered the period of GAVI’s HSS grant to Tajikistan from 2008-2014.

    The full report of the assessment is now available on GAVI’s website. Please visit the page for more information.

    You can also download the full report here.

  • Final Evaluation of Gavi’s Support to Albania

    After the conclusion of Gavi’s support period (2014) to the Albania, Curatio International Foundation conducted the evaluation study and assessed financial and programmatic sustainability through an in-depth analysis of Albania’s experiences and immunization programme performance before, during and after the conclusion of Gavi’s support period to the country.

    The evaluation also identified factors contributing to the sustainability of these programs and their achievements. The evaluation considered the types and quality of support received and the way in which Gavi’s support to Albania was considered.

    Main Findings:
    • The coordination mechanism between partners  established at the time of Gavi support continues to operate, although the frequency of the meetings has decreased
    • All Gavi supported activities have been continued : The Hep B and pentavalent vaccines and Auto-Disable (AD) syringes are fully financed by the Government, and are safeguarded in the MoH budget
    • Stable and high immunization coverage rates (> 95%) for all antigens included in the national immunization schedule have been sustained as of today at the national and district levels
    • Achievements in safe injection have been sustained in Albania
    • After Gavi support ended, Albania has continued to introduce new vaccines
    • The budget planning mechanism used for vaccine procurement during the Gavi support period has been maintained and institutionalized
    • The use of the UNICEF procurement mechanism for purchasing all vaccines in the immunization schedule has been sustained.

    The full report of the evaluation is now available on the GAVI’s website, please visit the page for more information.

  • Response to the “Final evaluation of GAVI support to Bosnia and Herzegovina"

    Gavi, the Vaccine Alliance published response to the “Final evaluation of Gavi support to Bosnia and Herzegovina” conducted by Curatio International Foundation.

    Gavi assess the final evaluation and the given recommendations as an important document for the transition country program development.

    “We view these evaluations as particularly important to help inform how we can better help countries transition away from Gavi support in the future and to provide lessons learned and recommendations that could inform Gavi’s Graduation Policy going forward.” – Read the full document.

    The evaluation assessed both financial and programmatic sustainability through an in-depth analysis of BiH’s experiences and immunization program performance before, during and after the conclusion of Gavi’s period of support for the country. The evaluation also identified factors contributing to the sustainability of these programs and their achievements and gives five key recommendations to Gavi.

    To read the final evaluation report, please follow the link.

  • Final Evaluation of GAVI Alliance's Support to Bosnia and Herzogovina

    In 2014 Curatio International Foundation conducted a final evaluation of GAVI’s support to Bosnia & Herzegovina (BiH), commissioned by the Global Alliance for Vaccines and Immunization (GAVI) Alliance Secretariat.

    The evaluation assessed both financial and programmatic sustainability through an in-depth analysis of BiH’s experiences and immunization program performance before, during and after the conclusion of GAVI’s period of support for the country. The evaluation also identified factors contributing to the sustainability of these programs and their achievements.

    GAVI’s support to BiH was evaluated along three-evaluation focus areas: planning (pre-GAVI support), implementation (support received during GAVI period) and outcomes (post-GAVI support). Additionally, evidence related to each of the focus areas was assessed against five OECD/DAC evaluation criteria: relevance, efficiency, effectiveness, impact/results, and sustainability, with greatest emphasis on sustainability.

    The recommendations derived after the evaluation are planned to help further define M&E and potential programmatic activities to be conducted in graduating countries in the future.

    To read the final evaluation report, please follow the link.