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FINANCING ARV EXPERIENCE FROM MALAYSIA

FINANCING ARV EXPERIENCE FROM MALAYSIA. BY SHA’ARI NGADIMAN, MD, MPH, EIP, AM MINISTRY OF HEALTH MALAYSIA. OUTLINE. Our Structure National Strategic Plan on HIV and AIDS Activities Impacts of the activities AIDS Expenditure ARV & Logistic Cycle Conclusion. Deputy

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FINANCING ARV EXPERIENCE FROM MALAYSIA

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  1. FINANCING ARV EXPERIENCE FROM MALAYSIA BY SHA’ARI NGADIMAN, MD, MPH, EIP, AM MINISTRY OF HEALTH MALAYSIA

  2. OUTLINE • Our Structure • National Strategic Plan on HIV and AIDS • Activities • Impacts of the activities • AIDS Expenditure • ARV & Logistic Cycle • Conclusion

  3. Deputy Minister of Health OUR STRUCTURE Involve in process of financing, planning, procurement , distribution, monitoring etc State Health Office : 15 District Health Office : 141 Government Hospital : 138 Health Center : 985

  4. OUR STRUCTURE SPAD State HIV/STI Officer

  5. Target of NSP on AIDS 2011-15 • 80% MARPs reached prevention programmes • 60% of MARPs use condoms consistently. • 60% of IDUs use clean injecting equipment. • Able to eliminate vertical HIV transmission • 80% ARV coverage for eligible PLHIV,

  6. HIV NOTIFICATION IN MALAYSIA Cumulatifve HIV = 98,279 Cumulative deaths = 15,521 PLHIV (end of 2012) = 82,758

  7. CUMMULATIVE ON HAART AS 31 DEC 2012 39,000 Adult Eligible for ARV in 2012 (EPP Model) 39,000 Adult Eligible for ARV in 2012 (EPP Model) 15,028 on ARV in 2012

  8. Expenditure 2008 – 2012 DOMESTIC FUND FOR HIV WORKS Expenditure (USD) ARV : 2011 – USD 16.10 mil 2012 – USD 20.41 mil USD 16.76 1st Line ARV USD 3.65 2nd Line ARV 38%

  9. ARV in Malaysia • Eligible criteria • Drugs listed in MOH Drug Formulary • By specialist • Available in hospitals and health centers with specialist • Also at hospitals or health centers without specialist through follow-up by visiting specialist • Can be dispense through Integrated Dispensing Medicine System

  10. ARV in Malaysia • PLHIV above 15 yrs • 1st line – 91.7% • 2nd line – 8.0% • 3rd line – 0.3% • PLHIV below 15 yrs • 1st line – 71.0% • 2nd line – 27.0% • 3rd line – 2.0%

  11. FLOW OF MOH DRUG FORMULARY REVIEW PANEL • Director-General of Health (DG) - Chairman • Deputy DG of Medical Services • Director of Pharmaceutical Services • 8 Consultants in Public Services • 3 Pharmacists in Public Services

  12. Provides the policy and administrative approach to : • Control • Promote • Encourage rational, safe and cost effective drug prescribing and usage MOH DRUG FORMULARY • List of drugs can be used by ALL MOH institutions • Serves as guide for the selection of drug therapy • First published in October 1983 • Review 2 – 3 times a year • 1530 drugs are listed • www.pharmacy.gov.my Objectives

  13. PROCUREMENT PRINCIPLES • Public accountability - Procurement should obviously reflect public accountability entrusted with the Government • Transparency - All procurement regulations, conditions, procedures and processes need to be clear and transparent to facilitate better understanding among suppliers and contractors. • Best value for money - Government procurement should yield the best returns for every Malaysian Ringgit spent in terms of quality, quantity, timeliness, price and source. • Open and fair competition - Processes involving Government procurement should offer fair and equitable opportunities to all those participating or competing in any procurement. • Fair dealing - All acceptable bids will be processed fairly based on current rules, policies and procedures.

  14. Policies on Drug Procurement • Local product (priority) • Imported product : have to get approval from Ministry of International Trade and Industry & Ministry of Finance • Value for money • HOW? • Consession Company - Pharmaniaga Logistics Sdn Bhd (Approve Purchased Product List - APPL) • Central Contract (e-Tender/e-Bidding/Direct Negotiation) • Local Purchase by Quotation or Direct Purchase Drug Purchased in 2012

  15. Importing Generic & Local Production • First Asian country issue Compulsory licensing in 2003 • Local production of ARVs as part of our effort to confront the challenges of HIV/AIDS. • Currently, domestic pharmaceutical industry has capability to produce almost all dosage form and almost 80% of various categories in National Essential Drug List (NEDL) through the Malaysian Organization of Pharmaceutical Industries (MoPI).

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  17. Logistic Cycle of ARV’s Supply LIST A* : Consultant/ Specialist for specific indications only LIST A : Consultant/ Specialist LIST A/KK : Consultant/ Specialist/ Family Physician Specialist LIST B : Medical Officer LIST C : Paramedics LIST C+ : Midwifery Paramedics MOH Drug Formulary Review LOGISTIC INFORMATION Individual hospital, health center Every level Physician • Central Contract • Local Purchase • Concession Company Ministry of Health (Pharmaceutical, Medical, Public Health) Individual hospital, health center

  18. CONCLUSION • System for ARV procurement worked! • Funded by Government (tax payers) • Changing pattern of the epidemic • Reaching 80% coverage for ARV • Continue and enhance current funding & activities • New inovation? • Review NSP 2011-15

  19. TERIMA KASIH

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