04 December 2008

GMA 50 and BnB Programs Are Not Enough

PPI's BnB outlet in Salcedo Village
According to the World Medicines Situation, a 2004 publication of the World Health Organization (WHO), only 66 percent of the Filipinos had access to essential medicines. Access is measured based on the estimated percentage of the population with access to at least 20 essential medicines. Access to essential life-saving drugs depends on the availability and affordability of such, especially in areas of high morbidity and mortality.

Moreover, other factors also influence and have direct or indirect effects to access to essential drugs namely, rational selection and use of medicines, tailored procurement, sustainable financing and reliable health and supply systems.

GMA 50 Program

In 2000, the DOH initiated the Parallel Drug Importation Program (PDIP) as an innovative strategy to reduce the costs of essential medicines. This was expanded to the Gamot na Mabisa at Abot-Kaya (GMA 50) Program to ensure that affordable, high quality, safe and effective drugs and medicines are always available, especially to the poor.

The MTPDP targets to reduce the 2001 prices of essential medicines by 50 percent. According to the Pharmaceutical Management Unit of the DOH, GMA 50 parallel drug imports achieved an estimated average of 60.9 percent price reduction in 2004, a figure above the 50 percent target by the year 2010. In 2006, the prices of essential medicines decreased by an average of 41 percent, the same price reduction in 2005. Low priced medicines were available at all 72 DOH-managed hospitals and three local LGU hospitals located in the ARMM (two in Maguindanao and one in Lanao del Sur).

Botika ng Bayan (BnB)

To achieve the objective of attaining availability and access to low-priced quality essential medicines frequently bought by the poor, the intent is to saturate the market with low – cost essential drugs, the DOH together with the Philippine International Trading Corporation (PITC) launched in December 2004 the BnB project. The project is intended to set up a nationwide network of privately-owned and operated accredited pharmacies that shall sell low-priced PDI or generic drugs in competition with commercially priced medicines in the market.

The distribution network of the BnB expanded from 1,016 outlets in 2005 to 1,283 outlets in 2006. The DOH likewise issued Administrative Order (AO) no. 2006-0033 entitled “Guidelines for the DOH-PITC Expanded Drug Access Pilot Program using convenience stores as BNB Express Outlets.” The objectives of this AO are: (a) to identify areas of collaboration between the DOH and PITC in relation to the Expanded Drug Access Pilot Program; (b) to identify procedures for the operation of selected Botika ng Bayan as distribution network as well as accreditation of convenience stores under the Botika ng Bayan identified by PITC; and (c) to provide clear definition of roles and responsibilities among stakeholder entities.

The use of generic products by DOH facilities and institutions is also being encouraged by requiring these entities to use only generic terminologies in procuring, prescribing, dispensing and administering medicines. The same institutions are also asked to promote the Generics Law to enhance the public’s awareness of its objectives as well as to establish GMA 50 Help Desks to assist the public in gaining access to low-cost medicines and provide information on rational drug use.

More Needs and Challenges

Despite the programs adopted by the government to address the concern about high cost of medicines, there are still a lot of issues that needs to be resolved. These will include the following:

  1. Need to consolidate efforts of all key stakeholders. There are attempts to create a coalition of important stakeholders in the healthcare sector to consolidate their forces and work towards a common noble goal, without sacrificing each one’s interests. However, the efforts are unsustainable and the process politicize that it discouraged more active participation of other players, principally the medical profession.
  2. Need for healthy competition in the local market. Sadly, it is only the Philippines in the Asian region whose pharmaceuticals market is dominated by foreign multinationals that are able to dictate medicine prices. Healthy competition is one of the most effective measures that will drive down prices in the market. Efforts must be directed towards breaking the cartel-like hold of certain market players, upholding the primary objective of ensuring the overall health of the Filipino.
  3. Need to strengthen and develop the Philippine pharmaceutical industry. Efforts must be targeted towards strengthening the local supply base for quality medicines for a wide range of ailments. The Philippine pharmaceutical sector needs to undertake serious reforms that will enable it to better compete and survive in the market. Concerned stakeholders, both government and private, must work together in crafting a strategic plan for the industry, and implementing programs that will improve sustainability and productivity of the sector.
  4. Need to improve accessibility to medicines. By developing an alternative network of retail outlets -- as envisioned under the BnB program -- more Filipinos, even those living in far-flung areas hardly reached by regular supply of medicines, will have better access to quality healthcare at affordable prices. The next step should be to sustain the supply of all affordable medicines to these BnBs, including timely delivery.
  5. Need for a healthier policy and regulatory environment. Regular consultations among key stakeholders must be organized for healthy discussions on concerns and problems of the healthcare sector, and how the players can best work together to develop a more conducive policy and regulatory environment.
  6. Need for public information campaigns. Among the principal activities of concerned Government agencies should be be consumer awareness and information dissemination programs. Informed consumers can make informed choices, particularly in areas that most concern them, such as their family's health.