Download Dr. Thilak Siriwardana Director, Non Communicable Diseases Unit

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Dr. Thilak Siriwardana
Director, Non Communicable Diseases Unit
Ministry of Health
Sri Lanka
Contents of the presentation
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The Process
The Available
Drugs
The Cost
• How NCD Drugs were included in the essential list :
The process and the timelines
• The Available drugs at different levels of health
care centre.
• The cost to Government and Cost to patients
The Collaborations
• What other organisations supported this effort
outside government?
The Challenges &
Lessons
• The challenges and lessons in increasing access to
NCD drugs?
The Current
Coverage
• The current coverage and the plan for increase
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The
Process
• How NCD Drugs were
included in the essential
list : The process and the
timelines
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Mahinda Chinthana – Vision
for the future (Presidential
Manifesto)
2005
The Development policy
framework – Government of
sri Lanka
National Nutritional Council
of Sri Lanka
Health Master Plan
National NCD Policy &
Strategic Framework
National Authority on
Tobacco & Alcohol
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National Nutritional
Secretariat of Sri Lanka
National NCD Policy &
Strategic Framework
rd and 8th STRATEGIC OBJECTIVES
3
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RELATED WITH
Facilitate provision of optimal NCD care
by strengthening the health system to
provide integrated and appropriate
curative, preventive, rehabilitative and
palliative services at each service level
Ensure sustainable financing mechanisms
that support cost-effective health
interventions at both preventive and
curative sectors
The WHO Framework Convention on Tobacco Control (FCTC) and Sri Lanka
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• Sri Lanka signed the WHO FCTC on the 23rd September 2003.
• Sri Lanka ratified the WHO FCTC on the 11th November 2003.
National Authority on
Tobacco and Alcohol
Additional Fund Allocation of
National Health
Council
NCD Steering
Committee
National Cancer
Advisory Group
National NCD Working
Group
n 2011-2013
Policy Vision
A country that is not burdened
with chronic non-communicable
diseases (NCDs), deaths and
disabilities.
Policy Objective
To reduce premature mortality
(less than 65 years ) due to
chronic NCDs by 2% annually
over the next 10 years through
expansion of evidence-based
curative services, and individual
and
community-wide
health
promotion
measures
for
reduction of risk factors.
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A
Human
Resources
&
Dedicated
institutions
B
Health
Systems /
Infrastructure
C
Guideline
s Quality
and
Uniformit
y
D
Essential
Drugs &
Technologies
F
Monitorin
g
Evaluation
&
E
Demonstration
Projects
surveillanc
e
H
G
Multisectoral
Action
Involvement
of
Professiona
l Colleges
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Facilitated by Director NCD (focal
point)
Sri Lanka Medical
Association
College of Physicians
Formation of Subcommittee with all
stakeholders
Series of meetings and discussions for
compiling of essential list of medicine
College of General
Practitioners
College of
Community
Physicians
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The
Available
Drugs
• The available drugs at
different levels of health
care centre
+ AVAILABLITITY OF ESSENTIAL NCD
DRUGS AT DIFFERENT LEVELS OF
HEALTH CARE
THE ESSENTIAL 16 DRUGS WERE
MADE AVAILABLE AT THE PMCU
WHERE THE HLC WAS PLACED –
PRIMARY LEVEL
THEY ARE THE BASIC DRUGS TO TREAT
ALL THE COMMON NCDs AT THE
PRIMARY LEVEL
ALL OTHER INSTITUTIONS ABOVE PMCU
HAS DRUGS MORE THAN THE ESSENTIAL
16 DRUGS
Health Care in Sri Lanka – Free & Accessible
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Health
Systems /
Infrastructure
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LIST OF MEDICINES APPROVED
NAME OF THE DRUG
1
ADRENALIN TARTRATE 0.1% SOLUTION
2
ASPIRIN TAB 100mg
3
ATENOLOL TAB 50mg
4
ATORVASTATIN TAB 10mg
5
BECLOMETHASONE DIPROPIONATE AEROSAL INHALOR
6
CHLOPRPHENIRAMINE MALEATE TAB 4mg
6a
CHLOPHENIRAMINE INJECTION 10mg
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NAME OF THE DRUG
7
ENALAPRIL MALEATE TABS 5mg
8
FRUSEMIDE INJECTION 20mg AMPOULES
8a
FRUSEMIDE TABS 40mg
9
GLIBENCLAMIDE TAB 5mg
10
GLICERYL TRINITRATE TAB SUBLINGUAL
11
HYDROCHLOROTHIAZIDE TAB 25mg
12
HYDROCORTISONE HEMISUCCINATE INJ. 100mg
13
METFORMIN TAB 500mg
14
NIFEDAPINE SLOW RELEASE TAB 20mg
15
SALBUTAMOL RESP SOLUTION 0.5% SOLUTION
15a
SALBUTAMOL TAB 2mg & 4 mg
16
THEOPHILLIN SLOW RELEASE TAB 125mg
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The Cost
• The cost to Government
and the cost to patients
Distribution of Drug Budget by Broad Treatment Categories - 2009
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X-Ray
films,Chemicals,Contrast
media & Recording papers
3%
Miscellaneous items
0%
Antidotes
Drugs used in anaesthesia
2%
3%
Drugs used in the treatment of
musculoskeletal & joint
diseases
Drugs used in
1%
obstetrics,gynaecology
&
urinary tract disorders
0%
Drugs used in the treatment
of malignant diseases & for
Drugs
used in the
immunosupression
Drugs
treatment of
7%
acting
on
diseases of the ear,
the
skin
nose and
2%
oropharynx
Narcotics
1%
Surgical Dressings
8%
Drugs used in the treatment of
infections
23%
Drugs used in the treatment of
cardiovascular system
10%
0%the eye
Drugs acting on
1%
Drugs acting on the
gastrointestinal system
2%
Drugs used in the
treatment of the
endrocrine system
6%
Immunological product
and vaccines
12%
Drugs affecting
nutrition & blood
12%
Drugs used in the treatment of
diseases of the respiratory
system
Drugs acting on the central
nervous system
4%
21% of
Government the
Drug Budget is
for NCD Drugs
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Source : Prevention and control of selected NCDs in Sri Lanka: policy options and actions (World Bank, 2010)
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Expenditure on major NCDs by major spending
areas (%), Sri Lanka
Source : Prevention and control of selected NCDs in Sri Lanka: policy options and actions (World Bank, 2010)
Out-of-pocket Expenditure Breakdowns by Income Quintiles
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Poorest
Other
Pharma
2
3
Prv Hospital
Test
4
specialist
Richest
prvpract
Source: Ramesh Govindaraj, World Bank Private Health Sector Review Meeting, 4 April 2013
Unit
Cost
of
NCD
Drug
List
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NAME OF THE DRUG
1
ADRENALIN TARTRATE 0.1% SOLUTION
2
ASPIRIN TAB 100mg (150mg available)
3
ATENOLOL TAB 50mg
4
ATORVASTATIN TAB 10mg
5
BECLOMETHASONE DIPROPIONATE AEROSAL
INHALOR
6
CHLOPRPHENIRAMINE MALEATE TAB 4mg
6a
CHLOPHENIRAMINE INJECTION 10mg
COST COST
(RS) (USD)
22.93
0.176
1.50
0.012
0.438
0.003
0.79
0.006
211.47
1.624
0.14
0.001
18.14
0.139
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NAME OF THE DRUG
COST
(RS)
COST
(USD)
7
ENALAPRIL MALEATE TABS 5mg
0.22
0.002
8
FRUSEMIDE INJECTION 20mg AMPOULES
8.35
0.064
8a
FRUSEMIDE TABS 40mg
0.41
0.003
9
GLIBENCLAMIDE TAB 5mg
0.01
0.00008
10
GLICERYL TRINITRATE TAB SUBLINGUAL
0.08
0.0006
11
HYDROCHLOROTHIAZIDE TAB 25mg
0.28
0.02
12
HYDROCORTISONE HEMISUCCINATE INJ. 100mg
39.18
0.30
13
METFORMIN TAB 500mg
0.76
0.006
14
NIFEDAPINE SLOW RELEASE TAB 20mg
0.13
0.001
15
SALBUTAMOL RESP SOLUTION 0.5% SOLUTION
33.68
0.26
15a
SALBUTAMOL TAB 2mg & 4 mg
0.273
0.002
16
THEOPHILLIN SLOW RELEASE TAB 125mg
0.852
0.007
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The
Collaborations
• What other organizations
supported this effort
outside government?
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Involvement
of
Professional
Colleges
Sri Lanka Medical
Association
College of General
Practitioners
College of Physicians
College of Community
Physicians
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The
Challenges
& Lessons
Learnt
• The challenges and lessons
in increasing access to NCD
drugs
Facilitated by the
government commitment
System Issues ongoing –
Quality Failure, timing
Revision of list in place
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Lessons learnt by Doing….
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The
Current
Coverage
• The current Coverage
and plan for increase
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EXPANSION OF HEALTHY LIFESTYLE CENTRES
2011 - 2013
2011
2012
Legend
2013
Number of Centres
JAFFNA
14
JAFFNA
51
JAFFNA
52
0
1- 5
6 - 10
KILINOCHCHI
0
MULLAITIVU
0
KILINOCHCHI
0
MULLAITIVU
0
KILINOCHCHI
1
MULLAITIVU
1
VAVUNIYA
0
VAVUNIYA
14
VAVUNIYA
8
11 - 25
26 - 50
51 - 100
101 - 125
MANNAR
3
MANNAR
9
TRINCOMALEE
3
ANURADHAPURA
9
PUTTALAM
31
KURUNEGALA
89
PUTTALAM
36
GAMPAHA
2
KEGALLE
11
NUWARA
ELIYA
COLOMBO
11
6
KALMUNAI
39
BADULLA
30
MONARAGALA
10
KALUTARA RATNAPURA
2
13
GALLE
MATARA
0
1
KURUNEGALA
124
AMPARA
1
KANDY
6
HAMBANTHOTA
4
297
TRINCOMALEE
19
ANURADHAPURA
9
POLONNARUWA
8
BATTICALOA
1
MATALE
3
MANNAR
9
PUTTALAM
36
POLONNARUWA
32
BATTICALOA
6
KURUNEGALA
122
MATALE
21
AMPARA
7
KANDY
6
GAMPAHAKEGALLE
6
43
NUWARA
ELIYA
COLOMBO
0
15
KALMUNAI
40
BADULLA
MONARAGALA
10
POLONNARUWA
23
BATTICALOA
6
MATALE
13
GAMPAHA
20
KEGALLE
43
NUWARA
ELIYA
COLOMBO
11
15
KALUTARA RATNAPURA
10
45
GALLE
35 MATARA
17
GALLE
MATARA
20
17
581
AMPARA
7
KANDY
6
KALUTARA RATNAPURA
10
31
HAMBANTHOTA
4
TRINCOMALEE
14
ANURADHAPURA
28
KALMUNAI
39
BADULLA
49
MONARAGALA
24
HAMBANTHOTA
4
623
The future…
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Keeping Costs Down
Improving Access to HLC
especially that of men
Access to Medicines
Ageing
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