Strengthening Governance in Pharmaceutical Systems

Well-functioning health systems require continuous availability of safe and affordable pharmaceuticals of assured quality. However, the high value of medicines, the size of public pharmaceutical budgets, and the complexity of the supply chain leave pharmaceutical systems vulnerable to corruption and mismanagement.

Corruption can have a detrimental effect on individuals by leading to consumption of contaminated or falsified medicines and reduced access to pharmaceutical products. The damage of corruption does not stop at its disastrous health impact. Poor governance can also be costly for governments as pharmaceutical expenditures account for, on average, 25% of total health expenditures in low- and middle-income countries.

Various organizations and initiatives have stressed the importance of governance in pharmaceutical systems. The United Nations Sustainable Development Goals (SDGs) call for reductions in corruption and affirm the importance of governance in meeting development goals. In addition, the SDGs explicitly state that “access to safe, effective, quality and affordable medicines and vaccines for all” is part of achieving the SDG goal of universal health coverage.

From 2011 to 2018, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, implemented by MSH, supported a number of countries to strengthen governance to promote robust decision making, reduce opportunities for corruption, and help improve efficiencies to enable better access to and use of quality-assured pharmaceuticals.

To summarize these experiences, the report Strengthening Governance in Pharmaceutical Systems: A Compendium of Country Case Studies was recently published. This compendium provides a collection of eight case studies of approaches and strategies for strengthening governance in pharmaceutical systems.

These approaches and strategies are aligned with SIAPS’ governance-strengthening framework, which identifies four areas of intervention: policies and legislation supported by rule of law, governance structures that are able to exercise appropriate decision making, transparent and accountable systems and processes that are based on best-practice norms and guidelines, and human resource management systems that promote effective performance and ethical practices.

The report highlights the factors that may have enabled or constrained the success of governance improvement initiatives for selected pharmaceutical functions in a variety of health programs in different contexts, and it closes with reflections on challenges and lessons learned.

The compendium includes case studies on the:

• Reform and establishment of governing and decision making structures for post-Ebola recovery of the health system in Sierra Leone
• Harmonization of various medicines lists to guide procurement and establish a robust selection process in a context of political uncertainty in Ukraine
• Introduction of interventions to bolster the leadership, management, and oversight capacity of staff at regional and clinic levels in Cameroon

A common challenge in many of these cases was finding a suitable entry point for addressing governance issues. The Ukrainian and Cameroonian case studies show that targeting inefficiencies, such as wastage, can be a politically acceptable starting point for governance interventions. 

Designing a combination of interventions that target governance, management, and leadership practices can improve institutional and individual capacity, a common constraint for exercising and institutionalizing good governance.  

The case studies described in this compendium are expected to help advance progress in the countries where SIAPS worked and to provide momentum for advocacy and for similar efforts in other countries.

Read the case studies