WHO Framework for ATM | ||||
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1. Rational selection and use of medicines | 2. Pricing/affordability | 3. Reliable health system/health system structure | 4. Sustainable financing | |
I. Individual, household, and community level | 1a) Information asymmetry (user knowledge level; communication and language barriers – as for ethnic minorities) | 2a) High out-of-pocket payment | 3a) Geographical accessibility: physical barriers; distance to facilities; remoteness (combination of physical barriers and infrastructure weakness) | 4a) Community financing arrangements |
2c) Community participation in medicine delivery arrangements | ||||
4b) Role of government subsidies at community level | ||||
1b) Health seeking behavior, preference for private care, preference for secondary level of care (bypass primary health care), self-medication | ||||
4c) Focal models of subside | ||||
3e) Traditional medicine (e.g., unclear distinction between allopathy and non-allopathy) | ||||
1c) Beliefs about illness and treatment (traditional practices; demand for injections and branded medicines; prescribers and dispensers perception of quality of drugs) | ||||
II. Public and private health service delivery channels | 1d) Impact of advertisements on medicines; incentives (or lack of, leading to private or dual practice); medicines becoming a source in financing for health services | 2d) Medicine price variation according to geographical location (e.g., urban/rural differences, higher prices in remote areas); price differential between public and private | 3b) Distribution systems and supply chains | 4d) Health provider payment methods |
4e) Health insurance coverage and models | ||||
3c) Pharmaceutical services at local level | ||||
1e) Staff capacity for rational prescription and use of medicines; training curriculum | 3d) Informal markets – substandard quality and counterfeit medicines | |||
3f) Staff and technical capacity: for supply management; with managerial, interpersonal, and information technology (IT) skills; with local language skills | ||||
1f) Clinical treatment guidelines, and essential medicines list: development; incentives for implementation; operational mechanisms; standardization (including between private and public sectors) | ||||
3g) Responsiveness to patient needs; differential responsiveness between public and private | ||||
1g) Incentives for rational use of medicines and for implementation of generic policy | ||||
3j) Availability of medicines (especially in public sector) | ||||
III. Health sector | 1h) Staff deployment | 2b) Opportunity costs | 3h) Public-private mix: reliance on private sector delivery; public-private partnerships and their role in access to medicines | 4f) Government budgets for medicines |
2e) Medicine price information system | 4g) Reimbursement policies | |||
1i) Pharmacovigilance, information on adverse drug reaction, and other problems related to medicines | 2f) Impact of prices on access | |||
4h) Cost containment policies | ||||
3i) Central procurement policies vs. decentralization | ||||
2g) Policy and regulation for medicines price | ||||
3k) Quality assurance | ||||
2h) Incentives for implementation of generic policy | ||||
3l) Coordination between health policies and medicines policies; referral policy/referral system | ||||
1j) Medicine information system (not only price information)/competing with medicines advertisement | ||||
3m) Monitoring and evaluation systems; funding for monitoring and evaluation | ||||
IV. Beyond the health sector | 1k) Intersectoral initiatives (e.g., rational use of medicines in schools – role of Ministry of Education) | 2i) Patents and intellectual property issues | 3n) Governance and governing: law and regulation enforcement; transparency and accountability | 4i) Donor funding; harmonization and alignment; verticalized donor support |
2j) Finance policies: taxes, autonomy, privatization; exemption systems | ||||
4j) Patents and intellectual property issues | ||||
3o) Regional integration and economic cooperation (example: UNASUL, MERCOSUL) | ||||
4k) Finance policies: taxes, autonomy, privatization | ||||
2k) Trade and economic goals (impact of health sector policies outside the health sector) | ||||
4l) Trade and economic goals (impact of health sector policies outside the health sector) | ||||
3p) Promotion of research and development – new drugs/neglected diseases. | ||||
2l) Budget allocation to health | 4m) Budget allocation to health | |||
2m) Medicine production | 3q) Medicine production |