Thailand a country case study: good governance and preventing corruption
A joint Thailand WHO programme has success tackling corruption in the pharmaceutical sector and reducing the prices of medicines
Progress after five years
Thailand is in the final phase of the three-phase WHO Good Governance for Medicines programme (GGM) and there are already a number of significant achievements.
Lower costs for quality medicine procurement: the number of hospitals with best practices in medicines procurement has increased, a pooled medicines purchasing scheme by hospitals has been established, with an agreed list of medicines and suppliers.
National attention focused on the problem: national pharmaceutical laws and regulations have been reviewed, a national database on good governance in drug systems containing publications and articles on corruption, unethical practices and corrupt cases has been developed.
Information more readily available: newsletters, public communications including media, brochures, and web sites have been created. The minutes from national medicine meetings are publicly available and the topic of "good governance" has been added to the curriculum of 15 Faculties of Pharmacy.
In 1997, Thailand was in economic crisis with the devaluation of the Thai Baht. Hospitals under the Ministry of Public Health, providing 70-80% of health and medical services, were projected to be bankrupt within two years. In addition:
- medicine prices were increasing;
- hospitals were purchasing medicines at different prices from the same companies;
- pharmaceutical companies offered incentives to physicians for prescribing their products; and
- physicians often prescribed medicines by trade name rather than generic name.
Response: pharmaceutical management reform
In response, the government introduced pharmaceutical management reform: limiting the type and amount of medicines hospitals stocked, establishing provincial group medicines purchasing schemes and setting up a pharmacy information centre to share information among hospitals. In 2004, Thailand decided that the WHO Good Governance for Medicines programme (GGM) would support their goals of increasing transparency and ensuring access to medicines while saving precious resources.
Positive effect beyond the ministry of public health
The biggest change experienced by the Ministry of Public Health is co-operation within Thailand, between universities and the Food and Drug Administration of Thailand, as well as internationally with other GGM participating countries. "The exchange of information and experiences made possible through the GGM has helped us introduce new ideas and ways of doing things," Dr Chanvit Tharathep, Ministry of Public Health. "We also have a more systematic approach. We have a strategy and a clear direction with goals to meet against a timeline and a greater focus on transparency."
GGM 3-phase programme
Phase I: National assessment of transparency and potential vulnerability to corruption
Phase II: Development of a national programme on Good Governance for Medicines
Phase III: Implementing the national Good Governance for Medicines programme
Based on their experience, Thailand offers a word of advice for other countries. "First of all, they should do a medicines situation analysis in their countries, then develop a good governance framework appropriate to their context and environment. The gap between the existing system and the framework should be identified and the strategy should aim to fill the gaps," Dr Tharathep. "The transparency of the system is one of the crucial activities. For us, the pharmacy information centre has been the best tool for transparency. We have the pharmaceutical products prices from each company who sold their products to the Ministry of Public Health hospitals publicly accessible."
Started in 2004 in four Asian countries, the GGM programme is currently implemented in 26 countries. The goal is to reduce corruption in the pharmaceutical sector through the adherence to transparent and accountable administrative procedures and promoting ethical practices to strengthen health systems in countries.