Sustainable Financing to Ensure Access for All to TB Medicines

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1 Sustainable Financing to Ensure Access for All to TB Medicines David Collins MSH GLOBAL TB CONFERENCE 2015, BANGKOK THAILAND

2 Purpose of the Session What financing challenges exist that restrict access to TB medicines and pharmaceutical services, especially for the poor, and how can they be overcome? Taking into account that in some countries TB control costs are increasing and donor funding is reducing

3 TB Financing Tools for Advocacy and Planning TB Service Delivery Costing (and Financing) Tool TB Economic Burden Analysis Tool MDR-TB Cost-Effectiveness Analysis Tool MDR-TB Patient Cost Analysis Tool Treatment Interruption Impact Tool (new) All available from TB CARE I and MSH

4 Indonesia Data The Indonesia data is from before the new 2014 prevalence survey That survey discovered a higher prevalence rate than previously thought, which means that the case detection rate was much lower Mostly because case detection technology much better Around 40% of the cases detected were asymptomatic The implication is that the country will need much greater numbers of diagnostic equipment, reagents, and medicines

5 TB Economic Burden Analysis Tool Advocacy on the Human Burden in Indonesia

6 TB Economic Burden Analysis Tool Indonesia Advocacy on the Economic Burden

7 Indonesia DS-TB Caseload Targets Scenario 1 (Pre-prevalence Survey) Missing cases are being treated in the private sector?

8 Indonesia MDR-TB Caseload Targets Scenario 1

9 Projected Cost of TB Services in Indonesia - 25 years

10 Indonesia TB Financing Projections

11 Patient Access Challenge: 3 Countries (Patient Interviews Not Defaulter Interviews)

12 Financing Strategies Steps Project the costs based on treatment targets Prioritize based on likely available funding High-risk groups/high impact mechanisms/equity? See what savings can be made through cost-effectiveness Patient access and the use of enablers (e.g. for MDR-TB) spend money to save money See what savings can be made through efficiency Explore financing sources Confirm sources and align with cost elements (e.g. MDR-TB medicines from GF)

13 Financing Strategies: Who Can Pay The importance of estimating the long-term costs of medicines, storage and transport. Government work on long terms targets (Indonesia 25 years) and successful advocacy takes time Financing sources Government budgets - national, local? National social health insurance and/or community-based health insurance? Special taxes (e.g. tobacco, air tickets), corporate social responsibility

14 What can be done to improve costeffectiveness? Effective and timely detection case finding and diagnosis Timely cash flows Quantification, procurement, storage and distribution Prevent loss of funds due to expiry Private sector quality control how to incentivize? Prioritize the easy-to-reach symptomatic patients?

15 Medicines and Diagnostics The planning and use of medicines is dependent on timely and accurate diagnosis Need to align the strategic plan elements for TB medicines and for TB diagnostics Delays in diagnosis due to issues of procurement, storage, and distribution result in delays in treatment and can result in more severe cases Incorrect diagnosis can lead to wastage of drugs Changes in diagnosis, such as faster testing, will change the numbers of medicines and when they are needed.

16 Estimating the Cost and Cost Effectiveness of Medicines Distribution Study in Benin and Kenya Distribution costs are significant portion of total cost ACTs: 18% in Benin; 24% in Kenya RDTs: 21% in Benin; 18% in Kenya Major cost drivers: labor, utilities, and transport Health facilities compose over 50% of distribution costs Important to make sure that resources are not wasted but also adequately budgeted. How much can distribution be integrated with other medicines? Source: Estimating the In-Country Distribution Costs of Malaria Commodities in Benin and Kenya: Report. Brittany Johnson, Rima Shretta, Lisa Smith, Prashant Yadav, Ravi Anupindi, Seydou Doumbia. SIAPS.

17 The Role of the Private Sector Private doctors prescribe or provide and pharmacists provide TB medicines They generally are paid out of pocket They need to be accredited and have quality control How can they be motivated to behave like public health doctors? Indonesia capitation plus incentives?

18 Poor TB and MDR-TB Patients Cannot Fund Transport and Other Costs and Do Not Adhere to Treatment NTP and USAID TB CARE I Project/MSH 04/06/2015

19 THANK YOU