Improving how medicines are funded in low- and middle-income countries is crucial to ensure everyone has access to the medical care they need. In many low- and middle-income countries, individuals and families pay out-of-pocket which is inefficient and inequitable.
Additionally, 20% to 40% of health expenditures in these countries is wasted (according to a WHO report), often due to expiries; poor financial management; inefficient procurement, and outdated distribution practices. To expand essential health coverage with limited resources, countries need strong national pharmaceutical systems that can effectively gather, allocate, and manage resources to provide affordable, quality treatments and services.
USAID MTaPS collaborated with countries to enhance financial management of their health systems with a focus on reducing financial barriers to medicines, using evidence-based priority setting activities, and building stakeholders’ capacity in financial management. Here are a few key achievements:
MTaPS developed a balanced scorecard – a tool that uses evidence to decide how to allocate resources for health technologies, also known as a health technology assessment (HTA) – for health facilities in Asia. When it comes to implementing HTA, low- and middle-income countries lack the technical expertise and budget needed to ensure healthcare systems are created fairly and achieve lasting universal health coverage (UHC).
MTaPS published a paper in the International Journal of Technology Assessment in Health Care that assessed the adoption of HTA using a scoring system. The system scored on a scale of 1 to 5 to measure HTA progress in China, India, Indonesia, Malaysia, Philippines, South Korea, Taiwan, Thailand, and Vietnam.
The MTaPS scorecard provided a practical way to evaluate how HTA is being implemented, and identified weaknesses that were slowing down its progress. Those insights were effectively used to inform decision-making in Asia and beyond.
MTaPS supported the institutionalization of evidence-based priority-setting activities for medicines and other health technologies in low-and-middle income countries. For example, MTaPS developed a policy guide: A Roadmap for Systematic Priority Setting and Health Technology Assessment (HTA) for low-and-middle income countries looking to institutionalize their mechanisms, processes, and institutions for better resource allocation. The roadmap served as a framework to simplify policy making for HTA and help users decide why, when, and how to develop their own health assessment methods.
When it comes to managing infectious diseases, such as HIV, TB, and malaria, the roadmap has helped countries make resource allocation decisions, identify best-buy medications in essential medicines lists, support the design of health-benefit packages, assess the value of public health interventions, and design investment cases for donors across disease areas. This systematic priority setting continues to help countries ensure long-term financial sustainability.
To improve how countries manage and allocate pharmaceutical resources, MTaPS held training courses on budgeting for medicines, evaluating health technologies, and managing finances in the public pharmaceutical sector.
For example, MTaPS delivered a five-day regional training course on how to use a costing tool – that MTaPS developed for forecasting spending on pharmaceutical benefits coverage – to help stakeholders from Bangladesh, Nepal, and the Philippines. The financial management tool provided health sector planners with a single framework for scenario analysis, costing, health impact analysis, budgeting, and financing for all major diseases and health system components, which can inform national health sector strategic planning.
Training participants can now conduct more evidence-based pharmaceutical planning and budgeting. Stakeholders plan to extend the training to government officials.
