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The Flagship Framework is designed to help analysts and policy makers
develop reform initiatives that improve their health care systems in general
and, as used in this book, improve pharmaceutical sector performance in
particular. The framework is based on the argument that effective policy
development has to start by identifying the performance de??ciencies that
is, the outcomes that reformers want to improve. We call this step �iden-
tifying the problem.?? The logic here is simple: you are unlikely to reach a
goal unless and until you identify the goal that you are trying to reach.
Proceeding Buy Atorvastatin Online in this way is not always easy or obvious. Pharmaceutical
reformers often do not begin their efforts by identifying the outcome de??-
ciencies that they are unhappy with. Rather, they immediately focus on
perceived process failures that they want to correct or on particular solu-
tions that they favor. They might say, �Our problem is that we need to
decrease leakage of medicines from the public sector supply chain,?? or �We
need to regulate the high pro??t margins on brand-name drugs in private
sector pharmacies.??
A key feature of the method that we propose is that such statements are
premature at the beginning of the pharmaceutical reform process. It might
turn out that supply chain leakage or high private sector margins are
11
critical causes of the poor performance that a reformer wants to correct.
And it might turn out that a particular policy would be a plausible response.
But given their complexity, most pharmaceutical systems suffer from mul-
tiple failures. How is a reformer to know which process failures to address
or which initiatives to try? The answer is that reformers need to begin by
identifying which aspects of the performance of the system they want to
improve (Berwick, Godfrey, and Roessner 1990). To someone who leaps
directly to improving the Purchase Atorvastatin supply chain or regulating certain prices, our
response is, Why do that? What improvements in system performance
will such changes bring about? The answers to such questions will begin
to reveal the implicit problem de??nition behind the proposals in question,
the performance de??ciencies whose improvement can and should be
understood as the actual policy objective.
Disciplined thinking about identifying problems is especially important
because the world is awash in consultants and donors eager to convince
countries to adopt particular solutions. How are Buy Cheap Atorvastatin a nation�s policy makers to
know whether improving the nation�s clinical laboratory, or imposing
�regressive margin?? price regulation, or contracting out logistic functions, is
a sensible strategy? Reform advocates are often enthusiastic about Atorvastatin Simvastatin their par-
ticular solution precisely because they are advocates. An old saying in the
international-advice-giving world is, �To someone with a hammer, every
problem looks like a nail.??
Although such experts may have much to offer, our experience teaches
us that local knowledge and local inputs are critical to developing effec-
tive pharmaceutical system reforms. Only local governments can legiti-
mately decide on priorities or resolve the value con?icts that inevitably
arise in reforming the pharmaceutical sector. Moreover, local experts
often know best how their own systems actually function. They are often
those best able to judge which ideas will, or will not, work in their par-
ticular cultural and political context and with the available ??nancial and
administrative resources.
As discussed further below, serious value Atorvastatin 80 Mg con?icts are all too common
in pharmaceutical reform. To strike a balance among competing goals,
responsible and effective reform efforts have to combine technical analy-
sis with both ethical and political considerations. For example, should
countries spend limited funds on improving access to basic drugs for the
rural poor or on helping those with life-threatening illnesses to secure
expensive cancer chemotherapy agents? The pervasiveness of such value
con?icts provides yet Generic Atorvastatin another reason for reformers, as they begin the pro-
cess, to stop and re?ect on exactly which aspects of pharmaceutical sector
performance they most want to improve.
12 Atorvastatin Tablets Pharmaceutical Reform
Those decisions require reformers to think deeply about such issues as
the meaning of fairness in setting policy objectives and the extent to which
governments should respond to what Purchase Atorvastatin Online people want as opposed to what
they need. By involving various stakeholders and interest groups (from
civil society organizations to local importers) in a discussion Cheap Atorvastatin of these
questions, a nation�s planners and policy makers will be able to identify
con?icts among objectives and resolve them in an open and accountable
way. One example of an international effort to promote this process is the
Medicines Transparency Alliance, which was launched in 2008 by the
U.K. Department for International Development (DFID), in collaboration
with the World Health Organization (WHO) and the World Bank (Lancet
2008). Proceeding in that way has both philosophical and practical vir-
tues. A well designed, participatory process meets the test of legitimacy
set by democratic political theory. And in the realm of practical politics, it
can be an important step in marshaling support for reform (even as a badly
designed process can open up decision making to undue in?uence Atorvastatin Buy from
well-funded and organized interests).
Ultimate Performance Goals
How should policy makers decide which performance problems in the phar-
maceutical sector they most want to ??x? The Flagship Framework suggests
that health system performance problems in general, and pharmaceutical
sector performance problems in particular, can be usefully sorted into three
categories referred to Order Atorvastatin Online as �ultimate goals.?? These are health status, citizen satis-
faction, and ??nancial protection. Moreover, reformers may care about more
than a nation�s average level of performance in these areas. Variations in per-
formance across population groups (that is, the equity aspects of that perfor-
mance) often are, or Order Atorvastatin should be, of concern.
Health Status
Improving the health status of the population is a central goal of much phar-
maceutical policy making (and of health sector reform generally). If citizens
do not get artemisinin-based combination therapy (ACT) for malaria or
antiretroviral therapy (ART) for HIV, not to mention oral rehydration salts
for diarrheal disease or appropriate antibiotics for various infections, their
health status will suffer. However, deciding on health status in general as a
major performance goal is only the beginning of the process of problem
identi??cation. The questions then are, Which aspects of health status most
Using the Flagship Framework to Reform Pharmaceutical Policy 13
need attention? Is it Simvastatin Atorvastatin the prevalence of conditions that create an especially
high burden of disease in a particular country (for example, malaria in parts
of East Africa)? Is it poor performance versus comparable countries on a
basic health status index, such as under-??ve mortality rate? The discussion
below of the ethics and politics of priority setting will have more to say
about these questions.
Some studies of pharmaceutical policy use formal analytical methods to
try to measure the potential health status impact of alternative interven-
tions (for example, by calculating their comparative cost-effectiveness in
terms of gains in Quality Adjusted Life Years), and a growing number of
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