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Related post: 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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