Cross-sectoral and policy coherence needed to achieve national public health goals in Tanzania
On 22-23 March 2016, the consultation on “Policy Coherence on Improving Health Technology Access and Delivery”was co-convened by the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children (MOH-CDGEC); the Tanzania Commission for Science and Technology (COSTECH), and the ADP. The consultation, held in Dar-es-Salaam, aimed to enhance multi-sectoral coherence and collaborative action to improve access and delivery of health technologies. Participated by policy-makers, government officials and the private sector, the consultation facilitated engagement and learning between stakeholders from a number of sectors. They were sensitized on key cross‐cutting policy issues related to innovation and R&D, domestic pharmaceutical production and the medicines regulatory framework. This blog post about the discussions that took place is co-authored by Dr. Hassan Mshinda, Director-General of COSTECH and Dr. Henry Irunde, Chief Pharmacist at the MOH-CDGEC.
Our national policies and strategies – as reflected in the Tanzania Development Vision 2025 and the Health Sector Strategic Plan 2015-2020 (HSSP IV) – identify the need for a sustainable health delivery system as a national development priority. It is obvious that the ability to ensure access to, and delivery of, essential health services and technologies is a vital component of a health system.
At a recent consultation, participants identified the strengthening of domestic pharmaceutical production as a key strategy towards ensuring access and delivery of essential health technologies. In the long-term, a strong domestic pharmaceutical sector can help safeguard affordable access to essential medicines, and be better-placed to effectively respond to national health needs.
But clear, coherent strategies and support systems are needed to address the structural and economic challenges associated with promoting domestic pharmaceutical production. At the consultation, some key measures were discussed and examined. We think these provide a good basis for a coherent national strategy to achieve Tanzania’s goal of reaching a 60% market share for domestic manufacturers by 2018, up from their current share of 35%.
First, we need policies that facilitate access to market, so as to ensure sustainability through economies of scale. For example, if changes are made to eligibility criteria for public tenders for the procurement of select medicines, or if higher cost-preferences are provided, domestic manufacturers may be able to gain a larger proportion of the US$155 million domestic pharmaceutical market. Policies should also seek to reduce the cost of manufacturing; hence the current VAT on import of active pharmaceutical ingredients and other raw materials should be removed.
Second, the lack of investment capital is a major barrier. Pragmatic fiscal policies and financing schemes that offer commercial loans, with concessional terms, are needed to stimulate public and private investment. Access to capital is important for expanding pharmaceutical production lines and upgrading manufacturing facilities and processes to meet “Good Manufacturing Practice” (GMP) standards.
Third, greater technical capacity is needed to implement GMP and to improve the range, complexity, quality and market reach of domestically-produced medicines. Foreign expertise are needed to help develop the domestic sector and facilitate the transfer of technology and knowledge. In the long-term, we need to foster the growth of domestic innovation and technical capacities, by scaling-up the training of industrial pharmacists and chemical engineers in Tanzania.
Fourth, Tanzania already has an established and sophisticated drug regulatory system but is currently considering adopting some provisions from the African Union (AU) model law on medical product regulation. Better regional harmonization of medicines regulatory frameworks will make it possible to leverage limited resources and accelerate regulatory approval processes, opening up markets across the region for local Tanzanian manufacturers.
Fifth, we should explore how best to use the key flexibility available to Tanzania and other LDCs under the WTO TRIPS Agreement, which is the delay the grant of pharmaceutical product patents until 2033. In line with the approach adopted by the East Africa Community (EAC), all public health-related flexibilities of the TRIPS Agreement should be fully integrated into Tanzania’s national IP policies and laws. This can provide an enabling policy environment for domestic production, R&D and innovation.
Last, we need to strengthen the availability and quality of infrastructure and utilities in Tanzania, including improving the reliability and affordability of electricity and water, and allocation of land for construction of new pharmaceutical manufacturing facilities.
Finally, these policy priorities need to be addressed in a collaborative manner, with active contribution from a cross-section of stakeholders, from government ministries of health, industry and trade, and finance, as well as the private sector. We will also look to EAC and AU mechanisms and frameworks, including their respective pharmaceutical manufacturing plans of action, for policy and strategic guidance.
We are pleased to be working together with the Access and Delivery Partnership (ADP) to improve multi-sectoral coherence, which will be key towards improving equitable access to, and sustainable delivery of, health technologies.
Dr. Hassan Mshinda is the Director-General of the Tanzania Commission for Science and Technology;
Dr. Henry Irunde is the Chief Pharmacist at the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children.
Photo: Seated (L to R): Awa Dabo (Country Director, UNDP), Dr. Mpoki M. Ulisubisya (Permanent Secretary, MOH-CDGEC), Dr. Hassan Mshinda, Cecilia Oh (Programme Advisor, UNDP). Dr. Henry Irunde is in the second row, second from the left.
Photo credit: UNDP Tanzania.
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