Regional & South–South cooperation

Regional & South–South cooperation

Regional and South–South cooperation: Extending the reach of ADP

The ADP approach to facilitating South–South cooperation focuses on learning and exchanges on policy, programmatic and technical issues that comprise some of the most common challenges across different health systems. ADP has sought to harness the power of regional and global South–South collaboration to highlight the leadership of the Government of Japan in global health, as well as strategic, technical and policy partnerships that enable capacity strengthening and the transfer of a range of technical knowledge among stakeholders at the national, regional and global levels.

ADP has established strategic partnerships with relevant regional institutions in the regions of Africa, Asia-Pacific and South America, including the African Union, NEPAD, the East Africa Community (EAC), the Association of Southeast Asian Countries (ASEAN) and the Union of South American Nations (UNASUR). Through these partnerships, ADP is actively engaged in regional policy processes and collaborates on initiatives with wide implications for improving innovation, access and delivery of new health technologies. Notable initiatives include the collaboration with ASEAN and UNASUR on policy coherence and the partnership with the AU and NEPAD Agency on the AU Model Law.

Given that its in-country implementation experience provides a rich source of learning, ADP has identified opportunities for South–South exchanges that enable countries to share and learn from each other. Such exchanges have enabled a greater depth of support and sustainability for national level capacity strengthening. In total, over 700 policy-makers, technical experts, academics and other stakeholders from more than 38 countries in the regions of Africa, Asia-Pacific and Latin America-Caribbean have benefited from ADP South–South learning and technical exchanges. ADP has also established strategic and technical partnerships with a broad range of national and regional organizations, as well as global institutions and networks.14

Regional and South–South partnerships extend the visibility and awareness of the approach, tools and knowledge products of ADP among an increasing array of stakeholders. Four such initiatives have created collaborative platforms that have sustained the interest and participation of stakeholders.

The regional and global organizations include the following: the African Union Commission, the Association of South East Asian Nations (ASEAN), the East African Community (EAC), the international Decision Support Initiative (iDSI), INDEPTH Network, the Joint United Nations Programme on HIV/AIDS (UNAIDS), Management Sciences for Health (MSH), NEPAD Agency, the Prince Mahidol Award Conference (PMAC), the UN Economic and Social Commission for Asia and the Pacific (UN ESCAP), the United Nations Conference on Trade and Development (UNCTAD), and WHO Collaborating Centres.

The AU Model Law is one of the two key pillars of the African Medicines Regulatory Harmonization (AMRH) initiative, aimed at removing regulatory barriers that hinder patient access to health technologies in Africa through regional harmonization and capacity strengthening. ADP has provided expert legal advice and technical support throughout the process of developing the Model Law.

The collaboration continues, through the provision by ADP of technical expertise and support to national level implementation of the Model Law through the Technical Working Group on Medicines Policy and Regulatory Reforms (TWG-MPRR), comprising regulators and legal experts from the region to guide the domestication of the Model Law.

While ADP does not operate in each of the 55 AU Member States, it leverages the regional platform afforded by the AU and the NEPAD Agency to harmonize technical requirements and guidelines for the registration of medicines, with the aim of reduced registration cycles15 Given the need for robust regulatory frameworks and safety monitoring systems for the introduction of new health technologies, the Model Law will be an important means of enhancing capacities in the regulatory systems of the countries in the region – which account for a major share of global disease burden – and enable speedier approval and introduction of new health technologies.

ADP collaboration in this area also extends to the provision of legal advice and technical support for the establishment of the African Medicines Agency (AMA). With the May 2018 adoption of the treaty establishing the AMA, the second pillar of the AMRH initiative is close to realization. As the specialized regional technical agency, the AMA is expected to play a major role in providing regulatory guidance and technical assistance to AU Member States, as well as promoting the use of the AU Model Law to facilitate regulatory and legal reforms at continental, regional and national levels. In this context, ADP aims to build on the successful collaboration with AU and the NEPAD Agency, with a view to provide systematic and sustained technical support to AU Member States to accelerate the implementation of the Model Law at the national level.

View the issue brief here.

As national health systems come under increasing pressure to rationalize the use of limited resources, sustainable health resource allocation is key to ensuring that increasing demands on the health system can be met. Sustainable resource allocation relies on the consistent use of systematic priority-setting procedures. ADP promotes this approach by ensuring that national stakeholders have access to a key knowledge and capacity base for the establishment of HTA mechanisms that are relevant to their own country context.

Capacity transfer in relation to conducting and institutionalizing the HTA approach has been facilitated between the Indonesia MOH and HITAP in Thailand; and between the Tanzania Pharmaceutical Services Unit and PRICELESS in South Africa. These country-to-country examples are closely linked to ADP collaboration with national agencies, such as National Institute for Health and Care Excellence (NICE) in the United Kingdom, and with global learning networks on priority-setting and HTA platforms, such as iDSI and Health Technology Assessment International Asia.

To expand the knowledge base on HTA institutionalization for other LMICs to draw on, ADP-produced knowledge products include documentation of the country experiences and lessons learned in Ghana, Indonesia and the United Republic of Tanzania, as well as the processes and findings of pilot evaluations. ADP will continue its collaboration with HITAP and other key actors, to sustain the growing platform of resources that LMICs can draw on to understand the key steps and challenges to establish a national HTA mechanism. This will enable an increasing number of countries to accelerate institutionalization of HTA methodologies, driving technical and allocative efficiencies that align closely with national health policy priorities and disease burdens.

The deployment and use of new technologies will invariably encounter unanticipated or adverse reactions; hence, an effective monitoring system that can detect, assess and manage such events within the health system is required. As ADP works on strengthening human and institutional capacities to enable national PV systems to be set up for this purpose, it also promotes active exchanges of experiences and knowledge on PV between interested LMICs.

To promote best practice and sustainable capacity-strengthening for PV beyond its focus countries, ADP has supported networking and South–South exchange between PV experts across 13 countries in the Africa and Asia-Pacific regions.

Based on the experience of strengthening national PV systems in its focus countries, ADP has also developed and disseminated related knowledge products for use by an extended set of countries. The experience and lessons generated from implementing active safety monitoring of bedaquiline in Indonesia is a core element of this approach and is being documented as a guide for supporting other LMICs when introducing bedaquiline and/or other health technologies in their own settings.

ADP has helped to strengthen national PV centres and disease control programmes through study placements and regional technical exchanges on safety monitoring. This work has included training on cohort event monitoring for adverse event surveillance of new medicines, carried out in partnership with the WHO Collaborating Centre for Advocacy and Training in Pharmacovigilance, based at the University of Ghana Medical School. The technical capacities developed by focus countries for safety monitoring and PV will be crucial to facilitate the introduction of new health technologies in their own national settings.

A review of the policy and legal frameworks related to mandatory reporting of adverse drug reactions in selected LMICs, for example, enables countries to identify viable options that can facilitate the introduction of mandatory reporting of adverse drug reactions and inform the strengthening of relevant laws and policies in other countries.

ADP continues to develop this growing repository of relevant resources, helping a broad set of countries to pool financial and technical information on PV, so that this information can be readily available to interested national authorities to help strengthen the capacity of their PV systems.

‘Real life’ and country specific investigation of challenges in the introduction of new health technologies is an important way of identifying and addressing barriers in access, delivery and correct usage of new health technologies. ADP supports expanded use of such IR approaches, tools and mechanisms in and beyond ADP focus countries to facilitate the adoption and use of new health technologies.

Central to this strategy has been the development by ADP of a new comprehensive Implementation Research Toolkit to help LMICs strengthen IR capacity for identifying and addressing barriers to the effective use and scale-up of new technologies. The new toolkit uses an online modular learning approach, which is available in both English and French.16 In the first six months following its launch, there were 2019 users from 26 countries (18 from LMICs) and 3,642 unique sessions.

Beyond the toolkit, the lessons learned and good practices of ADP support and activities in the focus countries, including those gained through the development of national IR strategies and agendas, have been well documented and provide the basis for South–South sharing and learning for other LMICs in their process of strengthening IR capacities.

The ADP has strengthened IR capacities in non-ADP focus countries including India, through a collaboration with the Indian Council of Medical Research (National Institute for Research in Tuberculosis), and in Vietnam, in partnership with the INDEPTH Network.

View the IR toolkit here.