This book presents a radically new approach to how societies can get corruption under control. Since the late 1990s, the detrimental effects of corruption on human wellbeing have become well established in research. This has resulted in a stark increase in anti-corruption programs launched by international and national development organizations. Despite these efforts, evaluations of the effects of these anti-corruption programs have been disappointing. As it can be measured, it is difficult to find substantial effects from such anti-corruption programs. The argument in this book is that this huge policy failure can be explained by three factors. Firstly, that the corruption problem has been poorly conceptualized since what should count as the opposite to corruption—the quality of government—has been left out. Secondly, that the problem has been located in the wrong social spaces. It is neither a cultural nor a legal problem. Instead, it is for the most part located in what organization theory defines as the “standard operating procedures” in social organizations. Thirdly, that the general theory that has dominated anti-corruption efforts—the principal-agent theory—is based on serious misspecification of the basic nature of the problem. The book presents a reconceptualization of corruption and a new theory—drawing on the tradition of the social contract—to explain it and motivate policies of how to get corruption under control. Several empirical cases serve to underpin this new theory ranging from the historical organization of religious practices to specific social policies, universal education, gender equality, and auditing.

Controlling Corruption: The Social Contract Approach

The role of the World Bank

Countries around the world are setting out on the path to Universal Health Coverage but there are difficult choices to face along the way. Philosophy can help.

Making fair choices on the path to universal health coverage

Introduction: There is continued unmet medical need for new medicines across countries especially for cancer, immunological diseases and orphan diseases. However, there are growing challenges with funding new medicines at ever increasing prices along with funding increased medicine volumes with the growing prevalence of both infectious diseases and non-communicable diseases across countries. This has resulted in the development of new models to better manage the entry of new medicines, new financial models being postulated as well as strategies to improve prescribing efficiency. However, more needs to be done. Consequently, the primary aim of this paper is to consider potential ways to optimise the use of new medicines balancing rising costs with increasing budgetary pressures to stimulate debate especially from a payer perspective. Methods: A narrative review of pharmaceutical policies and implications, as well as possible developments, based on key publications and initiatives known to the co-authors principally from a health authority perspective. Results: A number of initiatives and approaches have been identified including new models to better manage the entry of new medicines based on three pillars (pre-, peri-, and post-launch activities). Within this, we see the growing role of horizon scanning activities starting up to 36 months before launch, managed entry agreements and post launch follow-up. It is also likely there will be greater scrutiny over the effectiveness and value of new cancer medicines given ever increasing prices. This could include establishing minimum effectiveness targets for premium pricing along with re-evaluating prices as more medicines for cancer lose their patent. There will also be a greater involvement of patients especially with orphan diseases. New initiatives could include a greater role of multicriteria decision analysis, as well as looking at the potential for de-linking research and development from commercial activities to enhance affordability. Conclusion: There are a number of ongoing activities across countries to try and fund new valued medicines whilst attaining or maintaining universal healthcare. Such activities will grow with increasing resource pressures and continued unmet need.

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Barriers for Access to New Medicines: Searching for the Balance Between Rising Costs and Limited Budgets.

The Kitakyushu Initiative International Workshop on Community-based Waste Management and Supporting National Measures was held in Surabaya City, Indonesia, from 27 to 28 August 2008, with participation of around 65 representatives of the selected member cities of the Kitakyushu Initiative Network from Indonesia as well as other AP counties, other cities from Indonesia with exemplar practices on waste management, national government, associations and supporting agencies, private sectors companies, academics from Indonesia, and environmental officials and practitioners groups from the host city Surabaya, in addition to the coorganizers UNESCAP and IGES.

UNITED NATIONS ECONOMIC AND SOCIAL COMMISSION FOR ASIA AND THE PACIFIC Asia-Pacific Outreach Meeting on Sustainable Development Financing

Background: The goal of the public procurement of pharmaceuticals is to purchase sufficient quantities of high-quality pharmaceuticals at cost-effective prices for a given population. This goal can...

https://www.tandfonline.com/doi/pdf/10.1080/16549716.2019.1694745

The risk of corruption in public pharmaceutical procurement: how anti-corruption, transparency and accountability measures may reduce this risk.

Access to safe, effective, good-quality medicines can be compromised by poor pharmaceutical system governance. This system is particularly vulnerable to inefficiencies and to losses from corruption, because it involves a complex mix of actors with diverse responsibilities. A high level of transparency and accountability is critical for minimizing opportunities for fraud and leakage. In the past decade, the Good Governance for Medicines programme and the Medicines Transparency Alliance focused on improving accountability in the pharmaceutical system and on reducing its vulnerability to corruption by increasing transparency and encouraging participation by a range of stakeholders. Experience with these two programmes revealed that stakeholders interpreted transparency and accountability in a range of different ways. Moreover, programme implementation and progress assessments were complicated by a lack of clarity about what information should be disclosed by governments and about how greater transparency can strengthen accountability for access to medicines. This article provides a conceptual understanding of how transparency can facilitate accountability for better access to medicines. We identified three categories of information as prerequisites for accountability: (i) standards and commitments; (ii) decisions and results; and (iii) consequences and responsive actions. Examples are provided for each. Conceptual clarity and practical examples of the information needed to ensure accountability can help policy-makers identify the actions required to increase transparency and accountability in their pharmaceutical systems. We also discuss factors that can hinder or facilitate the use of information to hold to account those responsible for improving access to medicines.

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Increasing transparency and accountability in national pharmaceutical systems.

Barriers to expanding access to medicines include weak pharmaceutical sector governance, lack of transparency and accountability, inadequate attention to social services on the political agenda, and financing challenges Multi-stakeholder initiatives such as the Medicines Transparency Alliance (MeTA) may help overcome these barriers Between 2008 and 2015, MeTA engaged stakeholders in the pharmaceutical sectors of seven countries (Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda, and Zambia) to promote access goals through greater transparency We reviewed archival data to document MeTA activities and results related to transparency and accountability in the seven countries where it was implemented We identified common themes and content areas, noting specific activities used to make information transparent and accessible, how data were used to inform discussions, and the purpose and timing of meetings and advocacy activities to help set priorities and influence governance decisions The cross-case analysis looked for pathways which might link the MeTA strategies to results such as better policies or program improvements Countries used evidence gathering, open meetings, and proactive information dissemination to increase transparency MeTA fostered policy dialogue to bring together the many government, civil society and private company stakeholders concerned with access issues, and provided them with information to understand barriers to access at policy, organizational, and community levels We found strong evidence that transparency was enhanced Some evidence suggests that MeTA efforts contributed to new policies and civil society capacity strengthening although the impact on government accountability is not clear MeTA appears to have achieved its goal of creating a multi-stakeholder shared policy space in which government, civil society, and private sector players can come together and have a voice in the national pharmaceutical policy making process Assuming that transparency is in place to leverage accountability, the success of MeTA’s efforts to promote accountability by the government as well as other stakeholders in the pharmaceutical sector will depend on how well efforts are sustained over time

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Promoting transparency, accountability, and access through a multi-stakeholder initiative: lessons from the medicines transparency alliance

Weak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharmaceutical committees, relationships with the private sector can result in conflicts of interest, which may introduce commercial biases into decision-making, potentially compromising public health objectives and health system sustainability. We conducted a descriptive, qualitative study of conflict of interest policies and practices in the public pharmaceutical sector in ten countries in the World Health Organization (WHO) South-East Asia Region (SEAR) (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste) between September 2020 and March 2021.We identified 45 policy and regulatory documents and triangulated documentary data with 21 expert interviews. Key informants articulated very different governance priorities and conflict of interest concerns depending on the features of their country's pharmaceutical industry, market size, and national economic objectives related to the domestic pharmaceutical industry. Public sector pharmaceutical policies and regulations consistently contained provisions for pharmaceutical committee members to disclose relevant interests, but contained little detail about what should be declared, when, and how often, nor whether disclosures are evaluated and by whom. Processes for preventing or managing conflicts of interest were less well developed than those for disclosure except for a few key procurement processes. Where processes for managing conflicts of interest were specified, the dominant strategy was to recuse committee members with a conflict of interest from relevant work. Policies rarely specified that committee members should divest or otherwise be free from conflicts of interest.Robust processes for conflict of interest prevention and management could ensure the integrity of decision-making and build public trust in pharmaceutical processes to achieve public health objectives. Upstream approaches including supportive legislative frameworks, the creation of oversight bodies, and strengthening regulatory institutions can also contribute to building cultures of transparency, accountability, and trust. 

/pdf/disclosure-transparency-and-accountability-a-qualitative-2r35r5jl.pdf

Disclosure, transparency, and accountability: a qualitative survey of public sector pharmaceutical committee conflict of interest policies in the World Health Organization South-East Asia Region

Deirdre Dimancesco

Papers

The risk of corruption in public pharmaceutical procurement: how anti-corruption, transparency and accountability measures may reduce this risk.

Increasing transparency and accountability in national pharmaceutical systems.

Promoting transparency, accountability, and access through a multi-stakeholder initiative: lessons from the medicines transparency alliance

Disclosure, transparency, and accountability: a qualitative survey of public sector pharmaceutical committee conflict of interest policies in the World Health Organization South-East Asia Region