This special box on Lebanon has been copied verbatim from the recently released (November 2010) "World Health Report 2010" about Good Governance for Medicines Program and Lebanon is one of the examples of the success stories.
Lebanon
Over the past few decades Lebanon has endured recurrent conflicts and instability that have severely impacted the health sector. As a result, in the 1990s Lebanon was faced with a weakened primary health care system, unrestricted growth of high technology health sector and high cost pharmaceuticals where the private sector played a prominent role. As part of its commitment to health system strengthening, the government adopted the GGM programme in 2007. Despite the challenging political situation faced by Lebanon at the time of GGM programme initiation, the MOH showed considerable commitment at a high level to institutionalize both transparency and accountability concepts in every aspect of medicine policy and management practice within the ministry.
The transparency assessment of the pharmaceutical sector identified a number of gaps which resulted in a number of changes at different levels. One of the gaps identified and immediately tackled was related to the national Good Manufacturing Practices (GMP) standards which was dated 1983. A national GMP committee was formed by ministerial decree no. 212/1, dated 18 March 2008, to update the national GMP. This committee included members from the private and the public sectors; the private experts represented academia, pharmaceutical manufacturers, and pharmacists. The revised GMP guidelines, officially adopted on 28 May 2009, are based on WHO GMP guidelines, the GGM transparency assessment findings and adjusted to the Lebanese law of pharmacy.
A group of experts from the MOH, academia and the pharmaceutical sector were also nominated in the GGM Task Force, which is responsible for the overall monitoring and implementation of activities. The group developed the national GGM framework, based on the WHO GGM framework model, and it was recently adopted by the MOH. It includes a national code of conduct, compilation of regulations and administrative procedures, mechanisms for collaboration with other good governance and anticorruption initiatives, whistle-blowing mechanisms and sanctions for reprehensible acts that work within the framework of Lebanese laws.
Other key changes based on the transparency assessment recommendations include:
•
Creation of a new committee responsible for the revision of the national essential medicines list
(EML). The new EML is currently being developed.
•
MOH tender list prepared using generic names since end of 2008.
•
Draft of ethical code for medicine promotion developed and placed on the MOH website to be
reviewed by all stakeholders before being finalized.
•
The development of written procedures, terms of reference, roles, responsibilities and professional qualifications of members for all committees.
•
The enforcement of a conflict of interest form as of 21 October 2010, to be filled by all members
of MOH committees dealing with pharmaceuticals, including the registration, pricing and GMP
(Good Manufacturing Practices) committees.
The challenges faced include poor understanding of transparency and good governance, fear of being evaluated (during phase I), and resistance to change. Despite these challenges, the MOH commitment, the dedication of the GGM programme team, the involvement of the public and private sectors, have all helped to reach the goals set.
[Full Report]
