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Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: A Workshop

January 13-14, 2014
Addis Ababa, Ethiopia

Background:

Sub-Saharan Africa (SSA) has one of the largest treatment gaps for mental, neurological, and substance use (MNS) disorders in the world. In 2011 the Grand Challenges in Global Mental Health initiative identified priorities that will make a significant impact on the lives of people living with MNS disorders. The reduction of cost and improvement of the supply of effective medications was highlighted as one of the top five challenges. Critical to the success of any effort to reduce the treatment gap is a demonstration that ignoring MNS disorders is not only devastating for overall population health but that it also undermines efforts to prevent and treat other causes of disease burden. Efforts in this area should not try to complete for resources used to combat infectious diseases, but should, instead, try to leverage those ongoing activities with initiatives targeted to MNS disorders. For low- and middle-income countries improving access to essential medicines can be a tremendous challenge and a critical barrier to scaling-up care for MNS disorders. Given the importance of access to essential medicines this workshop will bring to-

Page 116 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

gether key stakeholders to discuss opportunities for achieving long-term affordable access of medicines for MNS disorders.

Meeting Objectives:

Participants will be invited to:

Identify critical barriers that impact the procurement of essential medicines for MNS disorders.
- Explore challenges and opportunities for improving access to essential medicines in four critical areas: demand, selection, supply chains, and financing and pricing
Examine successful activities that increase access to essential medicines both within SSA and in other developing countries.
- Identify critical components of these models that might be features in SSA programs focused on MNS disorders.
Consider the role of governments, nongovernmental organizations, and private groups in procurement of essential medicines for MNS disorders.
- Examine current funding and payment practices at each level.
- Explore the impact of prescription practices on determining priority setting for acquiring essential medicines.
Identify the key components of a distribution framework that may serve as a demonstration project focused on increasing access for these essential medicines.

DAY ONE

8:30 a.m.	Welcome
	H. E. DR. KESETEBIRHAN ADMASU Minister of Health, Ethiopia
8:35 a.m.	Opening Remarks
	STEVEN HYMAN, Chair Director, Stanley Center for Psychiatric Research The Broad Institute

Page 117 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

8:40 a.m.	Access to essential medicines for MNS disorders with the greatest burden: Focus on depression, psychosis, and epilepsy
	ATALAY ALEM Professor of Psychiatry Addis Ababa University
9:00 a.m.	Current look at the supply of essential medicines for MNS disorders versus other disease areas (e.g., HIV/AIDS, malaria, tuberculosis)
	PRASHANT YADAV Director, Healthcare Research William Davidson Institute, University of Michigan
9:20 a.m.	Exploring successful access to medicine frameworks
	HANS HOGERZEIL Professor of Global Health Groningen University
9:40 a.m.	Charge to participants: workshop objectives and deliverables
	TEDLA GIORGIS Advisor, Officer of the Minister Ministry of Health, Ethiopia

SESSION I: CHALLENGES AND OPPORTUNITIES FOR IMPROVING ACCESS TO ESSENTIAL MEDICINES

Session Objectives:

Explore feasible opportunities for improving access to essential medicines in four challenge areas: demand, selection, supply chains, and financing/pricing. Examine how progress in one of these areas can impact the others. Consider current government, nongovernmental organizations, and private group decision-making strategies.

Page 118 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

9:50 a.m.	Overview and Session Objectives DAVID MICHELSON, Session Chair Vice President, Clinical Neuroscience and Ophthalmology Merck Research Laboratories
10:00 a.m.	Challenge 1: Insufficient Demand How is patient demand adversely affected by: The prevailing standard of care for MNS disorders? Provider training, prescribing ability, and prescribing knowledge? Ability of providers to monitor drug adherence and efficacy? Low awareness about availability of common medicines? Concerns around cost of both medicines and health care system use? Public stigma around MNS disorders? OYE GUREJE, Professor Department of Psychiatry University of Ibadan
10:25 a.m.	Challenge 2: Appropriate Selection How is appropriate selection of medicines adversely affected by: Low and/or variable availability? Regulatory and procurement procedures? Prescription practices and patient demand? Prioritizations based on disease area, cost, generation? HANS HOGERZEIL, Professor of Global Health Groningen University
10:50 a.m.	BREAK

Page 119 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

11:05 a.m.	Challenge 3: Ineffective Supply Chains How are supply chains for medicines adversely affected by: Absence of or delays in registration of drugs? Absence of monitoring of drug supplies? Transportation deficiencies?
	PRASHANT YADAV Director, Healthcare Research William Davidson Institute University of Michigan
11:30 a.m.	Challenge 4: High Pricing/Poor Financing How are pricing and financing of medicines adversely affected by: Tariffs and taxes placed on supply prices? High mark ups by suppliers and wholesalers? Inadequate financial price off-setting by distributers?
	MARGARET EWEN (PRICING) Pharmacist Health Action International
	DAN CHISHOLM (FINANCING) Health Economist World Health Organization
12:10 p.m.	Response Panel Is there one area that could be considered the greatest barrier to improvement or are all four areas equal in burden?
	Government Perspective ATALAY ALEM Professor of Psychiatry Addis Ababa University

Page 120 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

	Nongovernmental Organization Perspective CHRISTINA NTULO Basic Needs Uganda
	Private-Sector Perspective ISMET SAMJI, Director Portfolio Expansion GlaxoSmithKline
12:40 p.m.	Panel discussion with session speakers and participants How would changes in one area impact the other areas? For example, would increases in demand positively boost willingness of groups to finance essential medicines for MNS disorders?
	DAVID MICHELSON, Session Chair Vice President, Clinical Neuroscience and Ophthalmology Merck Research Laboratories
1:10 p.m.	LUNCH

SESSION II: SUCCESSFUL PROCUREMENT OF ESSENTIAL MEDICINES

Session Objectives:	Examine successful activities that have increased access to essential medicines both within SSA and in other developing countries. Explore acquisition and distribution models for other disease areas (e.g., diabetes, HIV/AIDS). Identify critical components that might be featured in programs focused on MNS disorders.
2:10 p.m.	Overview and Session Objectives
	EVA OMBAKA, Session Chair Senior Lecturer St. John’s University of Tanzania

Page 121 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

	Speakers will focus on the following questions: What were the challenges in developing and executing the project? What partnerships were critical to the success of the project? How were issues around demand, selection, supply chains, and pricing/financing addressed? Are there specific lessons learned that could be applied to efforts around MNS medicines?
2:20 p.m.	Set One—Country Programs
	Example I—National Health Insurance ALBERT AKPALU, Neurologist, Ghana
	Example II—Government Storage with Private Groups JAFARY LIANA, Accredited Drug Dispensing Outlets (ADDO), Tanzania
3:00 p.m.	Set Two—Infectious Disease Programs
3:00 p.m.	Example III—MDR-TB PAUL ZINTL Senior Advisor for Planning and Finance Program in Infectious Disease and Social Change Harvard Medical School
3:20 p.m.	BREAK

Page 122 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

3:40 p.m.	Set Three—Noncommunicable Disease Programs
	Example IV—Diabetes MAPOKO MBELENGE ILONDO, Senior Advisor Corporate Stakeholder Engagement Novo Nordisk A/S, Denmark Example V—Schizophrenia FRANCOIS BOMPART, Medical Director Access to Medicines Sanofi
4:20 p.m.	Lessons Learned—Discussion with Speakers and Participants What components of the examples presented might translate well into a project around MNS medicines? What common challenges and opportunities would a demonstration project need to address early on? EVA OMBAKA, Session Chair Senior Lecturer St. John’s University of Tanzania
5:15 p.m.	WRAP-UP AND ADJOURN

DAY TWO

8:15 a.m.

Day Two Welcome

STEVEN HYMAN, Chair
Director
Stanley Center for Psychiatric Research
The Broad Institute

Page 123 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

8:20 a.m.	Day One Panel Review: Defining the Challenges, Understanding the Lessons
	PAMELA COLLINS Director Office for Research on Disparities & Global Mental Health, National Institute of Mental Health
	ATUL PANDE Senior Vice President, Neurosciences Neurosciences Medicines Development Centre GlaxoSmithKline
	TEDLA GIORGIS Advisor Officer of the Minister Ministry of Health, Ethiopia
	DAN CHISHOLM Health Economist World Health Organization

SESSION III: A ROADMAP FORWARD—ADDRESSING THE CHALLENGES

Session Objectives:

Identify a roadmap forward to address the four challenge areas: demand, selection, supply chains, and pricing/financing. Consider country income levels (e.g., low, middle, and high) and MNS disorders (e.g., depression, psychosis, epilepsy) when discussing potential solutions.

8:50 a.m.	Session Objectives and Goals
	FRANCES JENSEN, Session Chair Professor and Chair, Department of Neurology University of Pennsylvania Health System

Page 124 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

9:00 a.m.	Challenge Area Discussions Identify components of a roadmap to address the challenge area. Discuss barriers and opportunities at the level of country income and MNS disorder. Challenge Area 1: Demand PAMELA COLLINS, Challenge Facilitator Challenge Area 2: Selection ATUL PANDE, Challenge Facilitator Challenge Area 3: Supply Chains TEDLA GIORGIS, Challenge Facilitator Challenge Area 4: Pricing/Financing DAN CHISHOLM, Challenge Facilitator
12:30 p.m.	LUNCH
1:30 p.m.	Building a Roadmap Forward—Within and Across Challenge Areas Challenge Facilitators PAMELA COLLINS, Challenge Facilitator—Demand ATUL PANDE, Challenge Facilitator—Selection TEDLA GIORGIS, Challenge Facilitator—Supply Chains DAN CHISHOLM, Challenge Facilitator—Pricing/Financing
3:00 p.m.	Discussion with Leaders and Participants Identify potential obstacles and opportunities to implementation FRANCES JENSEN, Session Chair Professor and Chair, Department of Neurology University of Pennsylvania Health System
3:30 p.m.	BREAK

Page 125 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.

SESSION IV: NEXT STEPS–IMPLEMENTING THE ROADMAP FORWARD

Session Objectives:

Explore available resources that could support a demonstration project. Identify tangible next steps for launching a demonstration project for MNS disorders.

3:45 p.m.	Overview STEVEN HYMAN, Chair Director Stanley Center for Psychiatric Research The Broad Institute
3:50 p.m.	Discussion with workshop session chairs, facilitators, and participants Identify potential next steps for launching a demonstration project Who would be critical partners to facilitate such a project?
4:30 p.m.	Closing Remarks
4:45 p.m.	ADJOURN

Page 126 Cite

Suggested Citation: "Appendix C: Workshop Agenda." Institute of Medicine. 2014. Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18380.