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Minutes 2007 - Health Action International – Asia Pacific

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					                             Review and Planning Meeting
                    Health Action International Asia-Pacific (HAIAP)
                                 30th-31st August, 2007
                         Cinnamon Grand, Colombo, Sri Lanka


Presentation of the Olle Hansson Award

Dr. Joel Fernando, Governing Council member of HAIAP welcomed the members to the 5th
Review and Planning Meeting and started the proceedings by inviting Dr. Tim Reed to present
the Olle Hansson award for year 2006 to Dr. K Balasubramaniam. Dr. Tim Reed introduced Dr.
Bala as a confidante, a friend and a leader who has placed HAIAP at the cutting edge of the
struggle against the hegemony of transnational pharmaceutical corporations. The special
contribution Mrs. Bala has made over the years was also appreciated.
The Olle Hansson award for year 2007 was presented to Dr. Eva Ombaka by Dr. K.
Balasubramanium. He introduced her to the audience as a long standing friend of HAIAP and a
Governing Council member of HAI Africa. She has been committed to promoting rational use of
drugs for several years and has proven herself to be an ideal candidate to receive the Olle
Hansson award.

Adoption of the Agenda

The adoption of the agenda for the 5th HAIAP Review and Planning Meeting 2007 was proposed
by Dr. Mira Shiva and seconded by Prof. Izham.

Election of chairpersons for the sessions

Dr Tim Reed, Dr. Eva Ombaka, Dr Claudio Schuftan, Dr. Romeo Quijano, Dr. Prem John and
Dr. Gene Nesparos were elected as chairpersons for the sessions.

Dollar account of HAIAP

The members were given the following information by Dr. Balasubramaniam.
In October 2006 HAIAP received a letter from the Central Bank of Sri Lanka notifying the
suspension of our dollar bank account as a consequence of a policy implemented by the
Government. This meant that it would not be possible to transfer money out of dollars out of Sri
Lanka. The only option was to relocate the secretariat to another country within the region. The
Governing Council and the members informed. However we decided to explore all possible
avenues.We shared our concerns with the Minister of Science and Technology Dr.Tissa
Vitharana, who is a close friend of HAIAP. His appeal to the Governor of Central Bank was
turned down. Then we approached Prof. Carlo Fonseka who introduced us to the Exchange
Controller of the Central Bank; an amicable gentleman. He encouraged us to make an appeal to
the Governor of the Central Bank with the backing of the Ministry of Health and Dutch Embassy.
Ms Nimalka Fernando, Director of an NGO dealing with gender issues introduced Dr.
Balasubramaniam to a senior official in the Central Bank who was very helpful.
Dr. Balasubramaniam accompanied by Dr. Tim Reed visited the Dutch embassy in April to
request for a letter of recommendation for HAIAP. The recommendation letter from the
embassy, among others stated the following “Dr. Tim Reed, Director of the HAI Global Board
informed that HAIAP is the crowning jewel of the Global Network”.



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On the 31st of July, Dr. Joel Fernando met with the Exchange Controller with all the relevant
documents and the letter from the Dutch embassy. Two weeks after the meeting, the Exchange
Controller, having denied our appeal three times before, called HAIAP office on the 15th of
August to convey that our request has been finally granted. It was an absolutely blissful day for
us at the HAIAP secretariat. Our local bank was granted permission by the Central Bank to
release the HAIAP dollar bank account the following day.
Ms. Beverly Snell stated how the entire membership felt Dr. Bala’s suffering and tenacity over
this issue and applauded his persistence to overcome it.

Adoption of the minutes 2006

The minutes of the HAIAP Review and Planning Meeting/Annual General Meeting 2006 were
adopted. The minutes were proposed by Dr. Claudio Schuftan and seconded by Dr. Zafrullah
Chowdhary.


HAI Global Network: Building an Integrated Framework for an Accountable and
Sustainable Future
By Dr. Tim Reed, Director, HAI Global Board.

The Global Program which was implemented in January 2007 was designed to bind the Global
HAI as a cohesive unit. It is important to us as it outlines the future of HAI and its funding.

The Global Program relies on HAI’s core mission- access to essential medicine, rational use of
medicine and democratization of medicine policies. It was formulated in collaboration with HAI’s
four regional coordinators, drawing on ISG papers called in 2005. We are funded because the
Global program capitalizes on HAI’s unique expertise in medicine policy, which is a critical
component of the Global health economy. The Global program no longer operates on core-
funding; and the total grant of 7.1 million Euros is distributed across four regions.

HAI Network problems

Health Action International strives to increase access to essential medicines and improve their
rational use. We have identified network problems that impede our progress. One was the
democratic deficit, as there was no representation of the regions in the Global Governing body.
This was identified by an internal review funded by HAI. This was the opinion of the donors as
well.
 The regional relationship was shown by dominance by HAI Europe. Their capacity was diverted
to organizing the Global program rather than engaging in problems civil society faced in Europe.
 As far as the Global position is concerned, we have tried for the last 20 years to establish an
official relationship with WHO, but have failed because of our constitution. The Global platform
was shaky, and we needed and outward facing agenda.

Governance Restructure

Restructuring in terms of Governance consists of transformation of the HAI Foundation Board to
the HAI Global Board, funded by Stichting Health Action International and the increase in
membership from 3 to 9. It is significant because previously we had three members, two from
Holland and one from Egypt who was never invited for meetings. Now we have a Global Board
with Global representation and a range of competencies. To appoint the democratized Global
Board, the regions were consulted and submissions were drawn from the regions. Dr. Prem

                                                                                               2
John was appointed from HAIAP. He stepped aside from his position of Chairperson on the
Governing Council to get on to the HAI Global Board.
The new constitution cleans up any conflicts of interest. Previously it was possible for the
representatives of Stinchting International to influence the allocation of funds for their own
projects, but now it is not possible with the close monitoring and evaluation protocols. This is
also partly the reason why Dr. Prem John had to step aside from the HAIAP Governing Council
to step on to the HAIAP Global Board.
The new constitution allows us to be legally accepted by WHO, therefore we can proceed with
our application to WHO, which is now in process.

HAI Network Restructure

HAI Europe had a problem earlier as it needed to allocate resources to serve the other three
regions as a Global coordinator as well as a Regional coordinator for Europe. As a solution HAI
Europe was split into two and HAI Global was introduced. This enabled HAI Europe to
specifically deal with European issues as it separated HAI Global from European campaigns.
HAI Global provides a secretariat for the Global board and the Global program. It also provides
a focal point for donors and a focal point to coordinate the Global program in the regions.

Donor Cash flow

The official recipient of funds from the donors is Stichting Health Action International, which is a
Global body. The funds received are then handed over to HAI Global secretariat, who in turn
disperses it among the four regions according to the funds they have requested initially through
the Global program. The funds are strictly dispersed for the activities of the Global program. We
are no longer in a situation to enjoy core funding, as adherence to the Global program requires
monitoring and evaluation protocols, it also plays a pivotal roll in our application process.

Accountability (Monitoring and Evaluation)

It is the exact same route of the donor cash flow but in reverse. Annual progress reports will be
evaluated by the Global board and then the donors.

Consequences for Amsterdam

Staff for HAI Global consists of the Director, Global Project Officer for pricing, two Global Project
Officers for rational use of medicine and promotion and a Communication Officer.
Their primary tasks are to raise funds for the regions to implement components of the Global
projects, liaise with WHO, coordinate the IGWG in coalition with WHO and to provide a Global
secretariat to coordinate regions.

HAI Europe has employed a Regional coordinator and two European Project Offices. Currently
they are coordinating European member’s projects, a project on Patient Organization funding,
Direct Consumer advertising project and a European pharma forum.

HAI Asia Pacific

HAIAP’s position has not changed constitutionally. In fact the Global restructuring has benefited
HAIAP by providing a clear contact point for Global issues and by giving HAIAP a Regional
representation at a Global level. The changes have contributed greatly to strengthen the
relationship between HAIAP and HAI Global.

                                                                                                   3
Components of the Global Program are annexed. (Annex III)

Framework and Targets for HAIAP Activities
2007 – 2010

Jinani Jayasekera, Project Officer, HAIAP gave a brief introduction to the framework and targets
for HAIAP activities for 2007-2010.

The program of activities for the next cycle will be the same; the members will carry out a
number of activities as in the previous years. The inter-country studies initiated in 2007 will
continue on till 2010.The country reports of these studies will be available to all members and
other members are encouraged to carry out these studies in their respective countries using the
published country reports as guidelines. Details of such activities will be finalized at the annual
HAIAP Review and Planning Meetings.

Activities for 2007

       Activity 3.2.2 – Regional Consultation on GATS & Public Health

The activities for this cycle began with the Regional Consultation on GATS and Public Health.
The goal of this consultation was to create a critical mass of health activists knowledgeable on
the GATS issues who will return to their countries and increase public awareness on the
consequences of our countries giving specific commitments to open the health sector. An
informed and educated public can certainly influence a country's response to the GATS by
bringing pressure on the negotiators to keep in focus the National Health Policy goal that Right
to Health is a Fundamental Human Right and resist the WB, WTO & IMF agenda to make
Health a marketable commodity.

     Activity 3.2.1 – National Medicines and Health Policies to ensure regular Access to
      Essential Medicine and Basic Healthcare

Inter country studies will be initiated to study the impact of privatization on health.

       Activity 2.1.2 – Advocacy and Campaigns to Remove Hazardous and Harmful drugs

HAIAP is in the process of carrying out an inter-country survey to identify the availability of a
priority list of harmful and hazardous drugs that are available in the different countries in the
region. As a continuation of this work HAIAP will work with other interested members to work
towards de-registration and removal of these drugs from countries in which they are still
available.

       Activity 2.1.5 – Education Campaign in Rational Drug Use

HAIAP is currently in the process of developing teaching aids for health workers on
comprehensive rational medicines use and management.

       Activity 2.2.1 – Monitoring of Legislation and Practices in Place to Curb Unethical Drug
                         Promotion

HAIAP is in the process of comparing national legislations and guidelines on drug promotion
with the WHO ethical criteria on medicinal drug promotion. HAIAP will also document complaint

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and reporting systems, how often they are used and how accessible the systems are for the
consumers. These results will be widely disseminated and used as advocacy material for stricter
controls and legislation on unethical drug promotion.

Activities for 2008


       Activity 1.2.1 – Continuous Monitoring, Information Management and Dissemination on
                         FTAs and Access to Medicines

This activity includes a Regional Consultation on the consequences of FTAs on Access to
Medicine. The Regional Consultation will be coupled with the sixth review and Planning meeting
and the Governing Council meeting. HAIAP will evaluate latest developments and effects of
current and future FTAs by commissioning country papers on the role of FTAs in the price of
medicines. HAIAP will act as a clearing house for information. HAIAP will also monitor the
immediate impacts of the TRIPS agreement (accessibility to medicines both in terms of
availability and affordability of medicines prices) after the developing countries became TRIPS
compliant since January 2005.

The following activities will be continued from last year,

       Activity 2.1.2 – Advocacy and Campaigns to Remove Hazardous and Harmful drugs

       Activity 2.1.5 – Education Campaign in Rational Drug Use

       Activity 2.2.1 – Monitoring of Legislation and Practices in Place to Curb Unethical Drug
                          Promotion

Activities for 2009

     Activity 2.1.1 – Strengthen the Network of Educators for Rational Drug Use

Activities for Year 2009 will begin with the Third International Consultation on Undergraduate
Medical Education. This will be coupled with the Seventh HAIAP Review and Planning Meeting
and the Governing Council Meeting.

       Activity 1.1.1 – Documentation of price control mechanisms

Based on HAI/WHO Medicines prices, the secretariat in collaboration with five members
interested in the project will develop a methodology to document price control mechanism,
country papers, national and regional campaigns to lobby governments to introduce drug price
control. Only some countries in the region have price control mechanisms and policies. HAIAP
will continue to monitor, keep up to date with different price control mechanisms (or the lack of
it). The information gathered on either the regressive or progressive policies in countries will be
collated and disseminated in appropriate form depending on the target audiences for
dissemination. These would involve all stakeholders such as members of HAIAP, key contacts
and other NGOs already working in the same priority areas, health ministry officials, other
relevant government officials, academia, other activists and the general public.




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       Activity 2.2.2 – Monitoring unethical drug promotion

There is a pressing need to identify unethical drug promotion practices. HAIAP will monitor,
gather evidence and document unethical drug promotion to be used as advocacy material for
stricter controls and legislation on drug promotion.
We will carry this activity in two or three countries and request the members to volunteer to
carry out these studies.

       Activity 2.1.2 – Advocacy and Campaigns to Remove Hazardous and Harmful drugs

Activity 2.1.2 was initiated in 2004 and will be carried out through the cycle. Previous country
reports will be available at this stage.

       Activity 1.1.5 – Increased public sector spending and financing mechanism for medicines

This activity includes National Workshops in two selected countries on financing mechanisms
for medicines to raise awareness and action at national level on financing for equitable access
to medicines. WHO has estimated that in developing countries consumers pay about 60 – 80
percent of the pharmaceutical expenses out of their own pockets. HAIAP in collaboration with
members will initiate national campaigns to lobby governments to develop healthcare financing
schemes based on recommendations drawn up at the recent HAIAP seminar.

       Activity 2.1.4 – National Drug Policy Advocacy

This activity includes a National Workshop in a selected country without a written National Drug
policy document. HAIAP will continue to advocate for better implementation of national drug
policies based on the essential medicines concept through information sharing, dissemination
and education of target groups such as consumers and key individuals in national policy making
fora.

       Activity 2.1.3 – Pharmacovigilance

 The Nepal country report on pharmcovigilance will provide guidelines for another interested
member to carry out a country project on pharmcovigilence. Adverse drug reaction monitoring
needs a well organized system, structure and expertise in place. HAIAP realizes this is in fact a
process that requires a vast amount of resources and should be supported by the Ministries of
Health. However there are many members of HAIAP who are currently interested in some form
of pharmacovigilance system. HAIAP will support those members who are trying to find out new
initiatives of adverse drug reporting and will convene a workshop/seminar/consultation on new
and innovative methods of pharmacovigilance that would not require the entire structure and
process of a thorough ADR monitoring system.

Activities for 2010

Activities for year 2010 include,
1. A Regional Consultation- The topic for the consultation will identified by the General
   Assembly during the seventh HAIAP Review and Planning meeting.
2. Eighth HAIAP Review and Planning Meeting
3. Meeting of the Governing Council
4. Other activities identified by the membership during the 2009 Review and Planning meeting.



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Presentations of ongoing and future inter-country collaborative
studies
   1. "National Medicines and Health Policies to ensure regular Access to Essential
       Medicine and Basic Healthcare".
       Facilitated by Assoc. Prof Izham

Preamble for the project prepared by Dr. Amit Sen Gupta is annexed (Annex IV).

HAIAP will keep abreast of detrimental effects of privatization of health. The objective of this
project is to document and disseminate the information to key individuals at policy making and
lobbying levels, civil society groups and also to the major stakeholder – the general public for
the purpose of building awareness and catalyzing a movement to oppose the attempts to
privatize health.
Five countries including, Philippines, Pakistan, India, Indonesia and Malaysia will partner in this
project. Prof. Izham agreed to develop a draft methodology and circulate it among the members,
within three months.

   2. Where there is no Pharmacist
      Facilitated by Ms. Beverley Snell

Project Justification

The WHO estimates that over third of the world’s population has no access to modern
medicines. Some of us doubt this statistic. Modern medicines are available in grocery stores in
the rural areas in most developing countries and dispensed by untrained persons. There are
thousands of registered retail pharmacies in developing countries. You find these busy with
consumers at most times. This indicates that there is a high use of uninformed and OTC use of
drugs. There is also evidence that all the dispensers at these pharmacies have not undergone
formal training in pharmacy practice. There is more harm than good done by this practice. Many
practitioners of traditional systems of medicine often dispense modern medicines. The doctor-
patient and dispenser-patient interaction is limited to a couple of minutes. There is insufficient
flow of information from the doctor and the dispenser to the patient. In developing countries the
rural community is served by just one health worker who is neither a doctor nor a pharmacist.
This person is usually trained to diagnose and prescribe as well as dispense medicines
appropriate for the level of work. In many cases they have guidelines written especially for their
health work in the community. In addition, Where There Is No Doctor (WTIND) has been used
by health workers all over the world as a useful guide. The first edition of WTIND was written in
1978 and it has only been revised in 2007. The 2007 edition addresses important issues. The
blue pages explain the changes- for example nutrition advice, changes in stomach ulcer
treatment, management of dehydration. An important section on sterilizing equipment has been
added and the illustration of first aid and wound management emphasizes the use of plastic
bags or gloves on hands. The Green Pages now include some additional medicines. This is
because some diseases have become resistant to the medicines that were used in the past. So
it is now harder to give simple medical advice for certain diseases-especially malaria,
tuberculosis, typhoid, and sexually transmitted diseases. For many infectious diseases, advice
about which medicines are available and effective in a particular area are needed. All of this
means that WTIND is a very useful reference for the actual treatment of problems. Health
workers in the remote settings where there is no doctor or pharmacist often have good national
treatment guidelines to follow as well as WTIND. What they don’t have is any training about the

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management of their medicines. They need to have a reliable supply of the right medicines and
they need to store those medicines properly as well as to know how to provide them to patients
together with all the needed information. They also need to be able to answer questions from
the community members about the use of medicines. Unfortunately, there is no quantification of
data to support all of these arguments. However, this does not mean that we should not address
this issue and make an intervention. Information found in the WTIND and other drug reference
books should not be duplicated, therefore WTINP should focus on the management of
medicines and their use in the community.

Project Objective

    To provide a user-friendly resource tool to communities to create awareness and
     knowledge about medicines and medical treatment that are currently available and given
     to them.
    To help develop community awareness and knowledge about medicines, and medical
     treatments that are currently available and given to them.
    Encourage informed self-care.
    To demystify medicines and medical science to enable lay people to understand the
     fundamental principles involved.
    To educate the people that many illnesses can be prevented or treated without
     medicines.
    Educate all the people;
                 On the concept of essential medicines
                 That medicines must be used correctly to get maximum benefit

    That there is some danger in the use of any medicines and never to use dangerous
     medicines for mild illness.


Target Audience

    Health workers in settings where they are the sole persons, or one of a very small
     team, who cares for community health. These workers diagnose, prescribe and dispense
     medicines. Such settings are common in rural Africa, some parts of Asia and in the
     Pacific Island Countries.

    Dispensers in the informal medicines market to prevent the dangers of this uninformed
     practice.

    Consumers, patients and care givers. To provide information that is not available to
     them from doctors and dispensers.

Conclusion

A foreword must state HAI principle and work approach with regard to drugs. We must take care
not to be accused of advocating the use of pharmaceuticals to communities that have a
traditional system of care and medication.


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It is important to include drug regulation laws in each country. When addressing the issue of
drug registration it should be limited to a small paragraph, as the people we are targeting will not
be involved in the work involved in registration of drugs. The process of registration is not
required.
Banned list of drugs, country wise should also be included. ContraIndications and adverse
effects of drugs must be explained. Cold Chains should be mentioned briefly under storage, to
show the need of refrigeration for some drugs. We must bear in mind that some areas will not
have electricity.
We will also need to include some common traditional approaches to care, distinguishing
between the good and ill practices. The book should include a comparison of relative costs of
some common drugs.
Guidelines by WHO on Good Pharmacy practice should be incorporated. A special section on
drug use in pregnancy with safe drugs, and what should be avoided must be listed.
Other areas that need to be included are rational combination drugs, Counterfeit,spurious and
sub-standard drugs, existence of bias among prescribers and desanitation of water. Inside back
cover must carry commonly dispensed units, doses.
Prior to finalizing the content a field test must be carried out to test the appropriateness of the
content. Changes, deletions, inclusions will be done according to the results of such visits.


   3. Multi-Country Survey on Banned/Restricted Pharmaceuticals
      Facilitated by Dr Niyada Kiatying-Anguslee

There are a number of organizations and individuals around the world that have already
gathered information and done research regarding the availability of harmful drugs in the
market. There are several publications that have comprehensive information regarding such
drugs. Some of these publications are;

   1. UN Consolidated List of Products Whose Consumption and\or Sale Have been Banned,
      Withdrawn, Severely Restricted or Not Approved by Governments (Eighth Issue
      Pharmaceuticals)
   2. Problem Drugs by Andrew Chetley
   3. Banned and Bannable Drugs 5th Revised Edition, Voluntary Health Association of India

The three publications provide the literature basis for the study.
There was wide support and need for an inter country project on harmful pharmaceuticals in the
region. There are still a number of drugs that have been banned in other countries which are still
available in the countries in the Asian region.
The document which was taken as a guideline to compile a list of harmful drugs was the Eighth
issue on Pharmaceuticals of the UN Consolidated List of Products Whose Consumption and\or
Sale have been banned/withdrawn/ severely restricted or Not Approved by governments
2003(which will be referred to as the UN list).
In developing the methodology to compile a primary list of hazardous drugs, we assumed the
severity of harm caused by a pharmaceutical can be associated with the number of countries
that have taken some restrictive action against the usage of that pharmaceutical. In order to
eliminate any errors coming from this assumption we also encouraged our project partners to
include hazardous drugs unique to their countries as well.

The secretariat compiled a list of harmful drugs which was prioritized taking in to account the
number of countries that have taken some sort of regulatory action as documented in the UN list
for each pharmaceutical substance. Out of the 113 drugs that have been either banned or

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restricted, the drugs which were banned in more than 5 countries were chosen as the
pharmaceuticals of concern to this project. Finally a list of 51 mono component products and 7
combination products were chosen as the primary list.
The list of 51 mono component products and 7 combination products were sent to the members
to map the registration status and the nature of the pharmaceutical available in the country. In
addition the members were encouraged to add “bannable” drugs which were registered in their
country and were not included in the list.

Conclusion

We want as many countries as possible to send in their registration status of the 51 drugs, in
order to get an idea of the availability of these drugs in the region. Reminders will be sent to all
the partners by the secretariat. The list of drugs with their registration status must be
accompanied with a short write up on how the data was collected. The members are also
encouraged to send in an additional list of hazardous drugs not included in the 51 drug list, with
an appropriate justification to include it to the “Bannable” Drug list.

[Post-script – A second meeting was held on the 30th night. Follow up plans were agreed.
Minutes of the meetings on the 30th will be circulated to the project members]

   4. Curbing unethical drug promotion: HAIAP study proposal
      Facilitated by Dr. Ken Harvey

This project will be based on relevant legislation and codes on drug promotion available in
different countries. Dr. Ken Harvey from Australia agreed to coordinate the collection of relevant
data and information. Data collected will be analyzed. Based on the analysis the first report will
be published with reform recommendations.

The second stage of the project will consist of evaluating the complaint system (5-10
complaints). The systems in each country will be examined and evaluated based on the time
taken, result and sanctions applied. A report will be presented including reform
recommendations and publicized.

Partners for the project are Prof. Izham from Malaysia, Dr. Seyedur Rahaman from Bangladesh,
Amitava from India, Dr.Talib Lashari from Pakistan and Dr.Niyada from Thailand.

Peoples’ Health Movement (PHM)

Peoples’ Health Movement of Sri Lanka was given an opportunity to share their experiences
with the HAIAP membership following a presentation from Dr.Edelina de la Paz on PHM Global.

Elections to the Governing Council

Dr K Balasubramaniam announced the results of the elections to the Governing Council. The
membership had elected Prof Tariq Bhutta and Dr. Qassem Chowdary to replace Dr. Prem John
and Dr Zafrullah Chowdhary who stepped down from the Governing Council this year.




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Any other matters
Invitations for the next meeting in 2008 were received from Bangladesh, Pakistan, Malaysia and
Thailand.

Dr. Prem John concluded the proceedings by thanking the HAIAP secretariat for organizing the
meetings and all participants for their contributions and attendance.




Annex I       List of Participants (Pg.13 – 18)
Annex II      Agenda (Pg. 19-20)
Annex III     Components of the Global Program (Pg. 21-)
Annex IV      Study on Privatization of Health Care, Preamble prepared by Dr. Amit Sen
              Gupta(21-23)




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Annex I

List of Participants

                 Name                Tele/Fax/E-mail                  Address
    Abdul Hafeez (Mr)       92 51 226 1085/ 4881         The Network for Consumer
                            92 51 226 2495               Protection
                            hafeez@thenetwork.org.pk     40A Ramzan Plaza
                            hafeez697@yahoo.com          G-9 Markaz, Islamabad
                                                         Pakistan
    Avijit Hazra (Dr)       91-33-2474 8553              Community Development
                            91-33-2475 5668              Medicinal Unit (CDMU)
                            cdmudocu@vsnl.com            47/1B, Garcha Road,
                            blowfans@cal2.vsnl.net.in    Kolkata 700 013
                                                         India
    Amitava Guha (Mr)       Tel: 91 33 2424 2862         Federation of Medical and Sales
                            Fax: 91 33 2424 4943         Representatives’ Association of
                            E-mail: fmrai@vsn.net        India
                            guhaamitava_@hotmail.com     60 Charu Avenue
                                                         Kokata 700 033
                                                         India
    Amit Sen Gupta (Dr)     +91 9810611425 (mobile)      National Campaign Committee for
                            91-11-26524323 (work)        Drug Policy
                            91-11-26862716               D 158, LGF, Saket,
                            E-mail: ctddsf@vsnl.com      New Delhi 110 017
                                                         India
    Beverley Snell (Ms)     Tel: 61 3 9282 2115          Essentials Drugs & Community
                            Fax: 613 9282 2144           Health Specialist Senior Fellow
                            E-mail: bev@burnet.edu.au    Centre for International Health
                                                         Macfarlane Burnet Institute for
                                                         Medical Research & Public Health
                                                         GPO Box 2284, Melbourne 3001,
                                                         Australia
    Claudio Schuftan (Dr)   Tel: +84 4 910 2903          P O Box 815
                            Fax: +84 4 910 2904          Saigon (Center)
                            E-mail: schuftan@gmail.com   Vietnam



    Eva Ombaka (Dr)         eva@epn.or.ke                Co-ordinator
                                                         Ecumenical Pharmaceutical
                                                         Network
                                                         P O Box 73860, City Square
                                                         00200
                                                         Nairobi




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Edelina P de la Paz (Dr)     HAIN                             Dr.Edelina P. de la Paz
                             Tel 63-2-9526312                 Executive Director
                             Fax 63-2-9526409                 Health Action Information Network
                             e mail: hain@hain.org            26 Sampaguita Avenue
                                                              Mapayapa Village II
                             Dept. of Family and Community    Barangay Holy Spirit
                             Medicine, Social Medicine Unit   Quezon City 1127
                             College of Medicine              PHILIPPINES
                             Tel/Fax 63-2-4006658             UP College of Medicine :
                             E mail: smucm@cm.upm.edu.ph      Dr. Edelina P. de la Paz
                                  delen27@yahoo.com           Associate Professor
                                                              Dept of Family and Community
                                                              Medicine
                                                              Vice Chief, Social Medicine Unit
                                                              College of Medicine
                                                              University of the Philippines
                                                              547 Pedro Gil St.
                                                              Ermita, Manila 1000
                                                              PHILIPPINES
Gene Nisperos (Dr)           Tel: +63 2 371 1285              Operations Officer
                             E-mail : headphil@gmail.com      Field Assistance Unit,
                             chdphils@sydsl.com.ph            Council for Health and
                                                              Development (Philippines)
                                                              19 Scout Borromeo Street, South
                                                              Triangle,
                                                              Quezon City, Philippines

Jayabalan T (Dr)             Tel: +60 4 8299 511              Consumers Association of Penang
                             Fax: +60 4 8298 109              228, Jalan Macalister
                             E-mail: drjaya@tm.net.my         10400 Penang, Malaysia
Joel Fernando (Dr)           Tel: 9411 2502449                Treasurer
                             Fax: 9411 2554570                Health Action International Asia -
                             E-mail: suneraf@sltnet.lk        Pacific
                                                              5, Frankfurt Place, Colombo 4
                                                              Sri Lanka
Ken Harvey (Dr)              614 1918 1910 (M) &              35 Mary Street
                             613 9479 1750 (O)                Hawthorn Victoria 3122
                             613 9818 1875                    Australia
                             k.Harvey@latrobe.edu.au
Krisantha Weerasuriya (Dr)   91 11 2337 0804 Ext 26314        Regional Advisor, ED&M Policy
                             91 98104 16366 (Mobile)          WHO – SEARO
                             91 11 2337 8510                  World Health House
                             weerasuriyak@whosea.org          New Delhi 110 002
                                                              India
Mira Shiva (Dr)              ++91-11-2685 5010                Member,
                             ++91-11-2651 2385                HAIAP Governing Council
                             91-11-2685 6795, 2696 2589       Director - WHD & RPD
                             mirashiva@yahoo.com              VHAI
                                                              Coordinator, AIDAN
                                                              A-60, Hauz Khas, New Delhi 110
                                                              016, India

                                                                                             13
Mohamad Ali Barzegar (Dr)       0098-911-111 1207 & 0098- 21-227    No.59, Darband Street,
                                37323                               P.O.Box: 19615 – 943,
                                0098 121 3112725, 3112818           Tadjrish, Tehran,
                                m_barzgar@hotmail.com               Iran
                                barzgar89@yahoo.com
Mohamed Izham Mohamed           Tel: 604 6532628                    Acting Program Chairman
Ibrahim (Assoc. Prof)           Fax: 604 656 9298 or 604 6570 017   Social and Administrative
                                mizham@usm.my                       Pharmacy
                                                                    School of Pharmaceutical
                                                                    Sciences
                                                                    Universiti Sains Malayisa
                                                                    11800 Penang, Malaysia

Niyada Kiatying Angsulee (Dr)   Tel: ++662-2188374                  Drug Study Group
                                Fax: ++662-2188443                  Faculty of Pharmaceutical
                                E-mail: Niyada.k@chula.ac.th        Sciences
                                Niyada@yahoo.com                    Chulalongkorn University
                                                                    Phayathai Rd., Bangkok 10330,
                                                                    Thailand
                                                                    11/156 Soi Kawna2
                                                                    Charansnitwong 13, Bangkok
                                                                    10160
                                                                    Thailand
Phan Vu Diem Hang (Ms)          Tel: 84 9 13270184 (Mobile)         No 10, NGO 186, PHO Doi Can
                                hanaq@netnam.vn                     Ba Dinh, Ha Noi
                                                                    Vietnam
Prem Chandran John (Dr)         91-44-2491 9890, 2491 0368          10, 32nd Cross Street, Besant
                                91-44-2821 6705                     Nagar,
                                hariprem@eth.net                    Madras 600 090
                                prem_john@vsnl.net                  India
P Subish (Mr)                   +977 61 526420 (work)               Assistant Professor
                                +977 61 522 653/160 (fax)           Dept. of Pharmacology,
                                subishpalaian@yahoo.co.in           Drug Information and
                                dic.mth@manipal.edu.np              Pharmacovigilance Center
                                                                    Manipal College of Medical
                                                                    Sciences
                                                                    P O Box # 155, Pokhara, Nepal
Razak Lajis (Mr)                604 657 0099 / 2924                 National Poison Centre
                                604 656 8417                        Universiti SAINS Malaysia
                                razaklajis123@yahoo.com             11800 Penang
                                                                    Malaysia
Romeo F Quijano (Dr)            Tel: 63 2 526 1816                  Department of Pharmacology and
                                Fax: 63 2 521 8251                  Toxicology
                                romyquij@yahoo.com                  College of Medicine
                                                                    University of Philippines Manila
                                                                    547 Pedro Gil Street
                                                                    Ermita, Manila 1000
                                                                    Philippines




                                                                                                  14
    Suksmaningsih, Sri Haruti (Ms)   Tel.+62-21-7981858                Indonesian Consumers
                                     Fax.+62-21-7981038                Organisation
                                     E-mail: konsumen@rad.net.id       Pancoran Barat VII No. 1
                                     www.ylki.or.id                    Duren Tiga
                                                                       Jakarta 12760
    Md Sayedur Rahman (Dr)           Tel: 88028619438/ 8801199840757   Associate Professor
                                     srkhasru@bdcom.com                Department of Pharmacology
                                                                       Bangabandhu Sheikh Mujib
                                                                       Medical University
                                                                       Shahbag
                                                                       Dhaka
                                                                       Bangladesh
    Tim Reed (Dr)                    Tel: +31 20 683 3684              Director
                                     Fax: +31 20685 5002               Health Action International Global
                                     E-mail: tim@haiweb.org            (HAI – G)
                                     Website: http://www.haiweb.org    Jacob van lennepkade 334T
                                                                       1053 NJ Amsterdam
                                                                       The Netherlands
    Zafrullah Chowdhury (Dr)         Tel: 8802 8617383 / 208           Gonoshasthaya Kendra (GK)
                                     Fax: 8802 8613567                 House 14e, Road 6, Dhanmondi
                                     E-mail: gk@citechco.net           R/A
                                                                       Dhaka 1205
                                                                       Bangladesh

Organisations/NGO’s

   Wijetunga, Rajah (Dr)             E-mail: wrajendra@wow.lk           President - SWETHA Society.
                                                                        (Former SOBA Society)
                                                                        330/4 Negombo Road
                                                                        Kurunegala
                                                                        Sri Lanka
   Edwards, C S (Mr)                 cs.edwards@cargillsceylon.com     Cargills Sri Lanka

    Mahanama Dodampegama (Mr)        Tel: 2387155                      Director
    President SLCPI                  Fax: 2342516                      A Baurs & Co Ltd
                                     Mobile: 0777378878                62 Jetawana Road
                                     E-mail: mahanama@baurs.com        Colombo 14
    Nimal Dias Jayasinghe (Mr)       Tel : 2694823                      (Immediate Past president of the
                                     Fax:2671877                        SLCPI)
                                     Mobile : 0773034653                Managing Director
                                     Email : nimjay@sltnet.lk           Emerchemie NB (Ceylon) Ltd
                                                                        60, Maligawatte Road
                                                                        Colombo 10.
    Adrian Basnayake (Mr)            Tel : 5337648/9                    ( Vice President and President
                                     Fax : 2685496                      Nominee of SLCPI)
                                     Mobile : 0777367688                Managing Director
                                     Email: adrian@abcpharmasl.com      ABC Pharma Services (Pvt) Ltd
                                                                        129, Kynsey Road
                                                                        Colombo 10.



                                                                                                       15
G D Dayaratne (Mr)          Tel: (00)94 - 11 - 2431368, 2431378,   Head, HPP,
                            2431408                                Institute of Policy Studies
                            Fax: (00)94 - 11 - 2431395             99, St. Michael’s Road
                            E-mail: ips@ips.lk                     Colombo 03
                                                                   Sri Lanka.

Sunimalee Madurawela (Ms)   Tel: (00)94 - 11 - 2431368, 2431378,   HPP, Institute of Policy Studies
                            2431408                                99, St. Michael’s Road
                            Fax: (00)94 - 11 - 2431395             Colombo 03
                            E-mail: ips@ips.lk                     Sri Lanka.
Tuley de Silva (Dr)         tuleyd@hotmail.com                     President, Pharmaceutical Society
                                                                   of Sri Lanka
                                                                   275/75 Prof. Stanley Wijesundera
                                                                   Mawatha. Colombo 7.

Sarath Fernando (Mr)        Tel: 9411 286 5534                     MONLAR
                            Fax: 9411 440 7663                     1151/58 A, 4th Lane, Kotte Road,
                            E-mail: monlar@sltnet.lk               Rajagiriya, Sri lanka
                            sarafdo@sltnet.lk

Damayanthi Perera (Dr)


Thanuja Dissanayake (Ms)    Tel: 009411 2300354                     Assistant secretary
                            Fax: 009411 2447669                     Ministry of Trade, Marketing
                            tanuja_dke@yahoo.com                    Development, & Consumer Affairs
                                                                    330, Union Place, Colombo 02
M.K.P.Chandralal            Tel: 0714020845                         214/3, Hospital Rd, Kalubowila,
                            E-mail: pchandralal@gmail.com           Dehiwala

Dr.S.L.Peiris               Tel: 9411 2693674                       (MO/MS unit)
                            Mobile : 0714 260222                    Ministry of Health Sri Lanka
                            sharika@health.gov.lk
Mrs.A Ahamed                Tel: 9411 2672003                       Legal Officer
                            Mobile: 0776610802                      Ministry of Health Sri Lanka
                            E-mail: arahamed1111@yahoo.com
Dilhara Pathirana           Tel. 2691228                            (Law & Society Trust, No 3,
                                                                    Kynsey Terrace, Colombo 8.

Balasubramaniam M (Mr)      Tel; 2314041                            Institute for Health Policy

Sirimal Peiris              Tel: 0773404775                         PHM Sri Lanka
                            E-mail: sirimalp@sltnet.lk              25/9 Francisco Place
                                                                    Moraturwa
                                                                    Sri Lanka
Dinesha Samararatne         Dinesha.samararatne@gmail.com           Lecturer, Faculty of Law,
                                                                    University of Colombo, P O Box
                                                                    1490
                                                                    Colombo, Sri Lanka



                                                                                                   16
     Christine Perera                  Tel: 9411 2854152               27/1 Andarawatta Road,
                                       christinesbp@sltnet.lk          Polhengoda, Colombo 5, Sri
                                                                       Lanka
     Nishara Mendis                    To-nishara@yahoo.com            Lecturer, University of Colombo,
                                       Mobile: 0722447067              P O Box 1490
                                                                       Colombo, Sri Lanka

Secretariat

                  Name                           Tel/Fax/E-mail                     Address
     Dr K Balasubramaniam              Tel: 9411 2554353             Advisor and Co-ordinator
                                       Fax: 9411 2554570             Health Action International Asia –
                                       E-mail: bala@haiap.org        Pacific
                                                                     5, Frankfurt Place, Colombo 4
                                                                     Sri Lanka
     Mrs D Kamalaneson                 Tel: 9411 2554353             Senior Secretary and Administration
                                       Fax: 9411 2554570             Officer
                                       E-mail: dilhani@haiap.org     Health Action International Asia –
                                                                     Pacific
                                                                     5, Frankfurt Place, Colombo 4
                                                                     Sri Lanka
     Ms Jinani Jayasekera              Tel: 9411 2554353             Project Officer
                                       Fax: 9411 2554570             Health Action International Asia –
                                       E-mail: jinani@haiap.org      Pacific
                                                                     5, Frankfurt Place, Colombo 4
                                                                     Sri Lanka
     Ms Chrishani Siriwardena          Tel: 9411 2554353             Communications and Inforamtion
                                       Fax: 9411 2554570             Officer
                                       E-mail: chrishani@haiap.org   Health Action International Asia –
                                                                     Pacific
                                                                     5, Frankfurt Place, Colombo 4
                                                                     Sri Lanka
     Mr R A Gunaratne                  Tel: 9411 2554353             Office Clark
                                       Fax: 9411 2554570             Health Action International Asia –
                                                                     Pacific
                                                                     5, Frankfurt Place, Colombo 4
                                                                     Sri Lanka
     Mr Earl Kamalaneson (Volunteer)




                                                                                                     17
Annex II

                               Agenda
     HEALTH ACTION INTERNATIONAL ASIA- PACIFIC (HAIAP)
                  Review and planning Meeting 2007
               th
             30 – 31st August, 2007 Colombo, Sri Lanka
Day 1
9.00 a.m. -10.00 a.m.     Welcome addresses
                          Presentation of the Olle Hansson commemorative certificate
                          Adoption of the agenda
                          Election of chairs for the sessions
                          Confirmation of Minutes of the 2006-HAIAP Review and Planning
                          Meeting 2006
                          Matters arising form the Minutes

10.00 a.m.-10.30 a.m.     HAI’s Global Vision & Where We Stand Constitutionally by Dr.
                          Tim Reed, Director, HAIE

10.30 a.m. - 11.00 a.m.   Tea

11.00 a.m. – 12.00 p.m.   Activities, Funding, Frame work and time plan targets for
                          HAIAP activities 2007-2010
                          Ms. Jinani Jayasekera, Project Officer
                          Dr K Balasubramanium, Advisor & Coordinator


12.00 p.m. – 12.30 p.m.   HAI News, Web Site and Communications
                          Ms Chrishani Siriwardena, Information and Communication
                          Officer

12.30 p.m. - 1.15 p.m.    Information Gathering and Dissemination on Privatization and
                          Health
                          Facilitator; Assoc. Prof. Izham

1.15 p.m. – 2.45 p.m.     Lunch

2.45 p.m.-4.00 p.m.       Where there is no Pharmacist
                          Facilitator; Ms. Beverley Snell

4.00 p.m. - 4.45 p.m.     Tea

4.45 p.m. - 6.00 p.m.     Multi Country Survey on Banned/Restricted Drugs project
                          Facilitators; Dr. Niyada Kiyatying- Anguslee and
                          Ms Jinani Jayasekera

                                                                                      18
Day 2
9.00 a.m. -9.45 a.m.      Monitoring of Legislation and Practices in Place to Curb
                          Unethical Drug Promotion
                          Facilitator; Ken Harvey


9.45 a.m. – 10.30 a.m.    Peoples Health Movement


10.30 a.m. - 11.00 a.m.   Tea


11.00 a.m. – 1.00 p.m.    Peoples Health Movement

1.00 p.m. – 2.30 p.m.     Lunch

2.30 p.m.-4.30 p.m.       Sharing Experiences
                          Brief Presentations by Members


4.30 p.m. – 5.00 p.m.     Tea

5.00 p.m. - 6.00 p.m.     Election of members to the Governing Council

                          Closing of Sessions




                                                                                     19
Annex III

Global Programme Theme I: Access

1.1.1 Continuous monitoring, information management and dissemination on different
      price control mechanisms and policies and their impacts
1.1.2 Initiate research on comparative medicines prices in the region and inaccessibility
      due to high medicine prices
1.1.3 Empowering and educating target groups to enable continuous advocacy and
      campaigns for affordable medicines prices
1.1.4 Collaborating liaising and supporting with other likeminded organisations on
       issues on medicine prices
1.1.5 Healthcare financing
1.2.1 Continuous monitoring, information management and dissemination on FTAs in
       relation to the availability and affordability of medicines
1.2.2 Building awareness and educating important target groups on the effect of
       intellectual property rights on access to medicines
1.2.3 Collaborate, liaise and support other like minded organizations and
       individuals working on intellectual property and access to medicines
1.2.4 Advocacy and lobbying at national, regional and international levels on
       the detrimental effects of policies

Global Programme Theme II: Rational Use

2.1.1 Revive Educators for Rational Drug Use
2.1.2 Continued advocacy and campaigns to remove a list of hazardous and
      harmful drugs that have been identified
2.1.3 Promoting and advocacy for Pharmacovigilance
2.1.4 Target group education and continued advocacy on national drug policies
      based on the essential drugs concept
2.1.5 Education of pharmacists and other health workers on RUM
2.2.1 Advocacy for legislation on drug promotion and monitoring of unethical drug
       Promotion
2.2.2 Continued monitoring of procedures that countries have in place to curb
       unethical drug promotion
2.2.3 Monitoring of unethical promotion

Global Programme Theme III: Medicine Policies are Developed through Democratic
                                 Processes
3.1.1 HAI-AP will identify key individuals at the national policy making level and
      lobby with the assistance of CSOs
3.1.2 Charter of Patients‟ Rights and Responsibilities
3.2.1 Monitoring, information management and dissemination
3.2.2 Conduct workshops, seminars and consultations at the national, sub-regional
       and regional levels
                                                                                            20
Annex IV
                             Study on Privatisation of Health Care
                                       A Draft Outline

Preamble

Health care systems need to be adequately financed and be resourced with trained human-power
require the availability of basic. The inability of poorer countries to pledge even a fraction of the
resources required to sustain their health care systems has its origins in the economic crisis that
engulfed poorer countries since the early 1970s. This crisis came within a few years of the Alma
Ata Declaration and prevented its bold and visionary aspirations from ever being put into
practice.

The abandonment of the PHC approach led to a global trend towards segmentation of health care
into public health care for the poor and private health care for the rich. On the face of it this
seems an attractive proposition, one that the World Bank has been actively propagating.

The argument in favour of this segmentation is obvious – government resources can be directed
at those who cannot pay, while those who can are serviced by the private sector. Unfortunately
this argument is based on an extremely shallow and simplistic view of how health systems work.
Such a system results in the rich opting out of the public system and at the same time also
drawing away resources, political clout and accountability from the public system. What is left
is „poor service for poor people‟.

An expansion of the private sector also draws away resources from the public system in different
ways. It draws on a limited pool of health professionals, and on limited foreign exchange for the
import of drugs and equipment in developing countries. Ultimately it sucks resources away to
the extent that the public system is even more hard pressed to cope with its workload.

A parallel private and public sector allows the private sector to choose to cater to the most
lucrative and leave the poor, the elderly and the seriously sick for the public sector. The division
of health care systems into one for the poor and the other for the rich is not accidental, it appears
to be a clear ploy that reflects the present socio-economic inequities and is an effort to reinforce
them further.

The collapse of the public sector has led to the emergence of a disorganized and unregulated
private sector in developing countries. The growing private sector in health care is being helped
along in many countries by tax subsidies, and also directly by governments who decide to
outsource parts of the functions of the public sector to private providers. The private sector also
works through private insurance companies, which again are interested in targeting the affluent.

In many regions of the world the private sector is the only available health care option, given the
steady decline of the public sector. The experience with the private sector, however, shows that
the motive for profit dominates over other considerations. This leads to poor quality of care, or
the elimination of the poor from their clientele – or often both. Unethical behaviour by private

                                                                                                  21
providers is common and includes recourse to unnecessary investigations and medication.
Health care for profit promotes such behaviour at the expense of ethical and scientific treatment.
Further, with profit from individual patients being the main focus, the private sector rarely
engages in preventive care or in the promotion of public health measure.

Votaries of commercialization argue that a market based system improves quality of care and
efficiency, because of competition between providers and because consumers have more hcoice.
Ntohing could be farther from the truth. Patients – especially poor patients – rarely have enough
knowledge to choose between different options, or to negotiate better terms. Competition does
not improve quality if people cannot make an informed choice. Instead multiple providers only
target the affluent, and the poor are left with virtually no options. Private care is notorious for
flouting regulations, and the necessity to regulate them places a burden on public finances. A
system with multiple providers is inefficient because it cannot make use of “economies of scale”
in the case of purchases, or in the provision of services.

Basic Values – Equity and Rights to Health

The study is premised on the necessity to focus on equity – an understanding of deeper structural
factors that determine differential access to resources and health consequences. It flows from the
understanding that the ultimate goal, is not merely to look for health policies that favour the
poor, but policies that directly address the determinants of the inequitable distribution of
resources.

The study would also be located in the framework of Right to Health. Such a framework
unequivocally challenges the dominant global discourse of „Health care as a commodity‟ and
„safety nets for those left outside the benefits‟ and replaces this with a „Health care as a human
right‟ discourse.

Scope of Study

The study could have the following elements, which would be reflected in the final output:

National Health System
Analysis, based on:
    National Health Policy
    Present situation in provision of comprehensive care
    Gaps and coverage by different sectors (public and private)

Basic Health Statistics
    Disaggregated data (by gender, rural/urban, region/social and economic class)
    Mortality/Morbidity/Disease Prevalence Rates
    Utilization (Public versus Private) – OPD and in patient

Analysis of Private Sector:
    Categorization, viz. profit, not for profit/ individual, corporates, etc.
    Impact of State Policy in promoting privatization and recommendations

                                                                                                22
      State (province) and Regional trends
      Prevalence of Private Sector in Health (Medical Care) – disaggregated data regarding
       coverage
      Major Trends in spread of the private sector and ownership patterns (viz. increasing
       corporate ownership of hospital chains)
      Sectoral Impact, viz. Women, Children, HIV, TB, etc.

Some Specific Issues:
    Quality of Care and Malpraxis (With possible Case Study)
    Health Insurance
    Corporate Hospital (with possible case study)
    Organ Trade
    Human power development and deployment
    Regulation of Private Sector – Methods and Experience
    Use of Pharmaceuticals
    Use of Diagnostics
    Public Private Partnership (with possible case study)

Methodology

      Desk Appraisal of secondary data and reports.
      Possible sources in (India) include – National Family Health Survey (NFHS), Census
       Data, SRS (Sample Registration Scheme) Data.
      Use of a loosely structured questionnaire to elicit quasi quantitative data and Impressions.
       Case studies based on some primary investigation/data collection.

Suggested Timelines

Study of Secondary Literature                        :      1-3 months
Sourcing of Data from different sources              :

Data and Secondary Literature Analysis               :      4-6 months
Transaction of Questionnaire                 :
Development of Case Studies                  :

Report Writing                                       :      1-3 months

Total: 6-12 months (depending on resources and country specific situations)




                                                                                                23

				
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