Pharmaceuticals are a critical input forthe health sector. At the same time, the drug businesssustains many individual and corporate livelihoods andproduces handsome returns for those involved in the trade.Good governance is critical for the sector to maximizereturns for public health and minimize risks for patientsfrom ineffective or contaminated drugs. Given the largefinancial volume of the market, the potential for corruptionis significant. Vulnerable points are those at whichdecisions about market access and purchasing are made. Thisincludes institutional functions such as licensing,inclusion into formularies and public procurement as well asthe individual prescriber, who selects drugs for a specificpatient. Given the political and institutional resistanceagainst more transparency from the beneficiaries of thestatus quo, assessment of governance and corruption in thesector is not a straightforward exercise. The authorsdeveloped a more indirect approach that relies on a broaderassessment of the functioning of the sector and detection ofpatterns that suggest governance or management problems.From a developmental perspective, the focus is on reducingthe impact of bad governance (high drug prices, stock-outs,bad quality of drugs in circulation, irrational use ofdrugs) rather than identifying the actors and bringing themto justice. Even if the governance level cannot be toucheddue to political resistance, it may be possible to addressthe problem from a technical or management angle. Forexample, electronic procurement platforms and inventorymanagement systems make manipulation more difficult andallow for a faster discovery of irregularities. Theassessment framework was applied in eight countries, withadjustments based on client demand and political viability.In most cases, a follow-up after the assessment could bedocumented, showing that the data provided had relevance andimpact in the national policy dialogue. Three of the eightcountries signed up to a longer term program to increasetransparency in the sector (medicines transparencyalliance), others initiated specific projects to addressissues that were presented as a result of the initialassessment. In summary, the authors work could demonstratethat it is possible to effectively address pharmaceuticalgovernance issues in the context of a broader sectorassessment an approach that may face less politicalresistance than an inquiry based on a "governance andcorruption" labeled instrument.
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