GGM uses a bottom-up approach in implementation of project and policy development. While a 3-step approach gives a framework to the project, each stage can be adapted to suit the specific country situation.

 

Phase I: National assessment of transparency and potential vulnerability to corruption of the following 8 functions of the pharmaceutical sector: registration of medicines, control of medicine promotion, inspection of establishments, control of clinical trials, licensing of establishments, selection of essential medicines, procurement of medicines, and distribution of medicines. WHO's standardised assessment methodology collects qualitative information on structural indicators; quantification is then used to define the level of transparency for each function.

 

Phase II: Development of a national GGM programme including components such as: an ethical framework and code of conduct, regulations and administrative procedures, collaboration mechanisms with other good governance and anti-corruption initiatives, whistle-blowing mechanisms, sanctions for reprehensible acts, and a GGM implementing task force.

 

This process is based on experience with promoting good governance in various countries, which shows that efforts to end corruption need a coordinated application of two basic strategies: 1) a "discipline approach,” which is "top-down" and based on legislative reforms; and 2) a "values approach," which involves promoting institutional integrity through moral values and ethical principles and attempting to motivate ethical conduct by public servants. The results of the assessment in Phase I - identifying the loopholes in the systems - will help countries in applying the first approach (adjusting its laws and administrative structures and procedures in terms of medicines regulation and supply). A national policy document that establishes moral values and ethical principles to motivate ethical conduct should be developed in consultation with key stakeholders, such as Ministry of Health officials, the private pharmaceutical sector, the Ministry of Finance, civil society organisations (CSOs), and academia. According to WHO, this generates a sense of ownership and personal identification, essential for creating the intrinsic motivation for public servants to act ethically.

 

Phase III: Implementing the national GGM programme, which is envisioned as a fully integrated institutional learning process centring around facilitating the application of new administrative procedures for increased transparency/accountability and the development of leadership capabilities. "It is vital that national GGM frameworks should not become documents developed by a few key actors at central level." This process requires the systematic training of government officials and health professionals so that civil servants may personally identify with and commit to the framework. A training package is being developed that will focus on developing good governance skills such as consultation, conflict resolution, moral reasoning, and consensus-building.

Access to Medicines.

The project currently operates in 19 countries covering all WHO regions. The focus is on consolidating efforts in the participating countries and on extending the project to new interested countries. The selection of new countries and activities is based on requests by governments and in collaboration with WHO Regional Offices.

According to WHO, more than US$4.4 trillion is spent on health services worldwide each year. Transparency International (TI) estimates that 10 to 25% of global public health procurement spending is siphoned off and stolen. Furthermore, spending within the pharmaceutical sector (with its US$600 billion-plus global market value) accounts for up to 50% of total health spending in some developing countries. The high market value of products means they are a magnet for theft, corruption, and unethical practices. According to TI, in some countries up to two-thirds of all hospital medicines are "lost" through corruption and fraud. WHO states that waste of public resources reduces government capacity to provide access to good-quality essential medicines, corrupt pharmaceutical practices are detrimental to national health budgets, and inefficiency and lack of transparency reduce the credibility of public institutions and erode public/donor confidence in governments.