Implementation Supportive Framework Delphi Programme:
Gulf/EMRO SURVEY

Innovationsinstitut für Gesundheit und Gesellschaft gUG

Thank you for joining the Gulf/EMRO survey

We are very grateful for your support in developing tools and methods for implementing value-based healthcare technologies.

InTRODUCTION

Here you will find our previous publications on this topic:

1 ) Otte, M., Dauben, H. P., Ahn, J., Gutierrez Ibarluzea, I., Drummond, M., Simoens, S., … Suh, D. C. (2024). Value based healthcare and Health Technology Assessment for emerging market countries: joint efforts to overcome barriers. Expert Review of Pharmacoeconomics & Outcomes Research, 24(9), 1061–1066. https://doi.org/10.1080/14737167.2024.2398482

2) Otte M, Kaló Z, Al-Omar HA, Boysen M, Chen Y, Etges APBDS, Kockaya G, Gutierrez-Ibarluzea I, Seyam AM, Mullen D and Dauben H-P (2025) Contextual factors in value-based decision support to enhance health technologies adoption: the case of biosimilars. Front. Pharmacol. 16:1599013. doi: 10.3389/fphar.2025.1599013

3) Otte M, Al-Omar A, Guillen E, Gan YN, Gutiérrez-Ibarluzea I, Ertaylan G, Jahn B, Kittiratchakool N, Mullen D, Guerra Junior A, Dauben HP (2026). An Implementation Supportive Framework for context-sensitive health technology adoption: international expert validation using biosimilars. In Print.

Thank you for your effort and support

Join the Gulf/EMRO Delphi round #1

Thank you for participating in this Delphi Round 1 survey. This study aims to identify and prioritise contextual determinants that shape the implementation of biosimilars in the Gulf/EMRO region. The survey is part of a broader Implementation Supportive Framework (ISF) programme. Biosimilars are used here as a first use case to test a broader framework intended for application across health technologies. Your responses will help identify which contextual factors are most relevant for implementation decision-making in the region.

Please rate each item according to how important it is for understanding, planning, or supporting biosimilar implementation in your country. Use the comment boxes to explain your reasoning, suggest refinements, or identify missing factors.

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
A1: ...there is clarity about which institution leads biosimilar implementation at national level.	Strongly DisagreeA1: ...there is clarity about which institution leads biosimilar implementation at national level. Strongly Disagree	DisagreeA1: ...there is clarity about which institution leads biosimilar implementation at national level. Disagree	NeutralA1: ...there is clarity about which institution leads biosimilar implementation at national level. Neutral	AgreeA1: ...there is clarity about which institution leads biosimilar implementation at national level. Agree	Strongly AgreeA1: ...there is clarity about which institution leads biosimilar implementation at national level. Strongly Agree
A2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making.	Strongly DisagreeA2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making. Strongly Disagree	DisagreeA2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making. Disagree	NeutralA2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making. Neutral	AgreeA2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making. Agree	Strongly AgreeA2: ...there is alignment between regulatory approval, HTA recommendations, and reimbursement decision-making. Strongly Agree
A3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities.	Strongly DisagreeA3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities. Strongly Disagree	DisagreeA3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities. Disagree	NeutralA3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities. Neutral	AgreeA3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities. Agree	Strongly AgreeA3:...there is clarity of roles between ministries, HTA bodies, payers, hospitals, and procurement authorities. Strongly Agree
A4:...a formal national policy or guidance on biosimilar uptake and use exists.	Strongly DisagreeA4:...a formal national policy or guidance on biosimilar uptake and use exists. Strongly Disagree	DisagreeA4:...a formal national policy or guidance on biosimilar uptake and use exists. Disagree	NeutralA4:...a formal national policy or guidance on biosimilar uptake and use exists. Neutral	AgreeA4:...a formal national policy or guidance on biosimilar uptake and use exists. Agree	Strongly AgreeA4:...a formal national policy or guidance on biosimilar uptake and use exists. Strongly Agree
A5:...institutional procedures for switching from originators to biosimilars exist.	Strongly DisagreeA5:...institutional procedures for switching from originators to biosimilars exist. Strongly Disagree	DisagreeA5:...institutional procedures for switching from originators to biosimilars exist. Disagree	NeutralA5:...institutional procedures for switching from originators to biosimilars exist. Neutral	AgreeA5:...institutional procedures for switching from originators to biosimilars exist. Agree	Strongly AgreeA5:...institutional procedures for switching from originators to biosimilars exist. Strongly Agree
A6:...there are governance rules on interchangeability and substitution.	Strongly DisagreeA6:...there are governance rules on interchangeability and substitution. Strongly Disagree	DisagreeA6:...there are governance rules on interchangeability and substitution. Disagree	NeutralA6:...there are governance rules on interchangeability and substitution. Neutral	AgreeA6:...there are governance rules on interchangeability and substitution. Agree	Strongly AgreeA6:...there are governance rules on interchangeability and substitution. Strongly Agree
A7:...there is coordination between national and subnational decision-making levels taken place.	Strongly DisagreeA7:...there is coordination between national and subnational decision-making levels taken place. Strongly Disagree	DisagreeA7:...there is coordination between national and subnational decision-making levels taken place. Disagree	NeutralA7:...there is coordination between national and subnational decision-making levels taken place. Neutral	AgreeA7:...there is coordination between national and subnational decision-making levels taken place. Agree	Strongly AgreeA7:...there is coordination between national and subnational decision-making levels taken place. Strongly Agree
A8:...there is coordination taken place between public and private sector decision structures.	Strongly DisagreeA8:...there is coordination taken place between public and private sector decision structures. Strongly Disagree	DisagreeA8:...there is coordination taken place between public and private sector decision structures. Disagree	NeutralA8:...there is coordination taken place between public and private sector decision structures. Neutral	AgreeA8:...there is coordination taken place between public and private sector decision structures. Agree	Strongly AgreeA8:...there is coordination taken place between public and private sector decision structures. Strongly Agree
A9:...there is timeliness and transparency of biosimilar-related decisions.	Strongly DisagreeA9:...there is timeliness and transparency of biosimilar-related decisions. Strongly Disagree	DisagreeA9:...there is timeliness and transparency of biosimilar-related decisions. Disagree	NeutralA9:...there is timeliness and transparency of biosimilar-related decisions. Neutral	AgreeA9:...there is timeliness and transparency of biosimilar-related decisions. Agree	Strongly AgreeA9:...there is timeliness and transparency of biosimilar-related decisions. Strongly Agree
A10: ...implementation accountability across organisations involved in biosimilar adoption is given.	Strongly DisagreeA10: ...implementation accountability across organisations involved in biosimilar adoption is given. Strongly Disagree	DisagreeA10: ...implementation accountability across organisations involved in biosimilar adoption is given. Disagree	NeutralA10: ...implementation accountability across organisations involved in biosimilar adoption is given. Neutral	AgreeA10: ...implementation accountability across organisations involved in biosimilar adoption is given. Agree	Strongly AgreeA10: ...implementation accountability across organisations involved in biosimilar adoption is given. Strongly Agree
A11:...procurement decisions are integrated into broader clinical and policy goals.	Strongly DisagreeA11:...procurement decisions are integrated into broader clinical and policy goals. Strongly Disagree	DisagreeA11:...procurement decisions are integrated into broader clinical and policy goals. Disagree	NeutralA11:...procurement decisions are integrated into broader clinical and policy goals. Neutral	AgreeA11:...procurement decisions are integrated into broader clinical and policy goals. Agree	Strongly AgreeA11:...procurement decisions are integrated into broader clinical and policy goals. Strongly Agree
A12:...governance mechanisms to manage conflicts or resistance during implementation exist.	Strongly DisagreeA12:...governance mechanisms to manage conflicts or resistance during implementation exist. Strongly Disagree	DisagreeA12:...governance mechanisms to manage conflicts or resistance during implementation exist. Disagree	NeutralA12:...governance mechanisms to manage conflicts or resistance during implementation exist. Neutral	AgreeA12:...governance mechanisms to manage conflicts or resistance during implementation exist. Agree	Strongly AgreeA12:...governance mechanisms to manage conflicts or resistance during implementation exist. Strongly Agree

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
B1:...there is clarity about which budget holder benefits financially from biosimilar uptake.	Strongly DisagreeB1:...there is clarity about which budget holder benefits financially from biosimilar uptake. Strongly Disagree	DisagreeB1:...there is clarity about which budget holder benefits financially from biosimilar uptake. Disagree	NeutralB1:...there is clarity about which budget holder benefits financially from biosimilar uptake. Neutral	AgreeB1:...there is clarity about which budget holder benefits financially from biosimilar uptake. Agree	Strongly AgreeB1:...there is clarity about which budget holder benefits financially from biosimilar uptake. Strongly Agree
B2:...there is alignment between procurement incentives and prescribing incentives.	Strongly DisagreeB2:...there is alignment between procurement incentives and prescribing incentives. Strongly Disagree	DisagreeB2:...there is alignment between procurement incentives and prescribing incentives. Disagree	NeutralB2:...there is alignment between procurement incentives and prescribing incentives. Neutral	AgreeB2:...there is alignment between procurement incentives and prescribing incentives. Agree	Strongly AgreeB2:...there is alignment between procurement incentives and prescribing incentives. Strongly Agree
B3:...tendering structures exist that support biosimilar competition.	Strongly DisagreeB3:...tendering structures exist that support biosimilar competition. Strongly Disagree	DisagreeB3:...tendering structures exist that support biosimilar competition. Disagree	NeutralB3:...tendering structures exist that support biosimilar competition. Neutral	AgreeB3:...tendering structures exist that support biosimilar competition. Agree	Strongly AgreeB3:...tendering structures exist that support biosimilar competition. Strongly Agree
B4:...there are reimbursement mechanisms that do not disadvantage biosimilar use.	Strongly DisagreeB4:...there are reimbursement mechanisms that do not disadvantage biosimilar use. Strongly Disagree	DisagreeB4:...there are reimbursement mechanisms that do not disadvantage biosimilar use. Disagree	NeutralB4:...there are reimbursement mechanisms that do not disadvantage biosimilar use. Neutral	AgreeB4:...there are reimbursement mechanisms that do not disadvantage biosimilar use. Agree	Strongly AgreeB4:...there are reimbursement mechanisms that do not disadvantage biosimilar use. Strongly Agree
B5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist.	Strongly DisagreeB5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist. Strongly Disagree	DisagreeB5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist. Disagree	NeutralB5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist. Neutral	AgreeB5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist. Agree	Strongly AgreeB5:...ability of institutions to retain and reinvest savings generated by biosimilar adoption exist. Strongly Agree
B6:...financial incentives for providers or prescribers to support uptake exist.	Strongly DisagreeB6:...financial incentives for providers or prescribers to support uptake exist. Strongly Disagree	DisagreeB6:...financial incentives for providers or prescribers to support uptake exist. Disagree	NeutralB6:...financial incentives for providers or prescribers to support uptake exist. Neutral	AgreeB6:...financial incentives for providers or prescribers to support uptake exist. Agree	Strongly AgreeB6:...financial incentives for providers or prescribers to support uptake exist. Strongly Agree
B7:...financial disincentives exist that may discourage biosimilar use.	Strongly DisagreeB7:...financial disincentives exist that may discourage biosimilar use. Strongly Disagree	DisagreeB7:...financial disincentives exist that may discourage biosimilar use. Disagree	NeutralB7:...financial disincentives exist that may discourage biosimilar use. Neutral	AgreeB7:...financial disincentives exist that may discourage biosimilar use. Agree	Strongly AgreeB7:...financial disincentives exist that may discourage biosimilar use. Strongly Agree
B8:...there are budget silos that fragment responsibility for adoption decisions.	Strongly DisagreeB8:...there are budget silos that fragment responsibility for adoption decisions. Strongly Disagree	DisagreeB8:...there are budget silos that fragment responsibility for adoption decisions. Disagree	NeutralB8:...there are budget silos that fragment responsibility for adoption decisions. Neutral	AgreeB8:...there are budget silos that fragment responsibility for adoption decisions. Agree	Strongly AgreeB8:...there are budget silos that fragment responsibility for adoption decisions. Strongly Agree
B9:...there is price transparency and predictability in biosimilar procurement.	Strongly DisagreeB9:...there is price transparency and predictability in biosimilar procurement. Strongly Disagree	DisagreeB9:...there is price transparency and predictability in biosimilar procurement. Disagree	NeutralB9:...there is price transparency and predictability in biosimilar procurement. Neutral	AgreeB9:...there is price transparency and predictability in biosimilar procurement. Agree	Strongly AgreeB9:...there is price transparency and predictability in biosimilar procurement. Strongly Agree
B10:...multi-payer coordination exists where financing responsibility is fragmented.	Strongly DisagreeB10:...multi-payer coordination exists where financing responsibility is fragmented. Strongly Disagree	DisagreeB10:...multi-payer coordination exists where financing responsibility is fragmented. Disagree	NeutralB10:...multi-payer coordination exists where financing responsibility is fragmented. Neutral	AgreeB10:...multi-payer coordination exists where financing responsibility is fragmented. Agree	Strongly AgreeB10:...multi-payer coordination exists where financing responsibility is fragmented. Strongly Agree
B11:...there are long-term affordability considerations beyond short-term procurement price.	Strongly DisagreeB11:...there are long-term affordability considerations beyond short-term procurement price. Strongly Disagree	DisagreeB11:...there are long-term affordability considerations beyond short-term procurement price. Disagree	NeutralB11:...there are long-term affordability considerations beyond short-term procurement price. Neutral	AgreeB11:...there are long-term affordability considerations beyond short-term procurement price. Agree	Strongly AgreeB11:...there are long-term affordability considerations beyond short-term procurement price. Strongly Agree
B12:...there are financial sustainability considerations of implementation strategies over time.	Strongly DisagreeB12:...there are financial sustainability considerations of implementation strategies over time. Strongly Disagree	DisagreeB12:...there are financial sustainability considerations of implementation strategies over time. Disagree	NeutralB12:...there are financial sustainability considerations of implementation strategies over time. Neutral	AgreeB12:...there are financial sustainability considerations of implementation strategies over time. Agree	Strongly AgreeB12:...there are financial sustainability considerations of implementation strategies over time. Strongly Agree

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
C1:...physician confidence in the clinical comparability of biosimilars exists.	Strongly DisagreeC1:...physician confidence in the clinical comparability of biosimilars exists. Strongly Disagree	DisagreeC1:...physician confidence in the clinical comparability of biosimilars exists. Disagree	NeutralC1:...physician confidence in the clinical comparability of biosimilars exists. Neutral	AgreeC1:...physician confidence in the clinical comparability of biosimilars exists. Agree	Strongly AgreeC1:...physician confidence in the clinical comparability of biosimilars exists. Strongly Agree
C2:...physician willingness to initiate treatment with a biosimilar exists.	Strongly DisagreeC2:...physician willingness to initiate treatment with a biosimilar exists. Strongly Disagree	DisagreeC2:...physician willingness to initiate treatment with a biosimilar exists. Disagree	NeutralC2:...physician willingness to initiate treatment with a biosimilar exists. Neutral	AgreeC2:...physician willingness to initiate treatment with a biosimilar exists. Agree	Strongly AgreeC2:...physician willingness to initiate treatment with a biosimilar exists. Strongly Agree
C3:...physician willingness to switch stable patients from originators to biosimilars exists.	Strongly DisagreeC3:...physician willingness to switch stable patients from originators to biosimilars exists. Strongly Disagree	DisagreeC3:...physician willingness to switch stable patients from originators to biosimilars exists. Disagree	NeutralC3:...physician willingness to switch stable patients from originators to biosimilars exists. Neutral	AgreeC3:...physician willingness to switch stable patients from originators to biosimilars exists. Agree	Strongly AgreeC3:...physician willingness to switch stable patients from originators to biosimilars exists. Strongly Agree
C4:...patient trust in biosimilars as safe and effective treatment options exists.	Strongly DisagreeC4:...patient trust in biosimilars as safe and effective treatment options exists. Strongly Disagree	DisagreeC4:...patient trust in biosimilars as safe and effective treatment options exists. Disagree	NeutralC4:...patient trust in biosimilars as safe and effective treatment options exists. Neutral	AgreeC4:...patient trust in biosimilars as safe and effective treatment options exists. Agree	Strongly AgreeC4:...patient trust in biosimilars as safe and effective treatment options exists. Strongly Agree
C5:...there is sufficient communication with patients about biosimilars and switching.	Strongly DisagreeC5:...there is sufficient communication with patients about biosimilars and switching. Strongly Disagree	DisagreeC5:...there is sufficient communication with patients about biosimilars and switching. Disagree	NeutralC5:...there is sufficient communication with patients about biosimilars and switching. Neutral	AgreeC5:...there is sufficient communication with patients about biosimilars and switching. Agree	Strongly AgreeC5:...there is sufficient communication with patients about biosimilars and switching. Strongly Agree
C6:...there is trust in regulatory and HTA institutions that support biosimilar decisions.	Strongly DisagreeC6:...there is trust in regulatory and HTA institutions that support biosimilar decisions. Strongly Disagree	DisagreeC6:...there is trust in regulatory and HTA institutions that support biosimilar decisions. Disagree	NeutralC6:...there is trust in regulatory and HTA institutions that support biosimilar decisions. Neutral	AgreeC6:...there is trust in regulatory and HTA institutions that support biosimilar decisions. Agree	Strongly AgreeC6:...there is trust in regulatory and HTA institutions that support biosimilar decisions. Strongly Agree
C7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance.	Strongly DisagreeC7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance. Strongly Disagree	DisagreeC7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance. Disagree	NeutralC7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance. Neutral	AgreeC7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance. Agree	Strongly AgreeC7:...there is influence of scientific societies and clinical leaders on biosimilar acceptance. Strongly Agree
C8:...there is a perceived credibility of biosimilar manufacturers.	Strongly DisagreeC8:...there is a perceived credibility of biosimilar manufacturers. Strongly Disagree	DisagreeC8:...there is a perceived credibility of biosimilar manufacturers. Disagree	NeutralC8:...there is a perceived credibility of biosimilar manufacturers. Neutral	AgreeC8:...there is a perceived credibility of biosimilar manufacturers. Agree	Strongly AgreeC8:...there is a perceived credibility of biosimilar manufacturers. Strongly Agree
C9:...there are concerns about nocebo effects or negative patient expectations.	Strongly DisagreeC9:...there are concerns about nocebo effects or negative patient expectations. Strongly Disagree	DisagreeC9:...there are concerns about nocebo effects or negative patient expectations. Disagree	NeutralC9:...there are concerns about nocebo effects or negative patient expectations. Neutral	AgreeC9:...there are concerns about nocebo effects or negative patient expectations. Agree	Strongly AgreeC9:...there are concerns about nocebo effects or negative patient expectations. Strongly Agree
C10:...educational resources for clinicians and patients are available.	Strongly DisagreeC10:...educational resources for clinicians and patients are available. Strongly Disagree	DisagreeC10:...educational resources for clinicians and patients are available. Disagree	NeutralC10:...educational resources for clinicians and patients are available. Neutral	AgreeC10:...educational resources for clinicians and patients are available. Agree	Strongly AgreeC10:...educational resources for clinicians and patients are available. Strongly Agree
C11:...the is consistency of biosimilar messaging across institutions and stakeholders.	Strongly DisagreeC11:...the is consistency of biosimilar messaging across institutions and stakeholders. Strongly Disagree	DisagreeC11:...the is consistency of biosimilar messaging across institutions and stakeholders. Disagree	NeutralC11:...the is consistency of biosimilar messaging across institutions and stakeholders. Neutral	AgreeC11:...the is consistency of biosimilar messaging across institutions and stakeholders. Agree	Strongly AgreeC11:...the is consistency of biosimilar messaging across institutions and stakeholders. Strongly Agree
C12:...cultural resistance to switching or non-originator use in clinical practice exists.	Strongly DisagreeC12:...cultural resistance to switching or non-originator use in clinical practice exists. Strongly Disagree	DisagreeC12:...cultural resistance to switching or non-originator use in clinical practice exists. Disagree	NeutralC12:...cultural resistance to switching or non-originator use in clinical practice exists. Neutral	AgreeC12:...cultural resistance to switching or non-originator use in clinical practice exists. Agree	Strongly AgreeC12:...cultural resistance to switching or non-originator use in clinical practice exists. Strongly Agree

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
D1:...differences exist between public and private sector implementation pathways.	Strongly DisagreeD1:...differences exist between public and private sector implementation pathways. Strongly Disagree	DisagreeD1:...differences exist between public and private sector implementation pathways. Disagree	NeutralD1:...differences exist between public and private sector implementation pathways. Neutral	AgreeD1:...differences exist between public and private sector implementation pathways. Agree	Strongly AgreeD1:...differences exist between public and private sector implementation pathways. Strongly Agree
D2:...differences in biosimilar access between urban and rural areas.	Strongly DisagreeD2:...differences in biosimilar access between urban and rural areas. Strongly Disagree	DisagreeD2:...differences in biosimilar access between urban and rural areas. Disagree	NeutralD2:...differences in biosimilar access between urban and rural areas. Neutral	AgreeD2:...differences in biosimilar access between urban and rural areas. Agree	Strongly AgreeD2:...differences in biosimilar access between urban and rural areas. Strongly Agree
D3:...differences in implementation capacity across the country exist.	Strongly DisagreeD3:...differences in implementation capacity across the country exist. Strongly Disagree	DisagreeD3:...differences in implementation capacity across the country exist. Disagree	NeutralD3:...differences in implementation capacity across the country exist. Neutral	AgreeD3:...differences in implementation capacity across the country exist. Agree	Strongly AgreeD3:...differences in implementation capacity across the country exist. Strongly Agree
D4:...differences in implementation capacity across regions or states exist.	Strongly DisagreeD4:...differences in implementation capacity across regions or states exist. Strongly Disagree	DisagreeD4:...differences in implementation capacity across regions or states exist. Disagree	NeutralD4:...differences in implementation capacity across regions or states exist. Neutral	AgreeD4:...differences in implementation capacity across regions or states exist. Agree	Strongly AgreeD4:...differences in implementation capacity across regions or states exist. Strongly Agree
D5:...variability in hospital infrastructure relevant to biosimilar use exist.	Strongly DisagreeD5:...variability in hospital infrastructure relevant to biosimilar use exist. Strongly Disagree	DisagreeD5:...variability in hospital infrastructure relevant to biosimilar use exist. Disagree	NeutralD5:...variability in hospital infrastructure relevant to biosimilar use exist. Neutral	AgreeD5:...variability in hospital infrastructure relevant to biosimilar use exist. Agree	Strongly AgreeD5:...variability in hospital infrastructure relevant to biosimilar use exist. Strongly Agree
D6:...variability in pharmacy capacity and medicine handling systems exist.	Strongly DisagreeD6:...variability in pharmacy capacity and medicine handling systems exist. Strongly Disagree	DisagreeD6:...variability in pharmacy capacity and medicine handling systems exist. Disagree	NeutralD6:...variability in pharmacy capacity and medicine handling systems exist. Neutral	AgreeD6:...variability in pharmacy capacity and medicine handling systems exist. Agree	Strongly AgreeD6:...variability in pharmacy capacity and medicine handling systems exist. Strongly Agree
D7:...fragmentation of care pathways across providers and institutions exist.	Strongly DisagreeD7:...fragmentation of care pathways across providers and institutions exist. Strongly Disagree	DisagreeD7:...fragmentation of care pathways across providers and institutions exist. Disagree	NeutralD7:...fragmentation of care pathways across providers and institutions exist. Neutral	AgreeD7:...fragmentation of care pathways across providers and institutions exist. Agree	Strongly AgreeD7:...fragmentation of care pathways across providers and institutions exist. Strongly Agree
D8:...unequal access to specialist care relevant to biologic treatment exist.	Strongly DisagreeD8:...unequal access to specialist care relevant to biologic treatment exist. Strongly Disagree	DisagreeD8:...unequal access to specialist care relevant to biologic treatment exist. Disagree	NeutralD8:...unequal access to specialist care relevant to biologic treatment exist. Neutral	AgreeD8:...unequal access to specialist care relevant to biologic treatment exist. Agree	Strongly AgreeD8:...unequal access to specialist care relevant to biologic treatment exist. Strongly Agree
D9:...there are differences in supply chain reliability.	Strongly DisagreeD9:...there are differences in supply chain reliability. Strongly Disagree	DisagreeD9:...there are differences in supply chain reliability. Disagree	NeutralD9:...there are differences in supply chain reliability. Neutral	AgreeD9:...there are differences in supply chain reliability. Agree	Strongly AgreeD9:...there are differences in supply chain reliability. Strongly Agree
D10:...there are administrative barriers that differ by institution type.	Strongly DisagreeD10:...there are administrative barriers that differ by institution type. Strongly Disagree	DisagreeD10:...there are administrative barriers that differ by institution type. Disagree	NeutralD10:...there are administrative barriers that differ by institution type. Neutral	AgreeD10:...there are administrative barriers that differ by institution type. Agree	Strongly AgreeD10:...there are administrative barriers that differ by institution type. Strongly Agree
D11:...there are equity implications of biosimilar implementation decisions.	Strongly DisagreeD11:...there are equity implications of biosimilar implementation decisions. Strongly Disagree	DisagreeD11:...there are equity implications of biosimilar implementation decisions. Disagree	NeutralD11:...there are equity implications of biosimilar implementation decisions. Neutral	AgreeD11:...there are equity implications of biosimilar implementation decisions. Agree	Strongly AgreeD11:...there are equity implications of biosimilar implementation decisions. Strongly Agree
D12:..there is a need for differentiated implementation approaches across the health care systems.	Strongly DisagreeD12:..there is a need for differentiated implementation approaches across the health care systems. Strongly Disagree	DisagreeD12:..there is a need for differentiated implementation approaches across the health care systems. Disagree	NeutralD12:..there is a need for differentiated implementation approaches across the health care systems. Neutral	AgreeD12:..there is a need for differentiated implementation approaches across the health care systems. Agree	Strongly AgreeD12:..there is a need for differentiated implementation approaches across the health care systems. Strongly Agree

Implementation Supportive Framework Delphi Programme:
Gulf/EMRO SURVEY

Thank you for joining the Gulf/EMRO survey

InTRODUCTION

Thank you for your effort and support

Join the Gulf/EMRO Delphi round #1

Section B: Financing flows

Section C: Cultural acceptance and trust

Section D: Distributional context and system heterogeneity

Implementation Supportive Framework Delphi Programme: Gulf/EMRO SURVEY

Thank you for joining the Gulf/EMRO survey

InTRODUCTION

Thank you for your effort and support

Join the Gulf/EMRO Delphi round #1

Section B: Financing flows

Section C: Cultural acceptance and trust

Section D: Distributional context and system heterogeneity

Implementation Supportive Framework Delphi Programme:
Gulf/EMRO SURVEY