MeTA multi-stakeholder process – a way to improve transparency in the pharmaceutical sector

1. MeTA multi-stakeholder process – a way to improve transparency in the pharmaceutical sector Wilbert Bannenberg, Technical Director MeTA International Secretariat IACC 14 Bangkok, 13 November 2010

2. Overview MeTA What is the problem with medicines? What is MeTA trying to achieve? Why work multi-stakeholder? What have we learned so far? Conclusions

3. Medicines supply – Transparent? Source: SSDS Inc for the World Bank MeTA

4. Transparent prices & availability, but quality? Source: TI Global corruption report 2006 MeTA

5. Medicines supply chains are prone to corruption Source: TI Global corruption report 2006 MeTA

6. Access to medicines - background MeTA • 30% of mankind still no access to essential meds • Valid concept: essential medicines (WHO, 1977) • Government alone cannot provide access to all • Weak health systems • Policy, efficiency, management, HR, & financing issues • Private sector: off message? • High prices, wrong focus (non-essentials, sell where $$ is) • Exception: non-profit private sector (churches, NGOs) • Civil society: ideals & drive; but lacks expertise & resources

7. The MeTA Hypothesis MeTA • Work multi-stakeholder: • Structured dialogue: Govt – Private sector – CSO • All parties are asked to disclose information on: • Price, Quality, Availability, Promotion • Transparency, Dialogue & Accountability • Better ad-hoc solutions & policies • Mutual support & capacity building • Will eventually lead to better access to medicines

8. The birth of MeTA MeTA • UK cabinet white paper 2006 gave birth to MeTA • Based on 2004 Access to Medicines Policy • Modeled after Extractive Industries Transparency Initiative (EITI) • 10 year commitment • subject to positive evaluation after 2 years • 7 countries invited to join pilot phase 2008-2010 • Exploratory meetings with stakeholders 2007

9. MeTA MeTA International alliance: DFID (UKAID), WHO, World Bank Multi-stakeholder: private, public sector and civil society Country-led, bottom up process in 7 pilot countries: Peru, Ghana, Uganda, Zambia, Jordan, Kyrgyzstan, and the Philippines TA, (limited) $$ and capacity building from MeTA Intl.

10. MeTA Theory of Change Robust & relevant information(Transparency) Improved access to medicines Multi-sector data sharing(Accountability) Better policies and implementation(Efficiency) Routine Data Collection

11. Why use Multi-Stakeholder Processes? MeTA MSP’s engage stakeholders in processes of dialogue, trust building and collective learning, that aim to improve innovation, decision making and action. They may also be specifically focused on overcoming conflict. They are particularly relevant in situations where the dynamics between different stakeholder groups and interests means that progress is difficult or impossible without constructive engagement.

12. General Concerns with MS processes MeTA Incentives? Particular stakeholders being marginalised Self-selection of CSO participants Funding / resources Uneven information base Differences in language and culture Each set of stakeholders has to learn a new lexicon in relation to the other So as to get past previous, often deeply ingrained, prejudices…

13. Challenges in MS processes MeTA Will mutual accountability flow? Will civil society have a strong enough voice? Will civil society have the technical knowledge? Will the private sector engage? Will governments let go of some control? Is there a clear outcome, or only gradual change over time that might have happened anyway? (What can we measure?) Can everyone win?

14. Civil society involvement MeTA • Civil society engagement is crucial for MeTA • “Eyes and ears” of society • Civil society’s capacity was strengthened • strengthened networks & capacity, • promoted Essential Medicines concepts, • advocacy on national media, in Parliament • Performed pricing & baseline surveys • Learned how to do procurement ‘watch’ • All 7 pilot countries set up national CSO coalitions

15. Government (institutions) MeTA Opinion leaders see value in the principles of transparency and multi-stakeholder working Many concepts (SWAp, Basket funds, Paris/Accra) or similar projects (WHO/GGM, WB Transparency, U4 anti-corruption) competing for attention Civil servants are reluctant; change slowly Need for adapting medicines’ policies recognized Drug Regulatory Authorities active & benefitting

16. Private sector involvement MeTA • Brings us good and poor quality, even fake medicines • Private sector is very diverse at country level: • Brand-name - Local manufacturers • Generics - Wholesalers • Retail - prescribing health workers • Win-win possible • Good guys want the bad guys out (counterfeits, substandard) • Increase ethical standards & code of conduct • Basic health insurance • Access to more reliable data

17. MeTA lessons learned MeTA Activity needs to be led by participating countries The right people need to be involved from the outset Commitments needs to be made by all parties involved Gaining consensus and understanding requires a constant and frank exchange of views Some decisions will be tough - stay focused on the objectives Tools exist or have been developed Building trust takes time – but is crucial

18. Lessons from MeTA IF Right mix Enough time Clear aim and approach Sufficient resources Facilitation Learning and flexibility

19. Multi-sector lessons learned MeTA • Establishing multi-sector stakeholder groups takes time • Private sector fragmented, civil society weak and/or diverse • Little experience of working together • Demonstrating benefits of participation challenging at start • New process, uncertain link to policy, finding common ground • Worked best where focus existed – Philippines, Peru and Jordan • Sector contributions variable but some successes • Contributions from ‘private sector’ modest • Support for multi-stakeholder working increasing

20. Some results MeTA All:Baseline studies, disclosed data, new MS collaboration Ghana: analysis of NHIA data for evidence-based policy Jordan: new Treatment Guidelines and Rational Drugs List Kyrgyzstan: mini-labs to quality test 400 medicine samples Peru: legislation and systems for new Price Observatory Philippines: Cheaper Medicines Act; Universal Access policy Uganda:private sector and CSO consultation on new health & pharmaceutical strategy Zambia: media campaigns to raise awareness on medicines more at www.MedicinesTransparency.org

21. Evaluation – Summary MeTA • Model shows promise but needs consolidation, stronger communication and new implementation model: • Establish core set of activities, tools and sequence of activities • Better understanding of diversity of ‘private sector’ • Guidance on data disclosure/sharing • Flexible approach to multi-sector working • Embed in country processes and institutions • Stronger focus on value for money in implementation

22. Conclusions MeTA Multi-stakeholder working = new concept – not easy Each sector needs to “give & take” It takes time to build trust You can learn from each other Working multi-stakeholder brings benefits to all Interest is big, and patients will most likely get better access to medicines (if the MeTA process continues)

23. So what? MeTA MeTA pilot phase is over; the new DFID Ministers will shortly decide about next phase of MeTA All 7 pilot countries want to continue Most stakeholders now engaged in MS processes Needs more support of development partners and local organizations for long-term sustainability The concept of transparency is there to stay!

24. Contact? MeTA Wilbert Bannenberg wilbert@metasecretariat.org Mob: +31-6-20873123 www.MedicinesTransparency.org