Pilot Countries View from the Private Sector

1. Pilot CountriesView from the Private Sector MeTA Ghana MeTA Philippines MeTA Jordan MeTA Uganda MeTA Peru MeTA Zambia

2. MeTA Ghana John Allotey Manager, Business Development LaGray Chemical Company, Nsawam, Ghana

3. Summary Analysis at start of MeTA Lack of market data Medicines available in therapeutic areas Sources of medicines Pricing – both open market and retail Uncertainties around regulatory issues Steps in the approval process Time taken for approval of application Poor knowledge of government procurement system Competitive advantage of local manufacturers Personalities and approachability of government personnel Limited engagement with National Health Insurance Authority Medicines list Pricing

4. Major milestones • Active participation of private sector in MeTA • Participation in planning and launching the pilot • Launch of MeTA as multi-stakeholder process • Participation in ‘Level Playing Field’ with other sectors eg. Govt., CSO, etc • Movement towards regular, open stakeholder dialogue • Ghana forum • London Forum • Opportunity to present case of local manufacturing

5. Successes • Recognition of potentially rich sources of information for MeTA to harness and make an impact • Food and Drugs Board registry of medicines • Procurement information from Ministry of Health • National Health Insurance data on prescriptions • Value of political will • MOH support making MeTA Ghana possible • Meeting other stakeholders • Appreciation of problems of other stakeholders • Willingness to work as a team to improve access • The beginning of trust building

6. Challenges • Some lack of interest in work and activities of MeTA • Competing issues and challenges within the sector • Threats from ‘cheap’ competition • Threats (perhaps unintended) from foreign largesse (e.g. Affordable Medicines- Malaria) • Need of government support to build industry • Some suspicions around motives of MeTA • Status as independent entity questioned • Potential for manipulation of objectives • May be used by both local as well as multinational pharmaceutical companies to discredit each other

7. Lessons Learned • Transparency around medicine quality,availability and pricing is possible • Potential for data sharing or disclosure exists • MeTa can be honest broker because of multi-stakeholder status • Persistence required in sustaining interest of all • Commitment of stakeholders • Work required in allaying suspicion and obtaining consistent cooperation

8. Acknowledgements Dr. Paul A. Lartey – PMAG Dr. Isaac Morrison - SPMDP Pharmaceutical Society of Ghana Association of Licensed Chemical Sellers Ghana Medical Association Ghana Registered Midwives Association

9. Thank you John Allotey Manager, Business Development, LaGray Chemical Company, Nsawam, Ghana Email: john.allotey@lagraychem.com Mobile number: +233-20-831-7767 Website: www.lagraychem.com

10. MeTA Jordan Dr Ibrahim Al Abbadi Scientific Research Documentation Office Director The University of Jordan

11. MeTA Overview of Private Health Sector in Jordan 60 private hospitals and many specialized private clinics 16 High quality local pharmaceutical manufacturing (branded generics) Value of Jordan pharmaceutical market (2008) is 350m USD 80% (in value) corresponds to imported medicines 84 medicines’ local agents and around 160 subagents 1829 registered pharmacies Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009)

12. Overview of Private Health Sector in Jordan Cont. Chain pharmacies started operating in Jordan since 2001, the biggest is Pharmacy One with 45 branches Pharmaceutical expenditure as a percent of total health expenditure is 34.0% where the private sector accounts for 22.7% Distribution of pharmaceutical expenditure as a percentage of total pharmaceutical expenditure where the private accounts for 66.7% Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009)

13. MeTA Jordanian Pharmaceutical Exports million US $ The Target is 1 billion $ in 2011 Source: Jordan Association of Pharmaceutical Manufactures(2010)

14. Summary Analysis at start of MeTA The main issues for the private sector at the start of MeTA were: To get engaged more in the strategic planning process for the pharmaceutical sector in our country, and to get engaged more with the public sector and to share data and information on availability and patients needs

15. Major milestones The private sector represented by the local industry association as one of the MeTA council members The Medical and Pharmacy associations are represented in the MeTA council Participated in most of MeTA activities on the level of the council membership , the level of subcommittees and on the level of established task forces that are working on activities listed on our national workplan The MeTA council representatives of the private sector acted as facilitators for the baseline pharmaceutical surveys Encouraged the private sector mapping report to be conducted To conduct a workshop to promote ethical promotion guidelines

16. Major milestones Cont. Introduce the pharmaco-economics concept and its importance for RDL addition and deletion to the local industry and generic importers An introductory meeting about MeTA and its concept to the medical associations and professional associations Contributed in reviewing the criteria for adding and deleting medicines into the RDL , TORs and SOPs for the RDL committees, revised the classification criteria of drugs (Restricted, Un-Restricted & Authority required) listed in the RDL MeTA Council Private sector representative (local pharmaceutical industry), attended Private Sector meeting in London June 2009 Agreed with the MeTA Council to publish all outcomes on Jordan MeTA Web site

17. Successes The private sector is represented by the local pharmaceutical industry, Jordan Pharmacy Association and Jordan Medical Association The private sector participate in regular meetings and in most activities The private sector represented by the local industry will participate in a study about the FTA impact on access to medicine in Jordan Were involved in reviewing criteria for adding and deleting drugs to and from the RDL and the TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL) and the classification of drugs (Restricted, Un-Restricted, Authorized and Un- Authorized) in RDL

18. Challenges At Pharmaceutical level: Poor forecasting and estimation of medicines needs which leads to low availability of medicines in public sector where this will reflect on us as a private sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket High prices of some essential medicines since the private sector is securing the country with medicines

19. MeTA Challenges Cont. Private sector is not fully represented in the MeTA Council Private sector low level of disclosing data and low willingness to share information, such as information related to prices, promotional activities and quality Few patients associations budgets are partially supported by pharmaceutical companies High pharmaceutical promotion / hard to control

20. Challenges Cont. Short period, the two year MeTA pilot is not enough to present and measure the impact on medicines availability and RDU, as much as we worked and contributed as a sector the outcome will be noticed through years to come In order to present as a sector that we contributed to the main issues identified we needed more time to have this contribution measured by data to be presented to the whole public Lack of adherence to ethical promotion guidelines

21. Lessons Learned The need to engage our private sector more in the MeTA process MeTA has acted as a coordinating body for the pharmaceutical sector players and stakeholders The MeTA process has opened channels of communication between different stakeholders and different countries CSO as one of the stakeholder engagement with the MeTA process complements the overall picture and highlights patients’ need Reach a common understanding on concepts of pharmaco-economics , transparency, evidence-based medicine (EBM) and accountability

22. MeTA Lessons Learned Cont. To engage parliament in the MeTA council process and to involve the media more We started to understand each of the other stakeholder perspectives and identified that there were in fact common priorities and one objective between us to work on together The Data Disclosure survey was a useful exercise that improved communication and sharing/disclosing of information which is a core MeTA principle We have learned the importance of data disclosure and sharing information

23. Thank you Ibrahim Alabbadi PharmacoEconomist Email: i.abbadi@ju.edu.jo Mobile number: +962-777160810 Skype: Website: www.ju.edu.jo

24. MeTA Peru Berenice Pinto Augusto Rey

25. Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA Quality Ilegal Market Ethics Regulation

26. Main mailstones What milestones have been reached during the MeTA pilot phase? • Forming part of a roundtable where we are able to work together as a country on common interest (public, private and civil company). • Communication among the private sector, the public sector and the civil company has improved. • Communication of the companies that conform the private sector has improved (ADIFAN, ALAFARPE, COMSALUD-CCL). • Joint appreciations as private sector on problems that normally require a major approach by the public sector.

27. Successes What were the successes of the sector during the MeTA pilot phase? • Diffusion within the private sector of MeTA's objectives • Achieving commitment of the private sector stakeholders on access to medicines. • Permanent participation in MeTA Peru of 3 of the 4 private sector stakeholders. • Commitment and participation of ALAFAL • Better communication both inter and intra-sectorial. • Greater understanding of the multi-stakeholder process.

28. Challenges What challenges has this sector confronted during the MeTA Pilot Phase? • Sharing the concerns of the pharmaceutical sector. • Contribute to a common agenda among private sector which is presented in MeTA Peru. • Debate different points of view with other sectors .

29. Lessons Learned What lessons has this sector learned of MeTA? • Opportunity of dialogue among sectors. • The multi-stakeholder process allows to identify common problems. • Engage the opportunity that the government of the United Kingdom has offered us, to discuss pharmaceutical issues with transparency. • It is possible to build a shared vision across sectors. • Building trust is necessary among the sectors

30. Thank you Berenice Pinto C-electrónico: bpintoadifan@hotmail.com Número Celular: 511 992776311 / 511 4226480 Página Web: www.adifan.com.pe Augusto Rey C-electrónico: arey@alafarpe.com Número Celular: 511 995491392 / 511 4410693 Página Web: www.alafarpe.com

31. MeTA Philippines Reiner W. Gloor PHAP President Normita D. Leyesa PPhA President

32. Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Transparency in government Bidding / procurement (National Level / Local Government Units) Representation of stakeholders in the legislature Regulatory (Food and Drugs Administration) Safety and quality of medicines cGMP compliance

33. Major milestones What milestones have been achieved during the MeTA pilot phase? • Partnership with government and nongovernmental groups, civil society organizations • National fora – issues on ethical practices, drug promotions, quality of drugs discussed • GGM Awards

34. Successes What were the successes for your sector during the MeTA pilot phase? • Increase in acceptance of generic drugs by the public • Joint advocacies heard by other stakeholders • Review of promotional/marketing activities and advertisement of medicines • Review of Code of Ethics of Professional and Private Industry Organizations

35. Challenges What challenges has your sector endured during the MeTA pilot phase? • Expanding MeTA awareness to the public • Overcome initial misconceptions that MeTA was only concerned with medicine pricing • Improving access of essential/life-saving drugs to the public • Implementation of ethical promotions and advertisement of drugs • Adoption and adherence to professional health care practices • Strict observance of rational drug use

36. Lessons Learned What are the lessons that your sector has learned from MeTA? • To identify stakeholders like the PMA and encourage their earlier participation in the process • Continuous dialogue encourages trust and mutual respect among stakeholders • Importance of engaging stakeholders in an open interaction

37. Private Sector Composition PHAP PCPI (48 members) (123 members) PPhA PMA (8000 members) ( 63,000+ members)

38. Thank you Normita D. Leyesa President, Philippine Pharmacists Association Email: ndleyesa@yahoo.com.ph Website: www.metaphilippines.org.ph

39. MeTA Uganda Nazeem Mohamed C.E.O. Kampala Pharmaceutical Industries (1996) Ltd

40. Summary Analysis at start of MeTA Issues Market dominated by subsidised imports from India and China Prices are cheap, Huge variability in stocks Subsidised imports impact on competitiveness of local manufacturers Perceived lack of clear policies to support local manufacturing Lack of adequate Government support for local manufacturing

41. Issues 2 • Relatively strong regulations and enforcement in place • Increasing commercialization of health care provision • Weak infrastructure which increases the cost of distribution and availability of essential drugs. • Poor and inadequate patient and customer service • Lack of knowledge and dissemination of patient rights • Wide spread corruption in areas of health service delivery, procurement, leakage of products etc... • No point of reference to access data on pricing, margins, or availability of essential drugs

42. Major milestones Private sector has been provided a seat on the table!! Private sector recognized as a significant and growing player in health care service delivery Opportunities created for dialogue with the Government, CSO’s and development partners

43. Successes Invited to participate in development of Government’s Pharmaceutical Strategic Plan (NPSSP) for 2010-2015 Worked with CSO’s on “Counterfeit Bill” and submitted a common position to the Government Initiated discussion with Academia to improve technical skill base among graduates and company staff Initiation of a project to promote the value of “generics” and local manufacturing Identified need to collect and disseminate data on the market, e.g. Importation, use of different medicines, trends in usage, etc

44. Challenges The need for “patience for results” in working as part of a multi-sector team! Understanding that sectors have varying objectives and work in different ways, e.g. private sector tends to act with more sense of urgency Involving the “full breadth/spectrum” of private sector in the discussions and getting commitment for actions Lack of empirical information on characteristics, extent, growth and consequences of unregulated commercial health care provision

45. Lessons Learned Most issues of concern are common to different stakeholder groups Understanding and appreciating the role each sector can play in making multi stakeholder initiatives/processes work Identifying and involving all stakeholders that will contribute to the success of the multi stakeholder process The role of advocacy/lobbying in ensuring that private sector concerns are considered during policy formulation The need for strengthening the capacity of government to constructively engage the private sector Building trust and constructive policy dialogue are vital for successful engagement

46. MeTA Zambia Presenter Name : Ruth Mudondo Job Title: Director – Unicare Pharmaceuticals. Chair person – Zambia Pharmaceutical Business Forum.

47. Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Issues Private sector was battling with the challenges & problems– alone. Though Zambia Pharmaceutical business Forum (ZPBF) was in place. Lack of transparency at MOH – One of the major concerns of the Private sector Lack of flow of information and very little consultation between Pharmaceutical regulatory authority – Private sector – PRA Private sector was not able to access some of the information at PRA. Lack of unity among the business community - drive to fight for the common cause..... Needs Wanted someone to represent the private sector in the MeTA process

48. Major milestones What milestones have been achieved during the MeTA pilot phase? Establishment of Multi stake holders forum – Fantastic • PRA (Pharmaceutical Regulatory Authority) heard the challenges of the Private sector from a neutral body like MeTA • MOH was more willing to respond to the queries raised by the Private sector. • CSO and Media got to know the role of private sector in Health care. • Private sector found it easy to express their challenges in the MeTA meetings and most of the time private sector got the positive support from MeTA.

49. Successes What were the successes for your sector during the MeTA pilot phase? • Zambia Pharmaceutical Business Forum – Recognition • Issues pertaining to Local Pharmaceutical Manufacturers were taken up on FAST TRACK and are being addressed by relevant authorities. • Media Campaigns: Ordinary citizens got to know more about distribution of medicines and the challenges that are faced by the Public & Private sector in delivering quality medicines. • Radio program: Flow of information – Interactions – Public Participation • Documentary: Public awareness about the role of Private industry in National Health care – Increased

50. Challenges What challenges has your sector endured during the MeTA pilot phase? • Certain segment of Private sector is yet to appreciate MeTA activities. • Certain segment of private sector – Sceptical about MeTA. • Balancing the MeTA activities with the routine business activities is a challenge. • Getting co operation – conducting survey – is a real tough job • Understanding the concept of disclosure – Cant visualize the benefits – hence it is difficult to get the support of private sector.