MeTA Ghana

1. MeTA Ghana Country Overview Public Sector Private Sector Civil Society

2. Country Overview Augustina Koduah (Mrs) Country Coordinator

3. Multi-stakeholder process What were the major milestone in the multi-stakeholder process? Inaugural Meeting of Governing Council by Deputy Minister in September 2008 Official Launch in November 2008 First National forum in December 2009 CSO & Media Orientation in April 2009 Quarterly Governing Council Meetings to date Independent monitoring of medicines quality through routine testing with FDB & monitoring access to medicines using NHIS data based on agreed indicators with NHIA established Participated in major MeTA led International activities [MIAG & Jordan Training] Launch and Sensitization of Ghana MeTA CSO Group community targeted communication activities in April 2010

4. Examples Multi-stakeholder analysis workshop carried out in June 2010 National Multi-stakeholder Technical discussion forum on data disclosure in June 2010

5. Major achievements and successes What where the main achievements and successes of MeTA in your country? Active Multi-stakeholder Council made up of excellent spread of relevant stakeholders with sub committees (Administration, Advocacy & Technical) & a strong interest to move forward towards regular dialogue on medicines issues Independent Secretariat & Functional Website www.metaghana.org Facilitated an active independent civil society capacity to lead consumer advocacy campaign to support disclosure and accountability on access to medicines Baseline Pharmaceutical disclosure survey & sector scan studies completed Good collaboration established with NHIA to use data to monitor access to medicines based on agreed indicators with promising public health benefits Case studies shared with other MeTA countries through international meetings and country exchange visits

6. Major Achievement Results of Routine Minilab Quality Assurance Test led to necessary regulatory interventions

7. Overall challenges What have been the main challenges during the MeTA pilot phase? Initial unclear Standard Operating Procedures Latent mutual suspicion between the state and private sector; Nervousness of some stakeholders about change; MeTA assumes that enforcement mechanisms exist across the medicines manufacture, import, procurement and distribution systems, but historically enforcement of regulations is weak; Slow and Bureaucratic Decision Making process Maintaining momentum of stakeholders over time. (Diminishing returns) Working together to build trust & understanding between different stakeholders is difficult Timeliness and sustainability of financing beyond the pilot phase.

8. Lessons Learned What are the main lessons from MeTA in your country? Players in the pharmaceutical sector have varying interest and power Multi-stakeholder groups in the pharmaceutical sector have a better understanding of each other through transparent and systematic engagement Potential to make a positive impact in medicines access through transparent multi-stakeholder and systematic data sharing and disclosure works. Providing Ghanaian leadership on medicines transparency disclosure and dissemination of information to eliminate the risk of counterfeit and substandard medication as well as pricing in the supply chain

9. Thank you Name of presenter : Augustina Koduah (Mrs) Email: appidanq@yahoo.com Mobile number: +233 20 8769228

10. Public Sector Mr. Samuel Boateng Office of Chief Director Ministry of Health (MoH)

11. Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Strong existing enabling and legislative environment BUT Benefits of improved procurement not translating into affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey); Inconsistency with other sectors (private and mission) in terms of how standards (i.e. quality, availability and pricing) are developed and applied; Low consumer awareness due to very little information on quality, availability and prices of medicines in the public domain, Non-adherence to treatment guidelines by prescribers and irrational use of medicines by providers persists despite improved guidance and education; Supply chain performance problems from CMS downstream leading to high stock-out rate; Vulnerability of NHIS to fraud due to inefficient data analysis and dissemination Public health safety concerns arising from counterfeit and/or substandard products

12. Major milestones What milestones have been achieved during the MeTA pilot phase? • Proactive engagement with private sector, development partners & civil society through multi-stakeholder collaboration in information sharing to build consensus around availability, quality, pricing and rational use to increase access to essential medicines for the poor • Periodic monitoring of medicine prices and availability as well as their rational use using WHO standard indicators-2008 • Key Data on medicines from the NHIA made available for systematic analysis and dissemination to improve transparency, accountability, pricing and quality. • Independent monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’ 2009. • Partnership with CSOs to provide more information to consumers, around quality & rational use in medicines advocacy • Data validation of NHIA data carried out; awaiting dissemination

13. Successes What were the successes for your sector during the MeTA pilot phase? • Provided Ghanaian leadership on medicines transparency and accountability through multi-stakeholder engagement as model in West Africa for both effective governance and market efficiency. • Initiated opportunity for pricing and rational use of medicines monitoring mechanism to inform the NHIS • Reduced and/or eliminating the risk of counterfeit and substandard medication in the supply chain. • Provided mechanism for public sector commitment to fight inefficiency and corruption in the drug supply landscape.

14. Challenges What challenges has your sector endured during the MeTA pilot phase? • Mutual suspicions and mistrust between sectors; • Nervousness of all stakeholders about change; • Need to assume a degree of commitment to transparency by all stakeholders and willingness to be mutually accountable. • Sustaining regular open stakeholder dialogue and commitment of all parties in all sectors. • Right to Information Bill yet to be passed into legislation • Dealing with sensitivities of various interest groups in the sector

15. Lessons Learned What are the lessons that your sector has learned from MeTA? • Multi-stakeholder involvement helping to break barriers • Transparency & Accountability in the engagement process is vital for success of MeTA • The need to accommodate the interests and perceptions of all local stakeholders to reflect the character of the multi-stakeholder is a key ingredient for its efficiency • The essential elements of a strong, vibrant and sustainable MeTA in Ghana are: • Having the right people connected and committed • Willingness of stakeholders to be mutually accountable • Ghanaian ownership driven • Sustainable political commitment

16. Thank you Name of presenter: Mr. Sam Boateng Job Title: Office of Chief Director, MoH; Member, Ghana GC Email: samuel.boateng@moh.gov.gh Mobile number: +233 244 269336 Website: www.moh.gov.gh

17. Private Sector John Allotey Manager, Business Development LaGray Chemical Company, Nsawam, Ghana

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. Civil Society Presenter: Charles Allotey Executive Director-Health Access Network Ralph Ahiabu Director of Programs - DeSMAS

26. Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Lack of organized civil society coalition directly involved in issues related to access to medicines. Lack of capacity among civil society organizations to deal with medicines issues, especially where technical in nature. Ignorance among community members on issues surrounding medicine prices, quality, availability and access in general. Patients and consumers lacked information and power to realize their rights to healthcare and medicines - e.g. rights in Patient’s Charter, benefits and quality of care under National Health Insurance Scheme. Inadequate linkages and collaboration between the public, private and civil society sectors.

27. Major milestones What milestones have been achieved during the MeTA pilot phase? Built network and made linkages amongst civil society organizations across all 10 regions of Ghana. Enhanced capacity of network members on access to medicines and transparency issues - e.g. workshops at various levels. Established online social network (NING Group) to facilitate communication and mutual visibility of network members. Launch of Ghana MeTA Civil Society Group by the Deputy Minister of Health. Developed 4 educational posters targeted at consumers on relevant medicines issues in Ghana – translated into 7 major local dialects. Undertook community awareness-raising activities, including public fora and radio programs. Held a detailed mid-term review; developed forward plans for 2010-11. In sum: We have achieved a lot, with limited resources. And more is planned!

28. Successes What were the successes for your sector during the MeTA pilot phase? Enthusiasm has been created among community groups who are now able to engage in discussions on medicines issues. Trust and collaboration are emerging between CSOs and public sector agencies on transparency and access to medicine issues. We have enhanced awareness among consumers on patients responsibilities, counterfeit and substandard medicines, and the rational use of medicines. We have a database and linkages at national, regional, district and community levels that will facilitate information sharing and joint advocacy, right across the country.

29. Challenges What challenges has your sector endured during the MeTA pilot phase? Sustaining interest of network members to engage actively in the MeTA process following the establishment of the network. Aligning individual and organizational interests of network members to the core objectives of MeTA. Demands made on members engaged in the organizational process were very high due to the sacrificial nature of the work. Limited resources constrained the creative and innovative ideas that would have enriched the overall outcome. For example, we had hoped to engage in some operational research on medicine related issues in communities nationwide. This would have engaged network members proactively, resulting in (bottom up) data to complement that at policy level (top down).

30. Lessons Learned What are the lessons that your sector has learned from MeTA? Non-health professionals within the CSO network are able to engage with a wide range of stakeholders and the media on issues relating to transparency and access to medicines – The CSO network includes those working on governance, corruption, women’s rights, children’s rights, community health, etc. The CSO sector is gaining valuable knowledge and experience through participation in the MeTA multi-stakeholder process. Working with different stakeholders is possible and offers a better opportunity to address challenges than one stakeholder group acting alone. **For example, on [issue x]** Opportunity created through the MeTA process to work with people with diverse professional backgrounds, skills and expertise resulted in achieving better outcomes. **For example…we achieved…**

31. Thank you Name of presenter Charles Allotey Job Title Ghana MeTA CSO Group Coordinator Email: kallotey@gmail.com, han.ghana@gmail.com Mobile number: +233 (0)244280284 Skype: kallotey Website: www.hanghana.org