MULTI-STAKEHOLDER COLLABORATION: CAN IT IMPROVE TRANSPARENCY, DISCLOSURE AND ACCESS TO MEDICINES? EXPERIENCES FROM 7 ME

1. MULTI-STAKEHOLDER COLLABORATION: CAN IT IMPROVE TRANSPARENCY, DISCLOSURE AND ACCESS TO MEDICINES? EXPERIENCES FROM 7 META PILOT COUNTRIES Wilbert Bannenberg1,5; Samia Saad1; Christine Kalume1; Carolyn Green1; Claire Innes2; Saul Walker2; Gilles Forte3; Andreas Seiter4 1Medicines Transparency Alliance (MeTA) Pilot, United Kingdom; 2DFID; 3WHO; 4World Bank; 5Health Research for Action (HERA), Belgium Abstract Multi-Stakeholder Collaboration: Can It Improve Transparency, Disclosure and Access to Medicines? Experiences From 7 MeTA Pilot Countries. Bannenberg, Wilbert (1,5);Saad, Samia (1); Kalume, Christine (1); Green, Carolyn (1); Innes, Claire (2); Walker, Saul (2); Forte, Gilles (3); Seiter, Andreas (4) 1: Medicines Transparency Alliance (MeTA) pilot; 2: DFID; 3: WHO; 4: World Bank; 5: Health Research for Action (HERA), Belgium. Comments to wilbert@hera.eu Problem Statement: After 30 years of a valid essential medicines concept, 2 billion people are still without access to essential medicines (ATM). Efforts to promote ATM have largely focused on interventions by governments; they have not yet seriously involved the private (for profit, nonprofit) sector or civil society. Objectives: The MeTA pilot phase aimed to test the hypothesis that multi-stakeholder collaboration between government, private sector, and civil society improves disclosure, transparency, accountability, policies; and ultimately improves ATM. Design: Review, qualitative study. Setting: Global and national level, involving public and private sector, and civil society Study Population: Seven countries (Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda, and Zambia),who accepted an invitation by DFID to pilot MeTA. Intervention: In collaboration with stakeholders, MeTA established multi-stakeholder groups (MSGs) willing to perform a pilot of the MeTA hypothesis. These transformed into 7 national MeTA councils, establishing work plans, budgets, and national secretariats. Stakeholders were asked to transparently disclose key data about the overall medicines supply chain, analyse the information, seek country-specific solutions, and advocate for policies to improve access to medicines. Baseline studies were undertaken on the pharmaceutical sector and disclosure practices in all 7 countries. Four countries undertook WHO level II household and facility surveys. Five countries assessed the multi-stakeholder collaboration using a new tool. Civil society coalitions were formed and assisted with capacity building in all 7 countries. All 7 countries organised national fora to discuss MeTA data and reports. Establishing MSGs took more than 12 months; the pilot phase lasted 2.5 years. A second phase of MeTA started in 2012. Policies: Several MeTA countries also discussed national medicines policies, and contributed to changes in legislation, drug regulatory transparency, price surveys/ monitoring, generic policies, and evidence-based treatment guidelines. Outcome Measures: Baseline and country reports. MeTA review of the pilot phase. An independent evaluation of MeTA in February 2010 concluded that time was too short to reject or confirm the MeTA hypothesis, or to expect impact on ATM, but there were promising signs. Results: All 7 countries established active MSGs, performed baseline studies, disclosed and analysed data, advocated for better policies, and presented results to national fora and through Internet. Conclusions: Structured multi-stakeholder dialogue at country level can increase transparency and disclosure. The MeTA pilot phase was too short to prove whether or not it increases access to medicines. Funding Source: DFID (with technical support by WHO, World Bank) • 5. Implementation • All MeTA countries created Multi-Stakeholder Groups with government, private sector and civil society, called ‘MeTA Councils’. Their functions were: • to provide a platform for engagement and bringing stakeholders together • to serve as a forum to promote disclosure and advocacy towards greater transparency • to ensure governance of in-country activities and support to the project • All countries established small national MeTA Secretariats to support the national process • All countries formed national coalitions of civil society organisations interested in improving access to essential medicines • All countries organized annual MeTA Forums, where data and results were shared, discussed and published • All MeTA countries conducted baseline pharmaceutical sector scans and disclosure surveys (see posters 967, 977 and 1013); • Four countries carried out WHO-style facility & household surveys, and five underwent a new multi-stakeholder process analysis (see poster 1108) 6. Some Examples of Country Activities Ghana: Analysis of health insurance data for evidence-based policy Jordan:New Treatment Guidelines and Rational Drugs List Kyrgyzstan: Mini-labs introduced to test the qualityof circulating medicines Peru:Legislation and systems for a Medicines’ Price Observatory Philippines: Cheaper Medicines Act; Universal Access policy Uganda:Private sector and civil society consultation on new health & pharmaceutical strategy Zambia: Media campaigns to raise awareness on access to medicines • 2. The Problem • 2 billion people have no access to a basic package of essential medicines • >10 million people die annually due to lack of access to basic essential medicines • “ Up to 90 per cent of the population in developing countries purchase medicines through out-of-pocket payments. Medicines account for the second greatest household expenditure, right behind food” [Dr Margaret Chan, DG WHO, July 2010] • The complexity of the pharmaceutical market and a lack of information (or conflicting information) about the medicines supply chain • In countries where there is no up-to-date, validated information on the price, quality, availability and promotion of medicines, competition is distorted, corrupt practices are allowed to flourish and medicines are used irrationally • Without this information it is difficult, if not impossible, to identify where the system inefficiency or accountability lies, and therefore how the problems should be tackled, and by whom • 7. Lessons Learned • Multi-stakeholder working is a new concept – not easy – it takes time to build trust • Identifying champions in each sector can greatly help the process • Each sector needs to “give & take” (consensus building) • The MeTA process needs to be country-led (bottom-up) • Gaining consensus and understanding requires a constant and frank exchange of views • Tools for gathering baseline data on access do already exist; a new tool to measure multi-stakeholder collaboration has been developed • 3. The MeTA Hypothesis • Disclosing and sharing information in a Multi-Stakeholder Group is a sustainable, credible and effective process that leads to increased transparency, joint analysis, joint solutions, better policies and ultimately better outcomes (access to medicines) • In the specific case of MeTA this meant: • Bring together the 3 stakeholder groups: public, private sector and civil society (Multi-Stakeholder Group) • Ask all parties to disclose relevant information about the medicine supply chain (Transparency and Disclosure) • Ask them to jointly analyse and discuss in structured meetings (build trust) • If the MeTA hypothesis is true, this will: • Lead to better understanding of the problems (joint awareness) • Create incentives for change and achieve better solutions (joint accountability) • Lead to better policies and implementation (efficiency) • Ultimately result in improved access to medicines (results) • 8. Conclusions • Structured multi-stakeholder dialogue at country level can indeed increase transparency and disclosure • MeTA has found value in the MSG process for promoting policy change around improving access to essential medicines • MSG process needs to be given the space to mature. To continue, it will require continued investment, time and resources • The MeTA pilot phase was too short to prove whether or not it increases access to medicines • 9. Next Steps, Challenges • DFID has approved a 2nd phase of MeTA for the 7 existing and 2 new countries; Health Action International (HAI) and World Health Organization (WHO) will jointly manage the MeTA-2 secretariat. • How to embed MeTA-2 in country Access to Medicines and Health programmes • How to move from ad-hoc surveys to routine data collection and disclosure • How to sustain voluntary participation? How to support the various constituencies to participate? • 4. The MeTA Pilot Project • 7 countries piloted the hypothesis: Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda and Zambia • DFID, WHO and World Bank formed an alliance with the 7 pilot countries to support this process • An international MeTA Secretariat supported the process • Civil society organizations were given specific support to join the national process, and to ‘sit at the top table’ • The MeTA pilot phase ran from May 2008 till September 2010 • An external evaluation was done early 2010 • Country experiences were presented at the MeTA Global meeting in July 2010 • Country data were compared and summary reports written • All surveys, studies, presentations and country reports were posted on www.MedicinesTransparency.org • 10. Further Reading, Contacts • MeTA pilot review report and all data from the MeTA pilot phase can be found at: http://www.medicinestransparency.org/; • For more info on the 2nd phase of MeTA contact: DFID at meta@dfid.gov.uk, Tim Reed (HAI) at tim@haiglobal.org or Gilles Forte (WHO) at forteg@who.int