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Towards a Medicines Transparency Alliance (MeTA)

This presentation explores the need for transparency and accountability in the medicines market to address the problem of poor access to essential medicines. It discusses the MeTA proposal, highlights lessons from the Extractive Industries Transparency Initiative, and outlines the potential approach and benefits of MeTA. The presentation also introduces the pilot countries for MeTA and discusses the drivers of change and early findings.

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Towards a Medicines Transparency Alliance (MeTA)

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  1. Towards a Medicines Transparency Alliance (MeTA) Richard Laing and Ali Cameron with slides prepared by Michael Borowitz, DfID WHO Technical Briefing Seminar October 2007

  2. Manufacturer • Procurement • Agent (s) • Public • Private • mission Wholesaler Medical Stores Distributor Retailer Informal Sector/ Primary care Hospital Patient Problem: poor cannot access essential medicines Total Market Approach: public, private, and 3rd sector • Availability: Low availability in public sector • Price: High prices in private sector • Quality: Concerns about quality particularly of generics

  3. Source: SSDS Inc for the World Bank Example: complexity of medicines supply in Kenya

  4. Transparency and Accountability in Medicines • Market Failure • Complex chains of information asymmetry • Principal-agent problems • Response: government intervention • Government Failure • Health systems failure: accountability • Lack of state capacity • Unregulated private sector • Government/regulatory capture • Setting new equilibrium through transparency and accountability • Accountability system in drugs: • Consumer organisations • Professional organisations • 3rd party purchasers • Transparency changes the rules of the game

  5. Lessons from the Extractive Industries Transparency Initiative • Increase transparency and accountability in revenue flows from extractives companies to governments • Government led – multistakeholder – civil society • 5 stages: coming together, pilots, consolidating the rules of the game, expansion, new governance arrangements • Key strengths: • multi-stakeholder • accounting issues are matched with accountability • clear and narrow focus

  6. The MeTA Proposal Increase transparency and accountability in medicines procurement and supply, by: • Securing high level political commitment • Global public goods: activities on transparency using Global development funds: • Country-led process focusing on transparency and accountability • Multi-stakeholder forum: Getting the right people around the table – business, civil society and government – to agree how to disclose price, availability and quality data into the public domain – from both public and private sectors. • Transparency in pricing, availability, quality • Drilling down in therapeutic classes • Builiding capacity • Capacity of the state to regulate • Capacity of civil society to hold government to account • Research Observatory • Evidence-based policy • DFID funding £2mill for design, £25 million contribution

  7. Total Market Analysis semi-standardised approach • WHO/HAI pricing survey: what explains the results • Components analysis • Global reference prices (MSH, IDA, etc.) • Micro: Household survey data on medicines • WHA • Southampton survey review: LSMS, etc • Next wave? Dennis/WHO • Macro: Health financing: NHA • Private sector: Supply Chain mapping: • competition in different components • IMS-like data on price/volume • Informal sector • Public sector • Public procurement: extension of WHO/WB • Tracking: PETS, other tools

  8. Observatory/Info-mediary • What should you do? • Research observatory to bring together best practice (e.g. price controls) • Standardised reports on the pharma sector • Info-mediary role: e.g. GPRM database • Support evaluation of interventions • Support operation research • Partners: • Harvard, BU, Hopkins, LSTHM, LSE, Imperial, DFID RPC, NORAD/Cochrane Centre… more developing countries • Scoping

  9. Generic and Brand ARV Prices:ranges much greater for brands $1.945 $1.713 $1.356 Prices shown are per tablet Every dosage form tells a different story

  10. Phase I pilot countries for MeTA • Covering all regions: begin with one and spread out • Latin America: Peru (Bolivia) • East Asia: Phillipines (Vietnam, Cambodia, China) • EE/fSU: Kyrgyzstan • Middle East: Jordan • South Asia: India (Bangladesh, Pakistan) • Africa: Uganda, Kenya, Ghana (Zambia, Francophone) • Linked to WHO/WB/HAI

  11. Draw on scoping study, Including e.g. HAI Pricing survey Global Fund data etc Review existing data / research Agree key deliverables - identify blocks Disclosure and report production How MeTA might work Disclose data Establish multistakeholder group (MSG) Identify technical assistance required: Procurement, regulatory Medicines policy etc Political Commitment Evaluate results, develop recs Disseminate, debate, act Release MeTA report Scoping study: Full market analysis Drivers of change

  12. Early info on pilots • Jordan: • strengthening accountability: pricing survey not disseminated • Uganda • Putting price and regulatory data on website • Zambia • Price survey • Kyrgyzstan • Examination of diabetes/psychotropics • Transparency in hospital procurement • Phillipines • Dissemination of price information • Ghana • Disseminate existing data • Strengthen data collection and dissemination on medicines quality

  13. Supporting infrastructure for transparency and accountability • State capacity • Strengthening regulation • Strengthening insurance purchasers • Policy advice on regulating medicine prices • Civil society capacity • Strengthening NGOs—HAI • Strengthening professional societies • Equity and poverty lenses

  14. Next steps • Consultation • Pilots • Principles • MeTA Forum • Global public goods • Observatory • Info-mediary • Governance • Secretariat • Governance structure

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