MeTA Peru

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

2. MeTA Peru Germán Rojas, Technical Secretary Leda M. Perez, Consultant to MeTA in Peru

3. Multi-stakeholder process A commitment to engage Received a commitment from the MoH in early 2008 to participate in MeTA Participation of public and private sectors and civil society in MeTA global launch of May, 2008 A commitment to proceed Birth of the Grupo Impulsor, June 2008 MeTA Peru National Forum, November, 2008 Consolidation of Executive Committee and National Council between November, 2008 and February, 2009 Refinement of MeTA Peru national work plan, February, 2009-February, 2010 A commitment to implement Executive Committee continues to meet weekly to make decisions relative to work plan implementation National Council meets every two months to assess progress on work plan

4. Major achievements and successes • All sectors remain at the table! • Continuous nature of multi stakeholder process • Communication has changed as a result of MeTA • Progress on key areas of implementation • Price Observatory • Public purchases study • Development of Centers for Medicines Information • Agreement on key areas to be implemented • Development of a national generics policy • Development of baseline data studies, i.e., pharmaceutical sector scan and multi stakeholder process evaluation • Development of software for price observatory • Development of Website/communications plan

5. Overall challenges • The multi stakeholder process takes time • Sectors are working together which may have never had a history of collaboration • Without trust and relationships it is impossible to move the agenda forward. • Must adapt to new structures, i.e., Executive Committee, National Council, administrative and technical secretariats • The Executive Committee and National Council lead this process and not the Technical or Administrative Secretariats • This means that there are many minds at work and the Technical and Administrative Secretariats are beholden to the will of these voluntary bodies and not the other way around

6. Lessons Learned • The multi stakeholder process may be a useful manner of creating transparency and improving decision-making in the pharmaceutical sector. However, • Investments in relationship- and trust-building are essential • Such a process is difficult anywhere in the world, but may be particularly challenging in environments whose governments have been historically centralized. • While transparency in information about medicines and process is important, we must be careful that the mechanisms put in place do not create greater bureaucracies • There is value in a shared space between civil society, government and private sector to discuss common issues of concern.

7. Lessons Learned PUBLIC SECTOR PRIVATE SECTOR CIVIL SOCIETIES • Colegio Médico del Perú • Acción Internacional para la Salud • Foro Salud • Red Peruana de Pacientes y Usuarios • MINSA • EsSalud • Defensoría del Pueblo • Facultad de Medicina de la UNMSM • Gobiernos Regionales: Arequipa, Huánuco, Piura • Asociación Nacional de Laboratorios Farmacéuticos– ALAFARPE • Asociación Nacional de Industrias Farmacéuticas – ADIFAN • Comisión de Salud de Cámara de Comercio de Lima (COMSALUD) • Asociación Peruana de Entidades Prestadoras de Salud (APEPS)

8. President National Council MeTA Peru Vice-President 15 Members MoH Ombudsman Executive Committee MeTA Peru HAI Medical College of Peru ALAFARPE Technical Secretariat Communicator Administrative Secretariat Lessons Learned Support: International consultant

9. Thank you German Rojas, Technical Secretary Leda M. Perez, Consultant to MeTA in Peru Email: grojas3000@gmail.com and ledaperez@hotmail.com Mobile number: 511 99566 5509 (Leda) 511 999378102 (Germán) Skype: leda568 and grojas3000 Website: www.metaperu.org

10. Peru – Public Sector Melitón Arce Pedro Yarasca Pedro Tintaya

11. Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA Problems: Lax legislation for the Registration and Quality of medicines. Little transparency in the information of prices. Promotion and Publicity of medicines Needs: Transparency in information of prices of Pharmaceutical Products Politics of Generic Medicines Rational use of medicines: Listing of Essential Medicines of the Health Sector Greater availability and affordability of medicines

12. Registered medicines in Peru Total of Medicines with Sanitary Registration in force: 23,022 Fuente: SI-DIGEMID. Abril 2010 18/09/2014 12

13. Main mailstones What milestones have been reached during the MeTA pilot phase? During the period of the MeTA pilot phase, the following milestones have been achieved, favored by MeTA Peru: • Observatoriy of Prices of Pharmaceutical Products: • Regulatory framework for the OPPF • Development of the software for prices reports • Technological support :PCs, Server • Informative campaigns for the dissemination of the OPPF: Informative Modules Aspects that have facilitated to reach this milestones: • New legislation of Pharmaceutical Products, medical devices and sanitary products. • Obligatory nature of prescription in International Common Denomination (DCI)

14. Successes What were the successes of the sector during the MeTA pilot phase? • Elaboration and approval of the normative framework on the Observatory of Prices • Launch of the Observatory of Prices - Currently in Version 2. • Political commitment and support by the Minister of Health • Acceptability of the Observatory of Prices by part of the population

15. Examples Informative campaign on Prices of Medicines 18/09/2014 15

16. Challenges • What challenges have this sector to confront during the MeTA Pilot Phase? • To build a better trust among the associates. • The presence of divergent opinions during the process. • Greater capacity in technological and human resources.

17. Lessons Learned What lessons has this sector learned of MeTA? • Recognition of issues that should be revealed to the population (prices, availability, public purchases, information of medicines). • Allowing space for multisectorial dialogue. • Identification of objectives and common strategies among the associates, always respecting their points of view. • It has permitted to identify prominent tissues for the country in matter of medicines.

18. Thank you Pedro Yarasca e-mail: pyarasca@digemid.minsa.gob.pe Telf.: 0051-1-998704127 www.digemid.minsa.gob.pe

19. Private Sector Berenice Pinto Augusto Rey

20. 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

21. 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.

22. 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.

23. 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 .

24. 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

25. 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

26. Civil Society Marco Alegre Romero – Coordination CSOs

27. Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA? 43% of the country's population lacks access to essential medicines. CSOshadnotfluentaccesstoessentialcriticalinformationbythestate and theprivate sector in relationtoaccessto medicines. Therewas limited space for Civil Society participation to generate public policy on essential medicines. Absence of a National Policy for Generic Medicines. Weakness in the mechanisms of transparency and accountability of public administration in the early stages of the medicines supply chain.

28. Main mailstones What milestones have been reached during the MeTA pilot phase? • Being able to start working together to address access to generic medicines, between the State, Civil Society and Private. • Forming a Coalition of Civil Society Organizations • Tobeabletoformulate a national project by the CSOs Coalition and users, to train leaders in monitoring access to medicines.

29. Successes Which were the successes of the sector during the MeTA pilot phase? • Raise the issue about lack of access to medicines at national and regional levels. • Reachanagreement with the University for the development of post-graduate courses to train leaders in monitoring access to medicines. • Manage to jointly formulate a project that contribute to access of medicines among the national and regional CSOs • Theengagement of 18 out of 25 regions of the country in the implementation of the project

30. Challenges Whatchallenges has this sector confrontedduringthe MeTA PilotPhase? • To provide a better positioning of the CSOs on the National Council and the Executive Board of META Peru. • To achieve a cohesion between CSOs – Users, and technical people. • To engage active leaders in monitoring access to medicines at the national level articulated in the network.

31. Lessons Learned What lessons has this sector learned from MeTA? • You can better address the problem of access to essential medicines when working in collaboration with the state, civil society and the private sector. • TheCivil Society can improve the quality of dialogue and negotiation with the public and private sector when it has continuous access to information. • TheCivil society is divided according to the interests of each of its members. • The regions of Peru would like to address the problems ofaccess to essential medicines but do not have strategies and information to give an appropriate response.

32. Thank you Marco Alegre Romero C-electrónico: malegre84@yahoo.com Número Celular: (51) 1997273931 Skype: Página Web: www.forosalud.org.pe