Transcript Document

COUNTRY COMPARISON OF MULTI-STAKEHOLDER PROCESS ASSESSMENTS IN THE META BASELINE
Birgit Kerstens1, Samia Saad2, Wilbert Bannenberg1,2
1 Health
Research for Action (HERA), Belgium; 2 Medicines Transparency Alliance (MeTA) Pilot, United Kingdom
1. ABSTRACT 1108
PILOT COUNTRY:
Is there a multistakeholder alliance built
through MeTA?2
2. BACKGROUND
Medicines Transparency Alliance (MeTA) is a pilot multi-stakeholder alliance working to improve access and affordability of medicines for the one-third of the
world’s population unable to access essential medicines due to high cost or local unavailability. Implementing Component 3 of the MeTA baseline assessment
toolkit, i.e. the multi-stakeholder baseline assessment, provides an independent 360°degree assessment of the existing levels of multi-stakeholder
engagement, presents a snapshot of the multi-stakeholder process and identifies barriers and challenges to multi-stakeholder commitment in five of the seven
MeTA pilot countries: Jordan, Peru, the Philippines, Uganda and Zambia. Due to central budget constraints the multi-stakeholder baseline assessment was not
conducted for Kyrgyzstan and Ghana.
Is there a balanced
representation in the
multi-stakeholder group?
Yes
Yes
MeTA Jordan has worked hard over a
relatively short period of time to build its
multi-stakeholder alliance (KF I).
The current multi-stakeholder MeTA
Council comprises a number of
experienced and senior members
representing key stakeholder groups
such as the government, professional
associations, civil society, academia and
the private sector (KF I).
The current multi-stakeholder MeTA
Council comprises a number of
experienced, influential and well
respected members with long records of
public service both at government level
and in academia (KF I).
Partially
Partially
Yes
All sectors are included in the multistakeholder group, but: From those we
interviewed, there is a strong sense that
some stakeholders are perceived as
holding all the power within the multistakeholder MeTA Council and that they
are therefore able to control MeTA’s
agenda (KF XVI).
Some important stakeholders are
‘missing’ from the multi-stakeholder
process with the most commonly cited
being the Order of
Chemical/Pharmaceutical manufacturers
and the National Association of
Pharmacies and Drugstores (KF V).
There is an imbalance between
stakeholder groupings represented on
the Council as seats at the table have not
been allocated on a fair-share basis (KF
VI). During stakeholder interviews, the
Ministry of Health and the MeTA
Executive Committee were equally cited
as holding most power within MeTA. Civil
society and citizens groups were cited as
having least power (KF VII).
The 25-strong MeTA Council has
excellent representation from
government, various professional groups,
and the private sector. This partnership is
complemented by active participation of
MeTA’s civil society coalition known as
CHAT (Coalition for Health Advocacy and
Transparency) (KF II). There is no media
representation on the MeTA Council. It is
not clear from the workplan whether
media representation was considered
during initial stakeholder analysis when
forming the MeTA Council; or whether
this is a failure of engagement (KF XII).
Partially
No
Yes
The aim of the cross-country study is to present a comparative analysis of the main issues covered in the individual multi-stakeholder baseline assessment
reports which were prepared by five of the seven MeTA plot countries.
4. METHODOLOGY
Are the stakeholder roles
and responsibilities
understood and
practiced?
Stakeholders reported a general lack of
clarity around decision-making processes
(KF XIII). Erosion of trust due to a lack of
clarity around decision-making
processes, if left unchecked, could
undermine MeTA’s multi-stakeholder
process (KF XVII). In a similar vein, some
stakeholders, particularly in relation to the
sub-committees, do not fully understand
how roles and responsibilities are
allocated. There is a generalised
confusion about how activities are
allocated and executed with a clear
expressed need that greater transparency
is desirable in this area (KF XIV).
5. OUTPUT
The adjacent cross-country table shows the key findings of the multi-stakeholder assessment reports (third worksheet). Interpretation biases may be at stake
in these findings: the key findings of the individual reports (which are based on interviews and qualitative data) were used to make the "judgments" but it is
sometimes difficult to balance between the positive and negative findings.
Yes
6. CONCLUSIONS & RECOMMENDATIONS
Analysis of the cross-country tables of baseline component 3 can provide a quick overview of how well a
country has built the multi-stakeholder alliance through MeTA, whether there is balanced representation in the
multi-stakeholder group, and whether communication and information sharing has improved.
 The multi-stakeholder process in the Philippines has resulted in the strongest and most balanced stakeholder partnership
of all five pilot countries that underwent the multi-stakeholder baseline assessment at the end of the MeTA pilot phase,
with room for improvement in communication and information sharing and in stakeholder commitment, which is also the
case for Uganda and Zambia;
Have communication and
information sharing
improved thanks to
MeTA?3
 Jordan and Peru have built a strong multi-stakeholder alliance in a relatively short period (less than the Philippines) and
have contributed significantly to improved communication and information sharing about medicines in the country;
 Countries need to continue to sustain and/or improve the multi-stakeholder commitment.
Yes
Stakeholders have expressed a firm belief A large number of stakeholders agree
that MeTA Jordan has significantly
that MeTA has had a positive impact on
improved information sharing and
the exchange of information between
communication. Stakeholders have
stakeholders and appreciate the support
benefited enormously from being present from the Secretariat in this regard. The
together around one table (KF II). A large
Secretariat is praised for its
majority of stakeholders reported that responsiveness when problems arise (KF
they are very happy with the
II).
communication they receive from the
MeTA Secretariat, in terms of supporting
Council meeting proceedings; and
communication methods such as email,
SMS and telephone are used to good
effect. Information to support
stakeholders in policy work, decisionmaking activities, advocacy and general
awareness raising through
communication products however, has
been highlighted as an area for
improvement (KF XI).
Yes
7. FURTHER READING & CONTACTS
See the following linked posters: 1025 for an overview of the MeTA multi-stakeholder pilot; 1013 for the experience and results of the MeTA baseline
assessments; 967 for a cross-country comparison of the baseline pharmaceutical sector scan; 977 for a cross-country comparison of the data disclosure
surveys.
DFID has approved a continuation of the pilot phase . For more info on the 2nd phase of MeTA, please contact:
 DFID at [email protected], Tim Reed (HAI) at [email protected] or Gilles Forte (WHO) at [email protected]
UGANDA
ZAMBIA
Yes
Yes
Is there sufficient
stakeholder commitment
to the MeTA concept?
The current multi-stakeholder MeTA
In the year since its launch MeTA Zambia
Council comprises a number of high
has convened a broad group of
level, influential and well respected
stakeholders to work within the multimembers from Government, civil society
stakeholder process and has built a
and the private sector (KF I).
collaborative and spirited Council who
engage with each other in a constructive
way (KF I).
Yes
Yes
Partially
The MeTA Uganda Secretariat mirrors the There are concerns about the balance of
multi-stakeholder working pattern and is sectors on the MeTA Zambia Council and
comprised of representatives from the
the effect this may have on inclusion in
Government, civil society and the private
the process (KF XI).
sector (KF II). The private sector came to
the MeTA Uganda process later than the
other stakeholder groups but their limited
ability to feed into the work plan has been
recognised by the Council and future
planning processes will build in
opportunities for their issues to be
highlighted (KF V).
Partially
Generally, institutions that are part of the
Stakeholders within MeTA are clearly Some Council members are unsure about
Executive Committee are perceived as
comfortable with each other and work
their responsibilities as part of MeTA
having a greater capacity for decisionwell together. The Council’s Chair and
Uganda. This varied depending on
making, with the Council described as MeTA Secretariat staff have undoubtedly
sector. Government representatives
having a less active role in decisionestablished an enabling environment
found the lack of guidance in this area
making processes (KF IX). The perceived where stakeholders can freely express
particularly challenging. The
concentration of power within the
their opinions in an open way with each consequences of this are that ownership,
executive committee is acting as a barrier other without fear of reproach (KF III).
participation and implementation are all
to multi-stakeholder engagement within
affected with confused mandates
MeTA and is limiting constructive
between Government and MeTA Uganda
dialogue, teamwork and a sense of
(KF XIII).
ownership over the MeTA process,
including its country workplan (KF X).
The Executive Committee and Council
have never established or agreed internal
rules that clearly set out the governance
relationship between the Executive and
the Council, or how decisions will be
arrived at (KF XIV).
 Peru needs to ensure that roles and responsibilities are understood and practiced by all stakeholders.
More details on the multi-stakeholder assessments can be found on the MeTA website:
 Individual multi-stakeholder assessment country reports : http://www.medicinestransparency.org/meta-countries/
 Country comparison of multi-stakeholder process assessments : http://www.medicinestransparency.org/meta-countries/country-comparison/
 Tools for the multi-stakeholder baseline assessment: http://www.medicinestransparency.org/resources/meta-resources/meta-toolkits/
PHILIPPINES
Yes
3. OBJECTIVE
The multi-stakeholder assessment data was extracted from the individual country "Multi-stakeholder Assessment Report", prepared by Jordan, Peru, the
Philippines, Uganda and Zambia. The cross-country comparison comprises three worksheets:
 The first worksheet, “Selected indicators table”, presents a selection of the multi-stakeholder assessment data in the following categories: (i) main
stakeholders, (ii) MeTA governance and structure, (iii) MeTA multi-stakeholder process, (iv) barriers to multi-stakeholder engagement, (v) levers to multistakeholder engagement and (vi) recommended changes, whereby reference is made to the respective sections in the individual country reports.
 “Explanatory notes" is the second worksheet in the cross-country comparison Excel workbook and gives some background information on how the table in
the first worksheet is structured.
 The third worksheet presents "Key findings". The five questions under "Key findings" were not part of the multi-stakeholder assessments as such, but are
an attempt to present a qualitative interpretation of the multi-stakeholder process findings across the five countries. Based on the key findings of the country
reports, an attempt was made to synthesize the details in these five questions by answering Yes/No/Partially. A traffic light analysis was applied to this table,
with green for "yes", orange for "partially" and red for "no".
PERU
KEY FINDINGS1
Country Comparison of Multi-Stakeholder Process Assessments in the MeTA Baseline
Kerstens, Birgit (1); Saad, Samia (2); Bannenberg, Wilbert (1,2)
[email protected]
1: Health Research for Action (HERA), Belgium; 2: Medicines Transparency Alliance (MeTA) Pilot, United Kingdom
Problem Statement: No suitable tool existed to measure multi-stakeholder collaboration in MeTA countries. The concept was also new to in-country stakeholders, and led to substantial confusion and barriers in pilot countries at the start of MeTA.
Objectives: To assess the multi-stakeholder process in (MeTA) pilot countries and suggest ways to overcome barriers and challenges, with the ultimate aim of improving access to medicines.
Design: Cross-country study, desk-based review
Setting: The multi-stakeholder process involving public, private, and civil society sectors in five MeTA pilot countries (Jordan, Peru, Philippines, Uganda, and Zambia).
Study Population: A high level multi-stakeholder group (MSG), representing key national institutions from public, private, and civil society sectors; and from academia.
Intervention: MeTA partnered with the Institute of Development Studies (IDS ), a global charity for international development, research, teaching and communications. situated on the campus of the University of Sussex, to create a set of tools for MeTA baseline component
3, a multi-stakeholder assessment . The assessments were conducted between February and August 2010 through face-to-face interviews using standardised questionnaires, as well as two workshops with stakeholders involved in the MeTA multi-stakeholder alliances.
Data was collected for ~2 months. Findings were presented in country reports. Cross-country summary tables were developed for comparison purposes, and analyzed by a MeTA consultant.
Outcome Measures: The cross-country study compares the governance and structure of each MeTA pilot country MSG, the in-country multi-stakeholder process, the barriers and levers to multi-stakeholder engagement and lists all recommended changes for future
working.
Results: Report with a cross-country analysis of the multi-stakeholder assessments, showing in which areas the countries are similar or different, and how they compare in terms of governance, structures, communication, and data sharing. Lessons learned about the multistakeholder process: these can be used in the future by countries applying the MeTA concepts. Individual country assessment reports and the cross-country analysis have been placed in the public domain.
Conclusion: Analysis of the cross-country table of baseline component 3 can provide a quick overview of which country has built the best multi-stakeholder alliance through MeTA, whether there is balanced representation in the MSG, and whether communication and
information sharing has improved.
Funding Source: UK Department for International Development (DFID).
JORDAN
Yes
Stakeholders have a real understanding
of the need for dialogue and mutual
support within the MeTA Zambia
structures and processes (KF II). The use
of Sub-Committees has led to a sensible
division of labour amongst Council
members and the wider stakeholder body
(KF IV). Because the Secretariat is hosted
by Transparency International Zambia
(TIZ), an organisation with the mandate to
play the role of a watchdog institution
against corruption and poor governance,
the role of MeTA may have been
misunderstood by some Government
stakeholders (KF IX).
Partially
Partially
Partially
The majority of stakeholders reported
being appreciative of the communication
they receive from MeTA, the circulation of
MeTA Council minutes being a commonly
cited example. Despite having a welldeveloped and useful website, few
stakeholder cited the MeTA website as a
source of regular information or as a
vehicle to encourage multi-stakeholder
engagement (KF XV). The need to create
a range of new communication products
(a communication toolkit) is an important
tactic that could greatly support the multistakeholder process. We consider such
products as essential in promoting the
benefits of being a MeTA member; as
well as helping stakeholders
communicate more effectively with a nontechnical audience about MeTA’s
purpose. Other communications ideas
such as having on-line e-forums and
discussion groups were felt to be useful
by a range of stakeholders (KF XVII).
As MeTA Uganda’s work develops
organisational systems and
communications and processes will need
to adapt in order to engage and
incentivise a wider body of constituency
members. A greater focus on outward
communications through public relations
work and political engagement will be
necessary (KF XV). In the Ugandan
context there are significant gaps in the
availability of information and research on
essential medicines – this is a key gap
that MeTA Uganda could be filling
through a website that acts as a
repository of health resources and other
communications/information tools (KF
XVI).
MeTA Zambia has a sub-committee for
"Communications activities" (see
workplan). Overall stakeholders
considered the internal communications
to be useful and supportive (see section
7.8.1). Broader communications takes
place with radio shows and road shows
aimed at the general public. The Coalition
also plays a part in feeding information to
its constituents. Interviewees pointed to
the value of research in getting
information out. Work with Government is
under way (see section 7.8.2). It is
recommended to "Develop a public
relations plan and associated products,
particularly the website, which better
explain the added value and unique
approach of MeTA" (see Recommended
Partially
Partially
Partially
Council meeting attendance is variable
but the Chairs and the Secretariat are
aware of this and are thinking actively
about how members could be
incentivised (KF VIII). Stakeholders
outside the Council, particularly within
civil society, are keen to engage with
MeTA Uganda but there are currently few
opportunities to hear about the work of
the Council and to feed into decision
making and activity development (KF XI).
There is considerable passion shown for
the issues under discussion in the MeTA
Zambia Council and its Sub-Committees
and stakeholders show dedication in
working towards the delivery of the work
plan; often providing time and inputs on a
volunteer basis (KF III). The multistakeholder process has been hindered
by differing expectations of what the
project could achieve and its proposed
trajectory (KF VI). Volunteerism and
perceived inadequate financing for
activities de-motivates stakeholders in
MeTA Zambia (KF VII).
There is no doubt that there is
MeTA Peru has considerable potential to Attendance at MeTA Council meetings is
considerable passion and commitment to
affect desirable change and this is
active but only among a small circle of
MeTA’s agenda from stakeholders (KF I). observed by stakeholders who view MeTA regular members; and some members
as a space where team work could be
habitually do not attend. Sustained and
fostered (KF III).
productive engagement of key officials
within the Department of Health remains
a challenge (KF IX).
change #8).4
Notes : 1 These "key findings" are an attempt to present a qualitative interpretation of the multi-stakeholder process findings across the five countries. These questions were not asked within the framework of the stakeholder interviews conducted under Component 3 of the MeTA baseline
assessments, but added as an overall appreciation of the current multi-stakeholder process, based on the key findings (KF) of the individual country reports (to which a reference is made). More details can be found in the five multi-stakeholder assessment country reports. 2 Multistakeholder alliance is defined as members from public sector, private sector and civil society organisations. 3 See the Data Disclosure country reports for more details. 4 Since there are no key findings related to communication and information for MeTA Zambia, these findings have been
extracted from the report itself.