Medicines Transparency Alliance

Presented by Gilles Forte Department of Essential Medicines and Health Products, WHO On behalf of WHO and HAI Technical Briefing Seminar 29 Oct - 2 Nov 2012, Geneva

MeTA hypothesis

Transparency

Reliable information on medicines policies

Multi-stakeholder approach

Improved Policies Access to medicines improved

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MeTA aim

 MeTA aims at improving access to and use of quality medicines by increasing transparency of the pharmaceutical sector through collection of reliable data, valid analysis, and then disclosure for advocacy, accountability and policy dialogue among stakeholders e.g. private sector/public sector/civil society.

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About MeTA

 7 countries: – Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda and Zambia.

 Pilot Phase from 2008-2010 – Established multi-stakeholder platforms with MoH, CSOs; private sector etc. – – – Collected baseline data & capacity building for it; Initiated/tested transparency initiatives: e.g. Peru; External evaluation  Phase 2 from 2011-2015 – Address information gap from Pilot Phase – – Support countries transparency and disclosure strategy Convert dialogue into policy recommendations and interventions  WHO and Health Action International provide: – Project coordination – Technical support through the provision of data collection, analysis & dialogue methodologies, capacity building and policy guidance.

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MeTA Core Principles

 MeTA priorities are aligned with country priorities for improving access to medicines;  Governments perceive it as “a catalyst for evidence-based policy change and implementation”;  MeTA priority interventions will be implemented and monitored through an agreed workplan in line with national health and pharmaceutical workplans;  MeTA builds bridges, stimulates dialogue among stakeholders in countries, helps identify areas of common interest, facilitates alignment of goals between stakeholders;  MeTA facilitates countries sharing of experience and evidence to accelerate improvement;

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Private sector at country level

 Multinationals and Innovators  Generic importers  Local Manufacturers  Wholesalers, distributors  Retail pharmacies  Drug shops  Private health care providers  Mission Sector  Insurance companies 

et al …

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Civil Society at country level

 Health NGOs/CSOs (domestic & international)  Medicines NGOs/CSOs  Transparency NGOs  Patient Groups  Consumer Groups 

et al …

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Government at country level

 Ministries of Health  Medicines Regulators  Government Insurance Funds  Government Procurement  Chief Pharmacists/Medical Officers 

et al …

What could be disclosed?

Medicines Registration and Quality Assurance

 Market registration procedures and registration status of all medicines  Good Manufacturing Practice (GMP) outcomes for domestic and foreign manufacturers  Quality assurance processes in public and non-profit tenders  Quality assurance data during registration or procurement  Routine quality testing and adverse event monitoring

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What could be disclosed?

Medicines Availability

 Volume and value of medicines procured in the public and non-profit sectors  Volume and value of medicines supplied in the private sector  Availability of medicines to consumers  Routine audits for public, private, and non-profit medicines outlets

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What could be disclosed?

Medicines Prices

 Consumer and ex-manufacture prices of medicines in the public, private, and non-profit sectors  Public sector medicines procurement prices  Medicines price components in the public, non-profit, and private sectors  Pharmaceutical patents held in the country

Medicines use and Promotion

 Standard treatment guidelines  Essential medicines list  Medicines promotion regulations, policies, and industry practices

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MeTA "Success stories" from the Pilot (2008-2010)

 The National Medicines Regulatory Authorities of Kyrgyzstan, Uganda and Zambia have created web-sites on which they make available key information like list of registered medicines, list of authorized wholesalers, etc.

 Peru developed a database of medicines prices in public and private pharmacies. The system allows consumers to compare the prices and choose where to buy. This increased competion is meant to reduce prices of medicines.  Jordan conducted studies on access to medicines in health facilities and households. The studies indicated issues with rational use of medicines and therefore MeTA has supported the country to develop Standard Treatment Guidelines for key diseases.

 In the Philippines MeTA contributed to the enactement of the "Cheaper Medicines Act" 2008 and to the establishment of an e-procurement system for medicines.

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Lessons learned from the pilot

 Multi-stakeholder working is a new concept – not easy – it takes patience, understanding, diplomacy and tact;  Identifying champions in each sector can greatly expedite the process of multi stakeholder engagement and transparency;  Each sector needs to “give & take” to build consensus;  Conflict of Interest identification – transparency;  The MeTA process needs to be country-led and with guidance;  Gaining consensus and understanding requires a constant and frank exchange of views;  Tools for gathering baseline data on access do already exist; new innovative ‘user-friendly’ and cost effective tools required for M & E of progress.

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MeTA 2011-2015 targets

 Median consumer price ratio for EM decreased by10%;  Mean availability of EM increased by up to 10%;  Estimate efficiency savings through reduced prices, efficient procurement and appropriate use of medicines;  Transparency, accountability improved;  Multi-stakeholders policy dialogue effective and address country priorities;

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Main areas of technical work

Ghana Jordan Kyrgyzstan Peru Philippines Uganda Zambia Monitoring price and availability National drugs policy National drugs policy Analysis and use of phase 1 data Supply chain management RUM: antimicrobial resistance Monitoring price and availability Monitoring price and availability Analysis and use of existing data Medicines promotion assessment Monitoring price and availability RUM: DTCs Analysis and use of existing data Development of tools Determinants of availability Public sector procurement Public sector procurement Quality assurance Quality assurance Quality assurance

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Main areas of Civil Society activities

Ghana Jordan Kyrgyzstan Peru Philippines Uganda Zambia

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Assessment of CSO capacity Capacity building for communications Capacity building for communications Involvement of CSO in communications activities CSO campaigns to improve knowledge on patient rights Capacity building for collection of data and pilot data collection Expand involvement of CSO in promoting access to medicines Awareness of drug entitlement programmes Capacity building for communications Community monitoring pilot Empowerment of communities to own services and holder duty bearers to account Capacity building for community radio Improve awareness of regulatory issues CSO campaigns on patient rights and antibiotic use Expand involvement of CSO in development of methodologies and policy recommendations