meta ghana

Medicines Transparency Alliance

Country Overview

Public Sector

Private Sector

Civil Society

MeTA Ghana

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Medicines Transparency Alliance21/04/23 2

Country Overview

Augustina Koduah (Mrs)Country Coordinator


Multi-stakeholder processWhat were the major milestone in the multi-stakeholder process? Inaugural Meeting of Governing Council by Deputy Minister in September 2008

Official Launch in November 2008

First National forum in December 2009

CSO & Media Orientation in April 2009

Quarterly Governing Council Meetings to date

Independent monitoring of medicines quality through routine testing with FDB & monitoring access to medicines using NHIS data based on agreed indicators with NHIA established

Participated in major MeTA led International activities [MIAG & Jordan Training]

Launch and Sensitization of Ghana MeTA CSO Group community targeted communication activities in April 2010


Examples

Multi-stakeholder analysis workshop carried out in June 2010

National Multi-stakeholder Technical discussion forum on data disclosure in June 2010


Major achievements and successes

What where the main achievements and successes of MeTA in your country? Active Multi-stakeholder Council made up of excellent spread of relevant stakeholders with sub committees (Administration, Advocacy & Technical) & a strong interest to move forward towards regular dialogue on medicines issues

Independent Secretariat & Functional Website www.metaghana.org

Facilitated an active independent civil society capacity to lead consumer advocacy campaign to support disclosure and accountability on access to medicines

Baseline Pharmaceutical disclosure survey & sector scan studies completed

Good collaboration established with NHIA to use data to monitor access to medicines based on agreed indicators with promising public health benefits

Case studies shared with other MeTA countries through international meetings and country exchange visits

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Major Achievement

Results of Routine Minilab Quality Assurance Test led to necessary regulatory interventions


Overall challenges

What have been the main challenges during the MeTA pilot phase?Initial unclear Standard Operating Procedures

Latent mutual suspicion between the state and private sector;

Nervousness of some stakeholders about change;

MeTA assumes that enforcement mechanisms exist across the medicines manufacture, import, procurement and distribution systems, but historically enforcement of regulations is weak;

Slow and Bureaucratic Decision Making process

Maintaining momentum of stakeholders over time. (Diminishing returns)

Working together to build trust & understanding between different stakeholders is difficult

Timeliness and sustainability of financing beyond the pilot phase.

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Lessons Learned

What are the main lessons from MeTA in your country?

Players in the pharmaceutical sector have varying interest and power

Multi-stakeholder groups in the pharmaceutical sector have a better understanding of each other through transparent and systematic engagement

Potential to make a positive impact in medicines access through transparent multi-stakeholder and systematic data sharing and disclosure works.

Providing Ghanaian leadership on medicines transparency disclosure and dissemination of information to eliminate the risk of counterfeit and substandard medication as well as pricing in the supply chain

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Thank you

Name of presenter : Augustina Koduah (Mrs) Email: [email protected]

Mobile number: +233 20 8769228


Public Sector

Mr. Samuel Boateng

Office of Chief Director

Ministry of Health (MoH)


Summary Analysis at start of MeTA

What were the needs and issues in your specific sector at the start of MeTA?Strong existing enabling and legislative environment BUT

Benefits of improved procurement not translating into affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey);

Inconsistency with other sectors (private and mission) in terms of how standards (i.e. quality, availability and pricing) are developed and applied;

Low consumer awareness due to very little information on quality, availability and prices of medicines in the public domain,

Non-adherence to treatment guidelines by prescribers and irrational use of medicines by providers persists despite improved guidance and education;

Supply chain performance problems from CMS downstream leading to high stock-out rate;

Vulnerability of NHIS to fraud due to inefficient data analysis and dissemination

Public health safety concerns arising from counterfeit and/or substandard products


Major milestones

What milestones have been achieved during the MeTA pilot phase? Proactive engagement with private sector, development partners &

civil society through multi-stakeholder collaboration in information sharing to build consensus around availability, quality, pricing and rational use to increase access to essential medicines for the poor

Periodic monitoring of medicine prices and availability as well as their rational use using WHO standard indicators-2008

Key Data on medicines from the NHIA made available for systematic analysis and dissemination to improve transparency, accountability, pricing and quality.

Independent monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’ 2009.

Partnership with CSOs to provide more information to consumers, around quality & rational use in medicines advocacy

Data validation of NHIA data carried out; awaiting dissemination

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Successes

What were the successes for your sector during the MeTA pilot phase?

Provided Ghanaian leadership on medicines transparency and accountability through multi-stakeholder engagement as model in West Africa for both effective governance and market efficiency.

Initiated opportunity for pricing and rational use of medicines monitoring mechanism to inform the NHIS

Reduced and/or eliminating the risk of counterfeit and substandard medication in the supply chain.

Provided mechanism for public sector commitment to fight inefficiency and corruption in the drug supply landscape.

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Challenges

What challenges has your sector endured during the MeTA pilot phase?

Mutual suspicions and mistrust between sectors;Nervousness of all stakeholders about change;Need to assume a degree of commitment to

transparency by all stakeholders and willingness to be mutually accountable.

Sustaining regular open stakeholder dialogue and commitment of all parties in all sectors.

Right to Information Bill yet to be passed into legislation Dealing with sensitivities of various interest groups in

the sector

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Lessons Learned

What are the lessons that your sector has learned from MeTA?Multi-stakeholder involvement helping to break barriersTransparency & Accountability in the engagement process is

vital for success of MeTA The need to accommodate the interests and perceptions of

all local stakeholders to reflect the character of the multi-stakeholder is a key ingredient for its efficiency

The essential elements of a strong, vibrant and sustainable MeTA in Ghana are: Having the right people connected and committed Willingness of stakeholders to be mutually accountable Ghanaian ownership driven Sustainable political commitment

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Thank you

Name of presenter: Mr. Sam Boateng

Job Title: Office of Chief Director, MoH; Member, Ghana GC Email: [email protected]

Mobile number: +233 244 269336

Website: www.moh.gov.gh


Private Sector

John AlloteyManager, Business DevelopmentLaGray Chemical Company, Nsawam, Ghana



Lack of market data– Medicines available in therapeutic areas– Sources of medicines– Pricing – both open market and retail

Uncertainties around regulatory issues– Steps in the approval process– Time taken for approval of application

Poor knowledge of government procurement system– Competitive advantage of local manufacturers– Personalities and approachability of government personnel

Limited engagement with National Health Insurance Authority– Medicines list – Pricing


Major milestones

Active participation of private sector in MeTA– Participation in planning and launching the pilot

Launch of MeTA as multi-stakeholder process

Participation in ‘Level Playing Field’ with other sectors eg. Govt., CSO, etc

Movement towards regular, open stakeholder dialogue– Ghana forum– London Forum– Opportunity to present case of local manufacturing

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Successes

Recognition of potentially rich sources of information for MeTA to harness and make an impact– Food and Drugs Board registry of medicines– Procurement information from Ministry of Health– National Health Insurance data on prescriptions

Value of political will– MOH support making MeTA Ghana possible

Meeting other stakeholders– Appreciation of problems of other stakeholders– Willingness to work as a team to improve access– The beginning of trust building

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Challenges

Some lack of interest in work and activities of MeTA– Competing issues and challenges within the sector

– Threats from ‘cheap’ competition– Threats (perhaps unintended) from foreign largesse

(e.g. Affordable Medicines- Malaria)– Need of government support to build industry

Some suspicions around motives of MeTA– Status as independent entity questioned– Potential for manipulation of objectives

– May be used by both local as well as multinational pharmaceutical companies to discredit each other

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Lessons Learned

Transparency around medicine quality,availability and pricing is possible– Potential for data sharing or disclosure exists– MeTa can be honest broker because of multi-stakeholder

status

Persistence required in sustaining interest of all– Commitment of stakeholders– Work required in allaying suspicion and obtaining

consistent cooperation

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Acknowledgements

Dr. Paul A. Lartey – PMAG

Dr. Isaac Morrison - SPMDP

Pharmaceutical Society of Ghana

Association of Licensed Chemical Sellers

Ghana Medical Association

Ghana Registered Midwives Association

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Thank you

John Allotey

Manager, Business Development, LaGray Chemical Company, Nsawam, Ghana

Email: [email protected]

Mobile number: +233-20-831-7767

Website: www.lagraychem.com


Civil Society

Presenter: Charles Allotey Executive Director-Health Access Network

Ralph Ahiabu Director of Programs - DeSMAS



What were the needs and issues in your specific sector at the start of MeTA?Lack of organized civil society coalition directly involved in issues related to access to medicines.Lack of capacity among civil society organizations to deal with medicines issues, especially where technical in nature.Ignorance among community members on issues surrounding medicine prices, quality, availability and access in general.Patients and consumers lacked information and power to realize their rights to healthcare and medicines - e.g. rights in Patient’s Charter, benefits and quality of care under National Health Insurance Scheme. Inadequate linkages and collaboration between the public, private and civil society sectors.


Major milestonesWhat milestones have been achieved during the MeTA pilot phase?Built network and made linkages amongst civil society organizations across all 10 regions of Ghana.

Enhanced capacity of network members on access to medicines and transparency issues - e.g. workshops at various levels.

Established online social network (NING Group) to facilitate communication and mutual visibility of network members.

Launch of Ghana MeTA Civil Society Group by the Deputy Minister of Health.

Developed 4 educational posters targeted at consumers on relevant medicines issues in Ghana – translated into 7 major local dialects.

Undertook community awareness-raising activities, including public fora and radio programs.

Held a detailed mid-term review; developed forward plans for 2010-11.

In sum: We have achieved a lot, with limited resources. And more is planned!21/04/23 27


Successes

What were the successes for your sector during the MeTA pilot phase?Enthusiasm has been created among community groups who are now able to engage in discussions on medicines issues.

Trust and collaboration are emerging between CSOs and public sector agencies on transparency and access to medicine issues.

We have enhanced awareness among consumers on patients responsibilities, counterfeit and substandard medicines, and the rational use of medicines.

We have a database and linkages at national, regional, district and community levels that will facilitate information sharing and joint advocacy, right across the country.

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Challenges

What challenges has your sector endured during the MeTA pilot phase?Sustaining interest of network members to engage actively in the MeTA process following the establishment of the network.

Aligning individual and organizational interests of network members to the core objectives of MeTA.

Demands made on members engaged in the organizational process were very high due to the sacrificial nature of the work.

Limited resources constrained the creative and innovative ideas that would have enriched the overall outcome. For example, we had hoped to engage in some operational research on medicine related issues in communities nationwide. This would have engaged network members proactively, resulting in (bottom up) data to complement that at policy level (top down).

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Lessons Learned

What are the lessons that your sector has learned from MeTA?Non-health professionals within the CSO network are able to engage with a wide range of stakeholders and the media on issues relating to transparency and access to medicines – The CSO network includes those working on governance, corruption, women’s rights, children’s rights, community health, etc.

The CSO sector is gaining valuable knowledge and experience through participation in the MeTA multi-stakeholder process.

Working with different stakeholders is possible and offers a better opportunity to address challenges than one stakeholder group acting alone. **For example, on [issue x]**

Opportunity created through the MeTA process to work with people with diverse professional backgrounds, skills and expertise resulted in achieving better outcomes. **For example…we achieved…**

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Thank you Name of presenter Charles Allotey

Job Title Ghana MeTA CSO Group Coordinator Email: [email protected], [email protected]

Mobile number: +233 (0)244280284

Skype: kallotey

Website: www.hanghana.org

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