Wilbert Bannenberg, Technical DirectorMeTA International Secretariat

IACC 14Bangkok, 13 November 2010

MeTA multi-stakeholder process – a way to improve transparency in the pharmaceutical sector

Overview

What is the problem with medicines? What is MeTA trying to achieve? Why work multi-stakeholder? What have we learned so far? Conclusions

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Medicines supply – Transparent?

Contra-ceptives and

RHequipment

STIDrugs

EssentialDrugs

Vaccinesand

Vitamin ATB/Leprosy

BloodSafety

Reagents(inc. HIV

tests)

DFID

KfW

UNICEF

JICA

GOK, WB/IDA

Source offunds for

commodities

CommodityType

(colour coded) MOHEquip-ment

Point of firstwarehousing KEMSA Central Warehouse

KEMSARegionalDepots

Organizationresponsible

for delivery todistrict levels

KEMSA and KEMSA Regional Depots (essential drugs, malaria drugs,

consumable supplies)

ProcurementAgent/Body

CrownAgents

Governmentof Kenya

GOK

GTZ(procurement

implementationunit)

JSI/DELIVER/KEMSA LogisticsManagement Unit (contraceptives,

condoms, STI kits, HIV test kits, TBdrugs, RH equipment etc)

EU

KfW

UNICEF

KEPI ColdStore

KEPI(vaccines

andvitamin A)

Malaria

USAID

USAID

UNFPA

EUROPA

Condomsfor STI/

HIV/AIDSprevention

CIDA

UNFPA

USGov

CDC

NPHLS store

MEDS(to Mission

facilities)

PrivateDrug

Source

GDF

Government

NGO/Private

Bilateral Donor

Multilateral Donor

World Bank Loan

Organization Key

JapanesePrivate

Company

WHO

GAVI

SIDA

NLTP(TB/

Leprosydrugs

Commodity Logistics System in Kenya (as of July 2006) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to skinzett@cb.jsikenya.com or telephone 2727210

Anti-RetroVirals

(ARVs)

Labor-atorysupp-lies

GlobalFund forAIDS, TB

and Malaria

PSCMC(CrownAgents,GTZ, JSI

and KEMSA)

BTC

MEDS

DANIDA

Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level

MEDS

Provincial andDistrictHospital

LaboratoryStaff

Organizationresponsible fordelivery to sub-district levels

KNCV

MSF

MSF

JSI/DELIVER

KEMSA

JSI

WHO

Source: SSDS Inc for the World Bank

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Transparent prices & availability, but quality?

Source: TI Global corruption report 2006

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Medicines supply chains are prone to corruption

Source: TI Global corruption report 20065MeTA

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Access to medicines - background

30% of mankind still no access to essential meds Valid concept: essential medicines (WHO, 1977) Government alone cannot provide access to all

– Weak health systems– Policy, efficiency, management, HR, & financing issues

Private sector: off message?– High prices, wrong focus (non-essentials, sell where $$ is)– Exception: non-profit private sector (churches, NGOs)

Civil society: ideals & drive; but lacks expertise & resources

MeTA

The MeTA Hypothesis

Work multi-stakeholder:– Structured dialogue: Govt – Private sector – CSO

All parties are asked to disclose information on:– Price, Quality, Availability, Promotion

Transparency, Dialogue & Accountability – Better ad-hoc solutions & policies– Mutual support & capacity building

Will eventually lead to better access to medicines

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The birth of MeTA

UK cabinet white paper 2006 gave birth to MeTA– Based on 2004 Access to Medicines Policy– Modeled after Extractive Industries Transparency Initiative

(EITI) 10 year commitment

– subject to positive evaluation after 2 years– 7 countries invited to join pilot phase 2008-2010

Exploratory meetings with stakeholders 2007

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MeTA

International alliance: DFID (UKAID), WHO, World Bank Multi-stakeholder: private, public sector and civil society Country-led, bottom up process in 7 pilot countries:

Peru, Ghana, Uganda, Zambia, Jordan, Kyrgyzstan, and the Philippines

TA, (limited) $$ and capacity building from MeTA Intl.13/11/20109MeTA

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MeTA Theory of Change

Robust & relevant information

(Transparency)

Better policies and implementation

(Efficiency)

Multi-sector data sharing

(Accountability)

Improved access to medicines

Routine Data Collection

Why use Multi-Stakeholder Processes? MSP’s engage stakeholders in processes of

dialogue, trust building and collective learning, that aim to improve innovation, decision making and action.

They may also be specifically focused on overcoming conflict.

They are particularly relevant in situations where the dynamics between different stakeholder groups and interests means that progress is difficult or impossible without constructive engagement.

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General Concerns with MS processes

Incentives? Particular stakeholders being marginalised Self-selection of CSO participants Funding / resources Uneven information base Differences in language and culture Each set of stakeholders has to learn a new

lexicon in relation to the other So as to get past previous, often deeply ingrained,

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Challenges in MS processes

Will mutual accountability flow? Will civil society have a strong enough voice? Will civil society have the technical knowledge? Will the private sector engage? Will governments let go of some control? Is there a clear outcome, or only gradual change over

time that might have happened anyway? (What can we measure?)

Can everyone win?

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Civil society involvement

Civil society engagement is crucial for MeTA– “Eyes and ears” of society

Civil society’s capacity was strengthened– strengthened networks & capacity, – promoted Essential Medicines concepts, – advocacy on national media, in Parliament– Performed pricing & baseline surveys– Learned how to do procurement ‘watch’

All 7 pilot countries set up national CSO coalitions

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Government (institutions)

Opinion leaders see value in the principles of transparency and multi-stakeholder working

Many concepts (SWAp, Basket funds, Paris/Accra) or similar projects (WHO/GGM, WB Transparency, U4 anti-corruption) competing for attention

Civil servants are reluctant; change slowly Need for adapting medicines’ policies recognized Drug Regulatory Authorities active & benefitting

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Private sector involvement

Brings us good and poor quality, even fake medicines Private sector is very diverse at country level:

– Brand-name - Local manufacturers– Generics - Wholesalers– Retail - prescribing health workers

Win-win possible– Good guys want the bad guys out (counterfeits, substandard)– Increase ethical standards & code of conduct– Basic health insurance– Access to more reliable data

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MeTA lessons learned

Activity needs to be led by participating countries The right people need to be involved from the outset Commitments needs to be made by all parties involved Gaining consensus and understanding requires a constant

and frank exchange of views Some decisions will be tough - stay focused on the

objectives Tools exist or have been developed Building trust takes time – but is crucial

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Lessons from MeTA

IF Right mix Enough time Clear aim and

approach Sufficient

resources Facilitation Learning and

flexibility

Multi-sector lessons learned

Establishing multi-sector stakeholder groups takes time– Private sector fragmented, civil society weak and/or diverse– Little experience of working together

Demonstrating benefits of participation challenging at start– New process, uncertain link to policy, finding common ground– Worked best where focus existed – Philippines, Peru and

Jordan Sector contributions variable but some successes

– Contributions from ‘private sector’ modest– Support for multi-stakeholder working increasing

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Some results

All: Baseline studies, disclosed data, new MS collaboration Ghana: analysis of NHIA data for evidence-based policy Jordan: new Treatment Guidelines and Rational Drugs List Kyrgyzstan: mini-labs to quality test 400 medicine samples Peru: legislation and systems for new Price Observatory Philippines: Cheaper Medicines Act; Universal Access policy Uganda: private sector and CSO consultation on new health &

pharmaceutical strategy Zambia: media campaigns to raise awareness on medicines more at www.MedicinesTransparency.org

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Evaluation – Summary

Model shows promise but needs consolidation, stronger communication and new implementation model:– Establish core set of activities, tools and sequence of

activities– Better understanding of diversity of ‘private sector’– Guidance on data disclosure/sharing– Flexible approach to multi-sector working– Embed in country processes and institutions– Stronger focus on value for money in implementation

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Conclusions

Multi-stakeholder working = new concept – not easy Each sector needs to “give & take” It takes time to build trust You can learn from each other Working multi-stakeholder brings benefits to all Interest is big, and patients will most likely get

better access to medicines (if the MeTA process continues)

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So what?

MeTA pilot phase is over; the new DFID Ministers will shortly decide about next phase of MeTA

All 7 pilot countries want to continue Most stakeholders now engaged in MS processes Needs more support of development partners and

local organizations for long-term sustainability The concept of transparency is there to stay!

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Contact?

Wilbert Bannenberg wilbert@metasecretariat.org Mob: +31-6-20873123 www.MedicinesTransparency.org

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