tackling corruption in the health sector: the role of the medicines transparency alliance (meta)

Andrew Chetley

Communication Director

MeTA Secretariat

Medicines Transparency Alliance: helping markets work for the poor

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MeTA numbers

26 key supporters (governments and organisations) 10 broad principles 7 pilot countries 3 essential stakeholder sectors 2 major commitments 4 areas of information disclosure 1 goal: improve access to essential medicines for

the 2 billion people who currently lack access

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26 supporters of the objective of increased equitable access to medicines

Association of the British Pharmaceutical Industry

AstraZeneca Co-operative Investments Ecumenical Pharmaceutical Network F&C Investments GlaxoSmithKline Government of Peru Government of the Hashemite Kingdom of

Jordan Government of the Kyrgyz Republic

Government of the Republic of Ghana The Government of the Republic of the

Philippines Government of the Republic of Uganda Government of the United Kingdom Government of the Republic of Zambia

Health Action International Global Indian Pharmaceutical Association Institute for Democracy in South Africa International Federation of Pharmaceutical

Manufacturers and Associations International Pharmaceutical Federation Merck Novartis Partnership for Supply Chain Management SustainAbility Transparency International World Bank World Health Organization

…and growing daily …

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10 Principles

1. Good health is crucial to human dignity and to social and economic development.2. Efforts to improve health depend on effective health systems 3. Inefficient procurement, distribution, and supply of medicines, weak regulation and

poor supply chain management, and lack of information can result in unaffordable/unavailable medicines.

4. Urgent action is required to address these challenges.5. Public understanding could inform public debate, enhance public policy and drive

improvements6. High standards of transparency can build trust and accountability .7. A multi-stakeholder approach can build understanding on how to develop greater

transparency and accountability. 8. Action to increase transparency and accountability should do no harm, support

national development and harmonisation plans, respect the rule of law and be guided by concerns for social justice,

9. We recognise the need to pilot and evaluate these actions.10. Our ultimate objective is to increase equitable access to medicines.

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7 Pilot Countries

… pioneers, leaders, champions – innovators!… and an International Advisory Group

3 key stakeholder sectors

Public: (ministries – not only Health; health service managers and facilities; regulatory agencies; health and welfare insurance schemes)

Private: (manufacturers; wholesalers; distributors; retailers; private practitioners and services; private health insurance; investors)

Civil society: (communities, patients, consumers, transparency and rights groups, media, faith-based organisations)

2 major commitments

Progressive disclosure of data in four areas Development of an effective multi-stakeholder forum

– ‘All too often, government planners, business executives, and non-profit organisations have operated at cross-purposes and failed to coordinate their efforts in ways that would achieve shared goals.’ (Gupta, R. 2007. Health International, McKinsey & Co.)

… transparency and (mutual) accountability

4 disclosure areas; 4 contextual areas

Quality Availability Price Promotion

Supply chain operations Medicine affordability Equitable access Rational use

One goal

Increased access to essential medicines by poor people by:– shifting some decision making power– Increasing competitive pressure on suppliers– Improving the effectiveness of the supply chain– promoting better governance– ensuring more appropriate resource allocation– encouraging innovative and responsible business practices– Increasing the voice of patients and consumers

And improving people’s health!

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Complexity: of the medicines supply system

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

innovation

new and different voices

equity

dynamic dialogues

transformation

different perspectives

problem solving

mutual accountability

changing business practice

social justice

new partnerships

transparency

Complexity: of change

•18 months planning and consensus building •7 countries commit politically•Growing list of international stakeholders who support the concept•International Secretariat in place•International Advisory Group underway•International launch – “2nd phase of the peaceful revolution in international public health” now underway!

Achievements so far

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Peru: health insurance company brings down the price of medicines by 30% - who benefits?

Uganda: 50% of medicines for the public sector are found in the private sector – who pays twice?

Jordan: high prices include a government tax – united voices for change

Philippines: 2000 separate procurement approaches – how to avoid conflict of interest?

Four stories of change

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•How do we engage with new stakeholders (at every level) to increase support for the concept?•How do we work with the diversity at national level, yet still have meaningful sharing of lessons internationally?•How do we work towards multiple bottom lines: everyone wins (everyone prepared to give something away)?•What does success look like? (How will we know it has worked?)

Challenges we face

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More information

Contact the MeTA Secretariat– International Secretariat, info@metasecretariat.org– Andrew Chetley, achetley@metasecretariat.org

– www.MedicinesTransparency.org– and have your say: join in to MeTA-Dialogue – an

interactive discussion group at:

www.dgroups.org/groups/MeTADialogue/index.cfm