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Southern Arican Regional Programme

on Access to Medicines and Diagnostics

CIVIL SOCIETY MEETING REPORT

How can we work in partnership to improe access

to Medicines & Diagnostics in Sothern Arica?

21 22 March 2010, Nairobi, Kenya

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SouthernAfrica

2TABLE OF CONTENTS

RECORD OF THE CONSuLTATION

1. Establishing a common agenda to improve access in Southern Arica 3

2. Objectives o the consultation 3

3. Who was there 3

4. The meeting proceedings 4

5. Record o small group discussions & recommendations 4

6. Dening potential Partnerships or Action PACTs 5

7. Key points o consensus 6

8. Actions or the next steps 6

9. Conclusions 6

ANNEXES

A. Overview o SARPAM 7

B. SADC Pharmaceutical Business Plan 2007 2013: Summary 9

C. Participants List 10

D. Record o Open Agenda Discussions 11

E. First Drat CSLed Partnership or Action PACT Framework 23

F. The SARPAM Civil Society Reerence Group 25

G. Maniesto For Civil Society Action on Access to Medicines in southern Arica 26

H. Case Study: Partnership In Action 28

I. Workshop Evaluation 38

SARPAM Contact details

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ctiononAccesstoMedicines&DiagnosticsinSouthernAfrica

3RECORD OF THE CONSuLTATION

Through initial emailbased discussions, regional

and national CS representaties shared ideas on

how the cold potentiall contribte towards

improing access to medicines throgh more

intensie ocs on the sothern Arica region.

The subsequent consultation was called at short

notice to take advantage o the act that a number

o key Civil Society representatives would be

in Nairobi or other meetings. This oered an

opportunity or these individuals to engage in an

intensive process to:

MapouttheagendaforCivilSocietytoimprove

access to medicines and diagnostics in southern

Arica;

Learn about SARPAM and the possible

contributions it could make to the Access

agenda;

Interact with other CSOs working directly or

indirectly on pharmaceutical and treatment

access issues within the SADC region;

DeneaCivil-SocietyledPartnershipforAction

PACT in which each organizations potential

contributions are mapped out;

Engagewithaprocessforassessingthesupport

that each organization needs to make their

contributions as partners in the PACT;

Learn a methodology for developing further

Partnerships or Action.

1. ESTABLISHING A COMMON AGENDA TO IMPROvE ACCESS TO MEDICINES IN SOuTHERN AFRICA

3. WHO WAS THERE

2. OBjECTIvES OF THE CONSuLTATION

The Southern Arican Regional Programme on

Access to Medicines & Diagnostics SARPAM is

being designed through a process o consultation

and inormationgathering during an inception

phase that started in January 2010. During the

period, Partnerships or Action PACTs are

being explored to improe the aailabilit,

aordabilit and qalit o essential medicines

and diagnostics across the SADC region. These

PACTs should support implementation o the SADC

Pharmaceutical Business Plan to the end o 2013.

SARPAM oers the potential to strengthen thecapacity o regional institutions and civil society

to implement joint plans that will achieve agreed

results through multistakeholder action across

countries in the region.

The Responsible Action Consortium managing

SARPAM on behal o the U.K. Department

or International Development acilitated this

consultation or Civil Society in March 2010.

The meeting started with an open agenda or

participants to dene their own priorities to address

the challenge: How can we work in partnership to

improve access to medicines and diagnostics in the

Southern Arica region?.

Over 2 days, participants started the process o

engaging with each other as Arican Civil Society

to initiate a regionally ocused Civil Society Action

Networkthat will ocus on what Civil Society in the

SADC region can do to support implementation o

the SADC Pharmaceutical Business Plan.

Strong commitments to action were made by those

present to lead a Partnership or Action PACT

that will promote greater transparency in the

regional pharmaceutical marketplace and more

eective sharing and use o pharmaceutical market

inormation.

A Reerence Group o Civil Society ocal persons

was constituted to take this process urther with the

SARPAM programme management team.

The 25 participants Annex C represented a good crosssection o regional Civil Society Organizations CSO

and Faith Based Organizations FBO working on dierent Access issues, including: advocacy and campaigns;

legal and trade; research; service delivery; proessional standards and research.

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5

7. Qalit o Medicines

Supportforregionalstandardsandaccredited

quality control acilities.

InvolvementofCS in pharmacovigilanceand

raising prole o quality issues.

8. Priate Sector Engagement

CS platform can open debates on positive

engagement o the private sector including

participation in PACTs and other stakeholder

opportunities e.g. MeTA

CS advocate for increased Corporate Social

Responsibility CSR at country levels

9. Commnit Inolement

Studyandidentifybestwaystoworkwithand

support true community representation in the

dierent countries Link with and build capacity of Community

Based Organizations CBOs.

Advocate for sustainable nancing of

programmes that support communities e.g.

the WHO community care giver plan

10. Good Goernance

Promotedrugsupplysystemsthatarerobustand transparent and have measurable

indicators.

CSOs can act as critical watchdogs and

lobbyists.

11. Hman Rights and Access to Medicines

CSOscancarryoutevidence-basedadvocacy

CSbestrategicinaligningtheircompetencies

or maximum impact, including building

capacity or operational research.

On the second day, participants discussed possible

intervention areas in which CSOs/FBOs could take

more eective joint action with an intensied ocus

on southern Arica. They made the case or a range

o proposals or joint action through the PACT

mechanism, including to:

Establish a mechanism that will support pooled

and bulk procurement initiatives or essential

medicines. This would require: engagement o the

SADC Secretariat to recognize the role o FBOs

e.g. in service delivery; analysis o the reasons or

failuresofcrossborderbulk/pooledprocurement

attempts; and inclusion o FBOs in discussions on

a SADC pooled procurement market survey.

Strengthen the capacity o CSO/FBOs working

on access in the region to eectively support

implementation o SARPAM. Action areas

proposed could include: increasing capacity

of CSO/FBOs to handle medicines and access

issues; providing oversight through proessional

pharmacy networks/associations; harmonizing

the CS actions; targeting the maximization o the

utilization o the current TRIPS exibility to 2016

as provided or in WTO agreement.

Establish a collaboration platorm between SADC

and regional CSO/FBOs. Action areas proposed

could include: promotion o transparency and

accountability by applying the MeTA principles;

supporting at least 3 SADC countries to join MeTA

by 2011; and the reestablishment o the SADC

Pharmaceutical Task Force in which CSO are

members.

Establish a system or CS to continuously evaluate

Pharmaceutical Supply Management. Actions areas

could include: monitoring the supply chain as

well as the prices and availability o medicines at

acility level.

Advocate or development, harmonization and

implementation o treatment and diagnostic

guidelines in Southern Arica.

This process prodced consenss that the most

sel immediate PACT that Ciil Societ shold

lead is to promote greater transparenc in the

regional pharmacetical marketplace and more

eectie sharing and se o market inormation.

Initial mapping o the PACT Framework or this

identied the highest priority results that could be

jointly pursued, the range o partners that could work

together and some initial ideas o what each partner

organization might be able to specically contribute

towards achieving these results. This drat ramework

ollows in Annex E.

The group agreed that this ramework or the PACT

would need to be worked up urther and the SARPAM

programme management team was charged to

complete this task in collaboration with a Civil Society

Reerence Group see section 6 below.

6. DEFINING POTENTIAL PARTNERSHIPS FOR ACTION (PACTS)

RECORD OF THE CONSuLTATION continued

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6

Having the means to gather and disseminate

inormation, hold discussions and share documents

was considered a key requirement or successully

implementing this PACT. Participants agreed to use

o the Civil Society Action Network newsgroup and

online collaboration site in the SARPAM InoHub.

Use o short message service SMS was discussed as

a possible way o keeping everyone in the network

updated.

Participants agreed to:

1. Establish a regional Civil Society Reerence

Group, to which the ollowing individuals were

nomintated: Gichinga Ndirangu HAI; Donna

Kusemererwa EPN; Tapiwanashe Kujinga

PATAM; Franco Wandabwa ANECCA; and

Tasangana Matika (Seatini/Equinet). Terms

o Reerence or the group were discussed

immediately ater the meeting and adopted by

the Reerence Group members see Annex F.

2. All CS and aithbased organizations committed

to working through SARPAM should sign up to

a Maniesto or Civil Society Action on Access to

Medicines, based on principles o engagement that

were developed by a subgroup o participants

see Annex G.

3. Send 2 CS representatives Franco Wandabwa

and Cryson Miyoba to attend the Pharmaceutical

Market Analysis Study Readiness Retreat in Cape

Town.

7. KEy POINTS OF CONSENSuS

1. Complete the drating o a maniesto

responsibility o the SARPAM secretariat CS

Technical Lead and CS Coordinator that,ollowing consultation with the Reerence Group,

should be sent to all meeting participants to

present this to their organizations or signature.

2. Preliminary report o the consultation to be sent

to participants within a week o the meeting.

3. CS Technical Lead to communicate with the

participants and other CS who could not attend

the meeting on the next steps to take orward the

PACT.

4. CS Reerence Group to consider and recommend

how best to gather and disseminate inormation

between the CS, including pilot testing the SMS

methodology.

5. The SADC Pharmaceutical Business Plan and

SARPAMs one page summary to be sent to

all meeting participants by email SARPAMSecretariat.

6. The PACT methodology to be written up and sent

to all participants or use in their own meetings.

7. SARPAM Secretariat, in collaboration with the

Reerence Group, to complete the development

o the agreed PACT.

8. Assessments o what each Civil Society

organizations capacity needs are to eectively

contribute to the PACT will be carried out by the

SARPAM Secretariat. This will result in Enabling

Plans and resource requirements being scoped

out and presented to DFID or Implementation

Phase unding to be incorporated into the

SARPAM Inception Report.

8. ACTIONS FOR THE NEXT STEPS

The objectives o the consultation were achieved. However, as not all regional CS representatives were able

to attend, it will be important to share the report and to continue the conversations that were started. The

enthusiasm needs to be kept through regular communication and interactions, led by the SARPAM Civil

Society Lead Eva Ombaka, supported by a Civil Society Coordinator and in collaboration with the Civil Society

Reerence Group.

9. CONCLuSION

RECORD OF THE CONSuLTATION continued

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7ANNEX A | OVERVIEW OF SARPAM

The Southern Arica Regional Programme on Access to Medicines and Diagnostics SARPAM launched in January

2010. SARPAM is ounded on the belie that eective collective action and innovation will improve Access to

Medicines across the regional economic community. Working with member state governments, civil society,

regional institutions, international agencies, research networks and the private sector, SARPAM will support the

good work being done through existing partnerships and initiatives, as well as identiy new Partnerships or Action

that will achieve ambitious results.

The programme oers new resources in the orm o targeted unding, technical assistance, partnership building

and networking opportunities. As the primary sponsor o this new initiative, the UK Government hopes that

SARPAM will develop into a platorm or collaboration and partnership that will attract a broad support base over

the next 45 years. This will create signicant opportunities to substantially improve the marketplace or good

quality essential medicines.

SARPAM oers to support and strengthen the capacity o regional institutions to implement plans that will benet

rom multicountry action. The SADC Pharmaceutical Business Plan endorsed by regional Ministers o Health

in 2007 is the leading example o this. Civil Society Organizations within the region will be supported to lead

Partnerships or Action that have the potential to positively inuence the pharmaceutical market, including the

demand or medicines and their rational use.

A regional InoHub will be established to make transparent pharmaceutical market intelligence and evidence

or policy accessible to all stakeholders in the region. SARPAM will be undertaking an intensive Pharmaceutical

Sector Market Analysis during the rst 9 months o 2010 to provide a baseline data set. A regional Evidence or

Action Network will be supported as part o the Global Access to Medicines Research Network to set the agenda

or research and to make research ndings available as global public goods.

The Responsible Action Consortium, led by Re-Action! (Southern Arica) has been contracted by DFID to manage

implementation o SARPAM. This includes establishing a network o development proessionals to work with the UK

government southern Arica regional team so that priorities on Access to Medicines within SADC can be more eectively

responded to and local capacity can be built.

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8ANNEX B | SADC PHARMACEUTICAL BUSINESS PLAN 2007 - 2013: SUMMARY4

The Southern Arican Development Community SADC was ormally launched

on 17th August 2002 under a Treaty, and consists o 14 Member States with an

estimated total population o 200 million people. In its programmes and operations,

SADC is guided by a clear mission statement, which is To promote sustainable and

equitable economic growth and socioeconomic development through efcient

productive systems, deeper cooperation and integration, good governance,

and durable peace and security, so that the region emerges as a competitive and

eective player in international relations and the world economy.

SADC has identied the need to develop and implement a Pharmaceutical Programme in line with the SADC

Health Protocol and the SADC Health Policy. The purpose o the programme is to enhance the capacities o

Member States to eectively prevent and treat diseases that are o major concern to public health in the Region.The Programme mainly addresses issues that concern access to quality medicines in all Member States. The SADC

Pharmaceutical Business Plan has been developed within the context o global, continental and regional policy

rameworks, protocols and commitments. Based on a SWOT analysis, the Plan identies priority areas, objectives

and major activities that will be implemented both at regional and national levels to improve access to quality and

aordable essential medicines including Arican Traditional Medicines.

The overall goal o the SADC Pharmaceutical Business Plan is to ensure availability o essential medicines including

Arican Traditional Medicines to reduce disease burden in the region. Its main objective is to improve sustainable

availability and access to aordable, quality, sae, efcacious essential medicines including Arican Traditional

Medicines. In order to achieve the overall goal and the main objective, the ollowing strategies will be pursued:

i Harmonizing standard treatment guidelines and essential medicine lists;

ii Rationalizing and maximizing the research and production capacity o local and regional pharmaceutical

industry o generic essential medicines and Arican Traditional Medicines;

iii Strengthening regulatory capacity, supply and distribution o basic pharmaceutical products through

ensuring a ully unctional regulatory authority with an adequate enorcement inrastructure;

iv Promoting joint procurement o therapeutically benecial medicines o acceptable saety, proven efcacy

and quality to the people who need them most at aordable prices;

v Establishing a regional databank o traditional medicine, medicinal plants and procedures in order to

ensure their protection in accordance with regimes and related intellectual property rights governing

genetic resources, plant varieties and biotechnology;

vi Developing and retaining competent human resources or the pharmaceutical programme;

vii Developing mechanisms to respond to emergency pharmaceutical needs o the region; and

viii Facilitate the trade in pharmaceuticals within SADC.

In line with the SADC Protocol on Health, the Implementation Plan or the Protocol and the SADC Health Policy

Framework, the SADC Pharmaceutical Business Plan will be coordinated and implemented through the approved

SADC structure. The Business Plan has spelt out clear roles and responsibilities o all stakeholders that will

4. Adapted rom SADC PHARMACEUTICAL BUSINESS PLAN, SADC SECRETARIAT, 27 JUNE 2007, p. 35.

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9ANNEX B | SADC PHARMACEUTICAL BUSINESS PLAN 2007 - 2013: SUMMARY

be involved in the implementation process. At the political level, the implementation o the Plan will be

monitored through the established institutional ramework.

The implementation o the Plan will require substantial resources including human, material and nancial rom

dierent sources. The Plan is estimated to cost US$16 million. To ensure ownership and sustainability, Member

States will be required to budget or implementation o some o the interventions that need ongoing nancial

support. The SADC Secretariat will make all eorts to mobilize resources rom key stakeholders including

International Cooperating Partners.

A monitoring and evaluation ramework has been included in order to review activities during implementation

process. The Secretariat will acilitate capacity building on monitoring and evaluation. Appropriate technical

and nancial reports will be produced during and ater implementation o program specic activities outlined

in the Pharmaceutical Business Plan.

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11ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS

TOPIC

Ciil Societ Capacit bilding

PARTICIPANTS

Donna, Tapiwanashe, Aarti, Christa, Mike, Cryson

MAIN POINTS DISCuSSED

NeedinformationonSARPAMhowdoesSARPAMsupportcapacity?

DiscussiononSARPAMsowecanbuyintothebiggerpicture

Betterunderstandingofcapacity

Linkages between organizations e.g. management systems (JSI), sharing information lessons, even

opportunities or capacity building

Addressallissues:governance,infrastructure

CSrequirescapacitybuildingbutalsohascapacitytobuildinotherorganizationsincludinggoods

RECOMMENDATIONS

1. Consider internal opportunities

2. Involve CS in capacity building initiatives within the region as the actual implementers

3. CS needs inormation on SADC Pharmaceutical Business Plan PBP

4. Review maniestos vis a vis denition o Civil Society ensure capture dierent groups

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12ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued

TOPIC

Commnit inolement in Access to Medicines

PARTICIPANTS

Redemptor, Mike, Aarti, Eva, Cryson, Nalishebo, Franco, Phillip, Donna


(DRC)organizethroughsocialinsurancesomemoney,makecontractswithhealthcentresandhospitals

get treatment or a year

Twoevaluations(June/December)communitiesareinvolved

Communityparticipationis throughchiefs.Oneissuebroughtto theattentionisthatmedicineswere

not ree. Issue is with representation through chies is like the government not true representation

o community e.g. in DRC the Chie is civil servant. In Zambia, the Chie is part o the community, has

headman who is responsible or smaller communities thereore true representation chie is community

thereore is representative o CS

Useofpublicforumsindierentcountriese.g.inKenyalocalCBOsusedtomobilizecommunitiesfor

stockout campaign managed to get inormation rom the ground.

CBOsneedassistancefortransportandastipendforlunch

Traditionalhealersarealsoimportantwithregardtoruralsettings(SA).Sickpeoplegothererst.

Communitycaregivers criticalformonitoringstockouts,toidentifypatientsinthehomeprovide

basic services these are volunteers

District/CommunityCliniccommitteeslinkcommunitytoformalhealthcaresystemsplayacritical

role in some settings Political orces aect those that are made strong ater capacity building

Useofcaregiversisdependentonthespecicpriorityofcountries.Needtobecarefule.g.SAcreateda

monsterrecruit caregivers NGOs provide better package than government unhelpul competition

thereore government and the NGO world need to agree

FBOsaspartofcommunity

Community caregiverprogramme isreceived/ recognizeddierently indierentcountries issueis

controversial.SchemeworkedwellinWHO/UNsupportedareasalsoworkswellinspecicprogrammes

which are supported by outside agencies.

RECOMMENDATIONS

1. Need to understand relationships or community mobilization in specic situations

2. CBOs are a major ally build their capacity

3. Provide capacity support to traditional healers regarding HIV symptoms, reerral systems get their

integration create a platorm or engaging traditional healers. Look at linkages with CBO capacity

building

4. Recognition o the impact and role o community caregivers who are volunteers provide support and

to integrate into the public health system

5. Advocate to implement the community caregivers policy. Also consider unding mobilization that is part

o the government or sustainability

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13ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS continued

TOPIC

Ciil Societ Networking

PARTICIPANTS

Tapiwanashe, Redemptor, Nalishebo, Orgenes, Phillip


1. Broadly there are a number o CSOs and networks that are working on access to medicine. Mapping

exercise needed

2. Regional networks identied are:

PATAM

HAI Arica

ANECCA

Enquinet

EPN

3. There are many others working at country level

4. Need to identiy key issues or advocacy

Stop Stockouts

CEPA

Anti Microbial Resistance AMR

RECOMMENDATIONS

1. ConductaCSO/networkmappingonATM

2. Come up with an umbrella campaign on ATM

3. Agree on various components or the campaign

4. Identifyleadorganization/networksforeachcomponent

5. DevelopacomprehensivemediastrategyforongoingCSO/networkcommunication

6. Network consumer society organization in this region

7. Ideal to have an umbrella campaign that encompasses the components and the SADC business plan

and the member organizations can link up to it

8. TheumbrellacampaigntohaveparticularcomponentsthatareledbyCSOs/networkswithcapacity

and experience9. LeadCSOs/networkstoorganizecapacitydevelopmentinordertofulllSARPAMobjectives

10.AcomprehensivemediastrategywillhelpmemberCSOs/networkstonetworkwithinthecampaign

11. Setting up an email list, website and development o campaign materials

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TOPIC

Qalit o Medicines

PARTICIPANTS

Nalishebo, Orgenes, Cesar, Redemptor, Joseph, Phillip, Titus


Qualityisastandardnotaconcept

CSOstopromotetheavailabilityofqualityaordablemedicines

Needtodevelopregionalstandards

CSOstoassistinissuestodowithpharmaceuticalvigilance,counterfeitmedicineinimprovingquality

Capacitybuildingofregulatorsauthorizedtodierentiatebetweengenericsandcounterfeits

CSOstoworklikequalitywatchdogsindealingwithpharmaceuticalvigilanceissues

AdvocatingforCSOstobeinvolvedintheprocurementprocesses

Recognize,rewardandprotecttheachievementsoftheregionalpre-qualiedfactoriese.g.factoryin

Uganda

Anti-counterfeitActstobedevelopedbuttheseshouldnotaectaccess

CSOstogivesupporttotheregionalaccreditedlaboratories

RECOMMENDATIONS

1. Advocate or recognition, rewards and protection o the regional WHO accredited laboratories

2. Support the concept o regional quality control laboratories, und and supervise

3. Advocate or regional mini standards

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TOPIC

Research & inormation on Access to Medicines

PARTICIPANTS

Aarti, Shaun, Franco, Albert, Eva, Christa, Joseph, Cesar


Whatdrivesevidenceisthequestionsweask.CouldwehaveaFAQestablishedasaknowledgebase?

Whatdowemeanbyresearch?CompilinginformationandevidenceonAEM,Advocatingforsharing

and transparency o inormation. Existence o correct inormation. As CS we should contribute to the

existence o accurate inormation we can also do research operational, actionoriented, etc. Use CS to

gather inormation to triangulate what already exists. e.g. L2 and L1 WHO surveys

Weneedadatabase(openaccess)whichgrowsacrossthe region,alsointernationally.Getcollective

evidence on what is going on.

What ino do we collect and how to get into the database?

How to create a community o users around it? How to get it out?

EPN ismapping pharmaceutical personnel in various (SADC) countries. Use thismethodology and

compare to public sector in SADC countries?

DFIDissponsoringtheATMResearchNetwork.WhatrolecanCShaveinthisformalizednetwork?Could

we inorm the agenda? Can we provide the relevant academic research questions? CS may be the subject

o or may implement the research. CS can assist each other: networking, training, identiying research

areas, getting unds or research etc.

Informationforadvocacypurposesinformationforpolicypurposes.Knowwhattodowiththeresultsto

impact ATM.

Domesticatetheresearchtomakeitusefulforcountrycontext

RoleofCSindisseminationofresearchndingsEvidencebriefsoronepagersordecisionbriefsetc.

Based on research: here are the ndings and here are the recommendations signed by those involved.

Use as basis or advocacy and decision making.

ImportanttohavelinksbetweenacademicinstituteandCS.

NationallevelpartnersonSARPAM:communications,links,dedicatedtime,etc.SARPAMevidencefor

Action network exists ensure it is linked to the SARPAM CS network

Usetheinternationalnetworksandtheirresources,funding,abilities,time,toanalyzedataandevidence

AEM access to essential medicine

L1, L2 Level 1, Level 2 Surveys ( WHO)

FAQ - Frequently Asked Questions

RECOMMENDATIONS

1. Set up the SARPAM observatory to include a clearing house on inormation on research, data studies,

reports,toolsinSADC(withaFAQcapability)

2. MechanismtoestablishaCSlinkingfacilitytotheATMResearchNetwork

3. CSdevelopone-pageevidence-baseddecisionpapers(foraction,dissemination,inuencepolicy,etc)

that will become widely recognized as having scientic, political and civic support4. EnsuretheSARPAMEvidenceforActionnetworkiswelllinkedtotheSARPAMCSNetwork

5. Advocate or transparency o inormation

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TOPIC

Good Goernance

PARTICIPANTS

Titus, Michael, Tasangana, Cryson, Gichinga, JoAnne, Wilbert, Donna


What is good governance? We need denitions!

Corruption

Transparencyandaccountability

Regulation

Politicalenvironment

Eciency/eectiveness

Outcomes

CONCLuSION

CivilSocietyneedstoengageingoodgovernanceandcanplayanimportantroleasawatchdogand

lobbyist

STRATEGy

Insistonrobustdrugsupplysystemsthatarewellplanned,needsbasedandevidencebased Ensurethattherearemeasureable(SMART)andrelevantindicatorsthatcivilsocietycanmonitor

CSOthenshouldactasacriticalwatchdog

Insistongreatertransparency,whichwillleadtomoreaccountability

Theprocesswillreducevulnerabilityforcorruption,promotemoreandbetterregulation,leadingtomore

efcient systems and better access to better medication

RECOMMENDATIONS

1. Civil Society to involve itsel in governance o the supply chain

2. CSOs to act as a critical watchdog in procurement, quality, price and availability

3. Promote robust, transparent systems

impacting the

whole supplychain

Selection

ProcurementBudgets

Price

FinanceDistribution

UseofDrugs

Availability

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TOPIC

Hman Rights & Access to Medicines

PARTICIPANTS

Rose, Cesar, Christa, Tapiwanashe, Wilbert


AssessingHumanRightsaccesstomedicineincountries

Accesstolife

Accesstomedicineasaright

Everyonehastherighttohealthandmedicine

Righttohealth

Accesstomedicineandhumanrights

SADCprotocolsandtoolstobeusedforadvocatingforaccesstomedicine

Countryconstitutionsasastartingpointforadvocatingforaccesstomedicines

RSAinequalitiesduetounequalopportunities,commercializationofhealth.Languageweuseand

how we communicate very important

Zimbabweneedourgovernmentstotakearights-basedapproachtohealthcareandneedingallthe

people TAC in SA an example o a success story

In-countrysystemsi.e.SADCtribunalnotbeingutilized

Howlitigationhasbeenusedtoensureaccesstomedicineandlegislation

Howcanweget2billionpeopleaccesstomedicinerighttohealthcare,includingrighttomedicine?

Rightsandresponsibilitiesmakingessentialmedicinesapublicgoodinvolvementofprivatesector

to consider medicines as public goods

Governmentshavesignedadeclarationofhumanrights

Thereisahierarchythatexistsintermsofholding

Healthhumanrightsandaccesstomedicines

RECOMMENDATIONS

1. Evidence based advocacy need to build capacity in operational research so that evidence is based

to hold governments accountable

2. Empowering users through capacity building3. Legal campaigns mobilize legal instruments

4. Being strategic, aligning and harmonizing all our competencies together and having a common

ground or our work

5. Document the evidence properly so that it can be shared across

6. Comparing the countries

9. LeadCSOs/networkstoorganizecapacitydevelopmentinordertofulllSARPAMobjectives

10. AcomprehensivemediastrategywillhelpmemberCSOs/networkstonetworkwithinthecampaign

11. Setting up an email list, website and development o campaign materials

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TOPIC

Partnerships within SARPAM

PARTICIPANTS

Donna, Cryson, Phillip, Tasangana, Shaun, Aarti, Mike, Orgenes, Eva, Tapiwanashe


Anunderstandingoftermpartnership

Whoarepartners?

Denethe termpartnershipsinmorecleartermswithregardtopartnershipswithSARPAMwhatare

roles and the benets or partners?

RecognizethereareotherplayersinvolvedinATMandweneedtoincludethemsothereiscollaboration,

not competition

DiscussionofkeyareasoftheSADCPharmaceuticalBusinessPlan

RECOMMENDATIONS

1. Partnershipsareformal,structuredwithMoUsand/orCOMPACTS3

2. Ensure CS is always involved in all PACTs. SARPAM to provide platorm or building partnerships, especially

with governments.

3. Establish regional network and Reerence Group rom CS.

4. Establish a CSOled PACT.

5. Recognize a list o principles or engagement with SARPAM.

6. CS representatives to signup to a ormal commitment Maniesto.

7. Write up rom this meeting or representatives to share with their organizations.

8. SARPAM to provide overview o SADC PBP to wider group.

3. MoU/Compacts:AnMoUistypicallyabilateralagreementwherethepartiescanseekexternalarbitrationifeitherpartydefaultsontheagreement,

whereas a Compact is a multiparty agreement that needs to be enorced through mutual accountability.

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TOPIC

Sppl Chain Management

PARTICIPANTS

Franco, Malishebo, Albert, Joseph, Cesar, Titus, Christa, Wilbert, Redemptor


Comparesupplychainsintheregion(countries)Similarities?Dierences?Bottlenecks?

Whatarethebarriers?

a No coordinated, national level policies poor implementation and procedures

b Weak institutions PSM, quality assessment, CMS, NMRAs

c Poor inrastructure to support medicine delivery roads, cold chain, storage

d Weak stock management procedures

e) Insucient/irrationalnancingforPSMactivities(prioritizing) Corruption

Civilstrife(politicalenvironment,war)

WhatistheroleofCS?CapacitybuildingonPSMissues?MandEofcoreindicators?

StrengtheningsupplychainsofMissionDSOs&GovernmentCMSs

UseofIT?

Transparency/disclosureofinformationanddata(e.g.quantication,etc)

ThinktankonPSM(regionallevel),sharinginformation/bestpractices

PrioritysettingalongPSMe.g.selectionofEMs

Pooled procurement quantication of needs, negotiations with suppliers (promote among

countries at regional level. 3 studies done 4th study ongoing by Arica development Bank in

SADC show it can be done. never implemented WHY? Possible reasons: Bureaucracies,

Procurement kingdoms, No shared dollars, No harmonised NMRA, No exchange o inormation

inormed buying

WhatcouldCSdo?Campaignagainstbureaucracy!Implementtherecommendationsoftheabove

studies

Stockouts-

Match disease patterns and stocks at any level

Promote local production

- DoweknowthemostappropriatePSMsystemtomeetrequirements/demands?Istherea

success story No.!

SAAB SA Access Barometer SSO Stop Stock Outs

FBO Faith Based Organizations (mission) PSM Procurement Supply Management

CMS Central Medicine Stores NMRA National Medicines Regulatory Authority

DSO Drug Supply Organization

RECOMMENDATIONS

1. CS coalition umbrella regional establish the SARPAM Coalition

2. M&E by CS o PSM e.g. SSO campaign extend to SADC SAAB report

3. CS Policy Audit annual report card

4. Study the barriers to implementation o the recommendations rom the PP studies and network

among those organizations working on governance: META, HAI Arica, NEPAD, and AU?

5. Involve/EngageCSintechnicalissues(withtechnicalsupportasnecessary)sharelessonsfrom

FBOse.g.Quanticationmethods/exerciseatnationallevel

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TOPIC

TRIPS and Trade

PARTICIPANTS

Franco, Albert, Tasangana, Wilbert


Compulsorylicensingtocountriestoprovidecountriespatentpoolnegotiations

STATuS OF TRIPS

Middleincomecountrieshavetobecompliantby2000whilelowincomecountrieshavetobeby

2016. Arican countries are producing or are in the oreront o producing rst line. By 2016 LDCs will

be needed to be aligned with TRIPS. German government supporting countries that want to go or

complete licensing. Complete licensing is always point o patent laws. I old activists get involved it

could be watered down.

WhycountriesalwayssignandcomplainingHealthsystem/ministryisalwaysweakercomparedto

the trade ministry.

Activists have to be carefulwhen discussing issues ofTRIPS. Most countries areTRIPS compliant.

Correct and right inormation need to be given.

Need to have apaper (research) forthe14countries on the correct statein termsofcompliance.

In Europe there is a lot o case studies by pharmaceuticals but there is a need or comprehensive

inormation and acts rom Arica.

Makelinkswithlegislators/seminarsonTRIPS.Needtohavemeetingwithhealthandtradecommittees

at national and regional level. Need or inormation to be presented in a language or the lay people.

T.Matika(Seatini/Equinet)willshareadocumentpresentedtoSADConTRIPS.

PATENT POOL

TherewasameetinginGermanyandtherewasanagreementaboutthefactthatinformationneeded

to be claried about the process. Middle income and low income countries are already pressed to

enter the patent pool. Need more inormation on issues o patent pool

TRIPS

Move and encourage countries like South Africa for the adaptation and implementation of the

competition law. We need to analyze the scenario between now and 2016 to see how TRIPS roll out.

A question which we must also ollow is to see what will happen in 2017. Analysis results need to beproduced so it can be presented to CS Organizations.

RECOMMENDATIONS:

1. Arican civil societies need to take up advocacy and be a watchdog o maximum exibilities and

minimizing TRIPS + restrictions.

2. Need foranoverviewstudy/ research amongthe14countrieson thecurrentstateofTRIPS and

compliance(quick/rapidassessment).

3. More inormation needed to be provided on patent pool and how it is going to work and what benets

it provides to SARPAM beore moving orward.

4. Meetings with regional policy bodies and countries on TRIPS where bries are provided.

5. Brieng to health and trade ministry people on discussion o TRIPS.

6. Patent ree essential medicines or SARPAM members should be pushed or by CSOs in the region.

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TOPIC

Priate Sector Engagement

PARTICIPANTS

Shaun, Orgenes, Tasangana, Gichinga, Titus, Joseph


Denitionofprivatesectordiersindierentcountries(e.g.Privateforprot,Privatenotforprot).

Privatesectorhasanimportantroletoplay,especiallyprivateprovidersofhealthservice.

Alotofsuspicionofprivateforprot.Tendstobeexcludedfrompublicsectorinitiatives.

Ecienciesandinnovationofprivatesector.Oftenmoreeectivegovernanceinprivatesector.

Goodexamplesofprivatesectorinitiativese.g.Accesstomalariaproductsinitiative(AMP),ADDO

accredited drug outlets MSH.

Whatistheevidenceforlackofprivatesectoraccountabilityordelivery?

Distinguish between prices of medication vs. cost of treatment. Private sector can be more cost

eective.

TrendistowardsNationalHealthInsurance,whichrequiresprivatesector.

PrivatesectorhasnottakenfulladvantageofTRIPSprovisionsbecauseoflackofgovernmentsupport

e.g. For comparison licensing. This impedes access.

Insomecountriesthereisoverregulationoftheprivatesector.Controlvs.collaboration.

Needpositiveengagement(ratherthannegativeengagement).

Denetheproblemstobesolved/challengedforinnovativeresponse.

Denerulesofengagementforethicalpractice.

CScanlobbymultinationalstodomoreanddelivermoresocialbenet.

Normaltenderingprocessdoesnotallowforblendedvalueoers(includingsocialcontribution).

RECOMMENDATIONS

1. Invite private sector in all SARPAM Partnerships or Action.

2. Assess to what extent private companies have taken advantage o TRIPS or better use o TRIPS

exibilities?

3. CSO Platorm or open debate and positive engagement on role o private sector with government

acilitation4. Play an honest broker role in a 3 party orum with Government and MNCs. Possible link to MeTA.

5. Advocate or delegated corporate social responsibility by MNCs to country level.

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TOPIC

Drat Maniesto or Ciil Societ Action on Access to Medicines in Sothern Arica

(Developed through a meeting o: Gichinga, Shaun, Eva, Phillip, Titus)

PuRPOSE

A document that denes how we collaborate, as CSOs, in the context o SARPAM. Obligations, responsibilities

o CSOs and o SARPAM and commits partner to SARPAM

PRINCIPLES

Participateinpartnershipsforactionwherecontributionswilladdvalue

Commitment to thepurposeandobjectivesof SARPAM (plusprinciples)of SADC pharmaceutical

business plan.

Sharinginformationandresourcestoassistothers(growtogether)opencollaboration

Activeparticipation

Acceptingandaccountabilitycontributionsfromeveryone

Allowleadershipoftheorganization/swiththebestcompositiononspecicissues

Mutualrespectandrecognitionofrolesandcontributions,sharedbenets

OBLIGATIONS

Participateintheplatform(CSActionNetwork).Openconsultation

Inviteinparticipatingbyotherregionalandnationalstakeholders

Allowcontributionbyalltoacommonagenda

SignuptothecommitmenttoeachPACTthattheorganizationparticipatesin.

RESPONSIBILITIES

Sharedresponsibility

Acceptabilityagainstagreedcommitments

Workwithinnationallegalframeworks

Consultmembers

ELIGIBILITy

RegionalCSOoraliateofaregionalCSO(butnotbeexclusive)

AgreecriteriasuchasworkingonATM,membershipbase,fundingsource,etc

RECOMMENDATIONS:

1. Use MeTA denition o CSO

2. Establishadvisory/ReferenceGrouptoco-ordinate

3. Include statement o recognition o reason or CSO participation in maniest

4. Drat maniesto taken back to organizations by meeting representatives

5. Signatories will be listed as partners o SARPAM

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RES

uLTS

(To-BeAchieved)

ANECA

EPN

FIP

HAIAFRICA

META

P

ATAM

SEATINI

(EQuINET)

TAC

a

Imp

roved

Regional

Organization

o

CS

Internal

Organization

Weca

nassistwith

theor

ganizationo

SARPA

Masavibrant

s

tructure

b

Inormation

Sorces

Identifed

Provide

inormationonthe

competenciesthat

areavailablewithin

themembership

So

meoour

me

mbersare

invo

lvedinATM

wo

rkandcan

prov

idebaseline

inormation

SEATINIcanidentiy

inormation

(existing)on

essentialdrugslist

andmarketpricing

including

availability

c

D

ata

Collection

Workthroughour

technicalteamto

carryoutdata

gathering/research

atregionallevel

withemphasis

onPeadiatric

medicines

EP

Ncan

provid

erelevant

inorm

ationrom

then

etworkto

supportsetupo

monito

ringsystem

Su

pervise

nation

allevelsur-

vey,manager

ordatacollection

3prospective

METAcountries

unitedorMETA

GlobalForum

London

29June-1July

So

meoour

countrymembers

cancollectdataas

they

arealready

workingonthat

SEATINIcan

collectdatarelated

essentialdrugslist

andmarket

pricingincluding

availability

d

Inormation

Sh

aring

EPNcansupport

Datacollectionrom

membercountries

specif

callyrom

FBO

sector

SADCcountries

andCSOmeetat

ZambiaForum

1stweekJune

Wecansharethe

inor

mationthat

PATAMhasbased

on

ongoing

a

ctivities

SEATINIcanshare

inormationon

essentialdrugslist

Sha

reevidence

orca

sestudiesvia

M

SF/ARASA

e

Advocac

based

onIno

Spearheada

regionaladvocacy

campaignonaccess

tomedicinesin

SADCregion

Beingamember-

shiporganization

withm

embersin

anumb

eroSADC

countriesEPNcan

provideinormation

onPSM/supply

syste

msinthe

countries

N

etwork

sto

ck-outs,

ca

mpaign

pa

rtnersin

SADC

PATAM

s7strengths

liesinadvocacy

SEATINIcancarry

outadvocacy

workthrough

Parliamentary

Portolio

Committees

Regional

mo

bilisationin

a

ddressing

advo

cacygapson

stock-out,drug

p

ricesand

a

vailability

(TAC/??)

ANNEX E | FIRST DRAFT CS-Led PARTNERSHIP FOR ACTION (PACT) FRAMEWORK

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RES

uLTS

(To-BeAchieved)

ANECA

EPN

FIP

HAIAFRICA

META

P

ATAM

SEATINI

(EQuINET)

TAC

Tra

ining

Buildcapacityo

ANECCAmembers

onpaediatric

ormulationsand

medicines

1.Auditoexisting

technical

personnel

2.Inormation

sharingthrough

member

organization.

3.Examinationo

levelotraining

onaccessmatter.

4.Advocacyon

thoseintraining

onaccessmatter.

5.Examine

relevanceo

existingtraining

toaccessissues

Trainin

g

1.Age

nda

2.Met

hods

3.Tools

4.Training

Materials

5.Prov

ideTrainer

PA

TAMcan

help

withpolicy

develo

pmentaswe

havem

emberswith

techn

icalcapacity

g

Polic

Development

Usecurrentand

availableevidence

todevelop/review

policieson

medicines

Policy/strategy

development

Pushorpolicy

review/develop-

mentviaARASA

h

Stakeholder

Enga

gement

i

Dissemination

j

RegionalData-

bases/InoHb

ANNEX E | FIRST DRAFT CS-Led PARTNERSHIP FOR ACTION (PACT) FRAMEWORK

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26ANNEX G

FOR CIVIL SOCIETY ACTION ON ACCESS TO MEDICINES IN SOUTHERN AFRICA

PREAMBLE

The Southern Arica Regional Programme on Access to Medicines and Diagnostics SARPAM provides an

opportunity to make a critical dierence to peoples lives within the Southern Arican Development Community

SADC region and to encourage and support change that will address the complex issues relating to access

to medicines and diagnostics. One o the key outputs o the programme is an increased voice and inuence o

civil society reected in policies on access to medicines and diagnostics in Southern Arica.

Experience rom the Medicines Transparency Alliance MeTA countries has shown that Civil Society CS has

a vital role in keeping pharmaceutical companies, health proessionals and government civil servants and

organizations transparent, honest and accountable and CS organizations, along with the private sector and

governments as equal partners, are key actors to jointly seek solutions.

We, representing the Ciil Societ with interest in increasing access to medicines in the Sothern Arica

region are signatories to this maniesto as ollows:

PuRPOSE:

This document denes how we, the partaking civil society and aith based organizations CSOs and FBOs

collaborate, in the context o SARPAM. It species the intent, obligations, responsibilities and expectations o

SARPAM and our commitments as partners in SARPAM.

COMMITMENTS:

We commit to:

Participateinpartnershipsor action PACT where our contributions will add value SupportthepurposeandactivelyparticipateinpursuitoftheobjectivesofSARPAMandtheprinciplesof

the SADC Pharmaceutical Business Plan.

Shareinformation,expertise and resources,and fosteropencollaborationand consultation inorder to

assist each other towards mutual growth and success.

BeaccountabletoourCSpartnersonissuesthatwecommittocarryout.

AllowthepartnerCSorganization(s)withthebestexperienceandmostappropriatemandatetoleadothers

when working jointly on specic issues.

Mutuallyrespectandrecognizerolesandcontributionsofeachpartnertoacommonagendaandtoshare

benets.

Participatein theplatform,Civil Society ActionNetwork,by contributing ideas, comments, advice and

documents as may be appropriate or requested.

Inviteandsupporttheparticipationofotherregionalstakeholdersinordertoincreasecapacitytoachieve

our objectives

SignupandadheretothecommitmenttoeachPACTthatourorganization(s)participatesin.

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RESPONSIBILITIES:

We accept shared responsibility, acceptability and accountability against these agreed commitments. We

urther accept to work within national legal rameworks and to consult members regularly.

ELIGIBILITy:

We commit to the acknowledgement o diersit, broad representation and inclsiit. Thereore

initation or signatories are extended bt not limited to:

EstablishedandrecognizedregionalCSOsandFBOsoraliatesofsuchorganizations.

Anyorganizationwhichmeetsminimumcriteriaformembershipsuchasworkingonorinterestinaccess

to medicines ATM, membership base, unding source, etc.

EXPECTATIONS

We expect the Responsible Action Consortim managing the Sothern Arica Regional Programme to:

UseMeTAdenitionofCivilSocietyinthisrelationship.

FacilitatetheworkoftheReferenceGroupthathasbeenestablishedbytheCS.

SupporttheCSinimplementingtheagreedprogrammeofworkasmaybenecessary.

Facilitaterelationship-buildingbetweentheCSandtheSADCsecretariat,governments,privatesector,

donors and other partners committed to increasing access to medicines in the region.

KeepanaccuraterecordofsignatoriestothismanifestoandtolistthemaspartnersofSARPAM

Name and Stamp o CS Organization Responsible Action Consortium Stamp

Signature Signature

Date Date

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28ANNEX H | CASE STUDY: PARTNERSHIP IN ACTION

PuRPOSE

The purpose o this case study is to illustrate how the PACT approach was applied to achieve the ollowing

purpose:

TO FORGE A CIvIL SOCIETy PARTNERSHIP TO IMPROvE ACCESS TO MEDICINES INSOuTHERN AFRICA

A key principle o the PACT approach is that the participants take ownership o the PACT content and

conversations. Although there is a ramework that the PACT ollows, the agenda, the conversations and

agreements are incubated and driven by the participants. The ollowing diagram illustrates the process:

1

2

3

4

5

6

7

8

9

10

PREPARING THE

ENvIRONMENT

INTRODuCING THE

APPROACHArrival Opening

Reection ClosingExercise

Purpose

Proposals oraction

PACTMatrix

Agreementon results& partners

Denitiono PACTs

How?

Summary Clariy nextsteps

ClosingExercise

Finalreections byparticipants

Marketplaceo topics

List openagenda

discussiontopics

List openagenda

discussiontopics

Relate to

SARPAM and

SADC PBP

DEFINING THE OPEN

AGENDA

PACT

CONvERSATIONS

RE-FOCuS AGENDA

FOR 2ND SESSION

REvIEW

PROGRESS

PACT

CONvERSATIONS

PLANNING

FOR ACTION

DEFINE RESuLTS AND

PARTNER CONTRIBuTIONSS

CLOSE

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29ANNEX H | CASE STUDY: PARTNERSHIP IN ACTION continued

THE SCENE

A large meeting room and in the centre a circle o empty chairs.

On the periphery, ve tables each with seating or 10 people, a rereshment station and a stationery

desk.

On the walls, some posters and a banner bearing the SARPAM logo with the words: How can

we work in partnership to improve access to medicines in southern Arica?

When participants arrive, they move in and seat themselves at random in the main seating area.

The Civil Society Technical Lead, SARPAM members and

head o the civil society programme, briey welcomes

everyone to the workshop, describing it as the rst step

in a process that aims to change the situation or the

people o southern Arica through improved access

to essential medicines. The SARPAM director and

the acilitator rom ReAction!, the lead company in a

consortium responsible or implementing SARPAM, areintroduced.

In a short introduction to SARPAM, the SARPAM Director

covers DFIDs central role in SARPAM, explaining the

thinking behind the ninemonth inception phase or

SARPAM a pregnancy that we hope will deliver a live

born child and the dual nature o SARPAM working

with the SADC Secretariat and SADC member states on

the one hand, and with civil society structures on the

other. The Director emphasises the regional nature o

SARPAM and how this mandate could be taken up byCSOs. The rules o the game are not ocusing at the

individual country level.

The workshop acilitator takes the lead and highlights

the central question: How can we work in partnership

to improve access to medicines in southern Arica? She

gestures to a blank wall and says: This is our agenda or

the next two days . . . this is your journey, your process

and you set the agenda.

1

2

PREPARING THE ENvIRONMENT

INTRODuCING THE APPROACH

Poster describing the purpose o the meeting

Facilitator illustrating the agenda

Facilitator beginning the open space

acilitation process

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Ticket to ride . . . openness, choice, new beginnings.

The acilitator gives each person in the circle a ticket or

the twoday journey a card containing an afrmation

in the rst person. My intuition is powerul, I have thereedom to choose, I let go o the past. Participants are

invited to read out the message on the ticket.

With the mood set, the acilitator outlines the our principles o the workshop:

Showupandchoosetobepresent.

Beopentotheoutcomenotattachedtoit.

Payattentiontowhathasheartandmeaning.

Tellthetruthwithoutblameorjudgment.

Thefacilitatorrequestseveryparticipanttoidentifyanyissuesoropportunitiesthats/hewouldlike

to discuss during the course o the workshop, to write each item on an individual sheet o A4 paper

and to put his or her name on it.

A RuSH OF IDEAS

Participants duly take sheets o paper, write down their subjects, and read them out loudly.

Iminterestedin the supply chain howdowegetdrugsoutof the storeroomsand into

communities.

Myinterestissharingadvocacystrategiesforaccesstoessentialmedicines.

Iproposetalkingaboutacoalitiontoinuencepolicyontheaordabilityofmedicines.

IminterestedinTRIPSandmedicinesandtheimpactoffreetradeagreements.

. . . and so on.

They then stick their suggestions on the blank wall

indicated earlier which now carries a sign reading

Community Notice Board.

The acilitator explains that each one o thesesubjects will be the ocus o a meeting, which will

be chaired and run by the originator o the topic.

Participants can sign up or any meeting they are

interested in.

Two laws or participation in meetings are explained to the group:

The LawoftheBumbleBeeandtheButterywhichsanctionspeople ittingdiscussion

between groups to pollinate or add value.

TheLawoftheTwoFeetwhichencouragesparticipantstomoveoutofadiscussiongroup

where they are not engaged and join another.

Posters describing the workshop principles

A rush o ideas rom the participants

3 CONSTRuCTING THE AGENDA

ANNEX H | CASE STUDY: PARTNERSHIP IN ACTION continued

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Everyone goes to inspect the Community Notice Board,

with a view to merge topics or add new ones where there

are gaps. Participants begin to identiy common ground

between their own proposals and those o others. They

move individual sheets o paper so that clusters or lists o

related topics emerge and in this way, meeting themes

are dened.

10 CENTRAL DISCuSSION THEMES EMERGE:

Capacitybuilding

NetworkingamongCSOs(Partnershipislater

extracted as a dierent topic

TRIPSandtradeissues

Good governance and research (Research is

later dened as a separate topic

Supplychain

Medicinesquality

Communityinvolvement

Privatesectorengagement.

The agenda is now nalised and trading or time and venue begins. With the groups permission, the

acilitator helps rationalise the process o allocating time slots and meeting venues.

Four time slots are carved out or meetings, with between two and our meetings running at the same

time.

For the remainder o the rst day and the rst hour on Day 2, the meetings on participants sel

selected themes continue. Each group is chaired by an individual who proposed one o the original

topics that was collapsed into the theme. Main discussion points and recommendations are captured

on a standard reporting orm. These orms are posted on the Community Notice Board and, romtime to time, the acilitator reminds participants to consult the board to see what other groups have

debated and concluded.

The groups are very stable and participants intensely involved. The meetings are small enough or

everyone to have a say and hardly anyone makes use o the Law o the Two Feet.

The Community Notice Board

Trading or time and venue begins

4 PACT CONvERSATIONS

Engaging the issues . . . and each other

Participants engage in discussion at meetings around sel-selected themes

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The rst day concludes with a game a modied version o charades and reection on the day. Asked

to describe their experiences, participants venture:

Itwasdierent.

Fast.

Wesaidatthebeginningthiswouldtakeustwoweeks.Ittookusoneday.

At the beginning therewasmoreopportunity for our voiceto beheard.Thistimewe felt the

workshop was owned by us.

Peoplefelt alittlebitmoreinformationwasneededaboutSARPAM.Whoweareandwhatwill

happen when we leave this room.

The acilitator comments on how things appeared through her lens:

Theagenda-settingwasextremelyrapidandamazinglyrich.

Peoplewereintenselyengagedindiscussion;almostnousewasmadeoftheLawoftheTwoFeet.

The acilitator touches on aspects o a number o discussions and mentions that the meeting on

partnership had come up with the idea o a maniesto that would be the oundation o the civil

society CS partnership within SARPAM.

A discussion on how the process should unold, ollows. Participants express a need to ocus and move

towards an action plan:

IhavefearswecouldbeasinactiveastheSADCPharmaceuticalBusinessPlan.

Weneedabitmorestructure,alittlebetterideaofwherethedestinationlies.

The acilitator conrms that most o Session 2 will be devoted mostly to prioritisation and action

planning.

A game o charades and reections toconclude Day 1

The acilitator reects on the learning rom theday rom her lens

5 REvIEW PROGRESS


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6

7

8

RE-FOCuS AGENDA FOR 2ND SESSION

The Facilitator opens the next session. She creates a space or participants to reect on the previoussession and give eedback on their thoughts or the progress o this session.

Ater that, seated in the central circle, they receive a

detailed outline o SARPAM which DFID has initiated and

unded as a partnership venture, not a new entity. The

inormal presentation covers the broad objectives o the

programme, the specic work o the inception phase, the

rationale or the inception phase, the main players in the

Responsible Action Consortium, the budget allocation by

DFID, and the respective collaborations with civil society,

the SADC Secretariat, and governments in the region.

Participants gather in three discussion groups to complete the PACT meeting schedule rom Session 1.

The participants response is positive, captured in the comment: I want to suggest we look at ourselves

as the drivers o this agenda. We must own the platorm.

The acilitator invites participants to examine the

recommendations o the various meetings posted on

the walls and to rame those that appeal most to them

as proposals or joint action. This proposal can be an

individual or joint eort, but the proposers should

canvas support or the idea. Every participant has ten

votes represented by red stickerdots which they can

use as they like to indicate support or various proposals.

Some participants are active in canvassing support or their proposals while others simply pastethem on the notice board and hope the ideas will speak or themselves. Ater all proposals have been

pasted up the process o discussing their merits begins.

The SARPAM Director chairs this session, where necessary providing inormation about how the

proposal relates to other actions that SARPAM will undertake in the inception phase.

PACT CONvERSATIONS

PLANNING FOR ACTION

SARPAM Director outlines the partnership

venture

Support or various proposals indicates by redstickers or votes

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A TASTE OF THE PROPOSALS

DevelopaframeworkforcollaborativeworkwithSADC(becauseitismoreproductivetobeatthe

table than to shout rom the sidelines.

Conductahumanresourcesmappingexercise,focusingonpharmacists.

Advocatefortheharmonisationofdiagnosticprocessesandtreatmentguidelinesforselectedhealth

conditions.

Establishasystemforcivilsocietydatacollectionandwatch-doggingofprices,supplychainsand

availability o medicines in acilities.

As the discussion proceeds, some proposals are combined

and others are eliminated. The wording o some o the

rontrunners is changed to make proposals more inclusive

and suited to the dierent cultures o various civil society

groupings.

In the end, the rst CS Partnership or Action is dened as

ollows:

To establish a joint civil society system or gathering inormation on pricing o selected medicines,

supply chain eectiveness and availability o these medicines at acility level.

The Director indicates that this will strengthen one o the main deliverables o SARPAM during the

inception stage: an analysis o pharmaceutical markets across the SADC region.

ACTIvITIES AND RESPONSIBILITIES

At this point a giant matrix on the wall behind the

chairperson becomes the ocus o attention. Participants

are asked to:

Completethelefthandcolumnbyproposingcategories

o key activities needed or the partnership project

that they have adopted. These are then put into time

sequence.

Identifyappropriateorganizations inside and outside

the room who could be valuable contributors to this

partnership or action PACT, and spread these across

the top row.

Each o the activities and potential partner organizations is

written on a large Postit note and slotted into the matrix

in the relevant cell. Each organization is given a dierent

colour code.

Those organizations in the room are then asked to outline more specically what they mightbe able to contribute in terms o the various categories o activity. These details are written on Postit

notes in the organizations colour and posted into the relevant cell on the matrix.

Participants identiy proposals or joint action

Matrix on the wall to denote key activities andresponsibilities

Participants discussing contributions to thefrst CS partnership

9 DEFINE RESuLTS AND PARTNER CONTRIBuTIONSS


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The eect is illustrated below. An organization that posts a note under training, or example, might say:

Produce training materials and supply trainers.

The column or organizations not represented at the workshop, obviously, remains blank and their

commitments will be established at a later stage.

Activities EPN HAI Patam Aneca Seatini etc . . .

Internal organization

Identiy existing ino

Data collection

Inormation sharing

Advocacy

Training

Policy development

The matrix has eectively become the oundation o a plan o action and two months o planning have,

indeed, been accomplished in two days.

The CS Technical Lead acilitates the closing discussion

and directs attention to three key tasks:

Organising the partner organizations so that theprocess can move orward.

Framingthepurposeandobjectivesofthepartnership

in language that is clear and acceptable to all.

Creatingchannelsforcontinuedcommunication.

ORGANIzING THE CS PACT

The CS Technical Lead appeals to the group or assistance with organizing the partnership internally. A

task team is created with our key regional organizations HAI Arica, EPN, Patam and Aneca identied

as its core members. Each organization will determine who will represent it.

It is urther agreed that one person rom these organizations or one o their member organizations will

representtheCSPACTatameetinginCapeTownon29/30MarchwherethebroaderSARPAMmarket

analysis process will be discussed in detail.

FRAMING THE PACTS PuRPOSE AND MEMBER RESPONSIBILITIES

Apart rom attending to the objectives o the CS Pact, the task team would consider and strengthen

the recommendations o the workshop group on partnerships. They would revise, complete and

circulate the drat maniesto or PACT members, a document intended to be mutually binding

among partners.

CS Technical Lead acilitates closing discussion

10 CLOSE


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COMMuNICATION

Participants suggest that SARPAM needs a dedicated, wellunctioning website as a channel or communication.

The SARPAM Director explains the acility o the Frontline SMS system which will eventually be tollree orusers. Participants with mobile phones that are unctional in Kenya are invited to register immediately on the

SMS system.

CLARIFy NEXT STEPS

IMMEDIATE NEXT STEPS

Thetaskteamwillmeetsoon.

Thedraftmanifestoandstatementofresponsibilitieswillbecirculatedtoallparticipantstogetherwitha

summary o the meeting.

Eachparticipantshouldmeetwithhis/herorganizationtodiscussitscommitments tothePACTand

prepare a detailed description o the role it could play within the planning ramework developed. TheSARPAMsecretariatwilltalkone-on-onewitheachorganizationtoestablishresourcerequirements

in the inception phase and beyond.

CLOSING EXERCISE

Completing the pictre

The acilitator resumes acilitation and invites everyone to reect on the twoday experience and the amount

ofworkachieved.Sheaskseachparticipanttotakethejigsawpieces/hewasgivenatthestartofthedayand

to help build a puzzle on the table in the middle o the circle.

The jigsaw gradually takes shape and resembles the SARPAM banner: How can we work in partnership to

improve access to medicines in southern Arica?

Asked to comment on the jigsaw, people note there are pieces missing, and its a bit uneven and insecure,

but the image and the words are quite recognisable. As they speak they realise this is a metaphor or the

partnershipbuilding and projectplanning process they have just undertaken.

In a nal symbolic act, individuals close the circle by shaking hands with the person on either side.

Closing Jigsaw game The puzzle takes shape


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38ANNEX I | WORKSHOP EVALUATION

CSO Workshop: 2122 March 2010How can we as Ciil Societ improe Access to Medicines in Sothern Arica?

WORKS

HOP

WAyFORWARD

FACILITIES

1 2 3 4

1. Understanding o purpose 2 6

2. Achievement o workshop objective 1 10 6

3. Methodology and approach 1 7 11

4. Facilitation process and support 8 11

5. Level o participation o all delegates 1 5 13

6. Handling o questions and concerns 2 9 8

7. Building o relationships and networks 12 7

GENERAL REFLECTIONS AND SuGGESTIONS FOR FuTuRE CSO WORKSHOPS:

Good keep it up. Ensure that we all have the necessary background ino needed to be more resourceul in terms o partici

pation e.g. ino about SARPAM, your expectations and why you need CSO engagement should have beenclear upront.

I like the open agenda as a concept but or a group with no real connection beore hand I think a bit morestructure would have helped.

Advance planning. InitiallyIfearedthenoagendaapproachbutnowIappreciateit.Thankyou!

Involve more networks The workshop achieved a lot in two days the achievements exceeded my expectations. A new methodology thereore may take time to get ully knowledgeable. Perhaps an understanding o the key aims, expected results and the methodology. Also need more clarity

at the beginning

8. Clarity on individual role and accountability 4 11 4

9. Idea o uture communication through sms technology 1 2 11 5

GENERAL REFLECTIONS AND COMMENTS ON AGREED WAy FORWARD:

I liked the idea o participants coming up with the agenda. It looks realistic. I hope we shall adhere to it. It was a good beginning. Obviously it sets the basis or moving orward. More clarity needed but that is

within sight. Notfullysatisedwiththeaction/pactareaagreedbutwillsupportit.

Need or better clarity on dierence between individual role and tting into a bigger picture. Very good because cellphones are now available everywhere. Better more use o emails or record keeping purposes. Lesser use o SMS. Acceptable, can be improved.

Will become more clear as next steps report, communications evolve

9. Workshop venue and resources 6 13

10. Accommodation and meals 8 10

11. Travel logistics and arrangements 3 11 3

GENERAL REFLECTIONS AND COMMENTS:

Great organization. Well organized, good approach, results have been achieved rom nothing no agenda. Good start. SARPAM must sustain the interest, share ino and ensure that the momentum is not lost. The methodology and vision or the meeting was quite interesting and opened more opportunities o

ownership. Good.

The methodology and the principles o this workshop need to be tried elsewhere in Arica. Great meeting, the approach was completely innovative but idea in allowing participants to see the

agenda. Keep it up Sharon and Shaun. This was a really great. Good venture. This has proved that an agenda put up by participants enable them. To discuss broadly and in deep the

contents, since they are issues being encountered daily

SCORE KEy:

1 POOR; 2 SATISFACTORY; 3 GOOD; 4 EXCELLENT

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