wilbert bannenberg, technical director meta international secretariat iacc 14 bangkok, 13 november...
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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 [email protected] 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 [email protected] Mob: +31-6-20873123 www.MedicinesTransparency.org
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