CSO & media orientation workshop

Medicines Transparency Alliance in Ghana Dr Alex Dodoo, Ph.D., MPSGH, MRPharmS, FPCPharm Co-Chair, MeTA Ghana

What is the Medicines Transparency Alliance (MeTA)

Outline
Background and Concept
Problems of Access To Medicines
Why MeTA
Purpose and Strategies
Motivations for MeTA Stakeholders
09/06/09 MeTA @ Health Summit

What is MeTA
MeTA is an international initiative that aims to increase transparency in the registration , procurement , distribution and sales of essential medicines in developing countries
Born out of lessons learnt from EITI ( Extractive Industries Transparency Initiative)
The principal international partners are:
UK Department for International Development (DFID)
The World Health Organization (WHO)
The Health Action International (HAI)
The World Bank

The Problem
Essential medicines may be too expensive for some people or a segment of the population
Good quality medicines are often unavailable
Excessive mark-ups in both the public and private sectors
Perceived fraud and corruption within the medicine supply chain
Poor management
Manufacturer Procurement Agent (s) Wholesaler Distributor Retailer / health unit Patient

Why is this happening?
Market issues:
Information asymmetries
Weak signalling from market to producer
Imperfect competition
Collusion
Governance issues
Procurement efficiency
Effective regulatory systems-e.g. counterfeit medicines
Fragmented supply and distribution systems
Perceived ‘rent seeking behaviours’

The Players in the Medicine Field Patent R&D and clinical trials Manufacturing Pricing Distribution Registration Selection Procurement & import Promotion Inspection Conflict of interest Evergreening Counterfeit/ substandards Tax evasion Falsification of safety/Efficacy data Bribery State/regulatory capture Overinvoicing Pressure Unethical promotion Thefts Fraud Cartels Collusion Unethical donations

Purpose of MeTA
To build transparency and accountability
To increase access to good quality affordable medicines
To tackle … corruption and mismanagement
To work with all stakeholders – public, private and non-governmental
To proactively engage civil society and the private sector

MeTA Strategy Advocacy Training Research Partnerships

Characteristics Of Ghana’s Pharmaceutical Market
80% of products imported
Few local manufacturers - generics and producing under-capacity
Big Pharma involved only in sales
No manufacturing or drug development by big Pharma
State system for medicine procurement for public sector use
National Drug Policy, Standard Treatment Guidelines and NHIML to guide drug selection, procurement and reimbursements

Key Challenges in enhancing Access1
Benefits of improved procurement are not translating into affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey);
Slow progress of some key health indicators– i.e. Infant and child mortality, incidence of malaria and maternal health;
Low consumer awareness due to very little information on quality, availability and prices of medicines is available in the public domain,
Inconsistency across the public, private and mission sectors in terms of how standards (i.e. quality, availability and pricing) are developed and applied;

Key Challenges in enhancing Access to Medicines 2
Non-adherence to treatment guidelines by prescribers and irrational use of medicines by providers persists despite improved guidance and education;
Supply chain performance problems from CMS downstream leading to high stock-out rate;
Vulnerability of NHIS to fraud due to inefficient record keeping and analysis
Counterfeit and/or substandard products

MeTA Ghana pilot objectives
Establishing mechanisms to strengthen the collection, analysis and dissemination of data on medicines along the supply chain;
Facilitating peer oversight systems within and across health professions
Sustaining regular, open stakeholder dialogue;
Developing long-term strategy or ‘master plan’ for MeTA in Ghana.

Strategies 1
Undertake studies to assess the level of transparency and accountability in medicines regulation, procurement, distribution and use.
Regular monitoring of medicine prices and availability as well as their rational use using WHO standard indicators.
Regular monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’.
Publicize widely data on prices paid at various points along the supply chain, including those agreed at public tender.
Correlate procurement data to stock volumes and the availability of medicines to the consumer.

Strategies 2
Undertake periodic annual studies to understand and/or explain provider and consumer behaviour.
Enhance role of chemical sellers in ensuring medicines availability, affordability and rational use through regulation, training and efficient monitoring.
Enhance capacity of CSOs & Media to empower them play more active role in medicines advocacy
Facilitate agreement by pharmaceutical companies to publicize their supply prices to match tender data.
Undertake periodic studies on policies concerning ethical promotion of medicines.

Potential Benefits of MeTA to Ghana
Share good practices with other MeTA pilot countries
Provide Ghanaian leadership on medicines transparency and accountability across the West Africa region as model for both effective governance and market efficiency.
Provides opportunity for pricing and quality monitoring mechanism to inform the NHIS
Reduce and/or eliminate the risk of counterfeit and substandard medication in the supply chain.
Opportunity for enhanced national research capacity.
Provides potential mechanism for government commitment to fight inefficiency and corruption in the drug supply landscape.

Risks and assumptions
Mutual suspicions between government and private sector;
All stakeholders nervous about change;
Where are the enforcement mechanisms across the system? Enforcement of regulations is weak.
Civil society fragmentation needs to be addressed; assume that new coalitions can be forged.
Need to assume a degree of commitment to transparency by all stakeholders and willingness to be mutually accountable .
Timeliness and sustainability of financing.
Need to ensure plans are realistic for pilot phase - not ‘over-ambitious’.

MeTA structures in Ghana
MeTA Secretariat
Will be hosted by MoH initially
Seeking office space
MeTA Annual Stakeholder Forum
Larger workshop, broader representation;
To report on progress, share data.
09/06/09 MeTA

MeTA structures in Ghana
MeTA Governing Council:
Public sector: Ministry of Health, National Health Insurance Council, Ghana Health Services, Food and Drugs Board, Ministry of Trade, Attorney Generals ’ Department, Ministry of Finance;
Professional bodies: Pharmaceutical Society of Ghana, Ghana Medical Association, Nurses and Midwives Council;
Civil society: CSOs (health and non-health), media, academic institutions, faith-based service providers.
Private sector: Pharmaceutical Manufacturers Association of Ghana, Association of Private Medical and Dental Practitioners
International community: World Health Organization, DFID/World Bank/HAI/Other Development Partners Representative.
Meets quarterly, with first meeting after national launch.
Two co-chairs

Inputs of Governing Council
Oversee the activities of the initial phase of MeTA in Ghana
Scrutinizing data collected/disclosed on medicine quality, price and availability
Discuss what is revealed by data collected
Make recommendations and follow up actions based on data assessment
Coordinate data disclosure and other MeTA activities in country
Agreeing progress reports and lessons to be shared with other MeTA pilot countries and the international MeTA Forum

CSO & media orientation workshop

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