CSO & media orientation workshop


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Presentation by Dr Alex Dodoo, Co-chair, MeTA Ghana during the MeTA Ghana CSO & media orientation workshop, 16 April 2009.

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  • CSO & media orientation workshop

    1. 1. Medicines Transparency Alliance in Ghana Dr Alex Dodoo, Ph.D., MPSGH, MRPharmS, FPCPharm Co-Chair, MeTA Ghana
    2. 2. What is the Medicines Transparency Alliance (MeTA)
    3. 3. Outline <ul><li>Background and Concept </li></ul><ul><li>Problems of Access To Medicines </li></ul><ul><li>Why MeTA </li></ul><ul><li>Purpose and Strategies </li></ul><ul><li>Motivations for MeTA Stakeholders </li></ul>09/06/09 MeTA @ Health Summit
    4. 4. What is MeTA <ul><li>MeTA is an international initiative that aims to increase transparency in the registration , procurement , distribution and sales of essential medicines in developing countries </li></ul><ul><li>Born out of lessons learnt from EITI ( Extractive Industries Transparency Initiative) </li></ul><ul><ul><li>The principal international partners are: </li></ul></ul><ul><ul><ul><li>UK Department for International Development (DFID) </li></ul></ul></ul><ul><ul><ul><li>The World Health Organization (WHO) </li></ul></ul></ul><ul><ul><ul><li>The Health Action International (HAI) </li></ul></ul></ul><ul><ul><ul><li>The World Bank </li></ul></ul></ul>09/06/09 MeTA @ Health Summit
    5. 5. The Problem <ul><li>Essential medicines may be too expensive for some people or a segment of the population </li></ul><ul><li>Good quality medicines are often unavailable </li></ul><ul><li>Excessive mark-ups in both the public and private sectors </li></ul><ul><li>Perceived fraud and corruption within the medicine supply chain </li></ul><ul><li>Poor management </li></ul>Manufacturer Procurement Agent (s) Wholesaler Distributor Retailer / health unit Patient
    6. 6. Why is this happening? <ul><li>Market issues: </li></ul><ul><ul><li>Information asymmetries </li></ul></ul><ul><ul><li>Weak signalling from market to producer </li></ul></ul><ul><ul><li>Imperfect competition </li></ul></ul><ul><ul><li>Collusion </li></ul></ul><ul><li>Governance issues </li></ul><ul><ul><li>Procurement efficiency </li></ul></ul><ul><ul><li>Effective regulatory systems-e.g. counterfeit medicines </li></ul></ul><ul><ul><li>Fragmented supply and distribution systems </li></ul></ul><ul><ul><li>Perceived ‘rent seeking behaviours’ </li></ul></ul>
    7. 7. 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
    8. 8. Purpose of MeTA <ul><li>To build transparency and accountability </li></ul><ul><li>To increase access to good quality affordable medicines </li></ul><ul><li>To tackle … corruption and mismanagement </li></ul><ul><li>To work with all stakeholders – public, private and non-governmental </li></ul><ul><li>To proactively engage civil society and the private sector </li></ul>09/06/09 MeTA @ Health Summit
    9. 9. MeTA Strategy Advocacy Training Research Partnerships
    10. 10.
    11. 11. Characteristics Of Ghana’s Pharmaceutical Market <ul><li>80% of products imported </li></ul><ul><li>Few local manufacturers - generics and producing under-capacity </li></ul><ul><li>Big Pharma involved only in sales </li></ul><ul><ul><li>No manufacturing or drug development by big Pharma </li></ul></ul><ul><li>State system for medicine procurement for public sector use </li></ul><ul><li>National Drug Policy, Standard Treatment Guidelines and NHIML to guide drug selection, procurement and reimbursements </li></ul>09/06/09 MeTA @ Health Summit
    12. 12. Key Challenges in enhancing Access1 <ul><li>Benefits of improved procurement are not translating into affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey); </li></ul><ul><li>Slow progress of some key health indicators– i.e. Infant and child mortality, incidence of malaria and maternal health; </li></ul><ul><li>Low consumer awareness due to very little information on quality, availability and prices of medicines is available in the public domain, </li></ul><ul><li>Inconsistency across the public, private and mission sectors in terms of how standards (i.e. quality, availability and pricing) are developed and applied; </li></ul>
    13. 13. Key Challenges in enhancing Access to Medicines 2 <ul><li>Non-adherence to treatment guidelines by prescribers and irrational use of medicines by providers persists despite improved guidance and education; </li></ul><ul><li>Supply chain performance problems from CMS downstream leading to high stock-out rate; </li></ul><ul><li>Vulnerability of NHIS to fraud due to inefficient record keeping and analysis </li></ul><ul><li>Counterfeit and/or substandard products </li></ul>
    14. 14. MeTA Ghana pilot objectives <ul><li>Establishing mechanisms to strengthen the collection, analysis and dissemination of data on medicines along the supply chain; </li></ul><ul><li>Facilitating peer oversight systems within and across health professions </li></ul><ul><li>Sustaining regular, open stakeholder dialogue; </li></ul><ul><li>Developing long-term strategy or ‘master plan’ for MeTA in Ghana. </li></ul>
    15. 15. Strategies 1 <ul><li>Undertake studies to assess the level of transparency and accountability in medicines regulation, procurement, distribution and use. </li></ul><ul><li>Regular monitoring of medicine prices and availability as well as their rational use using WHO standard indicators. </li></ul><ul><li>Regular monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’. </li></ul><ul><li>Publicize widely data on prices paid at various points along the supply chain, including those agreed at public tender. </li></ul><ul><li>Correlate procurement data to stock volumes and the availability of medicines to the consumer. </li></ul>
    16. 16. Strategies 2 <ul><li>Undertake periodic annual studies to understand and/or explain provider and consumer behaviour. </li></ul><ul><li>Enhance role of chemical sellers in ensuring medicines availability, affordability and rational use through regulation, training and efficient monitoring. </li></ul><ul><li>Enhance capacity of CSOs & Media to empower them play more active role in medicines advocacy </li></ul><ul><li>Facilitate agreement by pharmaceutical companies to publicize their supply prices to match tender data. </li></ul><ul><li>Undertake periodic studies on policies concerning ethical promotion of medicines. </li></ul>
    17. 17. Potential Benefits of MeTA to Ghana <ul><li>Share good practices with other MeTA pilot countries </li></ul><ul><li>Provide Ghanaian leadership on medicines transparency and accountability across the West Africa region as model for both effective governance and market efficiency. </li></ul><ul><li>Provides opportunity for pricing and quality monitoring mechanism to inform the NHIS </li></ul><ul><li>Reduce and/or eliminate the risk of counterfeit and substandard medication in the supply chain. </li></ul><ul><li>Opportunity for enhanced national research capacity. </li></ul><ul><li>Provides potential mechanism for government commitment to fight inefficiency and corruption in the drug supply landscape. </li></ul>
    18. 18. Risks and assumptions <ul><li>Mutual suspicions between government and private sector; </li></ul><ul><li>All stakeholders nervous about change; </li></ul><ul><li>Where are the enforcement mechanisms across the system? Enforcement of regulations is weak. </li></ul><ul><li>Civil society fragmentation needs to be addressed; assume that new coalitions can be forged. </li></ul><ul><li>Need to assume a degree of commitment to transparency by all stakeholders and willingness to be mutually accountable . </li></ul><ul><li>Timeliness and sustainability of financing. </li></ul><ul><li>Need to ensure plans are realistic for pilot phase - not ‘over-ambitious’. </li></ul>
    19. 19. MeTA structures in Ghana <ul><li>MeTA Secretariat </li></ul><ul><ul><li>Will be hosted by MoH initially </li></ul></ul><ul><ul><li>Seeking office space </li></ul></ul><ul><li>MeTA Annual Stakeholder Forum </li></ul><ul><ul><li>Larger workshop, broader representation; </li></ul></ul><ul><ul><li>To report on progress, share data. </li></ul></ul>09/06/09 MeTA
    20. 20. MeTA structures in Ghana <ul><li>MeTA Governing Council: </li></ul><ul><ul><ul><li>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; </li></ul></ul></ul><ul><ul><ul><li>Professional bodies: Pharmaceutical Society of Ghana, Ghana Medical Association, Nurses and Midwives Council; </li></ul></ul></ul><ul><ul><ul><li>Civil society: CSOs (health and non-health), media, academic institutions, faith-based service providers. </li></ul></ul></ul><ul><ul><ul><li>Private sector: Pharmaceutical Manufacturers Association of Ghana, Association of Private Medical and Dental Practitioners </li></ul></ul></ul><ul><ul><ul><li>International community: World Health Organization, DFID/World Bank/HAI/Other Development Partners Representative. </li></ul></ul></ul><ul><ul><li>Meets quarterly, with first meeting after national launch. </li></ul></ul><ul><ul><li>Two co-chairs </li></ul></ul>
    21. 21. Inputs of Governing Council <ul><ul><li>Oversee the activities of the initial phase of MeTA in Ghana </li></ul></ul><ul><ul><ul><li>Scrutinizing data collected/disclosed on medicine quality, price and availability </li></ul></ul></ul><ul><ul><ul><li>Discuss what is revealed by data collected </li></ul></ul></ul><ul><ul><ul><li>Make recommendations and follow up actions based on data assessment </li></ul></ul></ul><ul><ul><ul><li>Coordinate data disclosure and other MeTA activities in country </li></ul></ul></ul><ul><ul><ul><li>Agreeing progress reports and lessons to be shared with other MeTA pilot countries and the international MeTA Forum </li></ul></ul></ul>