Medicines Transparency In Ghana

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Presentation on the medicines supply system in Ghana at the launch of the Medicines Transparency Alliance, London May 2008

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  • Title of presentation 04/06/09 MeTA
  • Medicines Transparency In Ghana

    1. 1. Daniel Kojo Arhinful MeTA pilot in Ghana MeTA
    2. 2. <ul><li>Population 20.9m </li></ul><ul><li>Population growth 2% p.a </li></ul><ul><li>Population<15yrs 46% </li></ul><ul><li>Life Expectancy at birth M/F 57/60 </li></ul><ul><li>GDP per capita $400 </li></ul><ul><li>Family size 4.5 </li></ul><ul><li>Child mortality per 1000 M/F 92/99 </li></ul><ul><li>Total health exp. % GDP 5.6 </li></ul><ul><li>40% live below National Poverty line </li></ul><ul><li>WHO report 2005/GDS 2003 </li></ul><ul><li># of doctors /per pop. 1:14,000 </li></ul><ul><li># of nurses /per pop. 1: 2000 </li></ul><ul><li># of Pharmacies/per pop. 1:16,077 </li></ul><ul><li># of LCS /per pop 1:2,322 </li></ul><ul><li>Credit MOH 2006 sector review </li></ul>
    3. 3. Transparency and accountability: policy and action <ul><li>Government and Presidential commitment to good governance; </li></ul><ul><li>Public Procurement Act 2003 & MOH Guidelines for health sector procurement; </li></ul><ul><li>Forthcoming Right to Information Bill; </li></ul><ul><li>History of civil society collaboration with government, e.g. through Access to Medicines Initiative and MOH/WHO/HAI Collaboration; </li></ul><ul><li>Data collection and reporting bodies on aspects of pharmaceutical supply chain and use – FDB, CMS, MOH-PU, GHS, CHAG, GNDP, NDRIC; </li></ul><ul><li>National Health Insurance Scheme significant opportunities to improve transparency, accountability, pricing, quality. </li></ul>
    4. 4. Policy framework for MeTA in Ghana <ul><li>Health Sector Programme of Work 2007-2011: Key Principles </li></ul><ul><ul><li>Health identified as key driver for poverty reduction and economic growth; </li></ul></ul><ul><ul><li>Commitment to enhance contribution of health industry to national economy; </li></ul></ul><ul><ul><li>Emphasis on “partnerships”, “people-centred”, “equity” and “efficiency” – all key themes for MeTA; </li></ul></ul><ul><ul><li>Emphasis on good governance and accountability in the health sector; </li></ul></ul><ul><ul><li>Plans to proactively engage civil society in consensus building and to provide more information to consumers, e.g. around quality and rational drug use; </li></ul></ul><ul><ul><li>Drugs and Essential Logistics Management objective: “address availability, affordability, sustainable financing, safety, quality and efficacy of medicines in a transparent manner .” </li></ul></ul>
    5. 5. Key Challenges 1 <ul><li>Urgent need to address maternal health and incidence of malaria, including as a route to tackling infant and child mortality; </li></ul><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>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>
    6. 6. Key Challenges 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, weak control systems; </li></ul><ul><li>Counterfeit and/or substandard products a problem - but very limited data. </li></ul>
    7. 8. 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>
    8. 9. MeTA in Ghana: main pilot activity <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>
    9. 10. 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>Will meet quarterly, with first meeting after national launch. </li></ul></ul><ul><ul><li>Two co-chairs </li></ul></ul>06/04/09 MeTA
    10. 11. MeTA structures in Ghana <ul><li>MeTA Secretariat </li></ul><ul><ul><li>Will be hosted by MoH initially. </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>06/04/09 MeTA
    11. 12. Status of MeTA workplan <ul><li>Core group has developed draft for review; </li></ul><ul><li>Will get feedback from the MeTA global secretariat; </li></ul><ul><li>Then will be submitted for consideration by the Governing Council in Ghana and then finalized. </li></ul>
    12. 13. National research priorities <ul><li>Already doing Household and Pharmaceutical Sector Level 2 surveys; </li></ul><ul><li>Have done pharmaceutical supply chain mapping in public sector with WHO; would like to expand to private and faith-based sectors. </li></ul><ul><li>National MeTA workplan includes conduct of Knowledge, Attitude, Behaviour and Practice studies. </li></ul><ul><li>Need to research drug quality issues - plans include synthesizing past studies, and conducting regular sentinel testing using GPHF minilabs. </li></ul>
    13. 14. Lessons learned so far… <ul><li>Value of building on previous collaborations; </li></ul><ul><li>Scoping study provided useful information, and mission debriefing got stakeholders on board; </li></ul><ul><li>Establishment of initial ‘core group’ of actors was helpful in getting ‘started’. </li></ul>
    14. 15. 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>
    15. 16. Support needs? <ul><li>Money to sustain processes. </li></ul><ul><li>Capacity building - for sentinel testing; for CSOs; for media. </li></ul><ul><li>Technical assistance to develop indicators to measure transparency and accountability of all stakeholders. </li></ul><ul><li>Technical assistance to help stakeholders use the data - e.g. in demand forecasting. </li></ul>
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