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Challenges to improve medicines transparency in Ghana


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This is a presentation by Dr Daniel Kojo Arhinful at the launch of the Medicines Transparency Alliance (MeTA) in Ghana in November 2008. MeTA is a global alliance, working in 7 pilot countries. For more information, see

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Challenges to improve medicines transparency in Ghana

  1. 1. Medicines Transparency Alliance (MeTA) in Ghana Daniel Kojo Arhinful NMIMR National launch in Ghana Accra, November 2008
  2. 2. Outline of Presentation <ul><li>What is the Problem </li></ul><ul><li>What is MeTA proposing and the principles </li></ul><ul><li>History of the process </li></ul><ul><li>Context of Implementation in Ghana </li></ul><ul><li>What are the Objectives and expectations </li></ul><ul><li>How MeTA might work </li></ul>
  3. 3. What is the problem? <ul><li>Poor people lack access to essential medicines </li></ul><ul><li>Prices are too high (private sector) </li></ul><ul><li>Products are not available (public sector) </li></ul><ul><li>Concerns about quality of products (public and private) </li></ul><ul><li>Need to focus on distribution from ‘port to patient’. </li></ul>Manufacturer Procurement Agent (s) Wholesaler Distributor Retailer / health unit Patient
  4. 4. Source Of Funds Procurement Agent/Body Point of first warehousing Point of 2 nd warehousing Point of 3th warehousing GOVERNMENT WB GLOBAL FUND USAID CENTRAL MEDICAL STORE Medicines supply systems in GHANA 2007 GAVI ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs Ped REAGENT Blood safety (+ test HIV) VACCINES CONDOMS Contraceptives MEDICAL SUPPLIES Government Multilateral Donor Bilateral Donor Category of Products color code MOH UNICEF USAID GOVT Of JAPAN UNFPA REGIONAL MEDICAL STORE DISTRICT MEDICAL STORE UN AGENCY Republic of Ghana ITNs D F I D GOVT Of JAPAN FAITH- BASED ORGs POP/ RDF HEALTH FACILITY HEALTH FACILITY FAITH- BASED ORGs FAITH-BASED ORGs DESIGNATED TREATMENT CENTRE UNFPA WHO GDF $7M $3.5M $0.4M ?? ?? ?? $4.2M ?? ?? $5.6M $0.7M $9M Storage & Distribution ??? Credit MOH/WHO Procurement Assessment 2007
  5. 5. Port to patient <ul><li>Available, evidence shows, </li></ul><ul><li>Efficiency of public procurement variable </li></ul><ul><li>Price mark-ups along supply chains </li></ul><ul><ul><li>Cumulative increase of 100% plus </li></ul></ul><ul><li>Low local manufacture </li></ul><ul><li>Counterfeits </li></ul><ul><ul><li>10 – 30% of the market in many countries </li></ul></ul>
  6. 6. What is the MeTA proposal? <ul><li>An alliance of countries, companies, civil society and international partners based on lessons from the Extractive Industries Transparency Initiative to </li></ul><ul><li>Increase transparency over key price, quality, procurement and availability data </li></ul><ul><li>Build accountability to address inefficiencies and reduce excessive pricing </li></ul>
  7. 7. Meta Principles <ul><li>Commitment to improving health </li></ul><ul><li>Comprehensive approach to health systems, including pharmaceuticals </li></ul><ul><ul><li>Weak pharmaceutical systems result in poor access, quality, affordability and health outcomes </li></ul></ul><ul><li>Transparency and accountability can: </li></ul><ul><ul><li>Improve system performance </li></ul></ul><ul><ul><li>Build confidence </li></ul></ul><ul><ul><li>Support equity and social justice </li></ul></ul><ul><li>Multi-stakeholder approach </li></ul>
  8. 8. <ul><li>Two scoping missions by the DFID UK </li></ul><ul><li>Preparatory work by core team </li></ul><ul><ul><li>Proposal development </li></ul></ul><ul><ul><li>Secure h igh level country political commitment </li></ul></ul><ul><li>Formation of country multi-stakeholder </li></ul><ul><li>International launch invitation </li></ul><ul><li>National launch and 2 year pilot in 7 countries </li></ul><ul><ul><li>Share learning across countries </li></ul></ul><ul><ul><li>Fine tune approach and aspirations </li></ul></ul>Unfolding story
  9. 9. <ul><li>How MeTA might work </li></ul>Political Commitment Establish multistakeholder group (MSG) Review existing data / research Agree key deliverables - identify blocks Disseminate, debate, act Disclose data Draw on scoping study, Including e.g. HAI Pricing survey Global Fund data etc Identify technical assistance required: Procurement, regulatory Medicines policy etc Release MeTA report Evaluate results, develop recs Scoping study: Full market analysis Drivers of change Disclosure and report production
  10. 10. Existing enabling and legislative environment for MeTA in Ghana <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>Data collection and reporting bodies on aspects of pharmaceutical supply chian and use –FDB, CMS, MOH-PU, GHS, CHAG, GNDP, NDRIC </li></ul><ul><li>NHIS significant opportunities to improve transparency, accountability, pricing, quality </li></ul>
  11. 11. Policy framework for MeTA in Ghana <ul><li>– Key Principles of 2007-2011 </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, around quality & RDU. </li></ul></ul>
  12. 12. Key Challenges 1 <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 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. What to do (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>Promote regular monitoring of medicine prices and availability as well as their rational use using WHO standard indicators. </li></ul><ul><li>Promote regular monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’ </li></ul><ul><li>Facilitate agreement by pharmaceutical companies to publicize their supply prices to match tender data. </li></ul>
  16. 16. What to do (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>
  17. 17. Risks and assumptions <ul><li>Mutual suspicions between stakeholder groups; </li></ul><ul><li>All stakeholders nervous about change; </li></ul><ul><li>Where are the enforcement mechanisms across the system? </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>
  18. 18. MeTA structures in Ghana <ul><li>MeTA Secretariat </li></ul><ul><li>M eTA Governing Council </li></ul><ul><ul><li>Oversee activities of MeTA in Ghana </li></ul></ul><ul><ul><li>Scrutinizing data collected/disclosed on medicine quality, price and availability </li></ul></ul><ul><ul><li>D iscuss what is revealed by data collected </li></ul></ul><ul><ul><li>M ake recommendations and follow up actions based on data assessment </li></ul></ul><ul><li>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>
  19. 19. Expectations of MeTA in Ghana <ul><li>Provide Ghanaian leadership on medicines transparency disclosure and dissemination of price information </li></ul><ul><li>Provide opportunity to reduce and/or eliminate the risk of counterfeit and substandard medication in the supply chain. </li></ul><ul><li>Facilitate civil society capacity building to support disclosure and accountability </li></ul><ul><li>Share good practices with other MeTA pilot countries </li></ul>
  20. 20. APPRECIATION <ul><li>Thanks for Attention </li></ul>