Medicines Transparency Alliance Presented by Deirdre Dimancesco Department of Essential Medicines and Health Products, WHO at the Technical Briefing Seminar 15 April, 2013

2 |2 | MeTA aim MeTA aims at improving access to quality medicines by increasing transparency of the pharmaceutical sector through collection of reliable data, valid analysis, and then disclosure for advocacy and policy dialogue among stakeholders.

3 |3 | The MeTA Hypothesis Robust & relevant information collected Information made available to relevant stakeholders Evidence-based policies and implementation Multi-sector data sharing and analysis Improved access to medicines

4 |4 | Rationale Inefficient markets and poorly functioning supply chains restrict the access to affordable, quality and appropriate medicines. Lack of information and information asymmetries fuel inefficiencies, distort competition, allow corrupt practice, hinder effective management and encourage irrational use of medicines. Medicines account for 3 of the 9 most common causes of inefficiency in health expenditure. –“[R]educing unnecessary expenditure on medicines and using them more appropriately, and improving quality control, could save countries up to 5% of their health expenditure.” World Health Report 2010

5 |5 | WHO Guiding Principles The importance of providing information transparently and involving the public to develop health policies was recognized as early as 60 years ago. –“Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people.” (Constitution of the World Health Organization) Evidence and information on medicine policies is a priority area of work. (WHO Medicines Strategy ). WHA resolution on strengthening national policy dialogue to build more robust health policies, strategies and plans (WHA64.8)

6 |6 | WHO DG Commitment WHO Director-General addresses the Executive Board Report by the Director-General to the Executive Board at its 130th Session,16 January 2012 –“[P]ublic health breaks new ground by tackling a long-standing need. That is: to build national capacity to generate and analyse basic health data. Without information, at country level, we can never have accountability. Without information, we can never know what a “best” or a “wise” investment really means. Without information, we are working in the dark, pouring money into a black hole.”

7 |7 | Global Commitments The United Kingdom will host the 2013 G8 Summit in Lough Erne, Northern Ireland from June. –Prime Minister David Cameron wants discussions to focus on ways in which G8 nations can support the development of open economies, open governments and open societies, including: promote greater transparency.

8 |8 | Universal Health Coverage Transparency and good governance are recognized as significant factors for achieving universal health coverage. –Communication is essential so that people are actually aware of their entitlements. Information to enable transparent monitoring is key. Background document to the Ministerial Meeting on UHC

9 |9 | MeTA and GGM Transparency Participation Accountability Ethics/anti- corruption Rule of law/regulation Voice Efficiency MeTA GGM

10 | About MeTA 7 countries: –Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda and Zambia. Pilot Phase from –Established multi-stakeholder platforms –Collected baseline data & capacity building for it; –Initiated/tested transparency initiatives Phase 2 from –Address information gaps –Transparency and disclosure –Convert dialogue into policy recommendations and interventions

11 | MeTA structure WHO and Health Action International provide: –Project coordination, administration –Technical support through the provision of data collection, analysis & dialogue methodologies, capacity building and policy guidance. MeTA councils –Public sector, private sector, civil society, academics –WHO Country Office support –Plan and implement MeTA workplan

12 | MeTA process Identifying challenges or gaps Setting priorities Defining a baseline Agreeing the process Gathering dataAssessing data Policy dialogue Dissemination of data and messages Multi-stakeholder dialogue Evidence based policy Advocacy Voice

13 | Types of information Medicines Registration and Quality Assurance Market registration procedures and registration status of all medicines Good Manufacturing Practice (GMP) outcomes Quality assurance processes in public and non-profit tenders Quality assurance data during registration or procurement Routine quality testing and adverse event monitoring Medicines Availability Volume and value of medicines procured Availability of medicines to consumers Routine audits for public, private, and non-profit medicines outlets

14 | Types of information Medicines Prices Consumer and ex-manufacture prices of medicines in the public, private, and non-profit sectors Public sector medicines procurement prices Medicines price components in the public, non-profit, and private sectors Medicines use and Promotion Standard treatment guidelines Essential medicines list Medicines promotion regulations, policies, and industry practices

15 | Successes from the pilot The National Medicines Regulatory Authorities of Kyrgyzstan, Uganda and Zambia created web-sites – registered medicines list, list of authorized wholesalers, etc. Peru developed a database of medicines prices in public and private pharmacies. –The system allows consumers to compare the prices and choose where to buy. This increased competition is meant to reduce prices of medicines. In the Philippines MeTA contributed to the enactment of the "Cheaper Medicines Act" 2008 and to the establishment of an e-procurement system for medicines. MeTA supported the country to develop Standard Treatment Guidelines for key diseases.

16 | Lessons learned from the pilot Multi-stakeholder working is not easy – it takes patience, understanding, diplomacy and tact; Identifying champions in each sector can greatly expedite the process of multi- stakeholder engagement and transparency; Each sector needs to give & take to build consensus; Conflict of Interest identification – transparency; The MeTA process needs to be country-led and with guidance.

17 | Phase 2 targets Decrease mean price of essential medicines by 10% Increase average availability by 10% Improve efficiency Build on the foundations of the MeTA pilot Focus on policy dialogue in alignment with country priorities

18 | Main areas of technical work GhanaMonitoring price and availability Analysis and use of phase 1 data JordanNational drugs policy Supply chain management Determinants of availability KyrgyzstanNational drugs policy Public sector procurement RUM:antimicrobial resistance PeruMonitoring price and availability Analysis and use of phase 1 data Public sector procurement Quality assurance PhilippinesMonitoring price and availability Medicines promotion assessment Quality UgandaMonitoring price and availability RUM: DTCsQuality assurance ZambiaAnalysis and use of existing data Public sector procurement

19 | Main areas of Civil Society activities GhanaAssessment capacityCapacity building for communications Communications activities JordanCapacity building for communications Campaigns to improve knowledge on patient rights KyrgyzstanCapacity building for collection of data and pilot data collection Capacity building for communications Campaigns on patient rights and antibiotic use PeruCampaigns to promote access to medicines Involvement in development of methodologies and policy recommendations PhilippinesCampaigns to improve awareness of drug entitlement programmes Community monitoring pilot UgandaCampaigns to empowe communities to own services and holder duty bearers to account ZambiaCapacity building for community radio Improve awareness of regulatory issues

20 | Factors for success Government commitment Country driven process True multi-stakeholder collaboration