1. Medicines Transparency Alliance08/08/2015 1 MeTA Peru Country Overview Public Sector Private Sector Civil Society

2. Medicines Transparency Alliance08/08/2015 2 MeTA Peru Germán Rojas, Technical Secretary Leda M. Perez, Consultant to MeTA in Peru

3. Medicines Transparency Alliance08/08/20153 Multi-stakeholder process A commitment to engage – Received a commitment from the MoH in early 2008 to participate in MeTA – Participation of public and private sectors and civil society in MeTA global launch of May, 2008 A commitment to proceed – Birth of the Grupo Impulsor, June 2008 – MeTA Peru National Forum, November, 2008 – Consolidation of Executive Committee and National Council between November, 2008 and February, 2009 – Refinement of MeTA Peru national work plan, February, 2009-February, 2010 A commitment to implement – Executive Committee continues to meet weekly to make decisions relative to work plan implementation – National Council meets every two months to assess progress on work plan

4. Medicines Transparency Alliance Major achievements and successes All sectors remain at the table! – Continuous nature of multi stakeholder process – Communication has changed as a result of MeTA Progress on key areas of implementation – Price Observatory – Public purchases study – Development of Centers for Medicines Information Agreement on key areas to be implemented – Development of a national generics policy – Development of baseline data studies, i.e., pharmaceutical sector scan and multi stakeholder process evaluation – Development of software for price observatory – Development of Website/communications plan 08/08/20154

5. Medicines Transparency Alliance Overall challenges The multi stakeholder process takes time – Sectors are working together which may have never had a history of collaboration – Without trust and relationships it is impossible to move the agenda forward. – Must adapt to new structures, i.e., Executive Committee, National Council, administrative and technical secretariats The Executive Committee and National Council lead this process and not the Technical or Administrative Secretariats – This means that there are many minds at work and the Technical and Administrative Secretariats are beholden to the will of these voluntary bodies and not the other way around 08/08/20155

6. Medicines Transparency Alliance Lessons Learned The multi stakeholder process may be a useful manner of creating transparency and improving decision-making in the pharmaceutical sector. However, – Investments in relationship- and trust-building are essential – Such a process is difficult anywhere in the world, but may be particularly challenging in environments whose governments have been historically centralized. While transparency in information about medicines and process is important, we must be careful that the mechanisms put in place do not create greater bureaucracies There is value in a shared space between civil society, government and private sector to discuss common issues of concern. 08/08/20156

7. Medicines Transparency Alliance Lessons Learned 08/08/20157 PUBLIC SECTOR CIVIL SOCIETIES PRIVATE SECTOR MINSA EsSalud Defensoría del Pueblo Facultad de Medicina de la UNMSM Gobiernos Regionales: Arequipa, Huánuco, Piura Asociación Nacional de Laboratorios Farmacéuticos– ALAFARPE Asociación Nacional de Industrias Farmacéuticas – ADIFAN Comisión de Salud de Cámara de Comercio de Lima (COMSALUD) Asociación Peruana de Entidades Prestadoras de Salud (APEPS) Colegio Médico del Perú Acción Internacional para la Salud Foro Salud Red Peruana de Pacientes y Usuarios

8. Medicines Transparency Alliance Lessons Learned 08/08/20158 President Vice-President 15 Members MoH Ombudsman HAI Medical College of Peru ALAFARPE National Council MeTA Peru Executive Committee MeTA Peru Technical Secretariat Communicator Administrative Secretariat Support: International consultant

9. Medicines Transparency Alliance08/08/20159 Thank you German Rojas, Technical Secretary Leda M. Perez, Consultant to MeTA in Peru Email: grojas3000@gmail.com and ledaperez@hotmail.comgrojas3000@gmail.com Mobile number: 511 99566 5509 (Leda) 511 999378102 (Germán) Skype: leda568 and grojas3000 Website: www.metaperu.orgwww.metaperu.org

10. Medicines Transparency Alliance08/08/2015 10 Peru – Public Sector Melitón Arce Pedro Yarasca Pedro Tintaya

11. Medicines Transparency Alliance08/08/201511 Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA Problems: – Lax legislation for the Registration and Quality of medicines. – Little transparency in the information of prices. – Promotion and Publicity of medicines Needs: – Transparency in information of prices of Pharmaceutical Products – Politics of Generic Medicines – Rational use of medicines: Listing of Essential Medicines of the Health Sector – Greater availability and affordability of medicines

12. Medicines Transparency Alliance08/08/201512 Registered medicines in Peru Total of Medicines with Sanitary Registration in force: 23,022 Fuente: SI-DIGEMID. Abril 2010

13. Medicines Transparency Alliance Main mailstones What milestones have been reached during the MeTA pilot phase? During the period of the MeTA pilot phase, the following milestones have been achieved, favored by MeTA Peru: Observatoriy of Prices of Pharmaceutical Products: – Regulatory framework for the OPPF – Development of the software for prices reports – Technological support :PCs, Server – Informative campaigns for the dissemination of the OPPF: Informative Modules Aspects that have facilitated to reach this milestones: – New legislation of Pharmaceutical Products, medical devices and sanitary products. – Obligatory nature of prescription in International Common Denomination (DCI) 08/08/201513

14. Medicines Transparency Alliance Successes What were the successes of the sector during the MeTA pilot phase? – Elaboration and approval of the normative framework on the Observatory of Prices – Launch of the Observatory of Prices - Currently in Version 2. – Political commitment and support by the Minister of Health – Acceptability of the Observatory of Prices by part of the population 08/08/201514

15. Medicines Transparency Alliance08/08/201515 Examples Informative campaign on Prices of Medicines

16. Medicines Transparency Alliance Challenges What challenges have this sector to confront during the MeTA Pilot Phase? – To build a better trust among the associates. – The presence of divergent opinions during the process. – Greater capacity in technological and human resources. 08/08/201516

17. Medicines Transparency Alliance Lessons Learned What lessons has this sector learned of MeTA? – Recognition of issues that should be revealed to the population (prices, availability, public purchases, information of medicines). – Allowing space for multisectorial dialogue. – Identification of objectives and common strategies among the associates, always respecting their points of view. – It has permitted to identify prominent tissues for the country in matter of medicines. 08/08/201517

18. Medicines Transparency Alliance08/08/201518 Thank you Pedro Yarasca e-mail: pyarasca@digemid.minsa.gob.pe Telf.: 0051-1-998704127 www.digemid.minsa.gob.pe

19. Medicines Transparency Alliance08/08/2015 19 Private Sector Berenice Pinto Augusto Rey

20. Medicines Transparency Alliance08/08/201520 Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA Quality Ilegal Market Ethics Regulation

21. Medicines Transparency Alliance Main mailstones What milestones have been reached during the MeTA pilot phase? – Forming part of a roundtable where we are able to work together as a country on common interest (public, private and civil company). – Communication among the private sector, the public sector and the civil company has improved. – Communication of the companies that conform the private sector has improved (ADIFAN, ALAFARPE, COMSALUD- CCL). – Joint appreciations as private sector on problems that normally require a major approach by the public sector. 08/08/201521

22. Medicines Transparency Alliance Successes What were the successes of the sector during the MeTA pilot phase? – Diffusion within the private sector of MeTA's objectives – Achieving commitment of the private sector stakeholders on access to medicines. – Permanent participation in MeTA Peru of 3 of the 4 private sector stakeholders. – Commitment and participation of ALAFAL – Better communication both inter and intra-sectorial. – Greater understanding of the multi-stakeholder process. 08/08/201522

23. Medicines Transparency Alliance Challenges What challenges has this sector confronted during the MeTA Pilot Phase? – Sharing the concerns of the pharmaceutical sector. – Contribute to a common agenda among private sector which is presented in MeTA Peru. – Debate different points of view with other sectors. 08/08/201523

24. Medicines Transparency Alliance Lessons Learned What lessons has this sector learned of MeTA? – Opportunity of dialogue among sectors. – The multi-stakeholder process allows to identify common problems. – Engage the opportunity that the government of the United Kingdom has offered us, to discuss pharmaceutical issues with transparency. – It is possible to build a shared vision across sectors. – Building trust is necessary among the sectors 08/08/201524

25. Medicines Transparency Alliance08/08/201525 Thank you Berenice Pinto C-electrónico: bpintoadifan@hotmail.combpintoadifan@hotmail.com Número Celular: 511 992776311 / 511 4226480 Página Web: www.adifan.com.pewww.adifan.com.pe Augusto Rey C-electrónico: arey@alafarpe.com Número Celular: 511 995491392 / 511 4410693 Página Web: www.alafarpe.comwww.alafarpe.com

26. Medicines Transparency Alliance08/08/2015 26 Civil Society Marco Alegre Romero – Coordination CSOs

27. Medicines Transparency Alliance08/08/201527 Analytical Summary at the beginning of MeTA What were the needs and problems in this specific sector at the beginning of MeTA?  43% of the country's population lacks access to essential medicines.  CSOs had not fluent access to essential critical information by the state and the private sector in relation to access to medicines.  There was limited space for Civil Society participation to generate public policy on essential medicines.  Absence of a National Policy for Generic Medicines.  Weakness in the mechanisms of transparency and accountability of public administration in the early stages of the medicines supply chain.

28. Medicines Transparency Alliance Main mailstones What milestones have been reached during the MeTA pilot phase?  Being able to start working together to address access to generic medicines, between the State, Civil Society and Private.  Forming a Coalition of Civil Society Organizations  To be able to formulate a national project by the CSOs Coalition and users, to train leaders in monitoring access to medicines. 08/08/201528

29. Medicines Transparency Alliance Successes Which were the successes of the sector during the MeTA pilot phase?  Raise the issue about lack of access to medicines at national and regional levels.  Reach an agreement with the University for the development of post-graduate courses to train leaders in monitoring access to medicines.  Manage to jointly formulate a project that contribute to access of medicines among the national and regional CSOs  The engagement of 18 out of 25 regions of the country in the implementation of the project 08/08/201529

30. Medicines Transparency Alliance Challenges What challenges has this sector confronted during the MeTA Pilot Phase?  To provide a better positioning of the CSOs on the National Council and the Executive Board of META Peru.  To achieve a cohesion between CSOs – Users, and technical people.  To engage active leaders in monitoring access to medicines at the national level articulated in the network. 08/08/201530

31. Medicines Transparency Alliance Lessons Learned What lessons has this sector learned from MeTA?  You can better address the problem of access to essential medicines when working in collaboration with the state, civil society and the private sector.  The Civil Society can improve the quality of dialogue and negotiation with the public and private sector when it has continuous access to information.  The Civil society is divided according to the interests of each of its members.  The regions of Peru would like to address the problems ofaccess to essential medicines but do not have strategies and information to give an appropriate response. 08/08/201531

32. Medicines Transparency Alliance08/08/201532 Thank you Marco Alegre Romero C-electrónico: malegre84@yahoo.com Número Celular: (51) 1997273931 Skype: Página Web: www.forosalud.org.pe