1. Medicines Transparency Alliance07/09/2015 1 MeTA Zambia Country Overview Public Sector Private Sector Civil Society

2. Medicines Transparency Alliance07/09/2015 2 Country Overview Violet Kabwe MeTA Zambia Consultant

3. Medicines Transparency Alliance07/09/20153 Multi-stakeholder process What were the major milestones in the multi-stakeholder process? Establishment of the MeTA Management Structure: Council, Forum and Sub – Committees Establishment of National Secretariat Developed Zambia MeTA website Communication strategies implemented at both policy and community levels: motion in parliament, TV and radio live phone in progs, community sensitization road shows, development of fact sheets etc Orientation workshops for MeTA Council members held in supply chain systems and regulatory issues/mandate Have developed synergies with GGM Conducted data disclosure tool Drafted advocacy position papers on ‘ADDO’ system in Zambia and counterfeit and sub- standard drugs Commissioned studies impinging on availability, affordability, and access to medicines Provided technical support to CSO Coalition capacity building on supply chain systems

4. Medicines Transparency Alliance Major achievements and successes What where the main achievements and successes of MeTA in your country? Successful, well-attended MeTA launch, opened by Minister of Health. Effective capacity building of Council members in supply chain management and functions of PRA. Successful mobilization of cross-party parliamentarians; moved motion in parliament which introduced MeTA concept to august house. Good buy-in from Cabinet Office –agreement to distribute MeTA materials. Establishment of national MeTA Secretariat Effective community mobilization efforts in rural pilot districts of North-Western Province –included 2 successful radio shows. Live radio/TV programmes have become popular and made MeTA ‘visible’ Community radio station managers mobilized through sensitization workshop. Mainstreaming of MeTA in community programs have gained popularity MeTA included in national health reform processes Reports commissioned for challenges of manufacturing sector, pricing structures in public/private sector, private sector mapping survey and data disclosure survey. MeTA Zambia website commissioned –impressive design. MeTA Forum meeting held 07/09/20154

5. Medicines Transparency Alliance Overall challenges (1) What have been the main challenges during the MeTA pilot phase? Creating trust and Commitment among stakeholders by striving to share joint MeTA learning among all stakeholders common MeTA benefits strategy or/and understanding that cuts across all sectors Commitment by all stakeholders was a challenge MeTA Council/CSO Coalition synergies were not apparent Felt need to set up sub – committees as implementation bodies of MeTA Council Expected support from government and CPs did not fully materialize Used two pronged approach, targeting both policy and community levels as entry points for dialogue/sensitization concerning MeTA core principles Capacity building of MeTA Council members in pharmaceutical sector and health care delivery systems. Making private sector representatives, line ministry officers and members of parliament to become aware and gain knowledge on MeTA issues 07/09/20155

6. Medicines Transparency Alliance Overall challenges (2) Delayed funding due to local bureaucracy meant late start to implementation of national work plan Delayed/disrupted recruitment and housing of Secretariat Support of other MeTA CPs to Initiative was not forthcoming Need to maintain continuous buy-in of all sectors and stakeholders time-consuming. Operations of Council and Sub-Committees depend on voluntarism, and high levels of commitment and time. Most members in full-time work so regular participation challenging, very apparent in the Research & Survey sub - committee. Large Council makes convening meetings logistically challenging and expensive. –Large numbers with varied skills mix means decision-making is slow. Initially, a calendar of Council and Sub-Committee meetings was not published in advance, made planning and scheduling challenging. Lack of clarity on the log frame, delayed work plan approval, and disrupted timely funding/ implementation. Adhoc requests from MeTA International for sudden activities a big challenge; especially with a tight work plan to implement Non – disclosure of pricing structures by most pharma industry Disclosure tool only made available in Sept 2009 –would have been useful as baseline data and for work plan development. 07/09/20156

7. Medicines Transparency Alliance Lessons Learned What are the main lessons from MeTA in your country? MeTA process is technical and complex, hence requires capacity for all members to move at the same pace. There are diverse interests among MeTA members who continuously strive to have common understanding and expected outcomes from the MeTA Process Establishing consensus requires constant lobbying for exchange of views Commitment of people important otherwise multi-stakeholder processes will not work MeTA members need medicines and management expertise MeTA can not operate in a political vacuum MeTA CSO needs to include members that are able to engage in dialogue at high profile level Two pronged approach in MeTA process (sensitization/lobbying at grassroots and policy levels respectively), improved MeTA ‘visibility” Non completion of desk review of data affected other dependent activities 07/09/20157

8. Medicines Transparency Alliance07/09/20158 Community Awareness Community awareness activities – MeTA roadshow in Mkushi Opportunity to create public awareness about MeTA Positive response to MeTA issues in rural communities

9. Medicines Transparency Alliance07/09/20159 Thank you Violet Kabwe Email: kabwe.violet@gmail.com Mobile number: +260976939364 Website: www.metazambia.orgwww.metazambia.org

10. Medicines Transparency Alliance07/09/2015 10 Public Sector Mrs Bernice Mwale Director – Product Registration Pharmaceutical Regulatory Authority

11. Medicines Transparency Alliance07/09/201511 Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA MeTA was initially to be housed within MOH, later agreed that Transparency International (Z) be host MeTA very much linked to public sector; MOH key to success of MeTA, even though not driving MeTA MeTA provides big opportunity to have all different stakeholders on one roundtable to discuss issues that could influence policies/practices Understanding core principles of MeTA by members very key Expected support from CPs MeTA members are volunteers, their time is at a premium The size of MeTA Council directly relates to MeTA effectiveness Targeting issues that directly impacts general public is measure of MeTA success

12. Medicines Transparency Alliance Major milestones Government has shown support towards MeTA as shown by the Minister of Health launching of MeTA in Zambia and other activities Government has participated in the MeTA live radio programs after some initial hitches Orientation workshop for MeTA Council members in PRA mandate/functions Orientation of MeTA Council members in the national supply chain systems (public and private) Collaborative meeting held between PRA and its stake holders Active participation of MOH and its institutions in Forum meeting Co-chairing of MeTA Council meetings 07/09/201512

13. Medicines Transparency Alliance Successes MeTA provided another forum for dissemination of information to wider circle of stake holders Participation in live MeTA radio programs MOH representative is Vice Chairperson of MeToA Council Successful orientation of MeTA Council members in the functions/mandate of PRA Successful collaboration by PRA with key stakeholders on various issues affecting them Successful orientation of MeTA Council members by MOH/its institutions on the national supply chain system Active participation of MOH, PRA and MSL IN THE MeTA Forum meeting 07/09/201513

14. Medicines Transparency Alliance Challenges (1) Big challenge for government employees to talk about transparency and accountability issues Finding time to attend to MeTA activities given busy schedules Weakness in the tools that were used to carry-out some surveys; should have been field tested first The surveys were supposed to gather more evidence for advocacy and influencing change Ensuring quality verses spending more money in a short time (to beat financial deadline). It was a challenge for some government officials in the MeTA sub-committees to follow tendering procedures rather than those followed in government (Comprehensive Tendering Procedures) 07/09/201514

15. Medicines Transparency Alliance Challenges (2) Balancing MeTA activities and government duties was a challenge, especially that MeTA programs do not give sufficient notice The role of MOH in MeTA is key, however, need to recognise that MOH is not the driver for MeTA MeTA may be expected to address all kinds of issues, even if these are influencing access to affordable essential medicines Most CPs needed to be reminded about MeTA. MeTA can be seen as a tool with which to ‘punish’ or ‘expose’ the weaknesses in the public health sector 07/09/201515

16. Medicines Transparency Alliance Challenges (3) The challenge MeTA presents is that all stakeholders and concerned citizens want to be counted within MeTA. This is clearly a difficult situation for MeTA Council and admin team MeTA is still in the formative stage and it may feel inadequate to tackle certain issues that impact on access to essential medicines Initial focus was on private sector from the regulatory point of view Misrepresentation of facts by consultant involved in desk review, delayed other MeTA follow on activities Some of the tools used for data collection appeared to be deficient in certain critical information. 07/09/201516

17. Medicines Transparency Alliance Lessons Learned (1) MeTA should have an independent stand alone registered secretariat It was an opportunity for government to share information with the general public to discuss health issues, the forum can be used to share information dialogues with other stakeholders to introduce/withdraw new policies, schemes,fees and report illegal practices It was learnt that it is important to identify issues surrounding a survey before it is carried out. Difficult to fit in MeTA activities 07/09/201517

18. Medicines Transparency Alliance Lesson Learned (2) There was need to have clear cut issues identified if a change was to be achieved it was a big opportunity for government to have all different stakeholders on one table hence a chance to raise awareness to other sectors. Awareness was also raised through the MeTA radio programs MeTA is very much linked to the public health sector. The MOH, even though not driving MeTA, is key to the success of MeTA There is a need to advocate for more infrastructure and health personnel to improve quality and accessibility of good quality medicines Focus on one or two issues was very necessary if tangible results were to be achieved The public health sector need not be seen as the only target for MeTA 07/09/201518

19. Medicines Transparency Alliance Lessons Learned (3) Knowledge of the purpose and intentions of MeTA by stakeholders. There is a need for all members and stakeholder to keep in mind the background that resulted in MeTA The support from Cooperating Partners has been below expectation MeTA members are volunteers and their time is at a premium The size of MeTA Council directly relates to the effectiveness of MeTA Targeting issues that directly impact the general public is a measure of MeTA’s success Clearly the time- frame for MeTA put pressure on members and the MeTA administrative team. All parties want to succeed. 07/09/201519

20. Medicines Transparency Alliance07/09/201520 Thank you Name of presenter : Mrs Bernice Mwale Job Title: Director – Product Registration (PRA) Email: bcmwale@pra.gov.zm Mobile number:+260977804353 Website: www.metazambia.orgwww.metazambia.org

21. Medicines Transparency Alliance07/09/2015 21 Private Sector Presenter Name : Ruth Mudondo Job Title: Director – Unicare Pharmaceuticals. Chair person – Zambia Pharmaceutical Business Forum.

22. Medicines Transparency Alliance07/09/201522 Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Issues  Private sector was battling with the challenges & problems– alone. Though Zambia Pharmaceutical business Forum (ZPBF) was in place.  Lack of transparency at MOH – One of the major concerns of the Private sector  Lack of flow of information and very little consultation between Pharmaceutical regulatory authority – Private sector – PRA  Private sector was not able to access some of the information at PRA.  Lack of unity among the business community - drive to fight for the common cause..... Needs  Wanted someone to represent the private sector in the MeTA process

23. Medicines Transparency Alliance Major milestones What milestones have been achieved during the MeTA pilot phase? Establishment of Multi stake holders forum – Fantastic  PRA (Pharmaceutical Regulatory Authority) heard the challenges of the Private sector from a neutral body like MeTA  MOH was more willing to respond to the queries raised by the Private sector.  CSO and Media got to know the role of private sector in Health care.  Private sector found it easy to express their challenges in the MeTA meetings and most of the time private sector got the positive support from MeTA. 07/09/201523

24. Medicines Transparency Alliance Successes What were the successes for your sector during the MeTA pilot phase?  Zambia Pharmaceutical Business Forum – Recognition  Issues pertaining to Local Pharmaceutical Manufacturers were taken up on FAST TRACK and are being addressed by relevant authorities.  Media Campaigns: Ordinary citizens got to know more about distribution of medicines and the challenges that are faced by the Public & Private sector in delivering quality medicines.  Radio program: Flow of information – Interactions – Public Participation  Documentary: Public awareness about the role of Private industry in National Health care – Increased 07/09/201524

25. Medicines Transparency Alliance Challenges What challenges has your sector endured during the MeTA pilot phase?  Certain segment of Private sector is yet to appreciate MeTA activities.  Certain segment of private sector – Sceptical about MeTA.  Balancing the MeTA activities with the routine business activities is a challenge.  Getting co operation – conducting survey – is a real tough job  Understanding the concept of disclosure – Cant visualize the benefits – hence it is difficult to get the support of private sector. 07/09/201525

26. Medicines Transparency Alliance Lessons Learned What are the lessons that your sector has learned from MeTA?  Importance of MULTISTAKE HOLDERS approach – well understood  Strength and weaknesses of other government institutions, learnt others limitations and started appreciating their efforts to be more transparent and accountable.  Importance of Disclosure tools – Give and take policy.  Importance of lobbying 07/09/201526

27. Medicines Transparency Alliance07/09/201527 PHARMACEUTICAL PRIVATE SECTOR IN ZAMBIA

28. Medicines Transparency Alliance07/09/201528 Challenges of Pharmaceutical manufacturing in Zambia – Lack of modern equipment – Limited research and development expertise

29. Medicines Transparency Alliance07/09/201529 Thank you Ruth Mudondo Director - Unicare Pharmaceuticals

30. Medicines Transparency Alliance07/09/2015 30 Civil Society Dimuna Phiri Paralegal Officer- Zambia AIDSLaw Research and Advocacy Network

31. Medicines Transparency Alliance07/09/201531 Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? *To build capacity amongst CSO’s so as to enable them to engage and deliberate in the multi stakeholder process* To acquire advocacy skills To understand policy formulation and analysis as well as government structures and functions To understand the drug supply chain in Zambia To acquire research and budget tracking skills To understand the Multi Stakeholder Process

32. Medicines Transparency Alliance Major milestones Advocacy training was conducted Drug supply chain training was conducted A training on policy formulation and analysis as well as the functions of government and it’s structures was conducted. 15 Civil society organization are fully committed in the coalition MeTA CSO’s took part in the radio programs and television documentary. 07/09/201532

33. Medicines Transparency Alliance Successes MeTA CSO secretariat is in operation The Work-plan was successfully developed and approved An advocacy strategy has been developed Increased knowledge amongst CSO’s on medicine issues to participate in various opportunities and forums. Developed networks with the private government and similar campaigns such as the Stop Stock Out Campaign. MeTA CSO has legitimacy because it has representation from the community. Multi-dimension civil society participation.(e.g. governance, faith based, media and human rights organisations.) 07/09/201533

34. Medicines Transparency Alliance Challenges The implementation period of the work-plan was too constraining. Dividing time between respective organisational duties and MeTA activities was a challenge Delay in the disbursement of funds Health issues are complex and time is needed to build adequate capacity to understand them. Co-opting organisations in the MeTA CSO process was a challenge on inception 07/09/201534

35. Medicines Transparency Alliance Lessons Learned The work plan was over ambitious (time-frame) Some trainings were too technical. Fluctuation in exchange rates affected the budget Harmonizing MeTA Zambia and MeTA CSO work-plan was a challenge There was under budgeting during the budget planning process There is so much that MeTA CSO’s can do as regards to issues on health in Zambia.(evidenced from the trainings) There is a need to share and link with other similar campaigns. CSO’s became aware that they had a role to play in the pharmaceutical sector 07/09/201535

36. Medicines Transparency Alliance07/09/201536 Thank you Name of presenter : Dimuna Phiri Job Title: Paralegal Officer- Zambia AIDSLaw Research and Advocacy Network Email: dimunaphiri@gmail.com Mobile number:+260979092885 Website: www.metazambia.orgwww.metazambia.org