1. Medicines Transparency Alliance13/09/2015 1 MeTA Jordan Country Overview Public Sector Private Sector Civil Society

2. Medicines Transparency Alliance13/09/2015 2 MeTA Jordan Dr Taher Abu ElSamen MeTA Council Chair HHC Secretary General

3. Medicines Transparency Alliance13/09/20153 Multi-stakeholder process (1) The Multi-stakeholder process in Jordan started by: Establishing the MeTA Council based on a multi-stakeholder membership, the MeTA Council is represented fully by multi- stakeholder, public and private sectors and the CSO, and they all agreed on a national country workplan

4. Medicines Transparency Alliance Multi-stakeholder in MeTA Council MeTA Council Private Sector Local Industry Professional Associations MOH Supply & Procurement Dpt. MOH Pharmacy Dept JFDAHHC JPD RMSJUHKAUH Civil Society & Patient groups Academia WHO DFID WB 9/13/2015 MeTA Int. Partners

5. Medicines Transparency Alliance Multi-stakeholder process (2) MeTA Jordan used the national forum Nov. 2009 as an opportunity to re-motivate and engage stakeholders especially the private sector and the CSOs. The diversity of the represented attendees gave a unique flavor for the forum especially during the discussion session The one day multi-stakeholder collaboration for MeTA pilot countries workshop carried out by Wageningen University in January 2010 was a success, 70 attendees from all MeTA Countries attended, since it supported the multi-stakeholder dialogue and collaboration by encouraging the active participation of key stakeholders from public, private and CSOs Conducting the data disclosure survey was an opportunity not only to collect data but also to work together as a multi- stakeholder, share information and exchange ideas which created more interest and commitment for future activities 13/09/20155

6. Medicines Transparency Alliance Multi-stakeholder process (3) MeTA Jordan will carry out the stakeholder mapping and communication audits in July 2010 through the IDS (part of Component 3 of the MeTA baseline assessment) to help map out the local communication partners and individual consultants. The work aims to create ‘communication’ or ‘learning’ spaces where MeTA representatives have a chance to reflect on their experiences and share these with a view to encouraging innovation and change Having MeTA in Jordan was an opportunity to get key people working in the pharmaceutical sector engage together in a multi- stakeholder membership and including patients along the way MeTA Jordan stakeholders reached a stage that they need skills to help them communicate with representatives of institutional partners who may come from very different positions 13/09/20156

7. Medicines Transparency Alliance Multi-stakeholder process (4) MeTA Jordan stakeholders are thinking strategically to develop a clear brand identity for MeTA and to recommend development of communication tools and messages to support the multi- stakeholder process The International MeTA Secretariat offered countries to identify and communicate the barriers and ensure that the appropriate guidance and support is mobilised within MeTA to address them 13/09/20157

8. Medicines Transparency Alliance Multi-stakeholder Milestones Establishing a multi-stakeholder MeTA Council MeTA Jordan national forum invited multi-stakeholder Nov. 2009 One day multi-stakeholder collaboration for MeTA pilot countries workshop in January 2010 Conducting the disclosure survey with stakeholders working together The planned stakeholder mapping and communication audits to take place in July 2010 through the IDS MeTA Jordan stakeholders have identifies the skills neded to help them communicate with representatives of institutional partners who may come from very different positions, planned between July and Sep. 2010 13/09/20158

9. Medicines Transparency Alliance Overall challenges in multi- stakeholder process A new concept and idea, it needs more time for people to accept and understand Lack of experience of multi-stakeholder process and the need for different communication skills for members Inter-personal /inter-institutional communication skills for MeTA Council Members was a challenge, (active listening etc training is needed) There are currently issues related to Council members listening to each other and putting their point across in a non- confrontational way People are not all used to operating in a forum where people represent organizations with such different positions and they need support on consensus building 13/09/20159

10. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (1) The Government is highly supportive of the MeTA process it supported and hosted MeTA at the HHC, a governmental institution, this gave the whole process an official identity and led to have the diverse public sector more engaged MeTA was launched in Jordan as a high profile national event in May 09 The highly committed MeTA Council Members started realizing the concept of transparency, they agreed on a national workplan based on the NDP, they agreed to publish all outcomes on Jordan MeTA web site, participated in the data disclosure survey and issued the first MeTA newsletter on April 2010 Jordan had hosted a session at the WHA on transparency and good governance May 09 13/09/201510

11. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (2) The MeTA process has opened channels of communication between different stakeholders and between different countries. Common understanding of each of the other stakeholder perspectives was identified, the fact that there are common priorities and one objective between stakeholders became more clear MeTA council private sector representative attended the private sector meeting in London June 09 Pharmaceutical Baseline Assessment Survey-Level II and a WHO/HAI surveys took place Supply Chain Mapping assessment took place in March 09 A Successful National Forum Nov 09 13/09/201511

12. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (3) In terms of CSO building capacity area: The CSO committee has drafted a CSO workplan where it is derived form the three major priorities in the overall national MeTA workplan in Jordan, “Build capacity of (CSOs) to monitor and increase accountability of all stakeholders with respect to the prices, availability, selection and quality of medicines in the public and private sectors A nucleus of a CSO coalition has started to form and a MoU was signed with the Int. MeTA Secretariat in November 2009 and a specific CSO workplan was approved accordingly the voice of patient is now becoming heard by the Government policy makers The very first activity was conducted to map and identify CSOs to assess their ability and willingness to work together and to engage them with the MeTA council, this activity has set the baseline work for the CSOs in Jordan 13/09/201512

13. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (4) In terms of CSO building capacity area: Workshop on building capacity of CSOs in order to strengthen their ability to monitor and increase accountability of all stakeholders regarding medicines prices, availability, selection and quality of medicines CSOs have Participated in the Harvard Flagship course and have participated in the country exchange visit to the Philippines Conduct a training on advocacy and communications in improving access to essential medicinesThe CSO level of engagement with the MeTA process is moving forward gradually At the start of the process there was limited activities and meeting but since November they become more engaged 13/09/2015MeTA13

14. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (5) In terms of evidence based medicine: Reviewed TORs and SOPs of various (therapeutic area- related) committees involved in selection of drugs to be included in Rational Drug List (RDL), reviewed criteria for adding and deleting drugs to and from the RDL, and finally reviewed classification of drugs (Restricted, Un-Restricted, Authorized and Un- Authorized) in RDL Introduce the pharmaco- economics concept and its importance for RDL addition and deletion to the local industry and generic importers A series of training sessions on pharmaco-economics to PTC 13/09/201514

15. Medicines Transparency Alliance Major achievements and successes for MeTA in Jordan (6) In terms of RDU: NICE has Pilot the development of an evidence-based care pathway, first step was (STG Gap Analysis in the public sector and second step was developing essential Hypertension STG) for all public primary health care facilities Conducted a Promotional for Rational Drug Use workshop 13/09/201515

16. Medicines Transparency Alliance Overall Challenges (1) At Pharmaceutical level: Poor forecasting and estimation of medicines needs which led to low availability of medicines in public sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket and all this is seen as our fault and Irrational Use of Medicines Willingness of the private sector to share information, such as information related to prices, promotional activities and quality High pharmaceutical promotion / hard to control even some patient group's budgets are partially supported by pharmaceutical companies No base line data to measure outcomes 13/09/201516

17. Medicines Transparency Alliance Overall challenges (2) At the MeTA Level: Short period, the two year MeTA pilot is not enough to present and measure the impact on the availability and RDU,, as much as we worked and contributed as a sector the outcome will be noticed through years to come We started the MeTA process with no base line data to rely on, the base line data to be collected started after the MeTA process commenced Changes in MeTA Council representatives positions/agendas can hinder their participation in medicines policy changes and creates a gap between Council members Private sector is poorly represented in the MeTA Council 13/09/201517

18. Medicines Transparency Alliance Overall challenges (3) MeTA has acted as a coordinating body for the pharmaceutical sector, also the MeTA process has opened channels of communication between different stakeholders and between different countries The international and the national MeTA Secretariat coordination role is integral for the MeTA process to move forward The Consultants Technical Advisory role is of a high value for the MeTA process and in improving quality of implementation of the national workplan The multi-stakeholders ( public, private and CSOs) process in very hard, it takes time to have the stakeholders understand each other's perspectives and identify that there were in fact common priorities and one objective to work on together 13/09/201518

19. Medicines Transparency Alliance Overall Challenges (4) At the MeTA Level: CSOs are still not represented in drug related committees like the Pricing Committee or Higher Drug Committee Difficulty in attracting new CSO groups to join the MeTA CSO coalition and there is an absence of coordination or sharing of expertise and experiences among the various CSOs Limited participation of CSO representatives in MeTA Baseline Data Disclosure Survey and no coordination for the CSOs work Poor role of the CSOs in the decision making process with limited role in patient counseling 13/09/201519

20. Medicines Transparency Alliance Lessons Learned (1) To continue exploring national opportunities for pursuing MeTA post-pilot in Jordan Looking for sustainability when MeTA ends in the country, we need to keep searching for other fund and contact other international partners like EU Opening channels with media to engage external stakeholders with the MeTA process and raise public awareness To recommend activities and present a prioritised workplan to the International MeTA Secretariat for discussion as soon MeTA has acted as a coordinating body for people working in the pharmaceutical sector 13/09/201520

21. Medicines Transparency Alliance Lessons Learned (2) CSO engagement with the MeTA process complements the overall picture and highlights patients’ need. Capacity for CSOs to engage more effectively needs to be built A budget for a CSO coordinator should have been listed in the CSO workplan and there should be an organized structure for the CSO coalition To engage parliament in the MeTA council process The stakeholders started to understand each others perspectives 13/09/201521

22. Medicines Transparency Alliance Lessons Learned (3) We have learned the Importance of Data Disclosure, many outputs we were keen to participate in towards disclosure, we agreed to publish all outcomes on Jordan MeTA Web site and learned that we should involve media more The MeTA process has opened channels of communication between different stakeholders and between different countries MeTA has acted as a coordinating body for the pharmaceutical sector players and stakeholders The Data Disclosure survey was a useful exercise that improved communication and sharing/disclosing of information- a core MeTA principle 13/09/201522

23. Medicines Transparency Alliance13/09/201523 Thank you for Listening Dr Taher Abu El Samen Email: taherhhc@yahoo.comtaherhhc@yahoo.com Mobile number: +962 79 726 7444 Website: www.meta.jowww.meta.jo

24. Medicines Transparency Alliance13/09/2015 24 Public Sector Presenter Name Job Title

25. Medicines Transparency Alliance Overview of Public Health Sector in Jordan 13/09/2015MeTA25 Jordan is characterized by a diverse and fragmented public sector. It consists of: MOH, Royal Medical Services, Jordan University Hospital, King Abdullah the Second University Hospital, King Husain Cancer Center and Prince Hamzeh Hospital The public sector covers about 72% of the population Pharmaceutical expenditure as a percent of total health expenditure is 34.0%, where public accounts for 11.3% Public pharmaceutical expenditure as a percentage of total pharmaceutical expenditure accounts for 33.3%. Pharmaceutical expenditure is growing at 17% per annum compared to GDP growth of 3.3% The public sector is represented at the Jordan MeTA Council by 9 members out of 18 Source: Jordan National Health Accounts (NHA) 2007

26. Medicines Transparency Alliance Comparison of Jordan Public Expenditure on Medicines with other Countries 26

27. Medicines Transparency Alliance Level of Public Sector Engagement The Government/ public sector has supported MeTA since the start of MeTA The public sector actively participates in all MeTA activities at the level of the Council, subcommittees and established task forces that work on activities in our national workplan MeTA Council representatives of the Public sector have acted as facilitators for the Baseline Pharmaceutical Assessment Household and Health Facility survey level II, as well as the Pharmaceutical Sector Scan The Public Sector is fully committed and are the main drivers for the MeTA process in Jordan 13/09/2015MeTA27

28. Medicines Transparency Alliance Level of Public Sector Engagement cont. MeTA is hosted at one of the public health sector institutions/ the High Health Council (HHC) The elected MeTA Chair is the Secretary General of the HHC Representatives from public sector were nominated to participate in the household and health facility survey level II technical committee. Representative pharmacists from public sector institutions participated in facility survey data collection Most of public sector representative at the MeTA Council actively participated in the baseline data disclosure survey 13/09/2015MeTA28

29. Medicines Transparency Alliance13/09/201529 Summary Analysis at start of MeTA The needs and issues in the public sector at the start of MeTA focused on three main areas: Improving Availability in the public sector through adapting and using transparent evidence based decision making for the Rational Drug List (RDL) Promoting Rational Drug Use through encouraging best practice and developing STGs The need for reliable Data to be used in forecasting etc. especially with the lack of Health IT within the public sector

30. Medicines Transparency Alliance Major Milestones Developed national Standard Treatment Guidelines (STGs) for essential hypertension for all public primary health care facilities (Expected Output: implementation of pilot STG after discussing implementation strategy with MoH) Reviewed TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL) (Expected Output: adoption of revised criteria for SOPs and Conflict of Interest declarations and increased accountability) Reviewed criteria for adding and deleting drugs to and from RDL (Expected Output: adoption of revised criteria and increased transparency in medicines selection processes) Reviewed classification of drugs (restricted, unrestricted, authorized and unauthorized) in RDL (Expected Output: adoption of revised classifications using transparent evidence based medicine criteria to inform decisions) 13/09/201530

31. Medicines Transparency Alliance Major Milestones cont. For reliable data on medicines availability and use they advised to have the Pharmaceutical Baseline Assessment Survey-Level II and a WHO/HAI surveys to take place and contributed data to them Supported and contributed to a Supply Chain Mapping Assessment Promoted a Rational Drug Use workshop amongst public sector health workers Advised that a series of training sessions on pharmaco- economics take place for health professionals -to date two training sessions have already taken place Promote good practice and work on the development of conflict of interest (COI) declaration and management system for all committees to improve accountability 13/09/201531

32. Medicines Transparency Alliance Successes The Government is highly supportive for the MeTA initiative in Jordan as mentioned earlier The public sector is committed to MeTA and they believe in the MeTA main objective and the five core principles The Government has supported MeTA and hosted the initiative at one of the governmental institutions -the HHC. This gave the whole process an official identity and led to the fragmented public sector working together towards improving availability through adapting/using evidence based decision making for the Rational Drug List (RDL) and promoting RDU through encouraging best practice 13/09/201532

33. Medicines Transparency Alliance Challenges At the level of the Pharmaceutical Sector: Poor forecasting and estimation of medicines needs which leads to low availability of medicines in public sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket Direct local purchases by institutions (prices of the private sector) instead of sticking to procuring jointly through JPD Irrational Use of Medicines and absence of national STGs in different disease areas Weak role and capacity of pharmaco- vigilance system Lack of private sector transparency 13/09/201533

34. Medicines Transparency Alliance Challenges cont. General Challenges: The two year period for MeTA pilot is too short and not long enough to measure outcomes and impact on the availability of medicines in the public sector and on Rational Drug Use Changes in MeTA Council representatives positions/agendas can hinder their participation in effecting medicines policy changes and creates a gap between Council members 13/09/201534

35. Medicines Transparency Alliance Lessons Learned 1. The main lesson learned is the importance of partnership AND the multi-stakeholder process: That public sector can be more effective in dealing with issues within the medicine supply chain in terms of availability, distribution, RDU when working with the private sector and civil society organizations (CSO), since the private sector secures the country with medicines and the CSO speak on behalf of patients’ and consumers’ and their needs The MeTA process has opened channels of communication between different stakeholders and between different countries MeTA has acted as a coordinating and facilitating body for the pharmaceutical sector players and stakeholders 13/09/201535

36. Medicines Transparency Alliance Lessons Learned cont. 2. We have learned the Importance of Data and Data Disclosure Participated fully in the Pharmaceutical Sector Data Disclosure Survey Contributed fully in the Pharmaceutical Baseline Assessment Survey-Level II: Facility and household and included the Pricing Survey within the baseline assessment facility survey Participated in the Pharmaceutical Sector Scan Survey Agreed to publish all outputs and data on Jordan MeTA Web site and learned that the media should be more involved Identified gaps and formulated recommendations for the Jordan pharmaceutical sector (based on existing pharmaceutical reform sector studies (WB 2004) and publish on the Jordan MeTA Web site 13/09/201536

37. Medicines Transparency Alliance13/09/201537 Thank you Name of presenter: Job Title: Email: Mobile number: +962 Website: www.meta.jowww.meta.jo

38. Medicines Transparency Alliance13/09/2015 38 Private Sector Dr Ibrahim Al Abbadi Scientific Research Documentation Office Director The University of Jordan

39. Medicines Transparency Alliance Overview of Private Health Sector in Jordan 13/09/2015MeTA39 60 private hospitals and many specialized private clinics 16 High quality local pharmaceutical manufacturing (branded generics) Value of Jordan pharmaceutical market (2008) is 350m USD 80% (in value) corresponds to imported medicines 84 medicines’ local agents and around 160 subagents 1829 registered pharmacies Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009)

40. Medicines Transparency Alliance Overview of Private Health Sector in Jordan Cont. Chain pharmacies started operating in Jordan since 2001, the biggest is Pharmacy One with 45 branches Pharmaceutical expenditure as a percent of total health expenditure is 34.0% where the private sector accounts for 22.7% Distribution of pharmaceutical expenditure as a percentage of total pharmaceutical expenditure where the private accounts for 66.7% Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009) 13/09/201540

41. Medicines Transparency Alliance Jordanian Pharmaceutical Exports million US $ 13/09/2015MeTA41 The Target is 1 billion $ in 2011 Source: Jordan Association of Pharmaceutical Manufactures(2010)

42. Medicines Transparency Alliance13/09/201542 Summary Analysis at start of MeTA The main issues for the private sector at the start of MeTA were: To get engaged more in the strategic planning process for the pharmaceutical sector in our country, and to get engaged more with the public sector and to share data and information on availability and patients needs

43. Medicines Transparency Alliance Major milestones The private sector represented by the local industry association as one of the MeTA council members The Medical and Pharmacy associations are represented in the MeTA council Participated in most of MeTA activities on the level of the council membership, the level of subcommittees and on the level of established task forces that are working on activities listed on our national workplan The MeTA council representatives of the private sector acted as facilitators for the baseline pharmaceutical surveys Encouraged the private sector mapping report to be conducted To conduct a workshop to promote ethical promotion guidelines 13/09/201543

44. Medicines Transparency Alliance Major milestones Cont. Introduce the pharmaco-economics concept and its importance for RDL addition and deletion to the local industry and generic importers An introductory meeting about MeTA and its concept to the medical associations and professional associations Contributed in reviewing the criteria for adding and deleting medicines into the RDL, TORs and SOPs for the RDL committees, revised the classification criteria of drugs (Restricted, Un-Restricted & Authority required) listed in the RDL MeTA Council Private sector representative (local pharmaceutical industry), attended Private Sector meeting in London June 2009 Agreed with the MeTA Council to publish all outcomes on Jordan MeTA Web site 13/09/201544

45. Medicines Transparency Alliance Successes The private sector is represented by the local pharmaceutical industry, Jordan Pharmacy Association and Jordan Medical Association The private sector participate in regular meetings and in most activities The private sector represented by the local industry will participate in a study about the FTA impact on access to medicine in Jordan Were involved in reviewing criteria for adding and deleting drugs to and from the RDL and the TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL) and the classification of drugs (Restricted, Un-Restricted, Authorized and Un- Authorized) in RDL 13/09/201545

46. Medicines Transparency Alliance Challenges At Pharmaceutical level: Poor forecasting and estimation of medicines needs which leads to low availability of medicines in public sector where this will reflect on us as a private sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket High prices of some essential medicines since the private sector is securing the country with medicines 13/09/201546

47. Medicines Transparency Alliance Challenges Cont. Private sector is not fully represented in the MeTA Council Private sector low level of disclosing data and low willingness to share information, such as information related to prices, promotional activities and quality Few patients associations budgets are partially supported by pharmaceutical companies High pharmaceutical promotion / hard to control 13/09/2015MeTA47

48. Medicines Transparency Alliance Challenges Cont. Short period, the two year MeTA pilot is not enough to present and measure the impact on medicines availability and RDU, as much as we worked and contributed as a sector the outcome will be noticed through years to come In order to present as a sector that we contributed to the main issues identified we needed more time to have this contribution measured by data to be presented to the whole public Lack of adherence to ethical promotion guidelines 13/09/201548

49. Medicines Transparency Alliance Lessons Learned The need to engage our private sector more in the MeTA process MeTA has acted as a coordinating body for the pharmaceutical sector players and stakeholders The MeTA process has opened channels of communication between different stakeholders and different countries CSO as one of the stakeholder engagement with the MeTA process complements the overall picture and highlights patients’ need Reach a common understanding on concepts of pharmaco- economics, transparency, evidence-based medicine (EBM) and accountability 13/09/201549

50. Medicines Transparency Alliance Lessons Learned Cont. To engage parliament in the MeTA council process and to involve the media more We started to understand each of the other stakeholder perspectives and identified that there were in fact common priorities and one objective between us to work on together The Data Disclosure survey was a useful exercise that improved communication and sharing/disclosing of information which is a core MeTA principle We have learned the importance of data disclosure and sharing information 13/09/2015MeTA50

51. Medicines Transparency Alliance13/09/201551 Thank you Ibrahim Alabbadi PharmacoEconomist Email: i.abbadi@ju.edu.jo Mobile number: +962-777160810 Skype: Website: www.ju.edu.jo

52. Medicines Transparency Alliance13/09/2015 52 Civil Society Dr Abdel Fattah Al Kilani MeTA Council Member

53. Medicines Transparency Alliance CSO Sector overview A total of 240 societies are registered officially in the ministry of social development, yet not all are active neither represents patient groups The history in working with the Civil Society Organizations in Jordan started in March 2008 when (HAI) facilitated a meeting/workshop for the CSO with the objective of bringing civil society groups together to take a decision as a group to form an independent alliance that will work effectively to enhance its role in policy planning and presenting the WHO/HAI survey results to them 13/09/2015MeTA53

54. Medicines Transparency Alliance Summary Analysis at start of MeTA Limited CSO role in influencing healthcare strategies and policies in Jordan Limited effectiveness and authority in solving patients’ problems regarding availability and affordability of medicines Major limitation on the CSO’s fundraising ability due to restriction by the Ministry of Social Development on the number of fundraising events (only two annually) There is an absence of coordination or sharing of expertise and experiences among the various CSOs 13/09/201554

55. Medicines Transparency Alliance Summary Analysis at start of MeTA Cont. At the early stage of MeTA, the MeTA/ CSO committee has identified the following areas to include in the CSO workplan: Priority Area 1: Engaging Civil Society Organizations (CSOs) to work together on promoting Transparency in the Medicines Supply Chain and improve Access to Medicines Priority Area 2: To continue to build capacity among CSOs to analyze data and explore and recommend policy options around medicines availability and affordability, promotion and prescribing practices, RDU and the use of generics Priority Area 3: Communication and Coordination 13/09/201555

56. Medicines Transparency Alliance Major milestones The very first activity was conducted to map and identify CSOs to assess their ability and willingness to work together and to engage them with the MeTA council, this activity has set the baseline work for the CSOs in Jordan Workshop on building capacity of CSOs in order to strengthen their ability to monitor and increase accountability of all stakeholders regarding medicines prices, availability, selection and quality of medicines in the public and private sectors. The main objective of the workshop was to introduce CSOs to medicines regulations and health polices Participate in the Harvard Flagship course Participate in the country exchange visit to the Philippines Conduct a training on advocacy and communications in improving access to essential medicines 13/09/201556

57. Medicines Transparency Alliance Success The MeTA Council has identified Building capacity in pharmaceutical policies for CSOs as one of its three main areas in the country workplan The CSO committee has drafted a CSO workplan according to the three major priorities in the overall national MeTA workplan in Jordan, “Build capacity of (CSOs) to monitor and increase accountability of all stakeholders concerning the prices, availability, selection and quality of medicines in the public and private sectors The specific CSO workplan was approved and a MOU has been signed CSOs are engaged in the MeTA initiatives A nucleus of CSO coalition started to form 13/09/2015MeTA57

58. Medicines Transparency Alliance Success Cont. The CSO level of engagement with the MeTA process is moving forward gradually At the start of the process there was limited activities and meetings but since November 09 they became more engaged The CSO representative and patient groups actively participated in all MeTA Jordan activities ( MeTA launch, MeTA forum, many workshops) The voice of patient is becoming heard from policy makers in the public sector/ example MS patient society Patient group representatives has 2 seats in the MeTA council A workshop on advocacy and communication was organized for CSOs with emphasis on team building activity, communication skills, persuasion & negotiation skills, advocacy, how to form a Coalition and engagement with the Media 13/09/201558

59. Medicines Transparency Alliance Challenges Poor role of the CSOs in the decision making process Few of the patient groups societies budget is partially supported by pharmaceutical companies CSOs are still not represented in medicines related committees such as : the pricing committee, higher drug committee / JFDA Limited CSOs role in improving patient counseling Encouraging new patient groups societies to join the coalition is a challenge Shortages of medicines availability in public health and high prices of medicine in the private sector 13/09/2015MeTA59

60. Medicines Transparency Alliance Challenges Cont. Limited participation of CSO representatives in Data disclosure survey tool MOU has taken some time to be approved and signed, accordingly funds were not available for CSO until a later stage CSOs need a coordinator to follow up on the activities listed in their work plan Reach a common understanding on the role of the patients focusing on the regulations,distribution of medicines and rational drug use 13/09/201560

61. Medicines Transparency Alliance Lessons Learned A budget for a CSO coordinator should have been listed in the CSO workplan CSO engagement with the MeTA process complements the overall picture and highlights patients’ need Capacity for CSOs to engage more effectively needs to be built To engage parliament in the MeTA council process There should be an organized structure for the CSO coalition and the CSO already started working towards forming an organized way on, also formed a three committees on their meeting on the 22 June 2010 13/09/201561

62. Medicines Transparency Alliance Lessons Learned Cont. More participation of CSO representatives in Data disclosure survey tool should have been considered To involve media more The stakeholders started to understand each others perspectives CSOs realized that this should have been happened earlier The CSO engagement with the process complement the overall picture and uncovers the patients’ needs 13/09/201562

63. MediaNGOsPatient Groups AL GHAD newspaper- Jordan Jordan Association for Consumer Protection Environmental Protection Society Jordan ass. For hemophilia & Thalasemia Jordan cancer society Diabetes Association Jordan medical association Jordanian society for tonsumer protection Jordan ass. For diabetic and cancer pt. Kidney patients friends society cerebral palsy foundation Garden and Home Association Jordan pharmacist association Jordanian psychiatric rehabilitation society Jordan Rose of Hope Society for arthritis pt. IBN-CINA FOR CELEBRAL palsy Jordan cultural ass. For development of law and legal capacities Jordan society for phenyl-keton urea Jordanian friends of behcet's disease pt. society liver patients friends society The Jordanian friends of cystic fibrosis association multiple sclerosis society Examples of Interested Civil Society Organizations

64. Medicines Transparency Alliance13/09/201564 Thank you Dr Abdel Fattah Al Kilani Consumer Protection Organization Representative Email jor_vet_asso@yahoo.comjor_vet_asso@yahoo.com Mobile number +962 799958059 Website www.meta.jowww.meta.jo