1. 1 Towards a Medicines Transparency Alliance (MeTA) Richard Laing and Ali Cameron with slides prepared by Michael Borowitz, DfID WHO Technical Briefing Seminar October 2007

2. 2 Problem: poor cannot access essential medicines Total Market Approach: public, private, and 3 rd sector Availability: Low availability in public sector Price: High prices in private sector Quality: Concerns about quality particularly of generics Manufacturer Procur ement Agent (s) Publi c Privat e missi on Whole saler Medic al Stores Distri butor Retail er Inform al Sector / Primar y care Hospit al Patie nt

3. 3 Example: complexity of medicines supply in Kenya Source: SSDS Inc for the World Bank

4. 4 Transparency and Accountability in Medicines Market Failure –Complex chains of information asymmetry –Principal-agent problems –Response: government intervention Government Failure –Health systems failure: accountability –Lack of state capacity –Unregulated private sector –Government/regulatory capture Setting new equilibrium through transparency and accountability –Accountability system in drugs: Consumer organisations Professional organisations 3 rd party purchasers –Transparency changes the rules of the game

5. 5 Lessons from the Extractive Industries Transparency Initiative Increase transparency and accountability in revenue flows from extractives companies to governments Government led – multistakeholder – civil society 5 stages: coming together, pilots, consolidating the rules of the game, expansion, new governance arrangements Key strengths: –multi-stakeholder –accounting issues are matched with accountability –clear and narrow focus

6. 6 The MeTA Proposal Increase transparency and accountability in medicines procurement and supply, by: Securing high level political commitment Global public goods: activities on transparency using Global development funds: Country-led process focusing on transparency and accountability –Multi-stakeholder forum: Getting the right people around the table – business, civil society and government – to agree how to disclose price, availability and quality data into the public domain – from both public and private sectors. –Transparency in pricing, availability, quality –Drilling down in therapeutic classes –Builiding capacity Capacity of the state to regulate Capacity of civil society to hold government to account Research Observatory –Evidence-based policy DFID funding £2mill for design, £25 million contribution

7. 7 Total Market Analysis semi-standardised approach –WHO/HAI pricing survey: what explains the results Components analysis Global reference prices (MSH, IDA, etc.) –Micro: Household survey data on medicines WHA Southampton survey review: LSMS, etc Next wave? Dennis/WHO –Macro: Health financing: NHA –Private sector: Supply Chain mapping: competition in different components IMS-like data on price/volume Informal sector –Public sector Public procurement: extension of WHO/WB Tracking: PETS, other tools

8. 8 Observatory/Info-mediary What should you do? Research observatory to bring together best practice (e.g. price controls) Standardised reports on the pharma sector Info-mediary role: e.g. GPRM database Support evaluation of interventions Support operation research Partners: –Harvard, BU, Hopkins, LSTHM, LSE, Imperial, DFID RPC, NORAD/Cochrane Centre… more developing countries Scoping

9. 9 Generic and Brand ARV Prices: ranges much greater for brands $1.945$1.713$1.356 Prices shown are per tablet Every dosage form tells a different story

10. 10 Phase I pilot countries for MeTA Covering all regions: begin with one and spread out –Latin America: Peru (Bolivia) –East Asia: Phillipines (Vietnam, Cambodia, China) –EE/fSU: Kyrgyzstan –Middle East: Jordan –South Asia: India (Bangladesh, Pakistan) –Africa: Uganda, Kenya, Ghana (Zambia, Francophone) Linked to WHO/WB/HAI

11. 11 How MeTA might work 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

12. 12 Early info on pilots Jordan: –strengthening accountability: pricing survey not disseminated Uganda –Putting price and regulatory data on website Zambia –Price survey Kyrgyzstan –Examination of diabetes/psychotropics –Transparency in hospital procurement Phillipines –Dissemination of price information Ghana –Disseminate existing data –Strengthen data collection and dissemination on medicines quality

13. 13 Supporting infrastructure for transparency and accountability State capacity –Strengthening regulation –Strengthening insurance purchasers –Policy advice on regulating medicine prices Civil society capacity –Strengthening NGOs—HAI –Strengthening professional societies Equity and poverty lenses

14. 14 Next steps Consultation Pilots Principles MeTA Forum Global public goods –Observatory –Info-mediary Governance –Secretariat –Governance structure