saul walker policy and research division, dfid jordan 4 december, 2007 medicines transparency...

Saul WalkerPolicy and Research Division, DFIDJordan 4 December, 2007

Medicines Transparency Alliance

(MeTA)

What is the problem?Globally, evidence shows that:• Poor people lack access to essential medicines• Prices are too high (private sector)• Products are not available (public sector)• Quality of products variable (public and private)

Need to focus on distribution from ‘port to patient’.

Manufacturer Procurement Agent (s)

Wholesaler Distributor Retailer / health unit

Patient

Port to patient

Globally, evidence shows,

• Efficiency of public procurement variable

• Price mark-ups along supply chains• Cumulative increase of 300% not uncommon

• Diversion and leakage

• Counterfeits • 10 – 30% of the market in many countries

What are we proposing in MeTA?

An alliance of countries, companies, civil society and others to:

• Increase transparency over key price, quality, procurement and availability data

• Build accountability to address inefficiencies and reduce excessive pricing

Meta Principles• Commitment to improving health

• Comprehensive approach to health systems, including pharmaceuticals• Weak pharmaceutical systems result in

poor access, quality, affordability and health outcomes

• Transparency and accountability can:• Improve system performance• Build confidence• Support equity and social justice

• Multi-stakeholder approach needed

MeTA ModelThree levels:

• Country level – secure political commitment, form multistakeholder group, disclose data into the public domain, support reform efforts

• International level – multistakeholder group (countries, civil society, companies and other private sector, donors and others) plus international secretariat

• Research Network – repository for key data and analysis, active research agenda, monitoring and evaluation

Make a high level political commitment to MeTA

• Form a multi-stakeholder group• Support civil society and others to engage

Common dimensions

Progressively disclose common data on:

• Core• Price• Quality • Availability

• Context• Supply chain• Affordability• Equity of access• Rational use of medicines

MeTA countries will:

PoliticalCommitment

Establish multistakeholder

group (MSG)

Reviewexisting data /

research

Agree key deliverables - identify blocks

Disseminate, debate,

act

Disclosure of data

Draw on existing data, including e.g.

WHO / HAI survey,Global Fund data

Identify needs for technical assistance:

procurement, regulation,medicines policy etc

Release MeTA report

Analyse, discuss,develop

recs

Diagnostic work e.g:Full market analysisDrivers of change

Disclosure and report production

Country level

Phase I pilot countries for MeTA

• Covering all regions: • Latin America: Peru • East Asia: Philippines• EE/fSU: Kyrgyzstan• Middle East: Jordan• South Asia: India• Africa: Uganda, Ghana

• 24 month duration• Share learning across countries• Fine tune approach and aspirations

Incrementalism

• MeTA isn’t big bang • Model seeks common commitments from

countries – won’t be achieved overnight• Ongoing iterations as learn from pilots

JORDAN- Main Findings (I)

• Low medicines availability in public sector (HAI/WHO)

• Over prescribing of brand medicines, antibiotics and NSAIDs prevalent• Need for ethical prescribing and

dispensing guidelines and training• No conflict of interest statements required

from members of procurement selection committee

• No supervision of pharmaceutical marketing and promotion practices – JFDA has recently launched guidelines

JORDAN-Main Findings (II)

• Poor counterfeit statistics and lenient legal penalties

• Need to improve coordination among public institutions through shared SOPs

• Local Industry supportive of MeTA• tackle unethical promotion by

multinationals during procurement tenders

Possible Activities Under MeTA

• Increase transparency, disclosure and dissemination of price information

• Civil society capacity building to support disclosure and accountability

• Support ethical medicines promotion• by multinationals, • by committees during procurement tenders• by local manufacturers selling in the

Jordanian private sector

Possible Activities Under MeTA

• Improve acceptability of generics to public and physicians

• Improved rational use of medicines led by the newly formed RDU at the JFDA, • physician prescribing behavior and

standard treatment guidelines

EXISTING INITIATIVES RELEVANT TO MeTA

• Independent JFDA established 2003• Pricing regulations and prices available on

website and JFDA mobile.• Rational Drug Unit recently formed

• HAI/WHO medicines survey 2004

• National Society for Consumer Protection MOU with JFDA (March 2007)

• Joint Govt. Procurement agency operational 2006. • Tender conditions and results on website

EXISTING INITIATIVES RELEVANT TO MeTA (II)

• World Bank MENA Region interested in being MeTA partner (has previously supported pharmaceuticals reform)

• Significant international donor financing in health sector• USAID Health Systems Strengthening

Project ($45 million 2005-2009)• Jordan recipient of GFTAM grants for TB

and HIV/AIDS

• JFDA is developing a code of ethics for marketing and promotion

saul walker policy and research division, dfid jordan 4 december, 2007 medicines transparency...

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