Medicines Transparency Alliance (MeTA) in Ghana

Daniel Kojo Arhinful NMIMR

National launch in GhanaAccra, November 2008

Outline of Presentation

What is the Problem What is MeTA proposing and the principles History of the process Context of Implementation in Ghana What are the Objectives and expectations How MeTA might work

What is the problem?

Poor people lack access to essential medicines Prices are too high (private sector) Products are not available (public sector) Concerns about quality of products (public and private)

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

Manufacturer Procurement Agent (s)

Wholesaler Distributor Retailer / health unit

Patient

Source Of Funds

Procurement Agent/Body

Point of first warehousing

Point of 2nd warehousing

Point of 3th warehousing

GOVERNMENT WBGLOBAL

FUND USAID

CENTRAL MEDICAL STORE

Medicines supply systems in GHANA 2007

GAVI

ESSENTIAL MEDICINES

ARVs MALARIA TB OIARVs

Ped

REAGENT Blood safety(+ test HIV)

VACCINES CONDOMS ContraceptivesMEDICALSUPPLIES

Government

Multilateral Donor

Bilateral Donor

Category of

Products color code

MOH UNICEF USAID

GOVTOf

JAPAN

UNFPA

REGIONAL MEDICAL STORE

DISTRICT MEDICAL STORE

UN AGENCY

Republic of Ghana

ITNs

DFID

GOVTOf

JAPAN

FAITH-BASEDORGs

POP/RDF

HEALTHFACILITY

HEALTHFACILITY

FAITH-BASEDORGs

FAITH-BASED ORGs

DESIGNATED TREATMENT CENTRE

UNFPA

WHO GDF

$7M $3.5M $0.4M ?? ?? ?? $4.2M ?? ?? $5.6M $0.7M$9M

Storage & Distribution

???

Credit MOH/WHO Procurement Assessment 2007

Port to patient

Available, evidence shows,

Efficiency of public procurement variable

Price mark-ups along supply chains

• Cumulative increase of 100% plus

Low local manufacture

Counterfeits

• 10 – 30% of the market in many countries

What is the MeTA proposal?

An alliance of countries, companies, civil society and international partners based on lessons from the Extractive Industries Transparency Initiative 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

Two scoping missions by the DFID UK Preparatory work by core team

• Proposal development

• Secure high level country political commitment

Formation of country multi-stakeholder

International launch invitation

National launch and 2 year pilot in 7 countries• Share learning across countries

• Fine tune approach and aspirations

Unfolding story

9

How MeTA might work

PoliticalCommitment

Establish multistakeholder

group (MSG)

Reviewexisting data /

research

Agree key deliverables - identify blocks

Disseminate, debate,

act

Disclose data

Draw on scoping study, Including e.g.

HAI Pricing surveyGlobal Fund data etc

Identify technical assistance

required:Procurement, regulatory

Medicines policy etc

Release MeTA report

Evaluate results, develop

recs

Scoping study:Full market analysisDrivers of change

Disclosure and report production

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Existing enabling and legislative environment for MeTA in Ghana Government and Presidential commitment to good

governance; Public Procurement Act 2003 & MOH Guidelines for

health sector procurement; Forthcoming Right to Information Bill; Data collection and reporting bodies on aspects of

pharmaceutical supply chian and use –FDB, CMS, MOH-PU, GHS, CHAG, GNDP, NDRIC

NHIS significant opportunities to improve transparency, accountability, pricing, quality

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Policy framework for MeTA in Ghana

– Key Principles of 2007-2011 • Health identified as key driver for poverty reduction

and economic growth; • Commitment to enhance contribution of health

industry to national economy;• Emphasis on “partnerships”, “people-centred”,

“equity” and “efficiency” – all key themes for MeTA;• Emphasis on good governance and accountability in

the health sector;• Plans to proactively engage civil society in consensus

building and to provide more information to consumers, around quality & RDU.

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Key Challenges 1 Benefits of improved procurement are not translating into

affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey);

Slow progress of some key health indicators– i.e. Infant and child mortality, incidence of malaria and maternal health;

Low consumer awareness due to very little information on quality, availability and prices of medicines is available in the public domain,

Inconsistency across the public, private and mission sectors in terms of how standards (i.e. quality, availability and pricing) are developed and applied;

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Key Challenges 2 Non-adherence to treatment guidelines by prescribers and

irrational use of medicines by providers persists despite improved guidance and education;

Supply chain performance problems from CMS downstream leading to high stock-out rate;

Vulnerability of NHIS to fraud due to inefficient record keeping and analysis

Counterfeit and/or substandard products

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MeTA Ghana pilot objectives

Establishing mechanisms to strengthen the collection, analysis and dissemination of data on medicines along the supply chain;

Facilitating peer oversight systems within and across health professions;

Sustaining regular, open stakeholder dialogue;

Developing long-term strategy or ‘master plan’ for MeTA in Ghana.

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What to do (Strategies 1)

Undertake studies to assess the level of transparency and accountability in medicines regulation, procurement, distribution and use.

Promote regular monitoring of medicine prices and availability as well as their rational use using WHO standard indicators.

Promote regular monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’

Facilitate agreement by pharmaceutical companies to publicize their supply prices to match tender data.

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What to do (Strategies 2)

Undertake periodic annual studies to understand and/or explain provider and consumer behaviour.

Enhance role of chemical sellers in ensuring medicines availability, affordability and rational use through regulation, training and efficient monitoring.

Enhance capacity of CSOs & Media to empower them play more active role in medicines advocacy

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Risks and assumptions

Mutual suspicions between stakeholder groups; All stakeholders nervous about change; Where are the enforcement mechanisms across the

system? Civil society fragmentation needs to be addressed; assume

that new coalitions can be forged. Need to assume a degree of commitment to transparency

by all stakeholders and willingness to be mutually accountable.

Timeliness and sustainability of financing.

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MeTA structures in Ghana

MeTA Secretariat MeTA Governing Council

Oversee activities of MeTA in Ghana Scrutinizing data collected/disclosed on medicine quality,

price and availability Discuss what is revealed by data collected Make recommendations and follow up actions based on

data assessment Annual Stakeholder Forum

Larger workshop, broader representation; To report on progress, share data.

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Expectations of MeTA in Ghana

Provide Ghanaian leadership on medicines transparency disclosure and dissemination of price information

Provide opportunity to reduce and/or eliminate the risk of counterfeit and substandard medication in the supply chain.

Facilitate civil society capacity building to support disclosure and accountability

Share good practices with other MeTA pilot countries

APPRECIATION

Thanks for Attention