Medicines Transparency Alliance13/09/ MeTA Uganda Country Overview Public Sector Private Sector Civil Society

Medicines Transparency Alliance13/09/ Country Overview Jacqueline Idusso Secretariat Coordinator

Medicines Transparency Alliance13/09/20153 Multi-stakeholder process Milestones: Multi-stakeholder collaboration: first time in the pharmaceutical sector Capacity building and formation of an umbrella organization for CSOs Participation of private sector and CSOs in the development of the NPSSP II Amendment of the counterfeit goods bill: a CSO-led process in which NDA and private sector were invited Input of MeTA Council was crucial to success of the “STOP STOCK OUT” campaign

Medicines Transparency Alliance Major achievements and successes NDA database of registered drugs is now searchable online Improved intra-government efficiency as NDA verification information will be available to MoH Improved access to information by the private sector e.g. MoH procurement plan, medicines price monitor Increased public debate and reporting on medicines-related issues such as stock outs Resolutions from the forum on NMS/JMS/NDA improving efficiencies re sharing information on quality assurance data 13/09/20154

Medicines Transparency Alliance Overall challenges Slow start Variable participation in the process (competing priorities, no direct incentives) High member expectations of funding esp. CSOs Disclosure is still a challenge, still in the process of making an inventory, modalities unclear Insufficient visibility for MeTA (esp. in MoH structures) Dissemination of available information from stakeholders is still not effective 13/09/20155

Medicines Transparency Alliance Overall challenges 2 The need for “Patience” in working as a multi- sector team! Acceptance that the different sectors work in different ways, e.g. Private sector appears to have more sense of urgency - deadline driven! Involve the “full” private sector in the discussions and get commitment for actions 13/09/20156

Medicines Transparency Alliance Lessons Learned It takes time for such initiatives to take off: pilot phase too short to expect meaningful results The disclosure survey unleashed gaps in pharmaceutical sector which MeTA is working to prioritize Better planning needful at onset of initiative to prevent delays in take off, ownership of activities. 13/09/20157

Medicines Transparency Alliance13/09/20158 WHAT NEXT?

Medicines Transparency Alliance13/09/20159 Thank you Jacqueline Idusso Mobile number: Skype: metauganda Website:

Medicines Transparency Alliance13/09/ Public Sector Presenter:Oteba Olowo Martin Job Title:Assistant Commissioner health Services (pharmacy)

Medicines Transparency Alliance13/09/ Multi-stakeholder process - milestones Establishment of the MeTA country chapter with a secretariat facilitated by a national coordinator CSO – Government – Private sector multistakeholder national MeTA council established the National Pharmaceutical Sector Strategic Plan (NPSSP) supported – draft NPSSP produced Facilitating transparency in the medicines registration process – register of medicines regularly updated and accessible on website free of charge

Medicines Transparency Alliance Multi-stakeholder process - milestones The three year procurement plan evaluated, updated and shared among stakeholders in the health sector 13/09/201512

Medicines Transparency Alliance Major achievements and successes – MeTA Uganda Joint action in areas hitherto of mutual suspicion achieved Understanding diversity, taking advantage of the opportunities therein for collective and effective policy development and implementation Medicines price monitoring conducted on a quarterly basis Process of computerizing medicines import data started and dialogue for continued support by other partners initiated The NPSSP reviewed through a wider stakeholder process – Document available in draft form (Yet to be costed) 13/09/201513

Medicines Transparency Alliance Overall challenges during the pilot – MeTa Uganda Appreciating the MeTA core values and value add to the various stakeholders Breaking barriers between stakeholders and opening up opportunities for synergistic actions – time waste Building trust and confidence among the stakeholders Time waste in addressing the individual stakeholder interests and concerns \Most project outcomes yet to be evaluated for broader impact 13/09/201514

Medicines Transparency Alliance Lessons Learned – MeTA Uganda Soliciting goodwill and support by stakeholders should not be taken for granted Stakeholder prior understanding of new initiatives provides good grounds for buy in The pilot phase as a consequence of the lag phase has been ultimately shorter than was expected creating pressure in the implementation of agreed on programmes at country Stakeholder engagement provides requisite grounds for mitigating and or eliminating potential conflict and allows for progressive synergy in moving forward agenda in medicines transparency programmes 13/09/201515

Medicines Transparency Alliance Lessons Learnt Understanding each others interests, mandates and responsibilities and positively sharing the concerns of the other parties. 13/09/201516

Medicines Transparency Alliance13/09/ Thank you Name of presenter:Oteba Olowo Martin Mobile number: Skype: Website:

Medicines Transparency Alliance13/09/ Private Sector Nazeem Mohamed C.E.O. Kampala Pharmaceutical Industries (1996) Ltd

Medicines Transparency Alliance13/09/ Summary Analysis at start of MeTA Issues – Market dominated by subsidised imports from India and China Prices are cheap, Huge variability in stocks Subsidised imports impact on competitiveness of local manufacturers – Perceived lack of clear policies to support local manufacturing – Lack of adequate Government support for local manufacturing

Medicines Transparency Alliance Issues 2 – Relatively strong regulations and enforcement in place – Increasing commercialization of health care provision – Weak infrastructure which increases the cost of distribution and availability of essential drugs. – Poor and inadequate patient and customer service – Lack of knowledge and dissemination of patient rights – Wide spread corruption in areas of health service delivery, procurement, leakage of products etc... – No point of reference to access data on pricing, margins, or availability of essential drugs 13/09/201520

Medicines Transparency Alliance Major milestones Private sector has been provided a seat on the table!! Private sector recognized as a significant and growing player in health care service delivery Opportunities created for dialogue with the Government, CSO’s and development partners 13/09/201521

Medicines Transparency Alliance Successes Invited to participate in development of Government’s Pharmaceutical Strategic Plan (NPSSP) for Worked with CSO’s on “Counterfeit Bill” and submitted a common position to the Government Initiated discussion with Academia to improve technical skill base among graduates and company staff Initiation of a project to promote the value of “generics” and local manufacturing Identified need to collect and disseminate data on the market, e.g. Importation, use of different medicines, trends in usage, etc 13/09/201522

Medicines Transparency Alliance Challenges The need for “patience for results” in working as part of a multi- sector team! Understanding that sectors have varying objectives and work in different ways, e.g. private sector tends to act with more sense of urgency Involving the “full breadth/spectrum” of private sector in the discussions and getting commitment for actions Lack of empirical information on characteristics, extent, growth and consequences of unregulated commercial health care provision 13/09/201523

Medicines Transparency Alliance Lessons Learned Most issues of concern are common to different stakeholder groups Understanding and appreciating the role each sector can play in making multi stakeholder initiatives/processes work Identifying and involving all stakeholders that will contribute to the success of the multi stakeholder process The role of advocacy/lobbying in ensuring that private sector concerns are considered during policy formulation The need for strengthening the capacity of government to constructively engage the private sector Building trust and constructive policy dialogue are vital for successful engagement 13/09/201524

Medicines Transparency Alliance13/09/ Civil Society Rosette Mutambi CSO Coordinator

Medicines Transparency Alliance13/09/ Summary Analysis at start of MeTA What were the needs and issues in your specific sector at the start of MeTA? Access to medicines:- Availability of medicines; Medicine prices; Monitoring and accountability; Rational use Create public awareness; increase transparency in medicine supply chain (policy and practice), roles of key medicine sector institutions (NDA,NMS etc) CSO coordination and communication Capacity building of CSOs for effective participation in medicine sector Representation of CSOs on the different decision making structures

Medicines Transparency Alliance Major milestones What milestones have been achieved during the MeTA pilot phase? Two CSOs HEPS and Uganda National Health Consumers Organization (UNHCO) were selected to sit on MeTA Council Rosette Mutambi (Executive Director HEPS) was chosen as first rotating Co-Chair of MeTA Uganda Council. At inception of MeTA in early 2008, HEPS was chosen to present CSOs on Ministry of Health Technical Working Group on Medicines Procurement and Management CSOs empowered to meaningfully participate in the planned multi-stakeholder activities in Uganda and feel more comfortable to engage with national policy processes MeTA has provided CSOs with access to government bodies Work plan on track 13/09/201527

Medicines Transparency Alliance Successes What were the successes for your sector during the MeTA pilot phase? For the first time ever, the Ministry of Health invited CSOs to the National Pharmaceutical Sector Strategizing Workshop in July/ August 2009 Increased public debate and reporting on medicine issues for example stock outs Increased collaboration between government bodies, private sector to improve access to medicine MeTA council provided useful input into materials used for the Stop Stock outs campaign Shared responsibility among CSOs in implementing work plan 13/09/201528

Medicines Transparency Alliance Challenges What challenges has your sector endured during the MeTA pilot phase? Constant communication which is required to maintain interest and to keep members updated on MeTA issues is a challenge High member expectations of funding District CBOs not yet aware of MeTA Increased pressure from public to CSOs to demand/cause change 13/09/201529

Medicines Transparency Alliance Lessons Learned What are the lessons that your sector has learned from MeTA? There is shared responsibility by all stakeholders to increase access to medicines and all sectors have a contribution MSP helps sectors to understand role of others and their key competencies in improving access to medicines MSP important in increasing transparency and accountability An enlightened Civil Society is crucial to advocacy 13/09/201530

Medicines Transparency Alliance13/09/ Capacity Building Workshop CSO participants of Capacity Building Workshop

Medicines Transparency Alliance13/09/ Thank you Rostte Mutambi Executive Director HEPS Uganda/ Co-chair MeTA Uganda Mobile number: Skype: Website: