1. Zambian Civil Society Organizations, TRIPS and Access to Medicines Zambia Civil Society Consultation Meeting 1 st October 2013 Daniel S. Libati, LLB (UNZA) CSO Consultant

2. Basis of CSO work? When one speaks of civil society and its work with regards to engaging government, the first question that has to be settled before such engagement takes place is with regards to the ‘BASIS’ of such engagement. Therefore, with regards to issues of access to medicines, the question is, what is the basis of CSO’s engaging government? The answer lies in asserting of a citizen’s human right(s).

3. Legitimacy of CSO work? The reason why the basis of engagement needs to be settled is so as to avoid the usual government rhetoric of – ‘what makes YOU (CSO) interested in this/these issues’? The question of the reasons that give rise to CSO work in this area (of access to medicines) being given legitimacy need to be settled! Therefore, where does civil society draw its legitimacy in this area?

4. Asserting a human right CSOs work is generally if not normally based on the asserting of fundamental human rights and freedoms, i.e. - CSOs engaged in the area of education assert the human right to education; - Those engaged in issues of governance assert the human right to participate in the running/governance of a country; - Those engaged in issues around health assert the human right to health.

5. Which human right? The human right to access to medicines has its roots in the human right to health. Sadly the Zambian Constitution, which is the supreme law of the land, does not GAURANTEE the right to health. However, the International Covenant on Economic Social & Cultural Rights (ICESCR) to which Zambia, as a Country is a party to, does guarantee the human right to health. And because Zambia is a party to that international instrument, under International law it cannot do anything whose effect would be that of taking away that right from its citizens. Instead, according to that ‘International law’, Zambia agreed to take steps to PROGRESSIVELY REALISE that right for its citizens.

6. The human right to access to medicines The right to health has been interpreted to include 4 BASIC ELEMENTS. These are: (1) Availability – Functioning public health and health-care facilities, goods and services, as well as programmes, have to be available in sufficient quantity within the State Party. (2) Accessibility – Health facilities, goods and services must be accessible to everyone without discrimination (including issues of non-discrimination, physical accessibility, economic accessibility (affordability), Information accessibility) (3) Acceptability – All health facilities, goods and services must be respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned. (4) Quality – All health facilities, goods and services must also be scientifically and medically appropriate and of good quality.

7. CSO work For CSOs in Zambia their engagement with change agents (mostly the government) tend to revolve around asserting the human right to health or the human right to access to medicines as it were. That engagement it should be noted has to a large extent revolved more around issues of the AVAILABILITY of medicines as a ‘good(s)’. This becomes quite clear when one takes the case of access to anti-retroviral drugs for example. The work of CSOs in this area has generally taken the form of mobilisation of public concern which once raised, has been expressed in reaction to ‘shortages’, ‘unavailability’ or ‘rationing’ of such drugs.

8. Government reaction Government has, in the area of access to medicines normally been reactive to the issues raised by CSOs. For instance, in reacting to the ‘public’ outcry to the recent ‘shortages’ of ARVs in the Country and what steps the government was putting in place, according to the Hon. Minister of Health Dr. Joseph Kasonde, M.P the shortage was as a result of delayed shipment caused by demand created by Tenofovir based regimens which most Sub-Saharan countries have started using.

9. CSO Initiatives thus far? Aside from constantly raising ‘public concern’ on drug shortages for instance, CSOs have over the last couple of years put into place a number of initiatives aimed at ensuring access to essential medicines. This has mostly been done through capacity building and public policy advocacy campaigns. Capacity building of CSO personnel in issues of TRIPS and Access to Medicines with support from donors been hosted by the University of Kwazulu Natal in Durban South Africa. Thus far personnel from TALC, NZP+, ZARAN (then), CITAM+ among other CSOs have been trained on issues around TRIPS and access to medicines. The Stop Stock Outs Campaign lead by Treatment Advocacy & Literacy Campaign (TALC) in conjunction with the Network of Zambian People Living with HIV (NZP+) has been an CSO public policy advocacy initiative that has over the years lobbied government around the need to stop the occurrence of stock outs of essential medicines. Quite recently there has been a campaign to engage local leaders in rural areas on issues of access to medicines lead by TALC and NZP+.

10. Medicines Transparency Alliance (MeTA) “In recent years failures in the procurement and supply of medicines have been acknowledged, with essential drugs often out of stock. The connection between the different units and healthcare facilities and the related information system … did not work routinely, forcing emergency procurement if/when funds were available. This led to high prices being paid, further deteriorating the situation.” CSO Initiatives thus far?

11. Medicines Transparency Alliance The concept of the Medicines Transparency Alliance is that of bringing together various stakeholders: - The private sector; - Civil society, - The government; and - Other interest groups With the aim of improving transparency in the medicine supply chain, so as to ultimately improve the lives of all public health service providers and beneficiaries

12. Consumer Action Forum At a country level CAFs are set up by Civil Society that seek to positively influence the pharmaceutical market including the demand for medicines and their rational use and advancing access to more affordable medicines. CSO Initiatives thus far?

13. MONITORING AND CHANGING… The question that begs to be answered is what then can civil society do to in relation to TRIPS to better MONITOR the elements of (a) accessibility, (b) availability, (c) acceptability and (d) quality of the human right to health or access to medicines (goods)? Beyond monitoring, what can be done to bring about the CHANGE needed to realise those elements of the right to health, or be it the right to access medicines? Even further beyond that, in order to do this, what will CSOs need?

14. Thank you for listening!!!