1. Saul Walker Policy and Research Division, DFID Jordan 4 December, 2007 Medicines Transparency Alliance (MeTA)

2. Page 1 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 Procure ment Agent (s) Whole saler Distrib utor Retaile r / health unit Patien t

3. Page 2 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

4. Page 3 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

5. Page 4 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

6. Page 5 MeTA Model Three 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

7. Page 6 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:

8. Page 7 Political Commitment Establish multistakeholder group (MSG) Review existing 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 analysis Drivers of change Disclosure and report production Country level

9. Page 8 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

10. Page 9 Incrementalism MeTA isnt big bang Model seeks common commitments from countries – wont be achieved overnight Ongoing iterations as learn from pilots

11. Page 10 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

12. Page 11 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

13. Page 12 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

14. Page 13 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

15. Page 14 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

16. Page 15 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