1. Wilbert Bannenberg, Technical Director MeTA International Secretariat IACC 14 Bangkok, 13 November 2010 MeTA multi-stakeholder process – a way to improve transparency in the pharmaceutical sector

2. Overview What is the problem with medicines? What is MeTA trying to achieve? Why work multi-stakeholder? What have we learned so far? Conclusions 13/11/2010MeTA2

3. 13/11/2010 MeTA 3 Medicines supply – Transparent? Source: SSDS Inc for the World Bank

4. 13/11/2010 MeTA 4 Transparent prices & availability, but quality? Source: TI Global corruption report 2006

5. 13/11/2010 Medicines supply chains are prone to corruption Source: TI Global corruption report 2006 5 MeTA

6. 13/11/20106 Access to medicines - background 30% of mankind still no access to essential meds Valid concept: essential medicines (WHO, 1977) Government alone cannot provide access to all – Weak health systems – Policy, efficiency, management, HR, & financing issues Private sector: off message? – High prices, wrong focus (non-essentials, sell where $$ is) – Exception: non-profit private sector (churches, NGOs) Civil society: ideals & drive; but lacks expertise & resources MeTA

7. The MeTA Hypothesis Work multi-stakeholder: – Structured dialogue: Govt – Private sector – CSO All parties are asked to disclose information on: – Price, Quality, Availability, Promotion Transparency, Dialogue & Accountability – Better ad-hoc solutions & policies – Mutual support & capacity building Will eventually lead to better access to medicines 13/11/20107MeTA

8. The birth of MeTA UK cabinet white paper 2006 gave birth to MeTA – Based on 2004 Access to Medicines Policy – Modeled after Extractive Industries Transparency Initiative (EITI) 10 year commitment – subject to positive evaluation after 2 years – 7 countries invited to join pilot phase 2008-2010 Exploratory meetings with stakeholders 2007 13/11/2010MeTA8

9. International alliance: DFID (UKAID), WHO, World Bank Multi-stakeholder: private, public sector and civil society Country-led, bottom up process in 7 pilot countries: Peru, Ghana, Uganda, Zambia, Jordan, Kyrgyzstan, and the Philippines TA, (limited) $$ and capacity building from MeTA Intl. 13/11/20109MeTA

10. Page 10 MeTA Theory of Change Robust & relevant information (Transparency) Better policies and implementation (Efficiency) Multi-sector data sharing (Accountability) Improved access to medicines Routine Data Collection

11. Why use Multi-Stakeholder Processes? MSP’s engage stakeholders in processes of dialogue, trust building and collective learning, that aim to improve innovation, decision making and action. They may also be specifically focused on overcoming conflict. They are particularly relevant in situations where the dynamics between different stakeholder groups and interests means that progress is difficult or impossible without constructive engagement. 13/11/2010MeTA11

12. General Concerns with MS processes Incentives? Particular stakeholders being marginalised Self-selection of CSO participants Funding / resources Uneven information base Differences in language and culture Each set of stakeholders has to learn a new lexicon in relation to the other So as to get past previous, often deeply ingrained, prejudices… 13/11/201012MeTA

13. Challenges in MS processes Will mutual accountability flow? Will civil society have a strong enough voice? Will civil society have the technical knowledge? Will the private sector engage? Will governments let go of some control? Is there a clear outcome, or only gradual change over time that might have happened anyway? (What can we measure?) Can everyone win? 13/11/201013MeTA

14. Civil society involvement Civil society engagement is crucial for MeTA – “Eyes and ears” of society Civil society’s capacity was strengthened – strengthened networks & capacity, – promoted Essential Medicines concepts, – advocacy on national media, in Parliament – Performed pricing & baseline surveys – Learned how to do procurement ‘watch’ All 7 pilot countries set up national CSO coalitions 13/11/2010MeTA14

15. Government (institutions) Opinion leaders see value in the principles of transparency and multi-stakeholder working Many concepts (SWAp, Basket funds, Paris/Accra) or similar projects (WHO/GGM, WB Transparency, U4 anti-corruption) competing for attention Civil servants are reluctant; change slowly Need for adapting medicines’ policies recognized Drug Regulatory Authorities active & benefitting 13/11/201015MeTA

16. Private sector involvement Brings us good and poor quality, even fake medicines Private sector is very diverse at country level: – Brand-name- Local manufacturers – Generics- Wholesalers – Retail- prescribing health workers Win-win possible – Good guys want the bad guys out (counterfeits, substandard) – Increase ethical standards & code of conduct – Basic health insurance – Access to more reliable data 13/11/2010MeTA16

17. MeTA lessons learned Activity needs to be led by participating countries The right people need to be involved from the outset Commitments needs to be made by all parties involved Gaining consensus and understanding requires a constant and frank exchange of views Some decisions will be tough - stay focused on the objectives Tools exist or have been developed Building trust takes time – but is crucial 13/11/2010MeTA17

18. Lessons from MeTA IF Right mix Enough time Clear aim and approach Sufficient resources Facilitation Learning and flexibility Equity Transparency Mutual benefit

19. Multi-sector lessons learned Establishing multi-sector stakeholder groups takes time – Private sector fragmented, civil society weak and/or diverse – Little experience of working together Demonstrating benefits of participation challenging at start – New process, uncertain link to policy, finding common ground – Worked best where focus existed – Philippines, Peru and Jordan Sector contributions variable but some successes – Contributions from ‘private sector’ modest – Support for multi-stakeholder working increasing 13/11/201019MeTA

20. Some results All: Baseline studies, disclosed data, new MS collaboration Ghana: analysis of NHIA data for evidence-based policy Jordan: new Treatment Guidelines and Rational Drugs List Kyrgyzstan: mini-labs to quality test 400 medicine samples Peru: legislation and systems for new Price Observatory Philippines: Cheaper Medicines Act; Universal Access policy Uganda: private sector and CSO consultation on new health & pharmaceutical strategy Zambia: media campaigns to raise awareness on medicines more at www.MedicinesTransparency.org 13/11/201020MeTA

21. Evaluation – Summary Model shows promise but needs consolidation, stronger communication and new implementation model: – Establish core set of activities, tools and sequence of activities – Better understanding of diversity of ‘private sector’ – Guidance on data disclosure/sharing – Flexible approach to multi-sector working – Embed in country processes and institutions – Stronger focus on value for money in implementation 13/11/201021MeTA

22. Conclusions Multi-stakeholder working = new concept – not easy Each sector needs to “give & take” It takes time to build trust You can learn from each other Working multi-stakeholder brings benefits to all Interest is big, and patients will most likely get better access to medicines (if the MeTA process continues) 13/11/2010MeTA22

23. So what? MeTA pilot phase is over; the new DFID Ministers will shortly decide about next phase of MeTA All 7 pilot countries want to continue Most stakeholders now engaged in MS processes Needs more support of development partners and local organizations for long-term sustainability The concept of transparency is there to stay! 13/11/201023MeTA

24. Contact? Wilbert Bannenberg wilbert@metasecretariat.org Mob: +31-6-20873123 www.MedicinesTransparency.org MeTA 13/11/201024