Challenges to improve medicines transparency in Ghana
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Medicines Transparency Alliance (MeTA) in Ghana
Daniel Kojo Arhinful NMIMR
National launch in GhanaAccra, November 2008
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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
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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
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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
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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
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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
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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
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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
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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
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APPRECIATION
Thanks for Attention