MEDICINES TRANSPARENCY ALLIANCE

PHILIPPINES

ON THE PATH TOMEDICINES FOR ALL

Improving access to quality medicines for the most vulnerable in the Philippines is an enormous challenge. More than a quarter of the Philippine population was still in poverty when MeTA began,1 making affordability of medicines critical. Yet statistics showed that most of the nation’s health spending was being borne by households. Of household expenditure on health, two-thirds was spent on medicines. The reasons Philippines patients have been responsible for such a significant proportion of out-of-pocket medicines costs are many, but one of the key challenges has been inefficiencies in medicines procurement. Prices paid for medicines have varied from one hospital to another – sometimes even within hospitals. Regulation of the medicines supply chain has been weak and storage practices have been wanting. Patients have been left out of the healthcare dialogue, and there has been a lack of awareness among consumers about what health benefits they are entitled to. The situation demands a comprehensive package of policy responses to pave the way to improved access to quality medicines.

1 Philippines National Demographic and Health Survey 2008. Manila: National Statistics Office; 2009 (http://dhsprogram.com/pubs/pdf/FR224/FR224.pdf, accessed 6 July 2015).

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The Medicines Transparency Alliance (MeTA) pilot began in the Philippines in 2008. Its mission was to contribute to good governance, transparency and accountability across the medicines supply chain, by engaging all stakeholders with an interest in improving health outcomes. Since then, a small secretariat overseen by a board of trustees has built MeTA into an 80-member alliance of individuals and organizations from civil society, government and industry.

MeTA has brought academics, civil society organizations and patients around the same table as professional associations, the private sector and government in meaningful dialogue. Issues are identified and debated. Points of contention often remain, but so too is consensus reached. The process has elevated the concerns of the patient in the policy-making process and has brought new scrutiny to government decision making. MeTA has laid the foundations for increasingly accessible safe, effective and quality medicines and their rational use.

The Philippines is one of seven countries to adopt MeTA– the programme is also active in Ghana, Jordan, Kyrgyzstan, Peru, Uganda and Zambia. It is currently funded by the UK Government through the Department for International Development.

responseOur

achievementsOur

Our policy dialogue series helped raise stakeholder awareness of priority health issues, and provided the platform for consultation and collaborative action.

We built consensus on the need for ethical medicines promotion, encouraging the local pharmaceutical industry to finalize its own code of ethics.

We drew attention to the need to engage and empower patient organizations and civil society, prompting the Department of Health to commit to engage the sectors in policy formulation, programme planning and implementation and monitoring.

We trained educators and healthcare professionals on issues including ethical promotions and good pharmacy practice standards.

We supported civil society organizations to design citizen-monitoring tools that will be used to determine grassroots awareness and the availability of medicine access programmes and patient benefit packages.

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Medicines Transparency Alliance

Forming an alliance to strengthen policyThe launch of the MeTA pilot coincided with a major development in medicines policy in the Philippines: the passage of the Universally Accessible Cheaper and Quality Medicines Act of 2008. Among the law’s main objectives are to allow early registration of medicines prior to patent expiry, prevent registration of medicines for new uses and cap prices of key medicines. While the pharmaceutical industry was deeply involved in the debate over the law, civil society and elderly groups campaigned from the sidelines. “Patients weren’t missing in the sense that they didn’t exist, but because their voice wasn’t loud enough,” says MeTA’s Chairman, the former Governor of Bulacan, one of the Philippines largest provinces, Roberto Pagdanganan. “Their voice wasn’t articulate enough and, therefore, not heard enough.”

MeTA changed that. For the first time it has given patient groups, as well as academics, a seat at the table alongside government, professional associations and industry. “Civil society now has a platform where we can float and share so many things,” says the chief executive officer of the National Pharmaceutical Foundation CSO, Teofila Remotigue. “We can do position papers for trade agreements, for example. MeTA is very helpful in making sure that there is monitoring and following up on policy — and I think the Department of Health (DOH) is listening to us because it is opening the door.”

MeTA has made medicines policy making more efficient and robust. The chief of the DOH’s Pharmaceutical Division, Dr Melissa Guerrero, says MeTA has elevated patients’ concerns in the policy-making process. “Before, patients had been nowhere when we crafted the policies,” she says. “We had long wanted to engage them in all our policies, because, after all, the policies should benefit the patients.”

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MeTA’s contribution to increasing transparency in the pharmaceutical supply chain

• Pharmaceutical Sector Scan; • Data Disclosure Survey; • Facility and Household Survey; • Survey of government procurement prices for essential medicines; • Mapping of medicine entitlement programmes of the national government.

• Round-table discussions (MeTA discussion series) where results of studies and surveys are disseminated to all relevant stakeholders.

• Training workshops for civil society (CHAT discussion series) on priority issues such as bilateral trade agreements, intellectual property rights and public health, theory of change, and social accountability mechanisms.

• Publication of all MeTA studies and reports in the websites of DOH and other stakeholder groups.

• Regular consultations with the DOH on specific issues related to universal health care, medicine access programmes and pharmaceutical supply.

• Policy recommendations from annual MeTA forums considered as key inputs in the implementation of the universal health care programme, and in the institution of reforms in the pharmaceutical sector.

• Stakeholder engagement in the DOH Advisory Council on the implementation of the Cheaper and Quality Medicines Act.

• Reforms and actions taken to improve and streamline DOH medicine access programmes to address duplication and overlaps, distribution inefficiencies, lack of public awareness, and weak monitoring.

• Development of social accountability/citizen monitoring tools (Medicines Watch and Philhealth Watch) to empower civil society to monitor and provide feedback on government medicines access and health insurance benefits programmes.

• Advocacy for the implementation of specific initiatives provided for in the Cheaper Medicines Act and in the law strengthening the Food and Drug Administration.

Key to how MeTA has worked

Robust evidence gathered and

analysed

Dissemination of evidence and

multi-stakeholder dialogue

Policy or practice recommendations Action

Advocacy and awareness raising

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Medicines Transparency Alliance

Improving access to safe and quality medicinesMeTA’s value as a venue for monitoring policy was highlighted after the DOH developed a drug price reference index to be used to cap medicine prices. While monitoring the implementation of the cap, MeTA stakeholders became concerned that only the price of expensive branded medicines had fallen, mainly to the benefit of those wealthy enough to afford them. It was agreed that to improve access to medicines for low-income earners, more comprehensive implementation of the complex Philippines benefits packages system, called Philhealth, was needed. In 2013, MeTA commissioned the first independent mapping of medicines access programmes to highlight gaps. It disseminated the findings among stakeholders, including MeTA’s CSO partner, the Coalition for Health Advocacy and Transparency (CHAT), at a MeTA round-table discussion. The study prompted MeTA and CHAT to develop community monitoring tools that will enable citizens to report on the availability, price and quality of medicines and Philhealth benefits packages.

Concern for inefficiencies in the medicines management cycle at the level of local governments prompted MeTA to collaborate with the DOH on the rollout of pharmaceutical supply chain management training targeting local government health facilities. Its goal is to institutionalize a system that is aligned with global standards as well as with the national system.

MeTA, in collaboration with its partners, also delivered training on substandard and counterfeit medicines, to raise awareness about their dangers. MeTA is also among the members of the Coalition for Safe Medicines advocacy group that was convened by the Food and Drug Administration (FDA).

MeTA’s contribution to improving governance

• Survey /needs analysis of the drug supply chain processes in local governments; • Stakeholder mapping and development of the framework for the engagement and

empowerment of patient organizations in the Philippines; • Study on the framework for the institutionalization of patient engagement and

consultation within the DOH structure.

• Pilot course on leadership, governance and transparency in pharmaceutical management for local government units.

• Training workshop on pharmaceutical supply chain management for local government health facilities.

• Participation in the Good Governance in Medicines (GGM) program, in collaboration with the WHO and DOH, specifically in the grant of awards for best practices in GGM among health facilities.

• Regional training workshops on the Philippine Practice Standards for Pharmacists and the joint WHO/FIP Guidelines on Good Pharmacy Practice.

• TA studies and reports in the websites of DOH and other stakeholder groups.

• DOH initiatives to streamline and rationalize internal medicines supply chain management system to address current gaps and overlaps.

• Initiatives to align national and local government medicines supply chain systems to improve overall access to essential medicines.

• Agreement to roll out capacity-building workshops on pharmaceutical supply chain management to all local governments.

• DOH and FDA commitment to engage and consult patient organizations and civil society organizations in policy making, and program planning, implementation and monitoring.

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The push for ethical standardsMedicines promotion is weakly regulated in the Philippines, but MeTA sparked a push for change by commissioning an influential study into the issue in 2013. “It opened the eyes of the government to the fact that there really needs to be standards, because they affect how physicians practice medicine and patient care,” the DOH’s Dr Guerrero says. “It’s not just the price of the medicines that is affected when pharmaceutical companies promote to doctors, it is also the quality of care — it leads to doctors prescribing unnecessarily.”

Many stakeholders were calling for a code of ethics, but the local industry was concerned that the push was being driven by multinational research companies. MeTA Philippines’ vice-chairman and senior official in the Philippines’ largest pharmaceutical company, United Laboratories, Jose Maria Ochave, says it became clear via MeTA that a code had broad support. “MeTA became the forum for looking at ethical marketing practices because of the links that MeTA provided. The domestic and the multinational pharmaceutical sectors talked to each other — normally they wouldn’t. They agreed to take a common stand on restrictions on marketing.”

MeTA has sought to buttress the push for ethical guidelines by strengthening civil society’s involvement, with the establishment of the ETHIKOS Movement — a broach CSO coalition to campaign for ethics in medicines promotion. MeTA piloted training modules on pharmaceutical promotion, and sought to integrate these in the regular curriculum of pharmacy and medicine schools.

MeTA’s contribution to improving the safety, efficacy and quality of medicines

• Study on barriers to reporting suspected substandard/spurious/falsely-labelled/falsified/counterfeit (SSFFC) Medical Products.

• MeTA Discussion Series: A Multi-stakeholder Approach to Strengthening Community Advocacy for Safe and Quality Medicines – a discussion on the dangers and risks of SSFFC and possible mechanisms to address the challenge.

• MeTA presentation during the celebration of the National Consciousness Week Against Counterfeit Medicines to support the WHO SSFFC initiative.

• Emphasis on training courses on the dangers and risks of counterfeit medicines, and how to address them, in school curricula, and as a continuing professional development course for licensed health and allied health professionals.

• Patient and civil society-led monitoring and reporting of suspected SSFFC medical products.

• Advocacy and information campaign on the dangers and risks of SSFFC medical products targeting patients and consumers.

• Participation in the Coalition for Safe Medicines, an advocacy and information group convened by the FDA.

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Medicines Transparency Alliance

A new force in medicines policyMany of those who pushed for the passage of the Cheaper Medicines law and advocated for reforms are now active members of MeTA, and see themselves as a custodian of the law with a responsibility to protect, monitor and evaluate it. Some see that role becoming increasingly important in the face of new challenges.

Pharmaceutical sector stakeholders now consider MeTA an arm of medicines policy making. MeTA vice-chairman Jose Maria Ochave says there is enormous value in an alliance of different interests supporting the government to see through commitments, such as the national government’s pledge to have universal health care in the Philippines. “The value of MeTA is really communication — if you want consensus you have to be a willing participant in transparent dialogue in a multi-stakeholder platform and that is the value of MeTA.” MeTA has many plans for the future, including improving the oversight of pharmaceutical promotion; institutionalizing patient engagement and consultation in DOH planning and policy; addressing barriers to reporting substandard and counterfeit medicines and improving supply chain management capacities among local governments.

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Building trust and cooperation between civil society, the private sector and government leads to strong and efficient policy making.

Information sharing and disclosure are encouraged and gaps in knowledge are best addressed when everyone is around the same table engaged in healthy dialogue.

The multi-stakeholder approach improves transparency.

When information is shared and disclosed among all stakeholders, there are improved opportunities for evidence-based decision making. Stakeholders are then better able to demand accountability from the government for the use of resources and attainment of health targets.

Sustainable change is possible when all stakeholders are engaged in the entire process of policy making, and in the planning, execution and monitoring of health programmes.

learnedWhat we’ve

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Medicines Transparency Alliance

GovernmentDepartment of Health: Dr Anna Melissa S. Guerrero, Chief, Pharmaceutical DivisionFood and Drug Administration: Maria Lourdes C. Santiago, Deputy Director GeneralPhilippine Health Insurance Corporation (Philhealth): Dr Francisco Z. Soria, Jr, Vice President, Quality Assurance GroupPITC Pharma, Inc.: Jose A. Capistrano, Jr, President

Pharmaceutical IndustryDrugstores Association of the Philippines: Celia Carlos, Past Chairman of the BoardPHAPCares Foundation: Dr Dr Edgar L. Posadas, Managing DirectorPharmaceutical and Healthcare Association of the Philippines: Teodoro B. Padilla, Executive DirectorPhilippine Chamber of the Pharmaceutical Industry: Tomas Marcelo Luke G. Agana III, Past PresidentGSK Philippines: Atty. Mailyn M. Ocampo, DirectorNovartis Philippines: Christine Fajardo, DirectorThe Generics Pharmacy: Benjamin Liuson, President

Health Professional AssociationsAsia Pacific Institute of Medicines Management: Leonila Ocampo, PresidentManila Pharmacists Society: Reynaldo Maxlito Umali, PresidentPhilippine Medical Association: Dr Minerva P. Calimag, PresidentPhilippine Pharmacists Association: Dr Olivia M. Limuaco, PresidentPhilippine Society of Hospital Pharmacists: Hazel Faye Docuyanan, PresidentPrivate Hospitals Association of the Philippines: Dr Rustico A. Jimenez, PresidentYoung Pharmacists Group: Bryan Posadas, President

Patient OrganizationsPhilippine Alliance of Patients with Chronic Illness/Psoriasis Philippines: Josefino de Guzman, PresidentPhilippine Alliance of Patient Organizations: Maria Fatima G. Lorenzo, President

Civil SocietyAlt*Health Foundation: Dr Elenita Loida A. Pedrosa, Executive DirectorAlternative Budget Initiative Health Cluster: Mercedes Fabros, LeadAyos na Gamot sa Abot-kayang Presyo Coalition: Atty. Paula Mae B. TanquiengCenter for Empowerment and Development of the Elderly and Seniors: Salvacion Basiano, PresidentCivika Institute: Dr Elmer Soriano, President

Damayan ng Maralitang Pilipinong Api: Emma Manjares, Executive DirectorHealthJustice Philippines: Ralph Emerson Degollacion, Project CoordinatorMedical Action Group: Edeliza Hernandez, Executive DirectorMinimal Government Thinkers: Bienvenido Oplas, Jr, PresidentNational Pharmaceutical Foundation: Teofila Remotigue, Chief Executive OfficerTask Force Kilos Damit: Laudicia Casana, PresidentWomanhealth Philippines: Ana Maria R. Nemenzo, National Coordinator

AcademeUniversity of the Philippines – College of Medicine: Dr Francisco Tranquilino, College Secretary and Special Assistant to the DeanUniversity of the Philippines – Department of Pharmacology: Dr Noel JubanUniversity of the Philippines – College of Pharmacy: Dr Imelda Pena, DeanUniversity of the Philippines – Universal Health Care Study Group: Dr Ramon Pedro Paterno, Dr Cecilia S. AcuinUniversity of Makati: Ma. Faye Nenette Cariaga, Donna FelixUniversity of the Philippines – School of Economics: Lourdes Desiree Cembrano, Consultant

ProjectsTulay sa Kalusugan (Improving Access to Medicines Project in the Philippines): Dr Anthony G. Faraon, Project LeadHealth Sector Catalyst/LUNAS: Dr Bryan Albert Lim

IndividualsRoberto M PagdangananAtty. Jose Maria A. OchaveCecilia C. SisonNormita D. LeyesaReiner W. GloorDr Arthur T. Catli

International PartnersWorld Health Organization – Western Pacific Regional Office: Dr Klara Tisocki, Lead, Essential Medicines and Health TechnologiesOffice of the WHO Representative in the Philippines. Dr Julie Lyn Hall, WHO Representative/Roderick L. Salenga, National Professional Officer – Essential Medicines and Health TechnologiesEU Delegation to the Philippines. Diana van DaeleThe World Bank. Dr Roberto Rosadia, Health Specialist

MeTA Philippines members

WHO/EMP/PAU/2015.3

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PHILIPPINES

The Medicines Transparency Alliance (MeTA) initiative is grounded in the theory that shining a light on an often opaque system will illuminate problems, improve efficiencies and empower stakeholders to hold decision makers accountable. The hypothesis is that making information transparent and bringing stakeholders together to discuss it will improve access to quality medicines for those who need them.

The global initiative began as a pilot in 2008 in seven countries, with the aim of establishing the multi-stakeholder platforms and collecting baseline data. The current phase, Phase 2, has focussed on making information transparent and using evidence to make policy recommendations. This document is one in a series of brochures that has been produced to share the highlights from the first three years of the second phase of the MeTA programme in each of the seven countries.

The project has been funded by the UK Department for International Development. WHO, in collaboration with Health Action International, has managed the global programme and provided in-country support.

As Phase 2 comes to an end in 2015, countries are considering options for long-term programme sustainability. To contribute, to get involved or for more information, contact:

MEDICINES TRANSPARENCY ALLIANCE

Julie HallWHO Country OfficePhilippines

+63 2 528 9763hallju@who.int

www.medicinestransparency.org

Gilles ForteWHO Essential Medicines and Health Products DepartmentSwitzerland

+41 22 791 4652forteg@who.int

www.who.int/medicines

Klara TisockiWHO Regional Office for the Western PacificPhilippines

+63 2 528 9026tisockik@wpro.who.int

www.wpro.who.int