MEDICINES TRANSPARENCY ALLIANCE

UGANDA

WORKING TOGETHERFOR BETTER ACCESS TO MEDICINES

2

Medicines Transparency Alliance

3

UGANDA

The Medicines Transparency Alliance (MeTA) began as a pilot in Uganda in 2009. The programme aimed to contribute to good governance, transparency and accountability across the medicines chain, through the engagement of all stakeholders with an interest in the outcome of the medicines market.

A 12-member MeTA Council was established with co-chairs from the Ministry of Health (MOH), civil society and the private sector. A coordinator was made responsible for day-to-day operations of MeTA, supported by a small secretariat. The council established committees to lead specific areas of work.

To gain a better understanding of the pharmaceutical situation in Uganda, MeTA undertook a comprehensive programme of surveys to build a robust evidence base for policy dialogue. It also built the capacity of civil society organisations to better engage with government.

Uganda was one of seven countries to adopt MeTA. The programme has also been active in Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, and Zambia. The programme is run with funding from the UK Government through the Department for International Development (DFID).

in UgandaMeTA

achievementsOur

✔ Civil society and the private sector have been involved in policy dialogue with the MOH for the first time.

✔ We revised the national medicines policy and developed a strategic plan for its implementation.

✔ We increased transparency by developing an online platform for the National Drug Authority’s (NDA) medicines register.

✔ We contributed to government efforts to improve the quality of medicines through monitoring in retail outlets and convening partners for national dialogue.

✔ We developed guidelines for the medicines benefits package for the proposed national social health insurance scheme.

✔ We undertook various surveys to generate evidence to inform policy positions

✔ We provided a platform for civil society organizations (CSO) to engage in social accountability and build relations with service providers to generate community led solutions to challenges.

4

Medicines Transparency Alliance

The overall pharmaceutical situation in Uganda has improved over the last 20 years. The country has a national medicines policy with an implementation plan, it has established central medical stores and a medicines regulatory agency, the NDA. Indicators of access to medicines have all been shown to be on the positive path. But despite the advances, Uganda still has challenges. Medicines regulations are in place but still more work is to be done on enforcing them; the out of pocket expenditure is high, estimated at about 70% and the prices for medicines are unaffordable for most of the population. The poorest risk devastating financial consequences because of the medicines they need to pay for. Many in rural areas have to travel more than an hour to get to a doctor.

challengesOur

5

UGANDA

First stepsStakeholders in the medicines supply chain say they had no interaction with each other before MeTA began. Denis Kibira, from the MeTA Secretariat, says there was a level of mistrust between the MOH, civil society and the private sector. “The Ministry of Health thought civil society were just noisemakers,” he says. Nor was there engagement between the private sector and civil society or government. “Civil society and the private sector have had very little to do with each in Uganda,” says MeTA co-chair, Nazeem Mohamed, chief executive officer of Kampala Pharmaceutical Industries. “And the Ministry of Health was generally extremely difficult to get hold of.”

MeTA has changed that. Its first steps were to establish a multi-stakeholder dialogue, which involved the founding stakeholders identifying interested partners, civil society organizations CSOs, manufacturers, health workers and representatives from the private sector. They began organizing regular roundtable discussions, where they swapped views and ideas on what they saw as the key issues were relating to increasing access to medicines.

“The work between civil society and the MOH has grown tremendously,” says Mr Kibira. “The trust has really grown – they do not see us just as noisemakers or people out to get them, but they see us as people contributing to their efforts.”

The principal pharmacist in the pharmacy division of the MOH, Fred Sebisubi, says the discussions helped the MOH better understand the extent of problems in communities – such as self-medication, lack of adherence to policies and the challenges manufacturers face in increasing the availability of medicines. “Before, we were trying to develop policies and mobilize resources – but maybe the policies did not really address the real challenges,” he says. “I think sharing views via MeTA has influenced how we create the policies.”

Nazeem Mohamed says the benefits of forging closer links between the sectors may seem “intangible”. But he says they have improved medicines policymaking. “MeTA has given the private sector a tremendous amount of insight into how the MOH works,” he says. “I have really appreciated the value that civil society offers to us – in the past, I never really thought about it much. So, to me, it’s been immensely valuable to sit around the table with other colleagues who used to be very difficult to approach.”

Stakeholders have been engaged in debates about availability and affordability of medicines. MeTA has helped address the lack of evidence on these issues, by carrying out price and availability surveys. This work confirmed that availability was much poorer in rural areas – particularly the private sector and led to changes in policy and the empowerment of CSOs to speak out, through a ‘Stop Stockouts’ campaign.

journeyOur

6

Medicines Transparency Alliance

Revising policiesUganda had a national medicines policy in place as MeTA began, but it hadn’t been updated since 2002. The MOH accepted MeTA’s proposal to review it, and, with technical support from WHO, a review process was launched in 2014. MeTA’s Denis Kibira says one of the key features of the process was its inclusiveness. “Civil society organizations were at the centre of the process,” he says. “The consultations were wide and the WHO consultant and Ministry of Health took as many views from as many stakeholders as possible.”

MeTA also played a leading role in supporting the revision of the National Pharmaceutical Sector Strategic Plan. Its aims to ensure a harmonized procurement system for health products, the availability of essential medicines and strong and effective management and regulations of the sector.

Despite being a government document aimed at identifying national goals and commitments, Nazeem Mohamed says it was not well known. “The previous plan had been developed with no feedback from stakeholders,” he says. “So now we have a plan which is endorsed by the private sector, civil society and the government.”

Both the national medicines policy and the National Pharmaceutical Sector Strategic Plan institutionalize stakeholder engagement. “They have special components on community and private sector engagement that were not there before,” says Denis Kibira. “I think it recognizes the important role of civil society and the private sector in policy development and in enhancing transparency.”

MeTA has also supported the revitalization of medicines and therapeutic committees (MTCs) in health facilities – which should be responsible for promoting the rational use of medicines, through proper medicines prescribing and medicines management. They had existed in Uganda, but had been dormant. MeTA researched how they were operating and designed interventions to support them to begin playing a more active role.

Increasing transparencyMeTA’s roundtable discussions generated a proposal to improve access to Uganda’s registry of medicines. “The national medicine register was only available in hard copy,” says Denis Kibira. “And anyone who wanted it had to pay for it. We thought that was unfair.” Further, the hard copy dated quickly, as new medicines were added to the register and others were taken off. MeTA stakeholders worked with the NDA to improve the document and publish it online. Dr Sebisubi says it means stakeholders have access to more current information, and it’s improved efficiency. “It has cut costs for industry. For example, investors wishing to know what medicines are sold in Uganda now have an online, real time and free resource to access.”

Enhancing qualityLike many medicines regulators around the world, the NDA has struggled with limited resources and the difficult job of trying to assure the quality of medicines for consumers. Mr Kibira says through the MeTA discussions, there was recognition that assuring the quality of medicines did not have to be a job for the NDA alone. MeTA became involved, establishing a quality of medicines assessment, which evaluates medicines from sentinel sites in the country side, in conjunction with WHO. In addition, industry recognized that the results of their quality assurance and testing regimes could be useful if disseminated to the NDA. Stakeholders agreed at a major forum to work together on the issue. “I think is a big step in terms of the medicines market in the country,” Mr Kibira says. “If you improve sharing of this information, then you work to contain some of the would-be offenders. So we hope we can have a forum where different stakeholders can routinely send information on quality of medicines – that would definitely help support the NDA’s mandate.”

7

UGANDA

MeTA’s approach to increasing transparency

• SurveyedstatusofNationalDrugAuthority’smedicinesregistry.

• Revisedregistryinconsultationwithstakeholders.

• Draftedrevisedpolicies.

• Registrynowavailableonline,allowinguserstosearchup-to-dateinformationaboutthe registration of medicines for free. See the Uganda National Drug Authority Drug Registerathttp://www.nda.or.ug/hmn_list.php.

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

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

✔ Gaps in knowledge are quickly highlighted when everyone is around the same table.

✔ The multi-stakeholder approach improves transparency.

✔ Well-informed stakeholders are better able to hold decision-makers to account.

✔ Sustainable change is more likely when all sectors have a stake in a policy.

learnedWhat we’ve

8

Medicines Transparency Alliance

MeTA’s approach to revising policies

• SurveyedstatusofpoliciesandidentifiedthenationalmedicinespolicyandNationalPharmaceutical Sector Strategic Plan as in need of revision.

• SubmittedproposaltoreviewpoliciestotheMOHandheldconsultationswithstakeholders.

• Participatedinthediscussiononrevisedpolicies.

• MinistryofHealthlaunchesnewnationalmedicinespolicy.

9

UGANDA

MeTA’s response to community concern about quality of medicines

• SupportedNationalDrugAuthorityactivitiesbyconductinganalysisof105samplesin four districts.

• FindingsdisseminatedtoNDA.

• RecommendedimprovedcollaborationbetweenstakeholdersandNDAtoaugmentNDA testing activities.

MeTA’s response to improving rational use of medicines

• MeTAfoundmedicinesandtherapeuticcommitteesinhealthfacilitiesweredormantand conducted research to assess their operations.

• ConsultedmembersofMTCsandfoundawillingnesstoplayanactiveroleinhealthfacilities.

• MaderecommendationsforinterventionstoimprovetheroleofMTCsinfacilities.

• Programmereceivedsupportfromexternalfundersandisnowbeingscaledup.

10

Medicines Transparency Alliance

MeTA Uganda membersGovernmentMinistry of Health, Fred Sebisubi, Martin Oteba (MeTA co-chair), Morries SeruNational Drug Authority, Hellen Ndagije Public Procurement and Disposal of Assets Authority, Moses Ojambo

Private sectorKampala Pharmaceutical Industries, Nazeem Mohamed (MeTA co-chair)Cipla Quality Chemical Industries Limited Michael Maynard Medical Access Uganda Limited, Sowedi Muyingo Surgipharm Uganda Limited, Kinny Nayer World Bank Institute/Quality Chemicals Limited, James Tamale Joint Medical Store Joanita Namutebi Lwanyaga and Emmanuel Higenyi

Professional associationsPharmaceutical Society of Uganda, Sam Opio

Civil societyCoalitionforHealthPromotionandSocialDevelopment,RosetteMutambi(MeTAco-chair)UgandaNationalHealthConsumersOrganisation,RobinahKaitiritimbaMakerere University, Fred Kitutu

MeTS SecretariatCoalition for Health Promotion and Social Development, Denis KibiraCatherine Nyadoi

Partner agenciesWorld Health Organization, Joseph Mwoga

WHO/EMP/PAU/2016.02

© World Health Organization 2016

Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Photos: © WHO/Prudence Nyamishana. Design and layout: L’IV Com Sàrl, Villars-sous-Yens, Switzerland.

Printed by the WHO Document Production Services, Geneva, Switzerland.

UGANDA

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.

Phase2oftheprojectcametoanendin2015andcountriesarenowconsideringcountriesare considering options for long-term programme sustainability. To contribute, to get involved or for more information, contact:

MEDICINES TRANSPARENCY ALLIANCE

Wondimagegnehu AlemuWHO Country OfficeUganda

+256 414 335532alemuwo@who.int

www.who.int/medicines/areas/coordination/meta

Gilles Forte WHO Essential Medicines and Health Products DepartmentSwitzerland

+41 22 791 4652 forteg@who.int

www.who.int/medicine

Ossy KasiloWHO Regional Office for AfricaRepublic of Congo

+ 47 241 39100kasiloo@who.int

www.afro.who.int