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Transcript of Slide 1 Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential? Saul Walker Senior...
![Page 1: Slide 1 Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential? Saul Walker Senior Health Advisor UK Department for International Development.](https://reader030.fdocuments.us/reader030/viewer/2022032805/56649ef55503460f94c0838c/html5/thumbnails/1.jpg)
Slide 1
Win-Win or Lose-Lose?Why is multi-stakeholder involvement essential?
Saul Walker
Senior Health Advisor
UK Department for International Development
![Page 2: Slide 1 Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential? Saul Walker Senior Health Advisor UK Department for International Development.](https://reader030.fdocuments.us/reader030/viewer/2022032805/56649ef55503460f94c0838c/html5/thumbnails/2.jpg)
Slide 2
Overview
• Pharmaceutical sector goals in tension
• All stakeholders can be “irrational”
• Health sector weaknesses facilitate ‘irrational’ behaviour
• Complexity of system makes dynamic multi-stakeholder approach necessary
• No perfect resolution - can support more open, robust and accountable processes
![Page 3: Slide 1 Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential? Saul Walker Senior Health Advisor UK Department for International Development.](https://reader030.fdocuments.us/reader030/viewer/2022032805/56649ef55503460f94c0838c/html5/thumbnails/3.jpg)
Slide 3
What do we want to achieve in the pharmaceutical sector?
• Objectives can be in tension over time
• All stakeholders may hold beliefs that conflict with these objectives
• Relation to objectives dynamic and contextual
• Improved health outcomes• Patient (and provider) satisfaction• Equity
• Quality, safety and efficacy• Rational use and cost-effectiveness• Sustainability• Innovation
• Competitive markets?• Local industry?
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Expanding Equitable Access
Available to the poor
Keeping Costs Affordable
To patient and to the health system
Effective interventionsLevels of care, innovation
4
Competing Pharmaceutical Policy Objectives?
Adapted from: Dennis Ross-Degnan (HMS)
Political cycles
Economic policies
External drivers
Organisational politics
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Slide 5
taxe
s
Consumers Providerspayments
treatment
Government (MOH)
info
rmat
ion
standards, payments
Drug Industry
standardslobbying
$$
mar
ketin
g promotion
oversight
Consumer Organizations
lobbying
support
informationstandards, education
Professional Organizations
lobbying
3rd Party Payers
payments payments, controls
coverageprice
informationinformation
Adapted from WHO
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Slide 6
System weaknesses
• Inequitable financing– Inability to afford full courses or
purchase of low quality products
• Poorly designed payment systems – Incentives for over supply or high-
cost medicines
• Incentives/opportunities for diversion
– Salary supplementation– Weak LMIS to monitor products
• Weak information systems– Poor procurement and distribution– Limited use of evidence in planning
• Weak regulation– Inappropriate promotion of medicines– Low quality crowds out good quality
• Donor practice– Unpredictable financing, vertical
programmes and multiple missions
• Weak HR and Training– Poor practice, low consumer
confidence
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Donors
Domestic political concernsRegulationsForeign/industrial policy
Pharmaceutical companies Profit focus (short/long) - marketingOpportunity costsIntellectual propertyStrategies for market share/volume
Wholesales, distributors, retailersProfit focus (short/long)Opportunity costsStrategies for market share/volume
International AgenciesProfile/fundingOverlapping agendasOrganisational structures/politicsPolitical outlook
Country GovernmentsLow budget allocationCompeting objectivesVested interestsPolitical outlook
People/Civil societyOverconsumption/self medicationPoor adherenceDisease specific groupsFunding/profile etcBelief systems
Potential for Poor Health Outcomes
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Multi-stakeholder processes
• Clear goals and values–Health improvement, equity etc–e.g National Medicines Strategy, NICE
• Stakeholder positions and interests–politics and Politics
• Agree basic rules of the game–How debate takes place–Agree can disagree
![Page 9: Slide 1 Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential? Saul Walker Senior Health Advisor UK Department for International Development.](https://reader030.fdocuments.us/reader030/viewer/2022032805/56649ef55503460f94c0838c/html5/thumbnails/9.jpg)
Multi-stakeholder processes
• Improve information–Agreement on facts
• Identify opportunities for alignment–Win-wins (e.g quality)–Balance, persuade or overcome
• Think systems–A fix here, an unexpected consequence there
• Accountability – using information
Can’t align everyone, on everything all of the
time
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Pharmaceutical companies Accurate information on pricingProactive roleBetter procurement and forecastingAchieve public health objectivesReduce pressure for inappropriate behaviour
Wholesales, distributors, retailersNew support for building capacityImproved market operationTackle corruption & wasteful practices
DonorsGood governance agendaIncrease access to medicinesSupport responsible businessIncrease aid effectiveness
International AgenciesGood governance agendaPromote ethical pharmaceutical procurement and supplyImprove health outcomes
Country GovernmentsDemonstrates commitment to good
governance – ↑ donor confidence Improved procurement and supplyBetter public health outcomes
Civil SocietyIncreased informationPlace at the tableSupportive environment for advocacyFinancial and other supportImproved dialogue with public and private sectors
Alignment on Transparency
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Medicines Transparency Alliance
• Strengthen transparency and accountability through sharing robust data and multi-stakeholder working
• Seven pilot countries–Formed multi-stakeholder groups (Govt, private sector, civil society)–Agreed work plans focused on improving and sharing information–Completed baseline studies–Began to share information and develop policy options together
• 5 countries completed multi-sector working analyses– (www.medicinestransparency.org/meta-countries)
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Slide 12
Medicines Transparency Alliance
• Multi-stakeholder working took time to develop
• Dynamics varied by country – strength of constituencies, familiarity with working together, priority issues
• Common issues: developing shared vision, ownership of processes, responsibilities, resourcing and communication
• Multi-stakeholder analysis – improvements in sector communication and participation, issue focused alliances
• Abstracts: 1108, 1025, 1013, 967
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Medicines Transparency Alliance
• Phase 2 approved June 2011
• Can MeTA deliver more accountability and better health outcomes?
• Move from data collation to analysis and use – test strength of multi-stakeholder approach
• International secretariat role: WHO EMD and HAI Global
Source: Kerstens, Saad and Bannenberg (ICIUM 1108)
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Slide 14
Questions
• How to build sufficient acceptance of basic rules?– Concept of conflict of interest in different cultures
• How to work in weak systems?– Lack of routine data, LMIS and regulatory capacity
• Can the complexity and dynamism of sector be managed?– Information desert to information overload
• How to balance short political timeframes and long solution lead-times?– Intermediate results, change management approaches
• How do we address the reality of power imbalances?– Governments, donors, companies, constituencies
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Slide 15
Acknowledgements
Dr Tim Reed
Dr Michael Reich
Samia Saad
Dr Willbert Bannenberg
Dr Andreas Seiter
Dr Anita Wagner
Dr Dennis Ross-Degnan
MeTA team
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Slide 16
Leading the UK government’s fight against world poverty
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