Presentation by Saul Walker of the UK Department for International Development describes the role of the Medicines Transparency Alliance in encouraging increased accountability in the medicines supply chain in developing countries.

1. The Medicines Transparency Alliance:
Accounting and Accountability in the Drug
A ti dA t bilit i th D
Supply Chain
Saul Walker, DFID
Global Health Supply Chain Summit
Zaragossa, 6 November 2008

2. Pharmaceutical Markets in Developing
Ph ti l M k t i D li
Countries
Low expenditures (ARVs an exception)
Inequitable financing (high out of pocket)
out-of-pocket)
Complex state/non-state, private/public mix
Weak infrastructure and HR
Weak regulatory environment
Very high information asymmetries
Provider/patient, supplier/purchaser
–
Weak LMIS and limited utilisation data
Strong external players - complex international environment
Portable, high value goods – potential for inefficiency,
diversion and corruption
di i d ti

3. Medicines Supply: A Complex Network
M di i S l C l Nt k
Government
(MOH)
Professional
Consumer
Organizations
Organizations
lobbying
standards
Drug Industry
standards,
information education
price coverage
3rd Party
y
Payers
payments
Consumers Providers
treatment
Source: WHO

4. Public Drug Supply Chain: Kenya
Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate
Commodity Logistics System in Kenya (as of July 2006) any inaccuracies to skinzett@cb.jsikenya.com or telephone 2727210
skinzett@cb jsikenya com
Commodity
Type Blood Anti- Labor-
Contra- Condoms
MOH
Vaccines
(colour coded) Safety
STI Essential Retro atory
ceptives and for STI/
TB/Leprosy Malaria Equip-
Reagents
and
RH HIV/AIDS Drugs Virals supp-
Drugs (inc. HIV ment
Vitamin A
equipment prevention (ARVs) lies
tests)
Organization Key
Government
World Bank Loan
Bilateral Donor
Multilateral Donor
NGO/Private
JSI/DELIVER
U U D
D J C K S Global
Gl b l
Source of A
G
S K N W B G
US
E F I I N I GOK, WB/ Fund for
N
A
funds for A f F H T UNICEF D MSF
GOK I
V
U I C D C D IDA AIDS, TB
Gov
commodities I W P O C F D
I
D A A V A and Malaria
D A A
U U GTZ C J
K PSCMC
Procurement E
Government
Crown
S K N W (Crown
U
E Japanese
D S
Agent/Body MEDS (procurement
R
UNICEF
Private
A f F H of K
f Kenya
Agents
A t MSF
S
Agents,
M
O Company implementation
C I
I W P O GTZ, JSI
P unit)
S
A
and KEMSA)
D A A
KEMSA
Point of first KEPI Cold
Regional KEMSA Central Warehouse MEDS NPHLS store
warehousing Store
Depots
Organization Provincial and
NLTP JSI/DELIVER/KEMSA Logistics KEPI
KEMSA and KEMSA Regional Depots MEDS
responsible District Private
Management Unit (contraceptives,
(TB/ (vaccines Hospital
for delivery to Drug
(essential drugs, malaria drugs, (to Mission
Leprosy condoms, STI kits, HIV test kits, TB and Source
Laboratory
district levels consumable supplies) facilities)
drugs drugs, RH equipment etc) vitamin A) Staff
Organization
Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,
responsible for
delivery to sub- Dispensaries come up and collect from the District level
district levels
Source: Steve Kinnset, PSI Kenya

5. Regulatory Framework
Taxes and Licensing of
import duties suppliers
Parallel Drug registration
imports policies
Information
Compulsory Price controls
Forecasting EDLs
licensing Profit controls
Formularies Margin limits
Domestic Patent Restrictions on
SUPPLY CHAIN
Price & Clinical
Legislation (TRIPS marketing &
(manufacturers wholesalers retailers)
availability guidelines
compliant) advertising
• Production efficiency (cost of production)
monitoring
• Volume efficiency/economies of scale
Patent Volume
• Market structure and competition (# of suppliers;
protection controls
brand vs. generic) among manufacturers,
wholesalers, and retailers
Publicized Utilisation
• Distribution efficiency
International Middle-man
price/quality data
• Mark-ups
trade policies policies
information
(e.g. TRIPS)
PRICES, AVAILABILITY, AND QUALITY OF ESSENTIAL MEDICINES
DEMAND
Patient-driven Provider Provider-driven
Disease patterns recommendations Knowledge
Procurement Co-payment
Socioeconomic status Incentives
practices policy
Education Brand preferences
- Drug selection
g
Patient
P ti t
Self-medication Influence of marketing
- Procurement
expectations
Brand preferences
basis
Influence of marketing
Cold Chain HR
Drugs selected for Prescription
reimbursement controls/incentives
(
(+ve/-ve lists)
)
Warehouses
Transport
Infrastructure and Services
Pricing policies - Generic
Referencing, negotiation substitution
etc
Purchasing
(public procurement; government and private insurance)
Adapted from Cherly Cashin, 2008 (forthcoming)

6. DFID Policy Framework for MeTA
Commitment to make progress towards the MDGs, including MDG
8 Target 17
“To provide access to affordable essential medicines in developing countries in co-operation
with pharmaceutical companies”
White Paper 3 Eliminating World Poverty: Making Governance
Work for the Poor
Places support for good governance at the centre of what DFID does
–
Focuses on increasing state capability, responsiveness and accountability
–
Commitment to apply experience of Extractive Industries Transparency
–
Initiative to other sectors

7. The MeTA “model”
model
Goal: increased access to medicines (esp. for the poor)
Purpose: Test if multi-stakeholder approach increases
transparency, governance, efficiency and accountability, and
encourages responsible business practices.
Objectives: establish multi-stakeholder process in seven
j p
countries and internationally; encourage progressive
disclosure of data on price, quality, availability and promotion
p ,q y, y p
of medicines; use the evidence to improve policies and
p
practice; share the learning; (design a sustainable approach)
; g; ( g pp )
MeTA 13/11/2008 7

8. MeTA’s Focus
MeTA’s focus will be on strengthening developing
country capacity to collect, analyse, disseminate and
use data on medicine quality availability, pricing and
quality, availability
promotion.
This will help improve transparency and accountability
around the way medicines are selected, regulated,
procured, distributed, supplied and then sold to and
used by patients.

9. Transparency?
Improving information access, scrutiny and use
Transparency = not only disclosure of the price, quality,
–
availability and promotion of medicines
Verifiable d t
V ifi bl data
–
how to use the information to identify barriers, to reduce
–
asymmetries and to agree on solutions
Accounting and Accountability
–

10. Accountability?
A multi-stakeholder approach
Country L
C t Level
l
–
Bring together players that impact pharmaceutical market
Scrutinise verifiable data: focus on outputs/outcomes
Build opportunities for agreement and action
Global alliance
–
DFID, WHO, World Bank
International P i t S t and Ci il S i t
It ti l Private Sector d Civil Society
International Advisory Group: influence constituencies, share
learning and incentivise progress (peer scrutiny)

11. What Brings People to the Table?
Country Governments
Donor Governments
Support from international community
Good governance agenda
Improved procurement and supply
Tackle corruption
Better public health outcomes
Increase access to medicines
Commitment to tackle corruption
C
Support responsible business
Commitment to financial probity and
Fiduciary duty on aid expenditure.
good governance
Civil Society
Increased information
International Institutions
Place at the table
Good governance agenda
Supportive environment for advocacy
Partnership with private sector
Financial and other support
Improve health outcomes
Improved dialogue with public and
Fiduciary duty on aid expenditure
private sectors
Pharmaceutical companies
Wholesales, distributors, retailers
Accurate information on pricing
New support for building capacity
Proactive role
Improved market operation
Better procurement and forecasting
Tackle corruption & wasteful
Achieve public health objectives
practices
Reduce pressure for inappropriate
behaviour

12. MeTA Process
Country Secretariat, M-S Group, Int’l and Local Partners
Changes in:
Information
New validated • Regulatory
Changes in drug
made public
d bli
data on drugs environment
Analysis and prices,
generated - • Incentive
Scrutiny by options for availability,
focus on structures
multi- change quality and or
outputs and • Business/prof’l
stakeholder promotion
outcomes practice
group
• Accountability
Improved
Improved mgmt info
processes
MeTA Toolkit MeTA website and Lesson sharing MeTA partners at
int’l and country level
Baseline assessment publications Technical Assistance

13. MeTA phase 1: March 2008- Oct 2010
MeTA Global launches:
15 M L d
May London, 21 M WHO A
May Assembly
bl
–
Activities in all 7 pilot countries
MeTA Secretariat, WHO World Bank can provide TA
Secretariat WHO,
–
4 meetings of the MeTA International Advisory Group
Global feed back meeting Feb 2010
feed-back
External evaluation of pilot phase
Phase 2? DFID commitment to MeTA= 10 years

14. Achievements at country level
MeTA dashboard Peru Ghana Zambia Uganda Jordan Kyrgyzstan Philippines
Exchange of letters
Multi‐stakeholder engagement Govt+CSO+Priv Govt+CSO+Priv Priv + CSO Govt+CSO+Priv Gov+CSO Govt+CSO+Priv
Pre‐MeTA organisation Grupo Impulsor Group of 7 CSO, Secr
MeTA Forum
MeTA Forum 13 14 Nov 08
13‐14 Nov 08 12 May 2008
12 May 2008 dec 07
dec‐07
MeTA Council 10‐sep‐08 regularly monthly
Two coordinators
MeTA Secretariat CIES GNDP High Health Council appointed WHO, Univ.
Workplan developed being drafted 6m / GBP50k zero draft by MOH only being drafted being drafted being reviewed
National launch 13‐14 Nov 08 14‐jan‐09 week 15 Dec 08 dec‐07
Workplan being implemented non‐MeTA funded
Progressive disclosure
14 MeTA 13/11/2008

15. Contact MeTA, DFID
Wilbert Bannenberg, Technical Director
wilbert@metasecretariat.org
wilbert@metasecretariat org
Mob +31-6-20873123, Skype wilbertb1
MeTA Secretariat, info@metasecretariat.org
www.MedicinesTransparency.org
M di i T
Saul Walker, DFID,
S l W lk DFID s-walker@dfid.gov.uk
lk @dfid k
Mob +44 (7748) 920 597