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Accountability In The Medicines Supply Chain

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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.

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Accountability In The Medicines Supply Chain

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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