MeTA Zambia

1
MeTA Zambia

• Country Overview
• Public Sector
• Private Sector
• Civil Society

2
Country Overview

• Violet Kabwe
• MeTA Zambia Consultant

3
Multi-stakeholder process

• What were the major milestones in the
  multi-stakeholder process?
• Establishment of the MeTA Management Structure
  Council, Forum and Sub Committees
• Establishment of National Secretariat
• Developed Zambia MeTA website
• Communication strategies implemented at both
  policy and community levels motion in
  parliament, TV and radio live phone in progs,
  community sensitization road shows, development
  of fact sheets etc
• Orientation workshops for MeTA Council members
  held in supply chain systems and regulatory
  issues/mandate
• Have developed synergies with GGM
• Conducted data disclosure tool
• Drafted advocacy position papers on ADDO system
  in Zambia and counterfeit and sub-standard drugs
• Commissioned studies impinging on availability,
  affordability, and access to medicines
• Provided technical support to CSO Coalition
  capacity building on supply chain systems

4
Major achievements and successes

• What where the main achievements and successes of
  MeTA in your country?
• Successful, well-attended MeTA launch, opened by
  Minister of Health.
• Effective capacity building of Council members in
  supply chain management and functions of PRA.
• Successful mobilization of cross-party
  parliamentarians moved motion in parliament
  which introduced MeTA concept to august house.
• Good buy-in from Cabinet Office agreement to
  distribute MeTA materials.
• Establishment of national MeTA Secretariat
• Effective community mobilization efforts in rural
  pilot districts of North-Western Province
  included 2 successful radio shows.
• Live radio/TV programmes have become popular and
  made MeTA visible
• Community radio station managers mobilized
  through sensitization workshop.
• Mainstreaming of MeTA in community programs have
  gained popularity
• MeTA included in national health reform processes
• Reports commissioned for challenges of
  manufacturing sector, pricing structures in
  public/private sector, private sector mapping
  survey and data disclosure survey.
• MeTA Zambia website commissioned impressive
  design.
• MeTA Forum meeting held

5
Overall challenges (1)

• What have been the main challenges during the
  MeTA pilot phase?
• Creating trust and Commitment among stakeholders
  by striving to share joint MeTA learning among
  all stakeholders common MeTA benefits strategy
  or/and understanding that cuts across all sectors
• Commitment by all stakeholders was a challenge
• MeTA Council/CSO Coalition synergies were not
  apparent
• Felt need to set up sub committees as
  implementation bodies of MeTA Council
• Expected support from government and CPs did not
  fully materialize
• Used two pronged approach, targeting both policy
  and community levels as entry points for
  dialogue/sensitization concerning MeTA core
  principles
• Capacity building of MeTA Council members in
  pharmaceutical sector and health care delivery
  systems.
• Making private sector representatives, line
  ministry officers and members of parliament to
  become aware and gain knowledge on MeTA issues

6
Overall challenges (2)

• Delayed funding due to local bureaucracy meant
  late start to implementation of national work
  plan
• Delayed/disrupted recruitment and housing of
  Secretariat
• Support of other MeTA CPs to Initiative was not
  forthcoming
• Need to maintain continuous buy-in of all sectors
  and stakeholders time-consuming.
• Operations of Council and Sub-Committees depend
  on voluntarism, and high levels of commitment and
  time.
• Most members in full-time work so regular
  participation challenging, very apparent in the
  Research Survey sub - committee.
• Large Council makes convening meetings
  logistically challenging and expensive. Large
  numbers with varied skills mix means
  decision-making is slow.
• Initially, a calendar of Council and
  Sub-Committee meetings was not published in
  advance, made planning and scheduling
  challenging.
• Lack of clarity on the log frame, delayed work
  plan approval, and disrupted timely funding/
  implementation.
• Adhoc requests from MeTA International for sudden
  activities a big challenge especially with a
  tight work plan to implement
• Non disclosure of pricing structures by most
  pharma industry
• Disclosure tool only made available in Sept 2009
  would have been useful as baseline data and for
  work plan development.

7
Lessons Learned

• What are the main lessons from MeTA in your
  country?
• MeTA process is technical and complex, hence
  requires capacity for all members to move at the
  same pace.
• There are diverse interests among MeTA members
  who continuously strive to have common
  understanding and expected outcomes from the MeTA
  Process
• Establishing consensus requires constant lobbying
  for exchange of views
• Commitment of people important otherwise
  multi-stakeholder processes will not work
• MeTA members need medicines and management
  expertise
• MeTA can not operate in a political vacuum
• MeTA CSO needs to include members that are able
  to engage in dialogue at high profile level
• Two pronged approach in MeTA process
  (sensitization/lobbying at grassroots and policy
  levels respectively), improved MeTA visibility
• Non completion of desk review of data affected
  other dependent activities

8
Community Awareness

• Community awareness activities MeTA roadshow in
  Mkushi
• Opportunity to create public awareness about MeTA
• Positive response to MeTA issues in rural
  communities

9
Thank you

• Violet Kabwe
• Email kabwe.violet_at_gmail.com
• Mobile number 260976939364
• Website www.metazambia.org

10
Public Sector

• Mrs Bernice Mwale
• Director Product Registration
• Pharmaceutical Regulatory Authority

11
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA
• MeTA was initially to be housed within MOH, later
  agreed that Transparency International (Z) be
  host
• MeTA very much linked to public sector MOH key
  to success of MeTA, even though not driving MeTA
• MeTA provides big opportunity to have all
  different stakeholders on one roundtable to
  discuss issues that could influence
  policies/practices
• Understanding core principles of MeTA by members
  very key
• Expected support from CPs
• MeTA members are volunteers, their time is at a
  premium
• The size of MeTA Council directly relates to MeTA
  effectiveness
• Targeting issues that directly impacts general
  public is measure of MeTA success

12
Major milestones

• Government has shown support towards MeTA as
  shown by the Minister of Health launching of MeTA
  in Zambia and other activities
• Government has participated in the MeTA live
  radio programs after some initial hitches
• Orientation workshop for MeTA Council members in
  PRA mandate/functions
• Orientation of MeTA Council members in the
  national supply chain systems (public and
  private)
• Collaborative meeting held between PRA and its
  stake holders
• Active participation of MOH and its institutions
  in Forum meeting
• Co-chairing of MeTA Council meetings

13
Successes

• MeTA provided another forum for dissemination of
  information to wider circle of stake holders
• Participation in live MeTA radio programs
• MOH representative is Vice Chairperson of MeToA
  Council
• Successful orientation of MeTA Council members in
  the functions/mandate of PRA
• Successful collaboration by PRA with key
  stakeholders on various issues affecting them
• Successful orientation of MeTA Council members by
  MOH/its institutions on the national supply chain
  system
• Active participation of MOH, PRA and MSL IN THE
  MeTA Forum meeting

14
Challenges (1)

• Big challenge for government employees to talk
  about transparency and accountability issues
• Finding time to attend to MeTA activities given
  busy schedules
• Weakness in the tools that were used to carry-out
  some surveys should have been field tested first
• The surveys were supposed to gather more evidence
  for advocacy and influencing change
• Ensuring quality verses spending more money in a
  short time (to beat financial deadline).
• It was a challenge for some government officials
  in the MeTA sub-committees to follow tendering
  procedures rather than those followed in
  government (Comprehensive Tendering Procedures)

15
Challenges (2)

• Balancing MeTA activities and government duties
  was a challenge, especially that MeTA programs do
  not give sufficient notice
• The role of MOH in MeTA is key, however, need to
  recognise that MOH is not the driver for MeTA
• MeTA may be expected to address all kinds of
  issues, even if these are influencing access to
  affordable essential medicines
• Most CPs needed to be reminded about MeTA.
• MeTA can be seen as a tool with which to punish
  or expose the weaknesses in the public health
  sector

16
Challenges (3)

• The challenge MeTA presents is that all
  stakeholders and concerned citizens want to be
  counted within MeTA. This is clearly a difficult
  situation for MeTA Council and admin team
• MeTA is still in the formative stage and it may
  feel inadequate to tackle certain issues that
  impact on access to essential medicines
• Initial focus was on private sector from the
  regulatory point of view
• Misrepresentation of facts by consultant involved
  in desk review, delayed other MeTA follow on
  activities
• Some of the tools used for data collection
  appeared to be deficient in certain critical
  information.

17
Lessons Learned (1)

• MeTA should have an independent stand alone
  registered secretariat
• It was an opportunity for government to share
  information with the general public to discuss
  health issues, the forum can be used to share
  information dialogues with other stakeholders to
  introduce/withdraw new policies, schemes,fees and
  report illegal practices
• It was learnt that it is important to identify
  issues surrounding a survey before it is carried
  out.
• Difficult to fit in MeTA activities

18
Lesson Learned (2)

• There was need to have clear cut issues
  identified if a change was to be achieved
• it was a big opportunity for government to have
  all different stakeholders on one table hence a
  chance to raise awareness to other sectors.
  Awareness was also raised through the MeTA radio
  programs
• MeTA is very much linked to the public health
  sector. The MOH, even though not driving MeTA, is
  key to the success of MeTA
• There is a need to advocate for more
  infrastructure and health personnel to improve
  quality and accessibility of good quality
  medicines
• Focus on one or two issues was very necessary if
  tangible results were to be achieved
• The public health sector need not be seen as the
  only target for MeTA

19
Lessons Learned (3)

• Knowledge of the purpose and intentions of MeTA
  by stakeholders. There is a need for all members
  and stakeholder to keep in mind the background
  that resulted in MeTA
• The support from Cooperating Partners has been
  below expectation
• MeTA members are volunteers and their time is at
  a premium
• The size of MeTA Council directly relates to the
  effectiveness of MeTA
• Targeting issues that directly impact the general
  public is a measure of MeTAs success
• Clearly the time- frame for MeTA put pressure on
  members and the MeTA administrative team. All
  parties want to succeed.

20
Thank you

• Name of presenter Mrs Bernice Mwale
• Job Title Director Product Registration (PRA)
• Email bcmwale_at_pra.gov.zm
• Mobile number260977804353
• Website www.metazambia.org

21
Private Sector

• Presenter Name Ruth Mudondo
• Job Title Director Unicare Pharmaceuticals.
• Chair person Zambia Pharmaceutical Business
  Forum.

22
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA?
• Issues
• Private sector was battling with the challenges
  problems alone. Though Zambia Pharmaceutical
  business Forum (ZPBF) was in place.
• Lack of transparency at MOH One of the major
  concerns of the Private sector
• Lack of flow of information and very little
  consultation between Pharmaceutical regulatory
  authority Private sector PRA
• Private sector was not able to access some of the
  information at PRA.
• Lack of unity among the business community -
  drive to fight for the common cause.....
• Needs
• Wanted someone to represent the private sector in
  the MeTA process

23
Major milestones

• What milestones have been achieved during the
  MeTA pilot phase?
• Establishment of Multi stake holders forum
  Fantastic
• PRA (Pharmaceutical Regulatory Authority) heard
  the challenges of the Private sector from a
  neutral body like MeTA
• MOH was more willing to respond to the queries
  raised by the Private sector.
• CSO and Media got to know the role of private
  sector in Health care.
• Private sector found it easy to express their
  challenges in the MeTA meetings and most of the
  time private sector got the positive support from
  MeTA.

24
Successes

• What were the successes for your sector during
  the MeTA pilot phase?
• Zambia Pharmaceutical Business Forum
  Recognition
• Issues pertaining to Local Pharmaceutical
  Manufacturers were taken up on FAST TRACK and are
  being addressed by relevant authorities.
• Media Campaigns Ordinary citizens got to know
  more about distribution of medicines and the
  challenges that are faced by the Public Private
  sector in delivering quality medicines.
• Radio program Flow of information Interactions
  Public Participation
• Documentary Public awareness about the role of
  Private industry in National Health care
  Increased

25
Challenges

• What challenges has your sector endured during
  the MeTA pilot phase?
• Certain segment of Private sector is yet to
  appreciate MeTA activities.
• Certain segment of private sector Sceptical
  about MeTA.
• Balancing the MeTA activities with the routine
  business activities is a challenge.
• Getting co operation conducting survey is a
  real tough job
• Understanding the concept of disclosure Cant
  visualize the benefits hence it is difficult to
  get the support of private sector.

26
Lessons Learned

• What are the lessons that your sector has learned
  from MeTA?
• Importance of MULTISTAKE HOLDERS approach well
  understood
• Strength and weaknesses of other government
  institutions, learnt others limitations and
  started appreciating their efforts to be more
  transparent and accountable.
• Importance of Disclosure tools Give and take
  policy.
• Importance of lobbying

27
PHARMACEUTICAL PRIVATE SECTOR IN ZAMBIA
28
Challenges of Pharmaceutical manufacturing in
Zambia

• Challenges of Pharmaceutical manufacturing in
  Zambia
• Lack of modern equipment
• Limited research and development expertise

29
Thank you

• Ruth Mudondo
• Director - Unicare Pharmaceuticals

30
Civil Society

• Dimuna Phiri
• Paralegal Officer- Zambia AIDSLaw Research and
  Advocacy Network

31
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA?
• To build capacity amongst CSOs so as to enable
  them to engage and deliberate in the multi
  stakeholder process
• To acquire advocacy skills
• To understand policy formulation and analysis as
  well as government structures and functions
• To understand the drug supply chain in Zambia
• To acquire research and budget tracking skills
• To understand the Multi Stakeholder Process

32
Major milestones

• Advocacy training was conducted
• Drug supply chain training was conducted
• A training on policy formulation and analysis as
  well as the functions of government and its
  structures was conducted.
• 15 Civil society organization are fully committed
  in the coalition
• MeTA CSOs took part in the radio programs and
  television documentary.

33
Successes

• MeTA CSO secretariat is in operation
• The Work-plan was successfully developed and
  approved
• An advocacy strategy has been developed
• Increased knowledge amongst CSOs on medicine
  issues to participate in various opportunities
  and forums.
• Developed networks with the private government
  and similar campaigns such as the Stop Stock Out
  Campaign.
• MeTA CSO has legitimacy because it has
  representation from the community.
• Multi-dimension civil society participation.(e.g.
  governance, faith based, media and human rights
  organisations.)

34
Challenges

• The implementation period of the work-plan was
  too constraining.
• Dividing time between respective organisational
  duties and MeTA activities was a challenge
• Delay in the disbursement of funds
• Health issues are complex and time is needed to
  build adequate capacity to understand them.
•  Co-opting organisations in the MeTA CSO process
  was a challenge on inception

35
Lessons Learned

• The work plan was over ambitious (time-frame)
• Some trainings were too technical.
• Fluctuation in exchange rates affected the budget
• Harmonizing MeTA Zambia and MeTA CSO work-plan
  was a challenge
• There was under budgeting during the budget
  planning process
• There is so much that MeTA CSOs can do as
  regards to issues on health in Zambia.(evidenced
  from the trainings)
•  There is a need to share and link with other
  similar campaigns.
• CSOs became aware that they had a role to play
  in the pharmaceutical sector

36
Thank you

• Name of presenter Dimuna Phiri
• Job Title Paralegal Officer- Zambia AIDSLaw
  Research and Advocacy Network
• Email dimunaphiri_at_gmail.com
• Mobile number260979092885
• Website www.metazambia.org