Country Overview

1
MeTA Ghana

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

2
Country Overview

• Augustina Koduah (Mrs)
• Country Coordinator

3
Multi-stakeholder process

• What were the major milestone in the
  multi-stakeholder process?
• Inaugural Meeting of Governing Council by Deputy
  Minister in September 2008
• Official Launch in November 2008
• First National forum in December 2009
• CSO Media Orientation in April 2009
• Quarterly Governing Council Meetings to date
• Independent monitoring of medicines quality
  through routine testing with FDB monitoring
  access to medicines using NHIS data based on
  agreed indicators with NHIA established
• Participated in major MeTA led International
  activities MIAG Jordan Training
• Launch and Sensitization of Ghana MeTA CSO Group
  community targeted communication activities in
  April 2010

4
Examples

• Multi-stakeholder analysis workshop carried out
  in June 2010
• National Multi-stakeholder Technical discussion
  forum on data disclosure in June 2010

5
Major achievements and successes

• What where the main achievements and successes of
  MeTA in your country?
• Active Multi-stakeholder Council made up of
  excellent spread of relevant stakeholders with
  sub committees (Administration, Advocacy
  Technical) a strong interest to move forward
  towards regular dialogue on medicines issues
• Independent Secretariat Functional Website
  www.metaghana.org
• Facilitated an active independent civil society
  capacity to lead consumer advocacy campaign to
  support disclosure and accountability on access
  to medicines
• Baseline Pharmaceutical disclosure survey
  sector scan studies completed
• Good collaboration established with NHIA to use
  data to monitor access to medicines based on
  agreed indicators with promising public health
  benefits
• Case studies shared with other MeTA countries
  through international meetings and country
  exchange visits

6
Major Achievement

• Results of Routine Minilab Quality Assurance Test
  led to necessary regulatory interventions

7
Overall challenges

• What have been the main challenges during the
  MeTA pilot phase?
• Initial unclear Standard Operating Procedures
• Latent mutual suspicion between the state and
  private sector
• Nervousness of some stakeholders about change
• MeTA assumes that enforcement mechanisms exist
  across the medicines manufacture, import,
  procurement and distribution systems, but
  historically enforcement of regulations is weak
• Slow and Bureaucratic Decision Making process
• Maintaining momentum of stakeholders over time.
  (Diminishing returns)
• Working together to build trust understanding
  between different stakeholders is difficult
• Timeliness and sustainability of financing beyond
  the pilot phase.

8
Lessons Learned

• What are the main lessons from MeTA in your
  country?
• Players in the pharmaceutical sector have varying
  interest and power
• Multi-stakeholder groups in the pharmaceutical
  sector have a better understanding of each other
  through transparent and systematic engagement
• Potential to make a positive impact in medicines
  access through transparent multi-stakeholder and
  systematic data sharing and disclosure works.
• Providing Ghanaian leadership on medicines
  transparency disclosure and dissemination of
  information to eliminate the risk of counterfeit
  and substandard medication as well as pricing in
  the supply chain

9
Thank you

• Name of presenter Augustina Koduah (Mrs)
• Email appidanq_at_yahoo.com
• Mobile number 233 20 8769228

10
Public Sector

• Mr. Samuel Boateng
• Office of Chief Director
• Ministry of Health (MoH)

11
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA?
• Strong existing enabling and legislative
  environment BUT
• Benefits of improved procurement not translating
  into affordability and availability for patients
  (e.g. 2004 WHO/HAI Medicines Survey)
• Inconsistency with other sectors (private and
  mission) in terms of how standards (i.e. quality,
  availability and pricing) are developed and
  applied
• Low consumer awareness due to very little
  information on quality, availability and prices
  of medicines in the public domain,
• Non-adherence to treatment guidelines by
  prescribers and irrational use of medicines by
  providers persists despite improved guidance and
  education
• Supply chain performance problems from CMS
  downstream leading to high stock-out rate
• Vulnerability of NHIS to fraud due to inefficient
  data analysis and dissemination
• Public health safety concerns arising from
  counterfeit and/or substandard products

12
Major milestones

• What milestones have been achieved during the
  MeTA pilot phase?
• Proactive engagement with private sector,
  development partners civil society through
  multi-stakeholder collaboration in information
  sharing to build consensus around availability,
  quality, pricing and rational use to increase
  access to essential medicines for the poor
• Periodic monitoring of medicine prices and
  availability as well as their rational use using
  WHO standard indicators-2008
• Key Data on medicines from the NHIA made
  available for systematic analysis and
  dissemination to improve transparency,
  accountability, pricing and quality.
• Independent monitoring of medicines quality
  through sentinel testing using GPHF minilabs
  2009.
• Partnership with CSOs to provide more information
  to consumers, around quality rational use in
  medicines advocacy
• Data validation of NHIA data carried out
  awaiting dissemination

13
Successes

• What were the successes for your sector during
  the MeTA pilot phase?
• Provided Ghanaian leadership on medicines
  transparency and accountability through
  multi-stakeholder engagement as model in West
  Africa for both effective governance and market
  efficiency.
• Initiated opportunity for pricing and rational
  use of medicines monitoring mechanism to inform
  the NHIS
• Reduced and/or eliminating the risk of
  counterfeit and substandard medication in the
  supply chain.
• Provided mechanism for public sector commitment
  to fight inefficiency and corruption in the drug
  supply landscape.

14
Challenges

• What challenges has your sector endured during
  the MeTA pilot phase?
• Mutual suspicions and mistrust between sectors
• Nervousness of all stakeholders about change
• Need to assume a degree of commitment to
  transparency by all stakeholders and willingness
  to be mutually accountable.
• Sustaining regular open stakeholder dialogue and
  commitment of all parties in all sectors.
• Right to Information Bill yet to be passed into
  legislation
• Dealing with sensitivities of various interest
  groups in the sector

15
Lessons Learned

• What are the lessons that your sector has learned
  from MeTA?
• Multi-stakeholder involvement helping to break
  barriers
• Transparency Accountability in the engagement
  process is vital for success of MeTA
• The need to accommodate the interests and
  perceptions of all local stakeholders to reflect
  the character of the multi-stakeholder is a key
  ingredient for its efficiency
• The essential elements of a strong, vibrant and
  sustainable MeTA in Ghana are
• Having the right people connected and committed
• Willingness of stakeholders to be mutually
  accountable
• Ghanaian ownership driven
• Sustainable political commitment

16
Thank you

• Name of presenter Mr. Sam Boateng
• Job Title Office of Chief Director, MoH Member,
  Ghana GC
• Email samuel.boateng_at_moh.gov.gh
• Mobile number 233 244 269336
• Website www.moh.gov.gh

17
Private Sector

• John Allotey
• Manager, Business Development
• LaGray Chemical Company, Nsawam, Ghana

18
Summary Analysis at start of MeTA

• Lack of market data
• Medicines available in therapeutic areas
• Sources of medicines
• Pricing both open market and retail
• Uncertainties around regulatory issues
• Steps in the approval process
• Time taken for approval of application
• Poor knowledge of government procurement system
• Competitive advantage of local manufacturers
• Personalities and approachability of government
  personnel
• Limited engagement with National Health Insurance
  Authority
• Medicines list
• Pricing

19
Major milestones

• Active participation of private sector in MeTA
• Participation in planning and launching the pilot
• Launch of MeTA as multi-stakeholder process
• Participation in Level Playing Field with other
  sectors eg. Govt., CSO, etc
• Movement towards regular, open stakeholder
  dialogue
• Ghana forum
• London Forum
• Opportunity to present case of local manufacturing

20
Successes

• Recognition of potentially rich sources of
  information for MeTA to harness and make an
  impact
• Food and Drugs Board registry of medicines
• Procurement information from Ministry of Health
• National Health Insurance data on prescriptions
• Value of political will
• MOH support making MeTA Ghana possible
• Meeting other stakeholders
• Appreciation of problems of other stakeholders
• Willingness to work as a team to improve access
• The beginning of trust building

21
Challenges

• Some lack of interest in work and activities of
  MeTA
• Competing issues and challenges within the sector
• Threats from cheap competition
• Threats (perhaps unintended) from foreign
  largesse (e.g. Affordable Medicines- Malaria)
• Need of government support to build industry
• Some suspicions around motives of MeTA
• Status as independent entity questioned
• Potential for manipulation of objectives
• May be used by both local as well as
  multinational pharmaceutical companies to
  discredit each other

22
Lessons Learned

• Transparency around medicine quality,availability
  and pricing is possible
• Potential for data sharing or disclosure exists
• MeTa can be honest broker because of
  multi-stakeholder status
• Persistence required in sustaining interest of
  all
• Commitment of stakeholders
• Work required in allaying suspicion and obtaining
  consistent cooperation

23
Acknowledgements

• Dr. Paul A. Lartey PMAG
• Dr. Isaac Morrison - SPMDP
• Pharmaceutical Society of Ghana
• Association of Licensed Chemical Sellers
• Ghana Medical Association
• Ghana Registered Midwives Association

24
Thank you

• John Allotey
• Manager, Business Development, LaGray Chemical
  Company, Nsawam, Ghana
• Email john.allotey_at_lagraychem.com
• Mobile number 233-20-831-7767
• Website www.lagraychem.com

25
Civil Society

• Presenter Charles Allotey
• Executive Director-Health
  Access Network
• Ralph Ahiabu
• Director of Programs - DeSMAS

26
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA?
• Lack of organized civil society coalition
  directly involved in issues related to access to
  medicines.
• Lack of capacity among civil society
  organizations to deal with medicines issues,
  especially where technical in nature.
• Ignorance among community members on issues
  surrounding medicine prices, quality,
  availability and access in general.
• Patients and consumers lacked information and
  power to realize their rights to healthcare and
  medicines - e.g. rights in Patients Charter,
  benefits and quality of care under National
  Health Insurance Scheme.
• Inadequate linkages and collaboration between the
  public, private and civil society sectors.

27
Major milestones

• What milestones have been achieved during the
  MeTA pilot phase?
• Built network and made linkages amongst civil
  society organizations across all 10 regions of
  Ghana.
• Enhanced capacity of network members on access to
  medicines and transparency issues - e.g.
  workshops at various levels.
• Established online social network (NING Group) to
  facilitate communication and mutual visibility of
  network members.
• Launch of Ghana MeTA Civil Society Group by the
  Deputy Minister of Health.
• Developed 4 educational posters targeted at
  consumers on relevant medicines issues in Ghana
  translated into 7 major local dialects.
• Undertook community awareness-raising activities,
  including public fora and radio programs.
• Held a detailed mid-term review developed
  forward plans for 2010-11.
• In sum We have achieved a lot, with limited
  resources. And more is planned!

28
Successes

• What were the successes for your sector during
  the MeTA pilot phase?
• Enthusiasm has been created among community
  groups who are now able to engage in discussions
  on medicines issues.
• Trust and collaboration are emerging between CSOs
  and public sector agencies on transparency and
  access to medicine issues.
• We have enhanced awareness among consumers on
  patients responsibilities, counterfeit and
  substandard medicines, and the rational use of
  medicines.
• We have a database and linkages at national,
  regional, district and community levels that will
  facilitate information sharing and joint
  advocacy, right across the country.

29
Challenges

• What challenges has your sector endured during
  the MeTA pilot phase?
• Sustaining interest of network members to engage
  actively in the MeTA process following the
  establishment of the network.
• Aligning individual and organizational interests
  of network members to the core objectives of
  MeTA.
• Demands made on members engaged in the
  organizational process were very high due to the
  sacrificial nature of the work.
• Limited resources constrained the creative and
  innovative ideas that would have enriched the
  overall outcome. For example, we had hoped to
  engage in some operational research on medicine
  related issues in communities nationwide. This
  would have engaged network members proactively,
  resulting in (bottom up) data to complement that
  at policy level (top down).

30
Lessons Learned

• What are the lessons that your sector has learned
  from MeTA?
• Non-health professionals within the CSO network
  are able to engage with a wide range of
  stakeholders and the media on issues relating to
  transparency and access to medicines The CSO
  network includes those working on governance,
  corruption, womens rights, childrens rights,
  community health, etc.
• The CSO sector is gaining valuable knowledge and
  experience through participation in the MeTA
  multi-stakeholder process.
• Working with different stakeholders is possible
  and offers a better opportunity to address
  challenges than one stakeholder group acting
  alone. For example, on issue x
• Opportunity created through the MeTA process to
  work with people with diverse professional
  backgrounds, skills and expertise resulted in
  achieving better outcomes. For examplewe
  achieved

31
Thank you

• Name of presenter Charles Allotey
• Job Title Ghana MeTA
  CSO Group Coordinator
• Email
  kallotey_at_gmail.com, han.ghana_at_gmail.com
• Mobile number 233
  (0)244280284
• Skype
  kallotey
• Website
  www.hanghana.org