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This issue of The Soul Beat looks at the issues in Africa surrounding access to medicines, including increasing transparency, accountability, and magnifying the voices of patients and consumers in the healthcare marketplace. Beginning with information about a new alliance of partners working in this field within 3 specific African countries - Ghana, Uganda, and Zambia - this issue highlights projects, strategic thinking, and resources of relevance.

If you would like your organisation's communication work or research and resource documents to be featured on the Soul Beat Africa website and in The Soul Beat newsletters, please contact soulbeat@comminit.com

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MEDICINES TRANSPARENCY ALLIANCE (MeTA) in AFRICA

1. Medicines Transparency Alliance (MeTA)
MeTA is an alliance of partners working at both national and international levels to improve access to medicines by increasing transparency and accountability in the healthcare marketplace. The Medicines Transparency Alliance (MeTA) is an effort to collaborate with the pharmaceutical sector to improve information flows, and to increase transparency and accountability about the selection, regulation, procurement, sale, distribution, and use of medicines in developing countries. By doing so, MeTA will work to improve how decisions are made about medicines, improve the way they are purchased and supplied, encourage innovative and responsible business practices, and increase the voice of patients and consumers in 7 countries: Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda, and Zambia.
Contact: info@metasecretariat.org AND admin@metasecretariat.org

2. Medicines Transparency Alliance (MeTA) in Ghana
MeTA Ghana launched in November 2008 and is working to increase transparency, consumer awareness, and consumer participation in procurement, distribution, and use of essential medicines in order to help increase accountability, improve efficiency, and increase value-for-money. At a MeTA African Skills Building Workshop in 2008, representatives of 7 Ghanaian non-governmental organisations (NGOs) set 3 objectives as part of their participation in MeTA: (1) press for a 10% reduction in prices of essential medicines by 2010; (2) advocate a 15% increase in availability of essential medicines in rural communities by 2010; and (3) strengthen the capacity of civil society organisations (CSOs) in dealing with essential medicines. MeTA Ghana is establishing mechanisms to strengthen the collection, analysis, and dissemination of data on medicines along the supply chain. Sustaining regular, open stakeholder dialogue is a core component of this process. Also, participants are facilitating peer oversight systems within and across health professions.

3. Medicines Transparency Alliance (MeTA) in Uganda
Scheduled to be launched in April 2009, the Uganda country programme builds on the Ugandan Government's efforts over the previous 14 years to improve the capacity of the health sector to ensure that patients take appropriate, affordable, safe medicines when they are needed. This process will also involve supporting the development of viable, efficient medicines markets and supply systems. The core work in Uganda will involve mobilising and building the capacity of CSOs to advocate for increased access to essential medicines. Research will facilitate the production and dissemination of information (guidelines, laws, etc.) on policies and practices on access to essential medicines. Another focus will be on undertaking advocacy to influence policy formulation and implementation, and monitoring and evaluation to increase CSO representation on decision-making structures at all levels.

4. Medicines Transparency Alliance (MeTA) in Zambia
CSOs have been active in building the MeTA strategy in Zambia, which is set to launch this month (March 2009). Four Zambian CSO representatives took part in the skills-building seminar held in Uganda in February 2008 designed to improve the capacity of the health sector to ensure that patients take appropriate, affordable, safe medicines when they are needed. The Zambia group met separately during this seminar, which led to the resolution to brief the wider CSO community and meet other organisations participating in the MeTA process in Zambia, to develop a baseline assessment of the situation in their country, and to organise an advocacy strategy.

5. Medicines Transparency Alliance (MeTA) African Civil Society Skills Building Workshop Process, Outcomes and Evaluation
This report documents the skills building workshop held by Medicines Transparency Alliance (MeTA) in Uganda in February 2008 for CSOs based in Ghana, Uganda, and Zambia. It explores the major topics covered, the processes that were used, some of the key outcomes and lessons, and highlights the initial plans made by country groups. The workshop brought together 22 participants from 20 organisations - 7 from Ghana, 5 from Zambia, and 10 from Uganda.

ADDRESSING ACCESS, QUALITY, AND ACCOUNTABILITY ACROSS AFRICA

ACTION

6. Stop Stock-outs - Kenya, Madagascar, Malawi, Uganda, Zambia
Launched in February/March 2009, this campaign is a call to action for African governments to meet their obligations to provide essential medicines by increasing the national budgetary allocation for the purchase of these medicines and by ensuring efficiency and transparency in the procurement, supply, and distribution of medicines. This advocacy campaign uses in-person events and information and communication technology (ICT) to demand action to eliminate "stock-outs", the term used when a pharmacy (in a medical store or health facility) temporarily has no medicine on the shelf.
Contact: info@stopstockouts.org

7. Malawi Health Equity Network (MHEN)
MHEN is an independent alliance of organisations and individuals working to improve the distribution, quality and access to health services throughout Malawi. MHEN seeks to accomplish this by influencing government policy and practice, as well as activities of donors and civil society through advocacy, networking, research, information dissemination, and budget monitoring. MHEN has developed a training protocol for data collection, held trainings, and published a training manual that was used in a July 2008 train-the-trainer session. Network members trained will conduct further trainings at the district level. Through national, regional, and district roundtables, MHEN provides opportunities for discussion and debate on issues such as health services delivery, health services quality, and health care financing. Through press conferences strategically scheduled when health-specific issues and crises occur, MHEN aims to raise awareness in the general public and to lobby governments to make change.
Contact: secretariat@mhen.org

8. HEPS-Uganda
HEPS-Uganda is a health consumer organisation advocating for health rights and responsibilities in Uganda. HEPS-Uganda has 3 main programmes. (1) Health Policy Advocacy Programme: HEPS-Uganda is the coordinator of the Uganda Coalition for Access to Essential Medicines (UCAEM). This programme involves advocating for consumer-friendly healthcare laws and policies at all levels of government and donors through policy analysis and research, influencing policy formulation, and monitoring and evaluating its implementation. (2) Community Outreach Programme: Activities include dissemination of information on health rights and responsibilities, including rational use of medicines (RUM), and training community members to be peer trainers. (3) Health Complaints and Counselling Desk: Complaints and compliments are collected through stakeholders' meetings, complaints boxes installed at health facilities, and questionnaires filled out by health consumers and observations. These complaints are analysed and reports are written which are then discussed with health facility management to agree on the needed improvements and/or redress.
Contact: HEPS@utlonline.co.ug

9. Ghana Essential Medicines Initiative (GEMI)
GEMI is a partnership between the Population Council, the Government of Ghana, American pharmaceutical companies, and rural Ghanaian communities. Its objective is to inform national policy recommendations on providing access to reproductive and child health care. The programme offers a sustainable cost-exemption strategy to provide essential drugs along with maternal and child health awareness raising and education for mothers. GEMI is designed to complement the work of an existing programme, the Community-based Health Planning and Services project, initiated by the Ghanaian government, which exempts children from all fees for essential medical care. This project posts nurses to rural communities where they provide basic curative and preventative health, as well as door-to-door maternal and child health visits, and community health talks. The nurses keep in contact with a doctor from the region via a two-way radio. According to organisers, while the project has been successful in increasing access to health care, it has created an unsustainable demand for pharmaceuticals. The GEMI project, by investigating solutions for providing essential medicines, as well as providing information for new mothers and instruction for healthy deliveries and care of newborns, hopes to fill this demand.
Contact: Lassane Placide Tapsoba ptapsoba@popcouncil.org OR Dr. Koku Awoonor-Williams kawoonor@gmail.com OR Maya Vaughan-Smith maya_vaughan-smith@brown.edu

10. Anti-Corruption Week 2007: Corruption in the Health Sector - Uganda
Anti-Corruption Week is an annual nation-wide Ugandan campaign, organised by Anti-Corruption Coalition Uganda (ACCU), that focuses on a different corruption-related issue each year. In 2007, the campaign examined transparency and accountability in the distribution of essential medicines, and was designed to ensure a significant increase in the availability of essential medicines in the public health sector. Campaign activities included processions, debates, forum theatre, and an extended media campaign. The campaign sought to introduce a way of increasing the accountability of health providers to the consumers and the communities that they are supposed to serve.
Contact: Jasper Tumuhimbise Mpiriirwe mpiriirwe@yahoo.com / info@anticorruption.or.ug OR MS-Danish Association for International Cooperation – Uganda co.msuga@ms.or.ug

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Medicines Transparency-focused Knowledge on The CI Website!

The Communication Initiative has collected and organised summaries and links to projects and resources that are either specific to the MeTA campaigns or related to the themes on which MeTA is focusing. There is additional knowledge here on Africa-specific campaigns and resources. Click here to access these knowledge summaries.


If you have information on communication initiatives or resources related to access, quality, transparency, and accountability in the healthcare marketplace in your country, please let us know - soulbeat@comminit.com

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STRATEGIC THINKING

11. Eastern and Southern Africa CSOs Discuss Their Role in Advocating for Access to Medicines
From October 6-8 2008, CSOs from 10 countries in Eastern and Southern Africa met to discuss issues related to access to essential medicines in their respective countries and to map out a strategy on how they could go about advocating and promoting access. Country presentations from Kenya, Malawi, Uganda, Zambia, and Zimbabwe revealed some cross cutting issues about the medicines situation. Each country noted that existing problems of stock-outs of essential medicines, a lack of government accountability, the need for community mobilisation to advocate for better public access and availability of medicines, inadequate funding for medicines sector, and a lack of trained human resources. Other challenges identified included the overstocking which leads to expiry of medicines, and rivalry between government agencies involved in procurement.

12. Improving Management of Childhood Malaria in Nigeria and Uganda by Improving Practices of Patent Medicine Vendors
by George Greer, Abiodun Akinpelumi, Leila Madueke, Beth Plowman, Bolaji Fapohunda, Youssef Tawfik, Rebecca Holmes, Joseph Owor, Uzo Gilpin, Cathy Clarence, and Bob Lennox
This report from 2004 explores the design, implementation, and preliminary results of interventions carried out in Nigeria and Uganda to reach patent medicine vendors (PMVs) in an effort to foster child survival. As detailed here, PMVs include individuals, owners, or attendants working in private shops that may legally sell over-the-counter drugs, yet generally they also illegally sell prescription drugs, such as antibiotics, sedatives, etc. The authors explain that a number of studies from sub-Saharan Africa have shown that between 15% and 82% of the population choose to first consult these informal providers for advice about and assistance with treatment of childhood illnesses. It has also been found that a large percentage of the drugs provided or dosages given, or both, at these private shops are inappropriate. In response, the Ministries of Health in Nigeria and Uganda, in collaboration with various partners, designed approaches to draw on PMVs for delivery of basic child survival strategies and products to those populations less served by the public sector. These two distinct exploratory models - both described as involving behaviour change communication, some of it highly participatory in nature - built on lessons from similar efforts in sub-Saharan Africa and elsewhere to develop approaches suited to the present situations in Nigeria and Uganda.

13. Malaria Treatment in Nigeria: The Role of Patent Medicine Vendors
Malaria Treatment in Nigeria: The Role of Patent Medicine Vendors
by Oladimeji Oladepo, Salami Kabiru, Babatunde W. Adeoye, Frederick Oshiname, Bola Ofi, Modupeola Oladepo, Olayinka Ogungbemi, William R. Brieger, Gerry Bloom, and David H. Peters
This policy brief from March 2009 discusses the role of the patent medicine vendor (PMV) in dispensing anti-malarial drugs (AMDs) in Nigeria. Reportedly, there are both fake medicines and those to which the malaria parasite has become highly resistant. A recent government recommendation is that people use artemisinin-combined therapy (ACT), though this study shows that it is the least commonly stocked by PMVs of the anti-malarial medicine and that PMVs are generally not aware of the recommendation. This briefing includes both policy recommendations and topics needing further research.

14. Getting Medicines to the Poor in Zambia
by Newton Sibanda
This May 2008 article documents the results of face-to-face interviews in Zambia with citizen consumers, a pharmacist, a Ministry of Health (MOH) spokesperson, and the executive director of Transparency International Zambia on the subject of medicine availability and affordability in Zambia. Problems cited by interviewees include high costs of non-generic medicine; questionable quality of generic medicine; budget transparency in funding and sale of medicine; bribery and theft; and supply and distribution. Medicine costs are described as being prohibitive for the economically poor. Costs can force people to visit traditional healers and buy generic (not always reliable) drug brands. Sometimes the cost forces a decision between buying food and buying medicine. In order to save money, some pharmacy clients will buy only half their prescription of antibiotics. This can result not only in ongoing illness, but also in antibiotic-resistant diseases. On the other hand, satisfying demand has, according to an MOH spokesperson, improved significantly - antiretrovirals for HIV/AIDS and drugs for tuberculosis and malaria had not run out in the 2 years prior to the interview; however, increased demand had resulted in shortages previously, particularly when hospitals and clinics dropped user fees, resulting in more attendance.

15. Widening Access to HIV/AIDS Drugs in Uganda
by Moses Sserwanga
This report is on the availability, distribution, and use of antiretroviral drugs (ARVs) in Uganda where between 80,000 and 100,000 people receive the medicine free of charge, leaving, as reported here in May 2008, at least another 100,000 HIV-positive Ugandans without access to these medicines. The report reviews the background of ARV distribution, including gaps in coverage, the financial challenges of ARV provision, and the efforts to stamp out corruption in the distribution system in Uganda. Through interviews, the author provides information about the gaps in distribution of ARVs.

16. Access, Quality, Transparency and Accountability in the Health Care Market Place in Uganda
by Evelyn Aero
In this November 2007 document, the author reviews the establishment of health care facilities in Uganda. As stated here, the share is 30% Government (MOH), 45% not-for-profit NGOs, and 25% for-profit (private); however, only 49% of households have access to health care facilities. "The distribution of services tends to mean rural areas are underserved and lower income households in urban areas are also underserved as for-profit outlets and crowded government hospitals are concentrated in the towns." In order to address these issues, the Government of Uganda developed a Health Sector Strategic Plan in which capacity building is one important aspect. Decentralisation is part of the 1995 National Constitution; thus, Ministries are responsible for policy, standards, guidelines, and monitoring of activities, while the direct implementation of the various programmes has been placed in the hands of district officials. As observed here, decentralisation is still in its early days in Uganda, and there is an observed need for improvement on issues like ownership of the programmes, planning cycles, and accountability.

RESOURCES

17. The Costly Access to Essential Medicines in Kenya: Voices of Consumers on Affordability and Availability
Between August and December 2007, Health Action International (HAI) Africa conducted a rapid qualitative survey in Kenya to gather testimonies from consumers about how they fulfilled their medical needs. This exercise was informed by findings from earlier studies on medicine prices and availability, which indicated that only about 30% of Kenyans had access to essential medicines, and that high prices and poor availability were the major factors limiting access. The testimonies were provided by people from urban and rural environments in different parts of the country. The survey respondents represented a range of income groups; they included small business operators, a small-scale farmer, a grocer, teachers, a thespian, and volunteer community workers and staff working in private firms. This booklet highlights the stories of 12 of the individuals who took part in the qualitative survey.

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