Zambia

University of East Anglia (Aikman), University of London (Unterhalter), Marie Stopes International (Boler)

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MeTA is based on the premise that bringing together various stakeholders - the private sector, civil society, the government, and other interest groups - in both face-to-face and virtual gathering spaces can spark action for supporting the development of viable, efficient medicines markets and supply systems.

Civil society organisations (CSOs) have been active in building the MeTA strategy in Zambia. Four Zambian CSO representatives took part in a skills-building seminar 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. A number of skills development sessions provided opportunities for participants to sharpen their abilities in research, communication and advocacy, and influencing and negotiating. They also explored how to monitor prices, improve collaboration and networking, make use of a rights approach to access to medicines, engage with the media, interpret data, develop policy briefs, and understand equity issues. A key feature of all the skills sessions was the emphasis on building on the experience of the participants and sharing that experience. The Zambia group met separately, which led to the resolution to brief the wider CSO community and meet other organisations participating in the MeTA process, to develop a baseline assessment of the situation in their country, and to organise an advocacy strategy.

Health, Rights.

"Bribery in the health system results in higher drug prices", Goodwell Lungu of Transparency International Zambia said as MeTA Zambia was being formed. And, Lungu elaborated, lack of information for patients about services and medicines - about where and when they are provided, about who provides them, and the procedures to be followed - creates an environment in which corruption can flourish.

Recent health reforms in Zambia aim to "provide equity of access to cost-effective, quality health care as close to the family as possible." But, according to MeTA Zambia, there are 3 main challenges around access to health: proximity to services, costs, and human resources. In urban areas, 99% of households are within 5 kilometres of a health facility as compared to 50% in rural areas. Household expenditures on health also vary according to location; economically poorer rural households spend a higher proportion on health when costs in kind are included. Human resources are also strained due to medical staff leaving the country or moving from the public sector to the private sector, as well as the impact of HIV and AIDS.

MeTA Zambia explains that, in recent years, failures in the procurement and supply of medicines have been acknowledged, with essential drugs often out of stock. The connection between the different units and health care facilities and the related information system (health care facilities sending up usage data to forecast, placing orders before drugs get out of stock, etc.) did not work routinely, forcing emergency procurements when/if funds were available. This led to high prices being paid, further deteriorating the situation.

MeTA

During the first phase of the project, research was conducted in 3 African countries - Mali, Uganda, and Zambia - to document the challenges media face in covering agriculture, rural development, and women. The 3 countries were selected based on agriculture's important role in their respective communities, their geographical spread, the diversity of their media sectors, and their accessible media environments. Results revealed that:

• Only 4% of media coverage is devoted to agriculture, yet agriculture makes up 34% of Sub-Saharan Africa's gross domestic product (GDP) and 40% of the region's exports, and it accounts for 70% of total employment.
• Women are almost invisible in the media. In the agricultural coverage monitored, women were focal points of just 7% of the stories. Yet women produce 70% of Sub-Saharan Africa's food and make up half the region's population.

During the second phase of the project, which launched in February 2009, frayintermedia, on behalf of the IWMF, established partnerships with 6 media houses in Mali, Uganda, and Zambia. The 6 selected media houses will participate in a programme that provides continuous on-site training and specialised attention to the journalists at these media houses. In Mali, the media houses are L'Essor, a state-owned daily newspaper, and Radio Klédu, an independent radio station. In Uganda, they are The Daily Monitor, an independent national daily newspaper, and the Uganda Broadcasting Corporation. In Zambia, the media houses are The Times and the Zambian National Broadcasting Corporation. The selected media houses are expected to establish foundations for best practices on how to cover agriculture and the role of women within agriculture and rural development, and to support gender equality in their newsrooms. The media houses have been selected after an assessment of their professional output, their openness to receiving training, and their ability to maintain sustainable coverage on agriculture and rural development.

Organisers say that by making use of a proven training model, the project strives to:

• increase and sustain accurate, consistent, and more rigorous news media reporting on agriculture and rural development;
• incorporate women's role, stories, needs, and solutions in the coverage of agriculture and rural economies;
• develop gender equality in the newsroom.

According to IWMF board member Akwe Amosu, the key component of this project is incorporating reporting on, by, and about women in agriculture in Africa. Amosu added that, "women reporters should have a better chance of getting out there and telling that story, trying to influence policymakers on behalf of the women who are living the real rural life in Africa."

Agriculture, Women, Food Security

According to IWMF, malnutrition and food insecurities remain a major challenge in Sub-Saharan Africa, and media has a responsibility to report on the crisis. IWMF explains that agriculture is a critical source of livelihood and a pathway out of poverty in most African countries, and it ought to be a key subject for African media.

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MeTA is, first and foremost, a collaboration: Stakeholders from public, private, and non-profit sectors working together to effect significant positive change. It is hoped that, by joining these personnel in face-to-face and virtual meeting spaces, brainstorming will be sparked about how to improve information access, scrutiny, and use, to the end of supporting the development of viable, efficient medicines markets and supply systems of essential health commodities such as contraceptives, diagnostics, drugs, laboratory supplies, and vaccines.

Specifically, MeTA's financial and technical support encourages a focus on making information about medicines publicly available. To that end, it will implement actions designed to strengthen national capacity – including the capacity of stakeholder groups to engage in a process to collect, analyse, disclose, and use data on the quality and registration status of medicines, their availability, price, and promotion policies and practices. Each country has its own context and ways of providing medicines. Analysis and public disclosure of how the medicine supply chain works, and issues affecting the affordability of medicines, equitable access, and the rational use of medicines will help to see how to improve policy, practice, and health outcomes for people. In general, however, when a country implements MeTA, it makes a commitment to progressively disclose a standard set of core data covering the quality, availability, price, and promotion of medicines. Stakeholders sign on to a core code of principles, and also commit to fully involve civil society, business, and other stakeholders in the effort to help address problems in the pharmaceutical market. This multi-stakeholder approach aims to shift some decision-making power to consumers and put greater competitive pressure on suppliers, as well as to promote better governance and more appropriate resource allocation by public purchasers.

In MeTA countries, the average person – in time – should be able to access a wide range of information on the price, availability, quality, and promotion of medicines via the internet, local newspapers, television, and radio, and through community meetings. Details about specific in-country events, activities, and strategies for information dissemination may be located on the interactive MeTA website.

To explore one strategy in detail, an important component of MeTA is dedicated civil society support managed by the MeTA International Secretariat since March 2008. Two consultants with experience in the medicines field and in working with civil society, governments, and industry around access to medicines, transparency, and accountability issues were hired to develop skills building workshops, the first of which was held in Uganda in February 2008, with the second in the Philippines in June 2008. These will be followed by: country-based activities by civil society organisations (CSOs) in the MeTA pilot countries, and a global feedback meeting during early 2010, where the lessons learned can be discussed, conclusions drawn, and recommendations made for future work.

A brief summary of the Uganda meeting illustrates MeTA capacity building strategies. Part of the first day was spent in a series of introduction exercises to encourage people to get to know each other. As this was meant to be a highly participatory workshop, particular attention was placed on identifying the skills and experience of the participants, through developing short descriptions of each participant to be part of the "gallery of experts" that was placed on a wall in the workshop room throughout the week. This helped to affirm the more than 280 years of experience in the medicines and transparency fields that participants brought into the room. Two sessions helped explain the overall MeTA process. The workshop followed a similar pattern throughout most of the week, with initial knowledge sharing sessions first thing in the morning, followed by a skills development session. In the afternoon, an open space period enabled participants to share experience and for the coverage of issues that emerged during other sessions. This was followed by a final session each day for participants to work in country groups to analyse the country situation and identify possible actions upon their return home. A series of field visits halfway through the week provided an opportunity for participants to test some skills and to explore issues of transparency and accountability with key institutions working in the pharmaceutical supply chain in Uganda.

Health, Rights.

According to the World Health Organization (WHO), 40 million people are living with HIV and AIDS in developing countries, but antiretroviral medicines (ARVs) are available to only 300,000 of the 5-6 million people currently in need of them. By 2015, WHO figures indicate, an estimated 10.5 million lives could be saved every year by expanding access to existing interventions for infectious diseases, maternal and child health, and non-communicable diseases. WHO cites the following central barriers preventing people from accessing essential medicine:

• Medicines are unaffordable to many people; ARVs and artemisinin-based anti-malaria medicines are particularly expensive.
• It is estimated that half of all medicines are inappropriately prescribed, dispensed, or sold, and that half of all patients fail to take their medicine properly.
• Health financing mechanisms leave households responsible for the cost of medicines, and the economically poorest and sickest are the least able to pay.
• Failures at any point of a country's supply system can lead to shortages of medicines; inefficient procurement systems have been found to pay up to twice the global market price for essential medicines.
• The quality of medicines varies greatly. One-third of WHO member states either have no regulatory authority or only limited capacity to regulate the market.
• Over 90% of medical research and development (R&D) focuses on the medical conditions of the richest 20% of the global population.