This issue of the Drum Beat looks at the issues surrounding access to medicines, including increasing transparency and 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 7 pilot countries, this issue highlights projects, strategic thinking, and resources of relevance.
Please send any additional information on communication-related work around medicines transparency to us at drumbeat@comminit.com [1] Many thanks!
MEDICINES TRANSPARENCY ALLIANCE (MeTA)
1. What Is the Medicines Transparency Alliance (MeTA) and How Will It Work?
MeTA is an alliance of governments, pharmaceutical companies, civil society, and other stakeholders which aims to increase access to essential medicines for people in developing countries. This will be done by working to increase transparency and accountability in medicines procurement and supply chains to tackle inefficiency, corruption, and fraud in 7 pilot countries: Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda, and Zambia.
For more information about MeTA please see:
2. What is Transparency?
According to MeTA, "transparency" is: the property of being able to see through something. In financial and political terms it has come to mean the full, clear and timely disclosure of relevant information, which in turn makes for easier understanding and encourages public scrutiny of processes and practices. For more information on transparency from MeTA's perspective, please click here [21] [PDF].
3. MeTA's Pilot Phase
In this first pilot phase, MeTA aims to focus on strengthening the capacity of 7 pilot countries to collect, analyse, disseminate, and use data on the quality, availability, pricing, and use of medicines. This work intends to help improve transparency and accountability with regard to the selection, regulation, procurement, distribution, and supply of medicines - including the ways in which they are prescribed to and used by patients. At the end of the 24-month-long pilot phase, MeTA plans to use an agreed-upon set of indicators to evaluate the campaigns. These indicators, which are currently being developed, will focus on the process of facilitating greater transparency and accountability. However, MeTA plans to also use these evaluation efforts to begin mapping the contribution that greater transparency and accountability can make: (1) to improving the efficiency of markets and health systems, and (2) to the ultimate goal of increasing access to medicines in developing countries, particularly for economically poor and disadvantaged people. MeTA plans to fully and directly involve the pilot countries in all monitoring and evaluation activities. For more information on implementing the pilot phase of MeTA, please click here [22] [PDF].
4. MeTA Dialogue
The MeTA Dialogue is an open online forum where you can have your say about transparency and accountability issues around medicines and see what other people are saying, click here. [10]
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MEDICINES TRANSPARENCY ON THE CI [24]
The CI has collected and organised summaries of action, strategic thinking, and resources related to Medicines Transparency! See the CI's Medicines Transparency site. [24]
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 - drumbeat@comminit.com [25]
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ADDRESSING ACCESS, QUALITY, AND ACCOUNTABILITY ACROSS THE WORLD
ACTION [26]
5. Good Governance for Medicines - Global [27]
Launched in 2004, this World Health Organization (WHO) programme works to ensure that essential medicines reach people - not the black market - by raising awareness of abuse in the public pharmaceutical sector and promoting good governance. Good Governance for Medicines (GGM) is an effort to curb corruption in pharmaceutical sector systems through the application of transparent and accountable administrative procedures and the promotion of ethical practices among health professionals. GGM uses a bottom-up approach in implementation of project and policy development.
Contact: Dr. Guitelle Baghdadi-Sabeti ggminfo@who.int [28]
6. Stop Stock-outs - Kenya, Madagascar, Malawi, Uganda, Zambia [29]
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 [30]
7. National Awards for Good Governance in Medicines - Philippines [31]
In 2008, the WHO and the Department of Health (DoH), in collaboration with META Philippines, undertook an initiative to highlight the importance of good governance and transparency in improving access to essential medicines for all Filipinos. The primary goal of the National Awards was to institutionalise the concept of good governance and transparency in the registration, selection, procurement, use, and management of medicines and overall management of medicines in the public and private sector. By recognising innovative and exemplary programmes from both the public and private sector, organisers hoped to provide incentives for good practices, build models and duplicate them, and create public awareness of good governance for medicines.
Contact: Crispinita Valdez ggmawards@yahoo.com [32]
8. Foro de la Sociedad Civil en Salud (ForoSalud) - Peru [33]
Established in 2002, ForoSalud works to influence the development and implementation of more responsive health policies in Peru. ForoSalud promotes research and participatory dialogue and debate on health issues within the country. It encourages civic engagement and review of the health sector and the government's policies related to the health sector. Through a long-term series of capacity-building workshops ForoSalud has worked to build awareness and action on issues such as human rights, the right to health, the rights contained in Peruvian law, and how people have a right to participate in decisions that affect them. This capacity-building process involved training ForoSalud on participatory methodologies to ensure that local health issues would be identified by the local people. Successive workshops focused on the importance of participation in realising people's right to health and on building capacity to participate in spaces such as Regional Health Councils. Participants were trained on topics such as how policies are constructed, the identification of different groups involved in policy development and implementation, and the power relations that shape the process.
Contact: Ariel Frisancho Arroyo afrisancho@care.org.pe [34]
The primary emphasis of the ZdravPlus Project is on drafting, revising, implementing, and evaluating pharmaceutical policies to support the health reforms in 5 countries in the Central Asian region. The emphasis in Kyrgyzstan and Kazakhstan is on the establishment, maintenance, and expansion of health insurance systems for medicines. Other regional and country-level work has addressed medicine quality, decentralisation of medicine procurement, medicine prices, human resource shortages, and evidence-based medicine, including selection and standard treatment guidelines and rational use of medicines. On a community level, ZdravPlus seeks to inform people not only about how to keep themselves and their families healthy, but also on their rights and responsibilities within the reformed and restructured primary health care system.
Contact: office@zplus.kz [36]
More ACTION [26] related to increasing transparency, access, and accountability for medicines is available through The CI's Medicines Transparency site.
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The Soul Beat 126 [37]focused on issues in Africa surrounding access to medicines, including increasing transparency, accountability, and magnifying the voices of patients and consumers in the healthcare marketplace. Click here [37] for The Soul Beat 126.
Son de Tambora 232 [38] (in Spanish) focused on issues in Latin America surrounding access to medicines, including increasing transparency, accountability, and magnifying the voices of patients and consumers in the healthcare marketplace. Click here [38] for Son de Tambora 232.
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STRATEGIC THINKING [39]
10. Accountability and the Right to the Highest Attainable Standard of Health [40]
by Helen Potts
This January 2008 study analyses the concept of accountability as a feature of human rights in the context of the right to the highest attainable standard of health. According to the author, accountability is the process that provides individuals and communities with the opportunity to understand how governments and others have discharged their right to health obligations, including the right to redress where mistakes are made. This monograph is intended as a starting point for health policymakers seeking to develop greater understanding of the area of accountability.
by Rajat Khosla and Paul Hunt
Published in August 2008, this briefing considers the responsibilities of pharmaceutical companies for enhancing access to medicines in the context of sexual and reproductive health. It draws upon and amplifies the work of one of the authors, Paul Hunt, who acted as United Nations (UN) Special Rapporteur from 2002-2008. For the most part, he - and colleagues in the Right to Health Unit - looked at the duties of States in relation to access to medicines. However, States reported that when endeavouring to enhance access to medicines, the policies and practices of some pharmaceutical companies were a serious obstacle. The Guidelines are grouped by themes such as transparency, management, monitoring and accountability, pricing, and ethical marketing. Each theme is followed by a brief commentary.
12. Making Health Markets Work for Poor People [42]
by Hilary Standing and Gerry Bloom
This editorial from the March 2009 id21 insights web magazine describes the weaknesses in regulation of the variety of market-based providers of health-related goods and services. Providers range from highly organised and regulated hospitals and specialist doctors to informal health workers and drug sellers operating outside the legal framework. The issue of id21 within which this article was published discusses the unregulated markets associated with porous public and private boundaries in the field of health and resulting problems with safety, efficacy, and cost in medical diagnosis and pharmaceuticals. Aspects of market characteristics, privatised pharmacy influence on prices, a model of wide provision of eyeglasses as social entrepreneurship, technology as a change agent for provider-patient relationships, and health insurance as a catalyst for provider behaviour are the range of topics that are covered in this id21 publication.
by Devi Sridhar
This July 2008 paper discusses the politics of access to essential medicines and identifies "space" in the current system where health concerns can be strengthened relative to trade. This issue is addressed from a global governance perspective focusing on the main actors who can have the greatest impact, including developing country coalitions and citizens in developed countries through participation in civil society organisations (CSOs). These actors have combined forces to tackle this issue successfully, resulting in the 2001 Doha Declaration on Public Health. The collaboration has been powerful due to the assistance of the media as well as the decision to work to compromise with pharmaceutical companies and their host countries. According to this paper, to improve access to essential medicines, six C's are needed: coalitions, civil society, citizenship, compromise, communication, and collaboration.
14. Health Systems and the Right to Health: An Assessment of 194 Countries [44]
by Gunilla Backman, Paul Hunt, Rajat Khosla, Camila Jaramillo-Strouss, Belachew Mekuria Fikre, Caroline Rumble, David Pevalin, David Acurio Páez, Mónica Armijos Pineda, Ariel Frisancho Arroyo, Duniska Tarco, Mitra Motlagh, Dana Farcasanu, and Cristian Vladescu
This December 2008 Lancet: Right to Health article reports on a survey of health and human rights in 194 countries over 18 months. It is based on General Comment 14, an understanding of the right to health care established in 2000 through the work of the United Nations (UN) Committee on Economic, Social, and Cultural Rights. This describes the right to the highest attainable standard of health as encompassing medical care, access to safe drinking water, adequate sanitation, education, health-related information, and other underlying determinants of health. 72 indicators were used for the survey assessment. The article contains several tables that present data in relation to how specific countries met the indicators. The final section of the article contains recommendations for various national and international actors within international efforts to apply, protect, and sustain the right to health.
by Hiba A. Zarour
In this presentation from a December 2007 event organised by the Jordan Food and Drug Administration and Health Action International (HAI), an intellectual property attorney explores legal approaches to increasing access to essential medicines in Jordan. Zarour begins by advising the government to engage in a process of listening to and learning from other governments, as well as NGOs, regarding access issues. He advises advocacy where appropriate, encouraging openness to interpreting or even challenging intellectual property (IP) laws. He advises legislating wisely, balancing rights with exceptions and insisting on flexibility. In the area of pharmaceuticals, he urges that a balanced legal system is essential. While rules are important to ensure IP protection of new medicines, limitations on these rules are equally important so that the medicines are made readily available and affordable.
16. Snakebites, Patents and Medicine Prices [46]
by Bienvenido Oplas, Jr.
This report provides an overview of a symposium held in September 2008 to explore strategies for improving access to health in the Philippines. Presentations and discussions focused on: improving access to medicines; the role of free trade and property rights in improving access to medicines and health care; barriers to access to health care, such as poor or non-existent infrastructure; and approaches to help bring down medicine prices.
17. Eastern and Southern Africa CSOs Discuss Their Role in Advocating for Access to Medicines [47]
In October 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 crosscutting issues, such as stock-outs of essential medicines, a lack of government of accountability, the need for community mobilisation to advocate for better public access and availability of medicines, inadequate funding for medicines sector, lack of trained human resources, and rivalry between government agencies involved in procurement.
by William D. Savedoff
According to this May 2008 U4 Brief on corruption in the health industry, hospitals spend a great deal of money on supplies and have been the object of a wide range of scams, including kickbacks and delivery of expired and substandard products, all of which can make the difference between an equipped facility and one that cannot offer life-saving treatments. Argentina and Bolivia have both attempted to curb corruption in procurement of hospital supplies. With varying degrees of success, their experiences tell a lesson: unless there are consequences attached to identified mal-practice, monitoring and publicising information will not guarantee sustained gains. The brief concludes that: corruption was common wherever impunity was the rule; shining light in dark corners can modify behaviors initially, but unless publicizing information has some consequences - whether through convictions, loss of employment, disciplinary actions or moral disapprobation - the gains from publicizing corruption may be short-lived; active local oversight can modify behaviors; and collecting data and comparing facilities can provide hard facts that not only assist in detecting corruption but also in understanding how it responds to different strategies.
19. Public Reporting and Transparency [49]
by John M. Colmers, M.P.H.
Prepared for The Commonwealth Fund/Alliance for Health Reform 2007 Bipartisan Congressional Health Policy Conference, this issue brief provides a short history of efforts to report information on health system performance in the United States (US) and identifies policy issues to consider when advancing such efforts. According to Colmers, publicising information on health system performance can make the health care system more accountable. Policymakers and health care purchasers advocate for public reporting with 3 goals in mind, in addition to promoting competition. They are: (1) to help providers improve by benchmarking their performance against other providers; (2) to encourage private insurers and public programmes to reward quality and efficiency; and (3) to help patients make informed choices about their care. While health care providers and payers face demands to conduct their business more transparently, questions remain about the accuracy of the reported price, process, and outcome information; the comparability of the results across different populations; and whether and how patients and others use the information in making decisions. To address these and other questions, health services research has been undertaken; specific lessons learned and proposed legislation are noted in this brief.
More STRATEGIC THINKING [39]articles related to increasing transparency, access, and accountability for medicines are available through The CI's Medicines Transparency site.
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This is just a gentle reminder to please raise within your organisation the possibility of supporting The CI's work through the CI Associates process - For details and sign up click here. [50] Also, to see Warren Feek's note in The Drum Beat 485 click here. [51] Thank you.
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RESOURCES [52]
20. Corruption in the Health Sector [53]
by Carin Nordberg and Taryn Vian
This November 2008 issue of the web journal U4 presents some resources for anti-corruption work in the health sector and information on the challenges of corruption in the health sector. The overview includes the causes and consequences of corruption, financial resources management, management of medical supplies, and health worker/patient interaction. The issue focuses on good practise examples, budget transparency, and the topic of salaries. It includes a literature review and links to relevant websites on health sector corruption.
21. Global Corruption Report 2006 [54]
Published by Transparency International, this report focuses on the relationship between corruption and health. This document states that corruption in the health sector deprives those most in need of essential medical care and helps spawn drug-resistant strains of deadly diseases. The book includes reports on: the risks of corruption in different health care systems; the scale of the problem: from high-level corruption in Costa Rica to counterfeit medicines in Nigeria; health care fraud in the US; the costs of corruption in hospital administration and the problem of informal payments for health care; the impact of corruption at various points of the pharmaceutical chain; and anti-corruption challenges posed by the fight against HIV/AIDS.
22. Measuring Medicine Prices, Availability, Affordability and Price Components: 2nd Edition [55]
Published by the WHO and HAI in May 2008, this manual offers a standardised methodology for measuring medicine prices, availability, affordability, and price, thereby facilitating national and international comparisons. It is a refinement of the first edition, published in 2003, in that it now integrates the experience gained through the more than 50 surveys that have since been conducted worldwide. The results have exposed many problems of poor access to medicines; for example: people having to work 15 days or more to afford one month's treatment for a chronic disease; important medicines not being available locally to patients; governments not passing on low procurement prices to their citizens; excessive mark-ups in the private sector; and taxes and duties being applied to essential medicines.
23. Medicine Pricing Matters [56]
Published quarterly, this e-bulletin provides information on the medicines prices survey work of HAI and the WHO, including ongoing survey results, workshops, advocacy campaigns, policy changes, monitoring work, project activities, and publications.
More RESOURCES [52] related to increasing transparency, access, and accountability for medicines are available through The CI's Medicines Transparency site.
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