Towards a Medicines Transparency Alliance (MeTA)

1. Towards a Medicines Transparency Alliance (MeTA) Richard Laing and Ali Cameron with slides prepared by Michael Borowitz, DfID WHO Technical Briefing Seminar October 2007

2. Manufacturer • Procurement • Agent (s) • Public • Private • mission Wholesaler Medical Stores Distributor Retailer Informal Sector/ Primary care Hospital Patient Problem: poor cannot access essential medicines Total Market Approach: public, private, and 3rd sector • Availability: Low availability in public sector • Price: High prices in private sector • Quality: Concerns about quality particularly of generics

3. Source: SSDS Inc for the World Bank Example: complexity of medicines supply in Kenya

4. Transparency and Accountability in Medicines • Market Failure • Complex chains of information asymmetry • Principal-agent problems • Response: government intervention • Government Failure • Health systems failure: accountability • Lack of state capacity • Unregulated private sector • Government/regulatory capture • Setting new equilibrium through transparency and accountability • Accountability system in drugs: • Consumer organisations • Professional organisations • 3rd party purchasers • Transparency changes the rules of the game

5. Lessons from the Extractive Industries Transparency Initiative • Increase transparency and accountability in revenue flows from extractives companies to governments • Government led – multistakeholder – civil society • 5 stages: coming together, pilots, consolidating the rules of the game, expansion, new governance arrangements • Key strengths: • multi-stakeholder • accounting issues are matched with accountability • clear and narrow focus

6. The MeTA Proposal Increase transparency and accountability in medicines procurement and supply, by: • Securing high level political commitment • Global public goods: activities on transparency using Global development funds: • Country-led process focusing on transparency and accountability • Multi-stakeholder forum: Getting the right people around the table – business, civil society and government – to agree how to disclose price, availability and quality data into the public domain – from both public and private sectors. • Transparency in pricing, availability, quality • Drilling down in therapeutic classes • Builiding capacity • Capacity of the state to regulate • Capacity of civil society to hold government to account • Research Observatory • Evidence-based policy • DFID funding £2mill for design, £25 million contribution

7. Total Market Analysis semi-standardised approach • WHO/HAI pricing survey: what explains the results • Components analysis • Global reference prices (MSH, IDA, etc.) • Micro: Household survey data on medicines • WHA • Southampton survey review: LSMS, etc • Next wave? Dennis/WHO • Macro: Health financing: NHA • Private sector: Supply Chain mapping: • competition in different components • IMS-like data on price/volume • Informal sector • Public sector • Public procurement: extension of WHO/WB • Tracking: PETS, other tools

8. Observatory/Info-mediary • What should you do? • Research observatory to bring together best practice (e.g. price controls) • Standardised reports on the pharma sector • Info-mediary role: e.g. GPRM database • Support evaluation of interventions • Support operation research • Partners: • Harvard, BU, Hopkins, LSTHM, LSE, Imperial, DFID RPC, NORAD/Cochrane Centre… more developing countries • Scoping

9. Generic and Brand ARV Prices:ranges much greater for brands $1.945 $1.713 $1.356 Prices shown are per tablet Every dosage form tells a different story

10. Phase I pilot countries for MeTA • Covering all regions: begin with one and spread out • Latin America: Peru (Bolivia) • East Asia: Phillipines (Vietnam, Cambodia, China) • EE/fSU: Kyrgyzstan • Middle East: Jordan • South Asia: India (Bangladesh, Pakistan) • Africa: Uganda, Kenya, Ghana (Zambia, Francophone) • Linked to WHO/WB/HAI

11. Draw on scoping study, Including e.g. HAI Pricing survey Global Fund data etc Review existing data / research Agree key deliverables - identify blocks Disclosure and report production How MeTA might work Disclose data Establish multistakeholder group (MSG) Identify technical assistance required: Procurement, regulatory Medicines policy etc Political Commitment Evaluate results, develop recs Disseminate, debate, act Release MeTA report Scoping study: Full market analysis Drivers of change

12. Early info on pilots • Jordan: • strengthening accountability: pricing survey not disseminated • Uganda • Putting price and regulatory data on website • Zambia • Price survey • Kyrgyzstan • Examination of diabetes/psychotropics • Transparency in hospital procurement • Phillipines • Dissemination of price information • Ghana • Disseminate existing data • Strengthen data collection and dissemination on medicines quality

13. Supporting infrastructure for transparency and accountability • State capacity • Strengthening regulation • Strengthening insurance purchasers • Policy advice on regulating medicine prices • Civil society capacity • Strengthening NGOs—HAI • Strengthening professional societies • Equity and poverty lenses

14. Next steps • Consultation • Pilots • Principles • MeTA Forum • Global public goods • Observatory • Info-mediary • Governance • Secretariat • Governance structure