Medicines Transparency Alliance (MeTA)
One in three people cannot access basic, essential medicines. For some, high cost is the obstacle. For others, the medicines are simply not available in their local health centre. Equitable access to medicines, like any other global public good, will not be sufficiently provided by market forces alone. However, the market can be governed more successfully towards the socially just provision of medicines through the greater transparency and accountability created by initiatives like the Medicines Transparency Alliance (MeTA).
MeTA is a coalition of partners working to increase transparency and accountability in the healthcare marketplace as part of the larger effort to improve access to medicines. The UK Department for International Development (DFID) is providing initial funding. Other partners include governments, global and national civil society organizations, pharmaceutical and other business interests, and the World Bank.
How MeTA works: a multi-stakeholder approach
MeTA functions through the building of a national decision making council and secretariat which bring together all relevant stakeholders —at both the international and national level—to create a comprehensive and unified work plan to improve transparency and accountability in the pharmaceutical sector. WHO helps to build strategic relationships across interest groups for the purpose of improving information flows, data collection and reporting, regulation, procurement, sale, distribution and use of medicines in developing countries. By doing so, MeTA will 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.
“MeTA has brought us together with people we used to be suspicious of – the government and regulators. For me, as a businessman, transparency regarding tendering, pricing and registration of products enables us to plan properly. It has been very beneficial.” John Allotey, Director of LaGray Pharmaceuticals Ltd, Ghana
Participant countries make a commitment to progressively disclose a standard set of core data covering the quality, availability, price, and utilization of medicines. Fulfillment of this commitment depends on the involvement of the full spectrum of implicated actors, including civil society, businesses and the public sector, who must work together to collect, share, debate, and apply the outcomes of gathered data. This multi-stakeholder approach aims to ensure that all interest groups have a voice in the pharmaceutical market and have access to the policy making process as it impacts them. The more accountable and transparent system governance thus generated by the MeTA collaboration shifts decision making power to consumers and puts greater competitive pressure on suppliers, which ultimately leads to a more equitable and fair distribution of essential medicines in the marketplace. And that means better population health.
Seven Pilot Countries
Launched in 2008, MeTA has already started work in 7 pilot countries: Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia. In all seven countries, a representative multi-stakeholder group is meeting regularly to tackle the particular problems found in their medicines supply chain. They have a collectively agreed workplan with a range of activities and short-term to long-term goals. With good dialogue taking place and trust established between the stakeholders, during the next year we expect to see new systems and structures being set up to disclose data around the four key areas of medicine quality, availability, price and promotion.
Case study: Building mutual trust in the pharmaceutical sector in Uganda
The establishment of MeTA in Uganda has greatly improved relationships between the public sector and its private and civil society counterparts by forcing them to meet together as peers and engage in constructive dialogue on the pharmaceutical sector. A monumental achievement was reached when representatives from the private sector and from civil society were invited—for the first time—to participate in development of the National Pharmaceutical Sector Strategic Plan and to influence the policy-making process. All participants attribute this shift in mindset to the relationships fostered through MeTA and an increased appreciation for the perspective of each sector. Thanks to the mutual trust built through multiple interactions during consultation for pharmaceutical policymaking, Civil Society Organizations (CSOs) also gained unprecedented access to public sector activities that had once been off limits to their critique. For instance, during the recent "stop stock out" campaign, CSOs were granted access to the National Medical Stores (NMS) in order to ascertain, as was suspected, whether poor management at central level was causing the insufficient availability of medicines at health facilities. In determining that the medical store had good stocks, civil society was able to move on to pinpointing the real cause of stock outs with investigation at the facilities themselves. NMS trusted civil society to conduct a neutral and fair assessment of its operations and was rewarded with positive feedback and improved credibility in the eyes of the public. Civil society achieved its goal of working towards the complete prevention of stock outs and has set a precedent for monitoring that is bound to continue into other areas. The visibility of the campaign eventually prompted the government to take greater responsibility for this issue, and in October 2009 a special unit was established to monitor drugs and health services. In addition to this, the medicines budget of NMS was separated from the Ministry of Health budget, to ensure that funds designated for purchasing medicines would not be diverted to other purposes.
MeTA has also initiated a significant expansion in the publicly available pharmaceutical data. The MeTA Council has encouraged the government to publish the results of the 2008 household survey on access to medicines, making Uganda the first country to do so. In addition, MeTA's support has made the continued quarterly monitoring of medicines prices and availability possible, where it would have otherwise halted due to lack of funds. This monitoring system is essential for measuring progress on the objectives of the National Medicines Policy, for which the dissemination of results makes public and private facilities accountable for their performance. For the time being, it can be said that, although stock outs remain a concern, availability of medicines in the public sector is increasing (see the green line in the chart on the right). Furthermore, Uganda's Medicines Regulatory Authority has launched an interactive database of registered medicines that will allow practitioners and patients alike to easily check whether medicines are authorized in the country and will therefore help push under-quality medicines out of the market. The database has been designed to include pricing information collected through the quarterly monitoring. This mechanism will draw attention to inequitable pricing and hopefully promote greater affordability over time.
There is no denying that MeTA has nurtured an atmosphere of collective action, mutual accountability and partnership across sectors that will translate into benefits for other areas of work related to pharmaceuticals. These expectations mark a watershed change in the way policymaking and information sharing happen in Uganda.