WHO-Health Action International (HAI) regional collaboration for Action on Essential Medicines in Africa
An innovative approach to collaborative working
In three countries - Ghana, Kenya and Uganda - Country Working Groups have been formed consisting of the Chief Pharmacist or designate in the Ministry of Health (MOH), the WHO Medicines Adviser in the WHO country office, and a representative of a civil society organization (CSO) participating in the HAI Africa network. Country Working Groups are responsible for planning and implementing the country level activities required to support the collaboration’s aims. The Country Working Groups work to expand interactive networks, nurture mutual trust, and promote a positive working relationship among MOH, WHO, and CSOs. A qualitative review carried out in working group countries by HLSP in 2008 found that the collaboration has generated significant added value and is perceived as:
- a space to generate synergies, among stakeholders with diverse interests and expertise for fulfilling national medicines policy needs;
- an enabling mechanism for the MOH and civil society to increase mutual trust and respect and to engage as strategic partners in policy processes; and
- a process for consultative, policy-relevant research that directly involves decision makers, meets country needs and increases the likelihood of policy implementation.
'WHO brings the normative role, HAI Africa the consumer perspectives, and the MOH the mandate and authority to get things moving. The combination increases credibility and the chances of making things work better.' MOH, Kenya
Prior to the Collaboration project, there was limited history of joint working between government and civil society on medicines in the three countries. Through its facilitative role and the technical expertise provided by the WHO National Medicines Advisers, WHO has helped to broker civil society’s contribution as a respected and strategic partner in policy making and implementation processes related to essential medicines. The partners, ministries of health, HAI Africa and WHO, are now effectively managing a coordinated approach to achieve shared and complex policy goals, in for example, protecting public health safeguards in new trade laws in Kenya and Uganda, and removing taxes and tariffs on selected essential medicines and raw materials in Ghana. This is being achieved through a complementary mix of approaches: collaborative research, civil society advocacy and campaigning, parliamentary lobbying, and policy dialogue with government ministries for health, trade and justice.
Case Study: Supporting implementation of the new antimalarial policy, Kenya 2006/7
Kenya introduced new malaria treatment guidelines for combination therapy in 2006. However, knowledge of existing malaria medicines in the market was limited. Before scaling up public sector distribution, the Regulatory Agency carried out an extensive survey to collect data on the range, registration status and quality of antimalarial medicines available from public and mission facilities, and from formal and informal sector retail outlets. WHO and HAI Africa supported the Regulatory Agency drawing on their respective expertise. HAI Africa helped to develop the survey methodology, while WHO advised on the quality control aspects, and facilitated linkages with a WHO pre-qualified laboratory for sample testing. This multi-stakeholder approach brought credibility as well as technical know-how to the results and their dissemination. A large proportion of the medicines (over 40%), most of which were from Kenya and India, were not registered in the country. Almost 20% of the medicines analyzed failed quality tests, raising concern of treatment outcomes and possible development of drug resistance. The Regulatory Agency has initiated the phase-out of non-complying products, and the less effective artemisin mono-therapies are being withdrawn from public and mission sector pipelines to be replaced with combination treatments.