: POLICY, LEGAL AND REGULATORY FRAMEWORKS...

ACKNOWLEDGEMENT

TRANSPARENCY AND

ACCOUNTABILITY IN

PHARMACEUTICAL

PROCUREMENT AND

SUPPLY CHAIN

MANAGEMENT

A TRAINING OF TRAINERS MANUAL FOR CIVIL SOCIETY

ORGANISATIONS IN EAST AFRICA

DAR-ES-SALAAMJUNE 2011PREPARED FOR THE WORLD BANK INSTITUTE

DRAFT MANUAL

October 2011 VERSION

Restricted distribution

Not to be quoted until

the final version has

been validated

This manual was prepared under the auspices of the World Bank Institute in Dar-Es-Salaam Tanzania by a panel comprising of the following members:

Agnes Kijo – Tanzania Food and Drug AuthorityAlphonce Katemi – WLAC, TanzaniaBaraka Kabudi – Mission for Essential Medicines, TanzaniaBubelwa Kaiza – FORDIADebra Gichio – Transparency International, KenyaEva Ombaka – Private ConsultantGodeliver Kagashe – Muhimbili University of Health Sciences, TanzaniaJoseph Mhando – St. John’s University of TanzaniaLaurent Shirima – Public Procurement Regulatory AuthorityLucy Nderimo – Medical Stores Department, TanzaniaMercy Masuki – Tanzania Women in Pharmacy Association(TAWOPHA)Mildred Kinyawa – Pharmacy Council, TanzaniaRobinah Kaitiritimba – UNHCO, UgandaRomuald Mbwasi – Private ConsultantScholastica Lucas – Sikika, Tanzania

The team would like to express their gratitude to Ms. Yvonne Nkrumah(Task Team Leader), Marilou Bradley, and Lydia Ndebele of the World Bank Institute Washington for their guidance, and Dr. Emmanuel Malangalila and Ms. Maryam Ahmed both of the World Bank Country Office, Tanzania for support and encouragement.

DISCLAIMER

This is a draft manual and work in progress and cannot be circulated except for purposes of soliciting comments.

TABLE OF CONTENTS

Background........................................................................................................................................... 7

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Target audience.................................................................................................................................... 7Manual Objective.................................................................................................................................. 7Scope.................................................................................................................................................... 7

MODULE 1 : POLICY, LEGAL AND REGULATORY FRAMEWORKS................................................91.1. Purpose..................................................................................................................................... 91.2. Specific Objectives....................................................................................................................91.3. Definition of Key Terms.............................................................................................................91.4. Regional and national policies...................................................................................................91.5. Public Procurement Policies and Guiding Principles...............................................................101.6. Legal and Regulatory Frameworks for Public Procurement....................................................111.7. Structure and System..............................................................................................................121.8. Other Legal Frameworks relating to the procurement of pharmaceutical products.................141.9. Key Actors...............................................................................................................................141.10. Activity.................................................................................................................................151.11. Summary.............................................................................................................................15

MODULE 2 : BASIC PRINCIPLES OF PHARMACEUTICAL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT.......................................................................................................................................16

2.1. General objectives...................................................................................................................162.2. Specific objectives...................................................................................................................162.3. Organisation of the module.....................................................................................................162.4. Technical (WHO) definitions....................................................................................................162.5. Introduction to Pharmaceutical Procurement and Supply Chain Management.......................17The supply chain.................................................................................................................................17Step 1: Selection.................................................................................................................................18Step 2: Procurement...........................................................................................................................18Step 3: Distribution..............................................................................................................................18Step 4: Use of medicines....................................................................................................................192.6. Good pharmaceutical procurement practice............................................................................212.7. PSCM performance indicators................................................................................................232.8. Medicines availability and access indicators...........................................................................232.9. Access and use of information................................................................................................252.10. Activity.................................................................................................................................272.11. Summary.............................................................................................................................27

MODULE 3 : GOVERNANCE CHALLENGES IN PHARMACEUTICAL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT AND THEIR EFFECTS......................................................................28

3.1. General Objective....................................................................................................................283.2. Specific Objectives..................................................................................................................283.3. Introduction............................................................................................................................. 283.4. Governance Challenges in Pharmaceutical Procurement and Supply Chain Management....293.5. Activity.....................................................................................................................................303.6. Summary.................................................................................................................................30

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3.7. Blibliography............................................................................................................................30MODULE 4 : CORRUPTION IN PHARMACEUTICAL AND SUPPLY CHAIN MANAGEMENT.....31

4.1. General Objective....................................................................................................................314.2. Specific Objectives..................................................................................................................314.3. Introduction............................................................................................................................. 314.4. Defining Corruption................................................................................................................. 314.5. Types of corruption..................................................................................................................314.6. Causes of Corruption..............................................................................................................324.7. Corruption in pharmaceutical procurement cycle....................................................................334.8. Activity.....................................................................................................................................344.9. Summary.................................................................................................................................34

MODULE 5 :PROMOTING CITIZENS’ RIGHT TO HEALTH AND STRENGTHENING CIVIC ENGAGEMENT IN ENSURING ACCOUNTABILITY..............................................................................35

5.1. General Objective....................................................................................................................355.2. Specific Objectives..................................................................................................................355.3. Introduction............................................................................................................................. 355.4. Definition of Terms..................................................................................................................355.5. Social accountability................................................................................................................365.6. Activity.....................................................................................................................................385.7. Summary.................................................................................................................................385.8. Bibliography............................................................................................................................ 38

MODULE 6 : SOCIAL ACCOUNTABILITY TOOLS............................................................................396.1. General Objective....................................................................................................................396.2. Specific Objectives..................................................................................................................396.3. Introduction............................................................................................................................. 396.4. Social Accountability Tools......................................................................................................396.5. Citizens’ Report Card (CRC)...................................................................................................396.6. Community Score Card (CSC)................................................................................................426.7. Public Expenditure Tracking Survey (PETS)...........................................................................456.8. Social Audit............................................................................................................................. 466.9. Activity.....................................................................................................................................466.10. Bibliography........................................................................................................................ 47

MODULE 7 :COMMUNICATION STRATEGIES FOR CSOs FOR POSITIVE CHANGE...................487.1. General objective.................................................................................................................... 487.2. Specific objectives...................................................................................................................487.3. Introduction............................................................................................................................. 487.4. Essential Elements of a good communications strategy.........................................................487.5. Managing expectations........................................................................................................... 517.6. Activity.....................................................................................................................................527.7. Summary.................................................................................................................................527.8. Bibliography............................................................................................................................ 52

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LIST OF ABBREVIATIONS

ADDO Accredited Drug Dispensing OutletAIDS Acquired Immune Deficiency SyndromeAO Accounting OfficerCBO Community Based Organisation CRC Community Report CardCSC Community Score CardCSO Civil Society OrganisationEDL Essential Drug ListGGM Good Governance in Medicines Procurement (WHO)HIV Human Immunodeficiency VirusINN International Non-Proprietary NameKEMSA Kenya Medical Supply AgencyMIS Management Information SystemMSD Medical Stores Department (Tanzania)

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NEMLIT National Essential Medicines List (Tanzania)NGO Non-Government OrganisationNMP National Medicines PolicyPE Procurement EntityPETS Public Expenditure Tracking SurveyPMU Procurement Management UnitPPRA Public Procurement Regulatory Authority (Tanzania)PPSCM Pharmaceutical Procurement and Supply Chain ManagementPSS Public Satisfaction SurveyPSU Pharmaceutical Services Unit (Tanzania)RBA Rights Based ApproachRFP Request For ProposalSTG Standard Treatment GuidelinesTB Tender BoardTB TuberculosisTFDA Tanzania Food and Medicines AuthorityTI Transparency InternationalTOR Terms Of ReferenceTOT Training Of TrainersSBD Standard Bidding DocumentsUD User DepartmentUN United Nations (Organisation)WBI World Bank InstituteWHO World Health Organisation

BackgroundThe pharmaceutical industry is an estimated $500 billion1 global business that requires a tight, safe, and efficient supply chain. The production and distribution of pharmaceutical products require validation at every aspect of the supply chain, from production and shipping right through to storage and distribution. Kinks in the process, therefore, can lead to delays in the transport and delivery of essential medicines, as well as the supply of expired products, and stock outs in local facilities. Ultimately, poor management of the process impacts the quality of health delivery to citizens.

The complexity of the pharmaceutical supply chain management (PSM) process, coupled with the multiplicity of actors involved—manufacturers, regulatory agencies, suppliers, and customers—also makes it especially prone to challenges such as corruption. Transparency International estimates that 10 to 25% of public procurement spending is lost due to corruption. Improving governance in PSM is, a priority for developing countries, the World Bank and development partners. These stakeholders, collectively see improved governance as a necesary process to ensure more efficient use of resources and better health outcomes.

This manual is a first step in equipping civil society organisations(CSOs) with the necessary tools to more effectively monitor PSM processes. It was developed by members of multistakeholder coalitions in Kenya, Tanzania and Uganda, focused on improving pharmaceutical procurement and supply chain 1 Kaye, Simon. Meeting the Pharmaceutical Industry’s Global Supply-Chain Challenge. http://www.pmpnews.com/article/meeting-pharmaceutical-industry’s-global-supply-chain-challenge

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management. This manual is a training guide and a “living document” that can be updated as more experiences and lessons are acquired and learned. It is also designed in a way that lends itself to adaptation to suit different sectors and settings.

Target audienceThe manual targets Civil Society Organisations (CSO)/Community Based Organisations (CBO) working on health, human rights, gender and others with interest in access to medicines.

Manual ObjectiveThe broad objective is to raise awareness, equip CSOs with skills, knowledge, and tools to promote transparency and strengthen accountability in the PSM process. It is designed to provide CSOs with basic information and tools to monitor PSM activities that can go beyond providing information to effectively assisting communities in moving beyond awareness to action.

ScopeThe manual was developed through a process of extensive research and consultations and reflects the technical input of numerous experts and institutions. It covers the following modules:

1. Basic principles of pharmaceutical procurement and supply chain management.2. Policy, legal and regulatory framework for pharmaceutical procurement and supply chain

management.3. Governance challenges in pharmaceutical procurement and supply chain management.4. Corruption in pharmaceutical procurement and supply chain management.5. The role of civil society organisations in the pharmaceutical procurement and supply chain

management.6. Social accountability tools7. Communication strategies for CSO for positive change

The modules are organized in a successive manner and inter-linked to each other. Each module is further organized into sub headings and concludes with group work to assess participants understanding of the module. The annexes comprise additional resources and links. It should be noted that the social accountability tools presented in this manual are not exhaustive.

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MODULE 1 : POLICY, LEGAL AND REGULATORY FRAMEWORKS

1.1. PurposeTo provide a general overview of the policy, legal and regulatory frameworks governing pharmaceutical procurement and supply chain management.

1.2. Specific ObjectivesBy the end of this session, participants will have:

A broad understanding of the policies governing pharmaceutical supply chain management as well as the key actors in the process;

An expanded knowledge of the legal and regulatory frameworks guiding procurement and supply chain management for pharmaceuticals;

1.3. Definition of Key Terms

1.4. Regional and national policies

There are variety of regional and national policies in the governance of pharmaceutical procurement and supply chain management. Within the East Africa Community, for instance, the relevant policies are anchored in the East African Protocol on Good Governance and the Africa Convention Against Corruption (Africa Convention). At the national level, the national health policy and fiduciary policies, which are usually set out in various Acts of Parliament govern the process. As a norm, most national health policy recognizes that good health is a major resource essential for poverty eradication and economic development. The policy outlines the health sector administrative set up; role of the ministry of health; policy vision, mission, objectives and strategies; national health services; cooperation with other sectors and basic health care, among others.

1.5. Public Procurement Policies and Guiding Principles

Public procurement policies are based on the need to make the best possible use of public funds (i.e. value for money), while conducting all procurement with honesty, fairness and due diligence. All public

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Policy refers to the series of comprehensive decisions developed and compiled to provide overall guidance to authority or entrusted structures and individuals involved in and obligated to make decisions in the course of governing, managing or discharging powers to implement public interest programmes or projects.

Policy

Legislation refers to an Act of Parliament debated and formally endorsed by the Legislature to legitimize, legalize, and regulate behaviors, activities and operations of individuals or systems in the private and public sector; local or national governments.

Legislation

A framework refers to a particular design or shape that defines a structure, system or operation. Framework

officers responsible for undertaking or approving procurement actions are guided by the following basic considerations of the public procurement policy in a particular country:

A sound procurement system is one that combines all the above elements. The desired impact is to inspire the confidence and willingness-to-compete of well-qualified bidders, contractors, service providers and consultants. This directly and concretely benefits the Procurement Entity (PE), responsive contractors, suppliers, service providers, consultants, the Government and other key stakeholders, and most importantly, ensures that governments get value for money and are able to reach more citizens with services.A procurement system that does not embrace the above elements stimulates hesitation to compete, submission of inflated bids/proposals containing risk premium, or submission of deflated bids/proposals followed by delayed or defective performance during the contract implementation stage. A poor procurement system may also result in bidders/consultants colluding to defraud the government and other procuring public bodies, bribery by frustrated or unscrupulous bidders and consultants, and abuse of the public trust for personal gain. Ultimately, the benefits do not reach the intended beneficiaries.

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The need for economy and efficiency in the use of public funds and in the implementation of projects including the provision of related goods and services. For complex purchases, value may imply more than just price. Other factors such as quality, delivery, and appropriateness (to mention a few) also need to be considered. Lowest initial price may not equate to lowest cost over the operating life of the item procured. But the basic point is the same: the ultimate purpose of sound procurement is to obtain maximum value for money.

Economy

The best public procurement system is simple and swift, producing positive results without protracted delays. Efficiency implies practicality, especially in terms of compatibility with the administrative resources and professional capabilities of the procuring entity and the procurement personnel it employ.

Efficiency

Good procurement is impartial, consistent, and therefore reliable. It offers all interested contractors, suppliers and consultants a level playing field on which to compete and thereby, directly expands the purchaser’s options and opportunities.Equal

Opportunities

Local manufacturing, contracting and service industries are given preference in bidding for public contracts so as to boost the national economy. Goods being procured are “manufactured goods” involving assembly, fabrication, processing etc., where a commercially recognized final product is substantially different in basic characteristics of its components and raw materials. As for services, local service providers may either bid alone or in joint venture with national counterparts or foreign firms to qualify for the preference.

Encouragement through

Preference Schemes

Good procurement holds its practitioners responsible for enforcing and obeying the rules. It makes them subject to challenge and to sanction, if appropriate, for neglecting or bending those rules. Accountability is at once a key inducement to individual and institutional probity, a key deterrent to collusion and corruption, and a key prerequisite for procurement credibility.

Integrity and Accountability

Sound procurement should also be seen to be transparent and fair. The policy establishes, then maintains rules and procedures that are accessible and unambiguous to all parties in the process. The procurement process should not only be fair, but should be seen to be fair.

Transparency

1.6. Legal and Regulatory Frameworks for Public Procurement

The legal and regulatory framework for procurement in countries in the region is basically hinged on the following:

The Procurement Act and accompanying regulations are the backbone of the regulatory framework on procurement and disposal of public assets including health sector goods. An Act normally sets out the key principles and the institutional framework for regulating and carrying out public procurement and disposal of public assets. Regulations are normally issued as secondary legislation for implementation of the main Act.The procurement legislation make it mandatory for all PEs undertaking procurement or disposal in the country to use the appropriate standard documents as prepared and issued by the regulatory bodies. These include the Standard Bidding Documents (SBDs). The SBDs are worded to permit and encourage competition and set forth clearly and precisely all the information necessary for a prospective tenderer/consultant to prepare tender for goods, works, non consultant services or proposal for consultancy services to be provided. They contain basic contractual provisions and safeguards, which are required by the Government in the execution of public procurement and the use of public funds.The SBDs and Standard Request for Proposals (RFP) are specifically aimed at achieving the following:

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Poor procurement

system

- Hesitation to compete- Submission of inflated bids/proposals containing risk premium- Submission of deflated bids/proposals followed by delayed or defective performance during the contract implementation stage

- Bidders/consultants colluding to defraud the government and other procuring public bodies - Bribery by frustrated or unscrupulous bidders and consultants- Abuse of the public trust for personal gain

The benefits do not reach the

intended beneficiaries.

Procurement legislation Regulations

Standard Bidding

Documents (SBDs) and guidelines

Standard Bidding

Documents (SBDs) and guidelines

Tender Evaluation Guidelines have been prepared for use by PEs in the evaluation of tenders, in accordance with the provisions of the Act and Regulations made under it.

Proposal Evaluation Guidelines set out the format of a sample evaluation report that facilitates the evaluation of consultants’ proposals and the subsequent review of the proposals by the tender boards.It is expected that competent, diligent and qualified personnel, knowledgeable about the appropriate procurement process, will perform the evaluation.

Guidelines for Preparation of Responsive bidsWhen Procuring Entities advertise for bid opportunities they aim at obtaining maximum competition from the bidders and get value for the money to be spent in the procurement/selection process. This can only be achieved if bidders submit commercially and technically responsive bids or proposals, so that eventually they are compared on their price or quality as the case maybe.The Guidelines for preparation of responsive bids/proposals are intended to assist bidders/consultants to prepare responsive bids/proposals in conformity with the bidding or RFP documents. Bidders and consultants are normally advised to spend enough time to acquaint themselves with the content of the Bidding and RFP documents.Regulatory bodies may from time to time issue other documents in form of circulars or directives for better carrying out of procurement activities.

1.7. Structure and System

Almost all Procurement Acts in the region provides the procedures on how the procurement functions should be handled using the organs established within the PEs. Basically, procurement is decentralized to PEs each of which has the head of the institution as the Accounting Officer (AO). Various steps of the procurement processes have to be approved by Contract Committees or Tender Board, recognized in the respective Acts as approving authorities. The day-to-day operations have to be carried out by the units responsible for managing the processes.Procurement laws provide for establishment of regulatory as well as complaints or appellate structures to provide bidders with the right procedure to challenge the procurement process. In the case of Tanzania, for instance, the Act2 and its Regulations provides three-tiers (levels) of handling procurement complaints which are:

2 Public Procurement Act, CAP 410 of 200411

Increasing predictability and uniformity in the

tender and selection process.

Increasing efficiency of the

tender and selection process and reduce costs.

Reducing unresponsive bids and proposals and

thus increasing competition.

Reducing preparation and

review time.

In Kenya, both the regulatory and appellate bodies are under the same oversight body, the Public Procurement Oversight Authority. Other countries in the East African region have both functions (regulatory and complaints/appeal handling system), but the bodies are either separate or under one institution.The figure below is an example of structures for pharmaceutical procurement and supply chain management in Tanzania.

Structures for pharmaceutical procurement and supply chain management in Tanzania

Ministry of Health & Social WelfareThe Ministry is responsible in formulating policies related to pharmaceutical management.Ministry of FinanceThe Ministry is responsible for the overall budget allocation and financing.National Therapeutic committeeResponsible for determination of STG and NEMLITPSUPSU is established under the Chief Pharmacist with the overall responsibility of overseeing the implementation of National Medicine Policy. It acts as an advisory and management unit for pharmaceuticals and pharmaceutical manpower.TFDAThis is a government agent under the ministry of Health responsible for regulating the medicines, food and cosmetics. It main functions are:Drug registrationDrug InspectionDrug informationPharmacy CouncilTo regulate the conduct of pharmacy profession and pharmacy practice. The main functions are:

Registration of pharmacists Enrollment of pharmaceutical technicians Listing of pharmaceutical assistants To regulate pharmacy services

Medical Stores Department (MSD)MSD is an autonomous department in the MoHSW responsible for the procurement, storage and distribution of pharmaceuticals.Regional and district levelsHealth Management Teams, Food and medicines committees, hospital therapeutic committees and health Board. These Boards are generally responsible for planning and control of pharmaceuticals, and health services.

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Accounting Officer (Head of PE)Public Procurement Regulatory Authority (PPRA)

Public Procurement Appeals Authority

1.8. Other Legal Frameworks relating to the procurement of pharmaceutical products

Medicines regulatory agencies regulate the manufacture, importation, exportation, distribution of medicines while ensuring that medicines are safe, of quality, and efficacious. Product registration is a legal requirement that must be fulfilled by all those engaged in putting the pharmaceutical products on the market. For this reason, the medicines procurement agencies are, in most countries, restricted to procure only products that are registered by the medicines regulatory agencies. The Tanzania Food and Medicines Administration, Kenya Pharmacy and Poisons Board, and the National Drug Authority of Uganda are responsible for medicines regulation in Tanzania, Kenya, and Uganda respectively.

1.9. Key Actors

There are other important players in the procurement process.

Procurement and Supplies Professional bodies: These are bodies, which have been established for registration of procurement and supplies professionals. In Tanzania, the body is Procurement and Supplies Professionals and Technicians Board.

Procurement Agent for Pharmaceuticals: All countries in the region have agencies responsible for procurement of pharmaceuticals. They are national Medical Stores Department (MSD) in Tanzania, Kenya Medical Supplies Agency (KEMSA) in Kenya, and National Medical Stores (NMS) in Uganda.

Anti-Corruption Agency: Nearly all countries in the region have established institutions such as bureau or commission for anti-corruption interventions. In Tanzania, for example, the Prevention and Combating of Corruption Bureau (PCCB) is the law enforcement agency mandated to investigate corruption. It works closely with the Public Procurement Regulatory Authority (PPRA) on developing anti-corruption strategy in public procurement.

Bodies responsible for Forecasting Medicine Needs: Such bodies include ministries responsible for health and finance, medicine procurement agency, health facilities, and vertical

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Procure-ment and Supplies

Professional bodies

Procurement Agent for Pharma-ceuticals

Anti-Corruption

Agency

Bodies responsible

for Forecasting

Medicine Needs

Inventory tracking entities

Patient Utilization Tracking

institutions

Drug dispensing

units

Ministry of Health & Social Welfare

Ministry of Finance

National Therapeutic committee

PSU

TFDA

Pharmacy Council

MSD

programs.3

Inventory tracking entities: Include the health ministry, medicine procurement agencies, health facilities, and Community Health Facility Committees.

Patient Utilization Tracking institutions: Health Insurance Fund Drug dispensing units: Hospitals, Dispensaries and other health facilities, Accredited Drug

dispensing Outlets (ADDO) (is the ADDO project also available in Kenya and Uganda? If not indicate that this is unique to TZ)

1.10. Activity

1.11. SummaryThe following have been covered in this module:

MODULE 2 : BASIC PRINCIPLES OF PHARMACEUTICAL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT

2.1. General objectives(a) To introduce participants to the basic principles of pharmaceutical procurement and supply

chain management.

3

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1. Illustrate the policy, legal and regulatory framework for pharmaceutical procurement and supply chain management in your country.

2. Describe the level of engagement of CSO and the role they could play in pharmaceutical procurement and supply chain management.

The regional and national policies for enhance

governance in PPSCM

An overview of the public procurement legal and regulatory

framework

The system and structures for

pharmaceutical procurement

Key players in PPSCM

(b) To inform participant of the methodologies used in monitoring and evaluating the supply chain.

2.2. Specific objectivesAt the end of the session the participant should be able to:

(a) Describe the medicine supply cycle;(b) Understand the principles of good pharmaceutical procurement practice;(c) Define availability, accessibility and affordability;(d) Understand the concept of medicine indicators;(e) Appreciate how to access and use information on PSM processes.

2.3. Organisation of the moduleThis module is organized into four sections - (i) procurement and supply chain management; (ii) best pharmaceutical procurement practice; (iii) medicines availability and access indicators; and (ii) access and use of information.

2.4. Technical (WHO) definitions

2.5. Introduction to Pharmaceutical Procurement and Supply Chain ManagementPharmaceutical procurement is a complex process, which involves many steps and different stakeholders. It is governed by government policies and regulations. The process involves all activities that occur from product selection through forecasting and procurement, inventory management, distribution to use by the clients. The series of sequential activities aim at ensuring that the right pharmaceuticals in right quantity and right quality are in the right place at the right time and right price.

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Access is technically defined as a construct that encompasses various distinct dimensions, and these are distinguished by sets of specific supply/demand relationships. Four dimensions of access emerge as being of particular relevance to essential medicines, vaccines, and other health commodities: Physical availability, Affordability, Geographical accessibility and Acceptability.

Access

Physical availability is defined by the relationship between the type and quantity of product or service needed, and the type and quantity of product or service provided.

Physical availability

Geographical accessibility is defined by the relationship between the location of the product or service and the location of the eventual user of the product or service.

Geographical availability

Affordability is defined by the relationship between prices of the products or services and the user’s ability to pay for them

Affordability

Acceptability (or satisfaction) is defined by the relationship between the user’s attitudes and expectations about the products and services and the actual characteristics of products and services.Acceptability

Quality of products and services is seen as a characteristic of access that cuts across all other dimensions of access i.e. quality is embedded in each of the four access dimensions.Quality

The figure below illustrates the pharmaceutical logistics cycle.4

The supply chainThe supply chain is an operational management chain. It describes the major activities that must be performed so as to ensure efficient and constant supply of any product including medicines. The simplest supply chain operational model consists of four steps: 1. Selection; 2. Procurement; 3. Distribution; and 4. Use.

Step 1: SelectionThe pharmaceutical supply chain starts by the identification of requirements, whereby health problems are reviewed, treatment identified, and selection of medicines completed. Standard Treatment Guidelines (STG) and National Essential Medicines (NEM) List are the outcome of the selection activity.

The selection process starts with a National Medicines Policy (NMP), which is a guide for action, containing the goals set by the government for the pharmaceutical sector and the main strategies and approaches for attaining them. The policy provides a framework to coordinate activities of pharmaceutical sector participants: the public and private sectors, non-governmental organisations

4 Management Science for Health, 2nd Edition, WHO/MSH, Kumarian Press.16

(NGOs), donors, and other interested parties. A national medicines policy may differ in its objectives, strategies and approaches. Most common objectives are:-

To make essential medicines available and affordable to those who need them; To ensure the safety, efficacy, and quality of all medicines provided to the public; To improve prescribing and dispensing practices and to promote the correct use of medicines

by health workers and the public.

National Essential Medicines ListsThe rationale for selecting a limited number of essential medicines is that it may lead to better supply, more rational use, and lower costs. An essential medicines list is a priority list based on the healthcare needs of a given population since essential medicines are those that are deemed to satisfy the health care needs of the majority of the population and that should be available in the appropriate dosage forms and strengths at all times. Access to essential medicines of assured quality is fundamental for the optimal performance of any health care system and uninterrupted supply of essential medicines determines the credibility of health services.

The choice of essential medicines depends on many factors, such as the pattern of prevalent diseases; the treatment facilities; the training and experience of available personnel; the financial resources; and genetic, demographic, and environmental factors. Only medicines, for which sound and adequate data on efficacy and safety are available from clinical studies, and for which evidence of performance in general use in a variety of medical settings has been obtained, are selected. The WHO provides a model list to assist the selection of national lists of essential medicines.

Step 2: ProcurementProcurement is a vital activity in the pharmaceutical supply chain as it plays a role in ensuring the acquisition of required products to support the health care delivery. The procurement process involves demand and supply planning. Demand planning includes identification of key requirements and alignment with the procurement budget. Supply planning, on the other hand, involves the following activities: packaging of requirements; selection of the appropriate procurement methods; resolution of issues on tender management; selection of suppliers and management of contracts. Personnel involved in pharmaceutical procurement are not involved in demand planning. Procurement methods and processes are discussed in section 2.5.2.

Step 3: DistributionDistribution is the logistical sequence of activities, which ensure that goods reach intended customers. It involves the clearance of goods, storage, inventory control, transport and delivery to health facilities. Effective drug distribution relies on well-designed systems and proper management. A well-designed and well-managed distribution system should:-

Maintain a constant supply of medicines; Keep medicines in good condition throughout the distribution process; Minimize medicine losses due to spoilage and expiry; Maintain accurate inventory records; Rationalize medicines storage points; Use available transportation resources as efficiently as possible; Reduce theft and fraud; and Provide information for forecasting medicines needs on a timely basis.

The logistical requirements of a distribution system are: (a) personnel; (b) space; (c) stock location systems; (d) storage facilities and handling equipment; (e) information systems; (f) communication facilities; and (g) transport.

The goals of medical stores management are to: 1) protect stored items from loss, damage, theft, or wastage, and 2) to manage the reliable movement of supplies from source to user in the least expensive way. Effective use of information is the key to achieving these goals. The integrated process is called inventory control. The purpose of an inventory control system is to ensure that the distribution system

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always contains the right goods in the correct quantities. A fully developed inventory control system has 3 key components:

1. An inventory management system to obtain the right goods and to monitor their intake and quality;

2. A stock control system to monitor the flow of goods within the system;3. A performance monitoring system to check that the system is operating effectively

The control system can be manual or computerized.

The main challenges of a distribution system are: (a) to ensure constant supply of medicines to health facilities; (b) to optimize accessibility to essential medicines; (c) to ensure the quality of medicines; and (d) to ensure safety and security of medicines during storage and distribution.

Step 4: Use of medicinesThis is the last step in the supply chain before the cycle starts again. The use of medicines is getting more attention in recent times because of concerns on irrational prescribing, mainly as a result of irresponsible promotional activities, the need to ensure optimal therapeutic outcomes (pharmaceutical care) and the need for close monitoring of adverse effects of medicines through pharmacovigilance.

2.1.1. Procurement methods and processes

Preparation of procurement planThe procurement plan is an instrument for implementation of the budget and should be prepared by the user department with a view to avoiding or minimizing urgent procurements that do not enable realization of value for money. The procurement plan must be integrated into the budgetary processes based on indicative or approved budget as appropriate.

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Procurement planning involves segregation of items due to their nature e.g. medicines, diagnostics, medical supplies and equipment, selection of procurement method and preparation of General Procurement Notice which is published to the public.

The aim of procurement planning is to:1. Avoid emergency procurement wherever possible;2. Aggregate requirements wherever possible within the procurement entity and between

procuring entities to obtain value for money and reduce procurement cost;3. Make use of framework contracts wherever appropriate to provide an efficient, cost-effective

and flexible means to procure pharmaceuticals;4. Avoiding order-splitting; and5. To align the procurement budget to the expenditure program.

Procurement methodsIdeally, all procurement should be conducted in a manner to maximize competition and achieve economy, efficiency, transparency and value for money. The following methods are widely used:

International competitive biddingThis is the method, which invites suppliers regardless of their nationality by means of tender notices and is advertised internationally and nationally to submit priced tenders.

National competitive biddingThis is the method, which invites suppliers within a nation by means of tender notices and is advertised nationally to submit priced tenders.

Restricted Competitive biddingA procurement method that restricts the issue of tender documents to a limited number of specified suppliers. These are often identified in a prequalification process.

Request for quotation (Shopping)Shopping is a procurement method based on comparing price quotations obtained from several suppliers (in the case of goods) or from several contractors (in the case of civil works), with a minimum of three, to assure competitive prices, and is an appropriate method for procuring readily available off-the shelf goods or standard specification commodities of small value, or simple civil works of small value.

Single source or Direct ContractingDirect contracting is contracting without competition (single source) appropriate under certain conditions e.g.

(a) Extension of an existing contract(b) Standardization of equipment or spare parts, to be compatible with existing equipment, may

justify additional purchases from the original Supplier.(c) The required equipment is proprietary and obtainable only from one source

The tender processA tender is a procurement process that is based on invitation of sealed bids from suppliers, which are subsequently opened for public scrutiny. The tender process is tedious and involves several steps including:

Preparation of bid documents: Bid documents are prepared by one person, with inputs from other technical staff as needed, and then checked by another. Often, standard templates are available to simplify this activity.

Advertisement of tenders: In international tenders, advertisement must be made in international media. World Bank tenders must be advertised in the UN Development Business online and Development Gateways. Adequate time must be provided for response.

Opening of tenders: Tenders are made available to the public on an appointed day and time. Each tender is read out and recorded in a register.

Evaluation of tenders: The evaluation of tenders must be done by competent persons using criteria that must have been included in the bid documents.

Adjudication and award: This is normally done by a tender committee, the composition of which can be stipulated by law or by internal regulations.

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Notification of award and contracting: Time is of essence in the tender process. For this reason prompt notification is necessary so as to provide adequate time to appoint an alternative in case the first choice defaults.

Contract management: An elaborate procedure follows the award of a tender to ensure that it is executed timely and as efficiently as possible. If a supplier fails to comply with delivery conditions a record must be made for future reference.

2.1.2. Emergency procurementUnder emergency conditions, the standard procurement methods can take too long. Under such circumstances past suppliers, extension of existing contracts and other direct contracting approaches can be used. The most important criteria that apply during emergency periods are reliability, and quality.

2.6. Good pharmaceutical procurement practice

2.1.3. IntroductionA good medicine supply system is based on operational principles for good pharmaceutical procurement that are based on four strategic objectives:

(a) To procure the most cost-effective medicines in the right quantities;(b) To select reliable suppliers of high-quality products;(c) To ensure timely delivery; and(d) To achieve the lowest possible total cost.

To procure the most cost-effective medicines in the right quantitiesAll organisations responsible for procurement should develop an essential medicines list to make sure that only the most cost-effective medicines are purchased. Procedures must also be in place that accurately estimates procurement quantities in order to ensure continuous access to the products selected without accumulating excess stock.

To select reliable suppliers of high-quality productsThe second objective is that reliable suppliers of high-quality products must be pre- selected, and that active quality assurance programs, involving both surveillance and testing, must be implemented.

To ensure timely deliveryThe third strategic objective is that the procurement and distribution systems must ensure timely delivery of appropriate quantities to central or provincial stores and adequate distribution to health facilities where the products are needed.

To achieve the lowest possible total costThe fourth objective is that the procurement and distribution systems must achieve the lowest possible total cost, considering four main components. The actual purchase price of medicines;

hidden costs due to poor product quality, poor supplier performance or short shelf-life; inventory holding costs at various levels of the supply system; and operating costs and capital loss by management and administration of the procurement and

distribution system.

2.1.4. Operational principles for good pharmaceutical procurement

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For efficient and transparent management

Different procurement functions and responsibilities (selection,

quantification, product specification, pre-selection of suppliers and

adjudication of tenders) should be divided among different offices,

committees and individuals, each with the appropriate expertise and resources for the specific function

Procurement procedures should

be transparent, following formal written procedures throughout the process and using

explicit criteria to award contracts.

Procurement should be planned properly and procurement

performance should be monitored regularly; monitoring should include an

annual external audit. A reliable management information

system (MIS) is one of the most important elements in planning and

managing procurement. Lack of a func-tioning MIS or the inability to use it ap-propriately is a key cause of program

failure.

For drug selection and quantification

Public sector procurement should

be limited to an essential medicines list or national/local

formulary list.

Procurement and tender documents should list medicines by their International

Nonproprietary Name (INN), or generic name. The INN is widely accepted as the standard for describing medicines on a

procurement list or tender request. However, all medicines supplied to the public health

system should be properly labeled in accordance with standards laid down by

law (or in accordance with labeling instructions), including the INN featured

prominently in addition to the brand name that may be on the label.

Order quantities should be based on a reliable estimate of actual need. An accurate

quantification of procurement requirements is needed to avoid stock-outs of some

medicines and overstocks of others. Past consumption is the most reliable way to

predict and quantify future demand, providing that the supply pipeline has been consistently

full and that consumption records are reasonably accurate. When funds are not available to purchase all medicines in the

quantities needed, it is necessary to prioritize the procurement list to match available

financial resources.

2.7. PSCM performance indicatorsPublic procurement regulatory authorities often monitor performance of procurement entities under their jurisdiction. The objective of the audits are to determine whether the procedures, processes and documentations for procurement, contracting and disposal of public assets by tender are in accordance with the provisions of the law, regulations and the standard documents prepared by the authority and that procurements carried out achieved the expected economy and efficiency, and the implementation of contracts conform to the terms thereof.

2.8. Medicines availability and access indicatorsThe performance of the supply chain can be effectively monitored by the use of indicators because direct measurement is often not possible. Indicators are parameters that can be monitored regularly to study the progress of a process or performance.

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For financing and competition

Mechanisms should be put in place to ensure reliable financing for procurement. Good

financial management procedures should be

followed to maximize the use of financial

resources.

Procurement should be effected in the largest

possible quantities in order to achieve economies of scale; this applies to both

centralized and decentralized systems.

Procurement in the public health sector should be based on competitive

procurement methods, except for very small or

emergency orders. As long as drug quality and service

reliability are assured, competition should be

increased to the point at which drug prices are as

low as possible.

Members of the purchasing groups should purchase all

contracted items from the supplier(s) which hold(s) the

contract.

For supplier selection and quality assurance

Prospective suppliers should be pre-qualified,

and selected suppliers should be monitored

through a process which considers product quality, service

reliability, delivery time and financial viability.

Procurement procedures/systems should include all assurances that the medicines purchased are of high quality, according to international standards. Four

components make up an effective quality assurance system:- selecting reliable suppliers of quality medicines;

- using existing national registration, manufacturing and import control mechanisms;

- establishing a program of product defect reporting; and- performing targeted quality control testing.

2.1.5. Types of indicatorsThere are two types of indicators:-

Evaluation or Performance indicators, which often focus on effects and impact; and Monitoring indicators, which focus on inputs, processes and outputs.

Indicators can also be qualitative or quantitative.

2.1.6. Criteria for indicatorsThe five necessary criteria for indicators are:

Clarity (easily understood and calculated); Usefulness (reflects an important dimension of performance); Measurability (can be defined in quantitative or qualitative terms and used within existing

constraints on information quality and availability) Reliability (permits consistent assessment over time and among different observers; and Validity (is a true measure of what it is meant to measure)

2.1.7. Indicator medicinesAccess indicators are qualitative criteria that provide information reflecting the operational efficiency of a supply chain. In most cases these criteria must be expressed quantitatively. In the management of the supply chain it is common practice to use a small number of medicines which, when regularly monitored, can provide the quantitative measure of the performance of the supply chain. Such medicines are commonly referred to as “indicator medicines”. Other names for indicator medicines are: markers, tracers or index medicines. When several indicator medicines are used together they are often referred to as “basket indicators”.

2.1.8. Choice of indicator medicinesIndicator medicines must be:

1. On the national list of essential medicines;2. Therapeutically important; and3. Widely used (for purposes of comparison)

To monitor and compare the performance of national medical stores in East Africa, the East African

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QUALITATIVE INDICATORS tend to be yes-or-no questions related to policy

and management processes e.g. Are medicines procured through

competitive tender? Is there a standard treatment manual? Qualitative indicators

generally reflect structural inputs and procedures that are prerequisites to policy

implementation and management performance.

QUANTITATIVE INDICATORS allow managers to set specific targets for outputs and performance; they facilitate monitoring

the achievement of these targets. Quantitative indicators can be in the form

of counts, rates, ratios, proportions, or percentages.

Percentage of households located more than five kilometers (or possibly greater than one hour’s travel) from a health facility/pharmacy that is expected to have a set of key items in stock at all timesAverage minutes of total waiting time during last visit to a health facilityAverage number of hours that health facilities are open and delivering health services

Percentage of households located more than five kilometers (or possibly greater than one hour’s travel) from a health facility/pharmacy that is expected to have a set of key items in stock at all timesAverage minutes of total waiting time during last visit to a health facilityAverage number of hours that health facilities are open and delivering health services

Average price differential between a generic and brand product for the treatment of tracer conditions.Public sector and private sector prices as compared with median international prices of medicines for tracer conditionsNumber of days lowest-paid government employee must work to pay for a standard recommended course of therapy for tracer conditionsPercentage of the population covered by any risk-sharing or prepayment scheme

Percentage of a set of unexpired key items in stockPercentage of time out of stock for a set of key itemsPercentage of prescribed items presented for dispensing that are not dispensedPercentage of facilities that have a source of good drug information, including a formulary or standard treatment guidelines (STGs)Presence of a consumer information service

Physical Availability Affordability

AcceptabilityGeographical accessibility

Community uses a set of indicators.

2.9. Access and use of information

2.1.9. Definition of transparencyTransparency relates to the availability, flow, accessibility and use of information.

2.1.10. Importance of transparency in pharmaceutical procurementThe World Bank has identified corruption as the single greatest obstacle to social and economic development by keeping millions of people trapped in poverty. Labeled as cancer by the same organisation, it is a cross‐sectoral problem affecting the public and private sectors alike. It also represents a gross departure from fundamental ethical standards.As mentioned, the pharmaceutical sector is particularly vulnerable to corruption and unethical practices. The commercial reality of the pharmaceutical market tempts the many different ‐ public as well as private ‐ actors involved. The pernicious effects of corruption arise not only from intentional mismanagement by an individual, but also from an inability to identify and ethically manage the conflicts of interest that can occur when institutions and individuals with authority interact. There is also a failure from an organisational position to institutionalize procedures that will prevent corrupt behaviour. Corrupt practices can have a threefold impact:

a health impact as the waste of public resources reduces the government’s capacity to provide good quality essential medicines, and unsafe medical products become available on the market;

an economic impact when large amounts of public funds are wasted. Indeed, it is estimated that pharmaceutical expenditures in low‐income countries amount to 10‐ 40% of total health‐care expenditures,1 representing potentially major financial loss;

an image and trust impact as inefficiency and lack of transparency reduce public institution credibility, decrease donors trust and lower investments in countries.

2.1.11. How to ensure transparency in pharmaceutical procurementThe responsibility of providing information on the procurement process lies with the procurement entity. This is normally embodied in procurement law of the country. It follows, therefore, that national regulatory authorities must provide means to ensure that this responsibility is effectively discharged by procurement entities. For example, in Tanzania’s PPA (2004), section 56(3) provides for disclosure of such information to the public. Similar provisions exist in Kenya and Uganda.

Information from procurement entities relating to procurement includes pre-qualification notices, tender advertisements and tender awards. It is common practice, nowadays, that such information would be displayed in websites of the procurement entities and the procurement regulatory agencies.

Public opening of tenders is a common method used to provide information to stakeholders. During tender opening, bidders and other interested parties are invited to witness the opening and record the bids that are read openly. It is also possible for individual participant to request and obtain certain information relating to submitted bids but this is usually limited where many bids are involved due to time and human resources constraints.

An additional and often useful source of information on procurement practices and malpractice are proceedings of procurement appeals established under national procurement laws. These bodies have been established to determine disputes arising from procurement processes e.g. contract awards.

Individuals and organisations are not restricted to information provided by procurement bodies, they have a responsibility to use other avenues to obtain the information they require. Such sources include:

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Participation of strategic stakeholders in institutional decision-making bodies is also another way of achieving transparency. However, this method is not preferred because it dilutes the independence of the external stakeholder in holding organisations responsible for their actions. Therefore, where it is employed, precautions are taken to minimize its effect on the observer’s independence.

2.1.12. Use of informationThe main concern of public authorities when considering the release of information is misquotation and misuse. It is important that persons and organisations that are provided information in confidence should not misuse such information in a manner that will erode the trust between the two parties. Misuse of information can also lead to legal action.

2.10. Activity

2.11. SummaryThis module has discussed and covered the following

Components of the pharmaceutical supply chain which include selection, procurement, distribution and use

Selection criteria Procurement methods and processes The tender process Best pharmaceutical procurement practice Procurement and supply chain management performance indicators Medicines availability and access indicators Access and use of information

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Official reports from government monitoring organisations such as the Office of the Auditor General

Annual reports of the respective organisationsResearch publications outlining the outcome of various

studies and performance assessments/evaluationsThe media

1. What are the common transparency issues in pharmaceutical procurement?

2. How would you ensure transparency in pharmaceutical procurement by:

a) Staff of the procurement unit?

b) Members of tender and evaluation committees?

c) Suppliers?

MODULE 3 : GOVERNANCE CHALLENGES IN PHARMACEUTICAL PROCUREMENT AND SUPPLY CHAIN MANAGEMENT AND THEIR EFFECTS

3.1. General ObjectiveThe objective of this section to help participants understand governance challenges in the pharmaceutical procurement and supply chain management and their effects;

3.2. Specific ObjectivesBy the end of the session, the participant should be able to:

1. Define governance as it relates to pharmaceutical supply chain management;2. Identify the governance challenges in pharmaceutical procurement and supply chain

management;3. Understand how these challenges impact access to medicines.

3.3. Introduction

3.1.1. DefinitionThere are many different definitions of governance. Although the definitions do not always use the same terminology, there is an emerging general consensus that governance is about managing the resources and affairs of society to promote the well-being of its citizens. The term “Good Governance” is increasingly used to emphasize the need for government, private sector, and civil society, to operate with due regard for the rule of law and especially in a manner that is free of corruption. 5 Good governance can be defined as an exercise of authority; control; or, a method or system of government or management characterized by the following basic principles:

1. Legitimacy based on a participatory approach and consensus orientation;2. A clear direction, strategic vision;3. Responsiveness to needs, effectiveness and efficiency;4. Transparency and accountability;5. Equity, inclusiveness, and rule of law6.

WHO defines good governance in pharmaceuticals as “the formulation and implementation of appropriate policies and procedures that ensure the effective, efficient and ethical management of pharmaceutical systems, in particular medicine regulatory systems and medicine supply systems, in a manner that is transparent, accountable, follows the rule of law and minimizes corruption.”7

3.1.2. Governance principles in pharmaceutical PSMGovernance in relation to pharmaceutical PSM requires a PSM system that functions on the basis of the above principles resulting in:

Procurement of the most cost-effective medicines and in the required quantities Selection of reliable sources of quality medicines Assurance of timely delivery Use of the lowest possible cost

3.4. Governance Challenges in Pharmaceutical Procurement and Supply Chain Management

3.1.3. Organisational Factors and CapacityAn effective procurement and supply chain management system depends very much on the existence 5 A framework for good governance in the public pharmaceutical sector, Roy Eloy, October 2008. WHO Department of Essential Medicines., http://www.who.int/medicines/areas/policy/goodgovernance/WHO-GGMframework.pdf6 ( Source: UNDP 1997)

7 A framework for good governance in the public pharmaceutical sector, Roy Eloy, October 2008. WHO Department of Essential Medicines., http://www.who.int/medicines/areas/policy/goodgovernance/WHO-GGMframework.pdf

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of a well-organized institutional structure that is responsible for carrying out the PSM process. In the early nineties, the East African Countries took action to reorganize their Central Medical Stores to become autonomous/semi-autonomous institutions with a broader mandate in instituting their procurement and supply chain management responsibilities. The restructuring of these public procurement agencies was also aimed at reducing the bureaucratic procedures in decision making, which affected their performance. Despite the reorganization, Central Medical Stores continue to face challenges, including the critical shortage of human resources, as well as inadequate skills and capacity in good procurement practice and supply chain management. For procurement and supply chain management to perform efficiently, adequately skilled and knowledgeable personnel must be in place.Another important challenge is the paucity of storage and transport utilities to effectively manage an efficient supply chain system. A functioning logistic system requires trained human resource, storage facilities, an effective and efficient transport system, and reliable information systems that allow continuous flow of data through reliable communication channels.

3.1.4. Financial FactorsAlmost all countries in the region experience challenges in financing health systems, including the procurement of pharmaceuticals. Shortage or erratic release of procurement funds leads to emergency procurement, which often necessitates bypassing the regular procurement procedures, and creating an enabling environment for corruptive practices.

3.1.5. Institutional ArrangementAs part of the public procurement reforms in Africa, most countries have established a central body with oversight responsibility for public procurement as a more effective means for eliminating waste, minimizing corruption and improving financial accountability. The public procurement legislative framework typically creates various layers of tender review committees to review procurement activities at each stage of the procurement cycle.In some countries, the Ministry of Health forms a tender committee with oversight responsibility for procurement of health sector goods. Approvals for the various stages of the procurement process remain within the jurisdiction of other agencies, often under the Ministry of Finance. These departments and agencies often fail to work together in an efficient manner, causing procurement delays that are especially problematic for medicines. What is seemingly lost in the institutional arrangement governing procurement is a well-defined, clear and simple administrative procedure to ensure effective coordination of the various departments and agencies of government involved in pharmaceuticals procurement.An even greater challenge for countries is how to enable bodies that have been set up as nominally independent institutions to manage pharmaceutical procurement and delivery systems, to function efficiently. (Some of these are precursors to Central Medical Stores – for example, the Kenya Medical Supplies Agency, others have been newly formed).

3.1.6. Disclosure of InformationNot all relevant stakeholders (public, private and CSO) are included in relevant aspects of the proper management of the procurement process and the maintenance of its integrity. For example, r ules, regulations, strategies, procurement plans, quantification results, committee and drug regulatory decisions are not often publicized or easily accessible. Also, information on qualified/invited bidders, winning bids, losing bids, records of procurements are not well maintained or made public.Information provides a “quick reflex” for both the institutions within government and CSOs to improve performance of the system. It can also be a stimulus action for change by CSOs.3.5. Activity

3.6. SummaryIn this module the following issues have been discussed:-

a) Defined Good Governance.27

Among the typical governance challenges in your country which one do you think is the greatest? Why? What measures must be taken to reduce or eliminate the challenge?

b) Identified Governance Challenges in Procurement and Supply Chain Management which included:

Organisational and capacity Financial Infrastructure and logistics management system Institutional arrangements Disclosure of information

3.7. Blibliography1. Transparency International – Kenya Anti-Corruption Training Manual (January 2011 (2))2. WHO Good Governance for Medicines programme an innovative approach to prevent

corruption in the pharmaceutical sector; Compilation of Countries case studies and best Practices Guitelle Baghdadi-Sabeti and Fatima Serhan; WHO report (2018)

3. WHO; Measuring transparency to improve Good Governance in the public pharmaceutical sector in Malawi ( 2008)

4. U4 - Anti-Corruption Resource Centre; Corruption in the Health Sector U4 Issue 2008:10

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MODULE 4 : CORRUPTION IN PHARMACEUTICAL AND SUPPLY CHAIN MANAGEMENT

4.1. General ObjectiveTo improve users’ understanding of corruption, causes, and equip them with strategies to prevent it.


1. Define corruption.2. List the causes and effects of corruption.3. Understand the main anti-corruption strategies that are usually used by anti-corruption

bodies.

4.3. IntroductionCorruption in the health system and, in particular, in pharmaceutical procurement and supply chain management is a concern in all countries within the East African region. Corruption reduces the already-limited resources available for the procurement of medicines, and lowers the quality, equity and effectiveness of pharmaceutical services provided.

4.4. Defining CorruptionThere is no universally accepted definition of corruption. Different individuals, groups or organisations often come up with different definitions. However, one general thread that runs through most of the general definitions is that corruption is negative and evil. Some definitions are:

a) Dishonest or illegal behavior, especially of people in authority.8

b) Abuse of socially accepted normsc) The abuse of power most often for personal gain or for the benefit of a group to which

one owes allegiance. 9

d) Unlawful acquisition of property at the expense of the public.e) Misuse of official authority for the benefit of an individual or a group10

f) The use of position, money or force to influence the acquisition of property or service.11

g) Transparency International define corruption as ‘The misuse of entrusted power for private gain 12

4.5. Types of corruptionThere are many different types and forms of corrupt practices. Each type has a different origin and exhibits different characteristics. Here are some examples.

8Oxford Advanced Learners Dictionary, 7th Ed, 2005.9 (Curbing Corruption, Economic Development Institute of World Bank)10(Adapted from Sourcebook for Corruption Prevention in the Public Service (KACC/DPM), p3).11 (The State of Corruptionin Kenya (NACCSC) p xi).12(P. Mwangi 2006, Handbook on Corruption (NACCSC), p4).

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4.6. Causes of CorruptionOne well known ‘cause’ of corruption is a situation where an individual who has ‘inclination’ towards corruption finds a ‘corruption opportunity’. Such a person is likely to engage in corruption. This scenario is usually summed up in this equation (I+O=C) meaning, Inclination plus Opportunity equals Corruption.

Another generally used equation is M+D-A=C, meaning Monopoly of Power plus Discretion, minus Accountability equals Corruption. This means that in situations where there is a lot of power and very wide discretion, and where accountability is not demanded, corruption is likely to occur.13

These are some causes of corruption in pharmaceutical procurement and supply chain management: Relationship of trust in most countries health professionals have assumed a cultural role as

trusted healers who are above suspicion. We don't like to believe that providers could have conflicts of interest that affect their judgment, but in fact this can be the case14.

Systems with direct public provision are prone to low productivity when insulated from competition or external accountability15

Services are highly decentralized and individualized making it difficult to standardize and monitor service provision and procurement16

Limited regulatory capacity in many developing countries17

Abuse of discretionary power. For example, an officer who has discretionary power to decide on who supplies goods or services in an organisation may award a contract to a company where he/she has an interest, or to a relative or friend.

Absence of transparency and accountability mechanisms. Passivity / complacency among citizens Non compliance with professional standards

4.7. Corruption in pharmaceutical procurement cycle

13Klitgaard Formula- www.pnphrdd.net/resouces/psosec/managing _corruption.ppt14Ahmed Nilufur, Chapter 14: Voices of Stakeholders in the Health Sector Reform in Bangladesh , in Health Policy Research in South Asia: Building Capacity for Reform, 2003, The World Bank, p. 377 as quoted in http://www.u4.no/themes/health/causesandconsequences.cfm#_ftn515William D. Savedoff, memo to Transparency International, 14 July 2004William D. Savedoff, memo to Transparency International, 14 July 2004 as quoted in http://www.u4.no/themes/health/causesandconsequences.cfm#_ftn516ibid as quoted in http://www.u4.no/themes/health/causesandconsequences.cfm#_ftn517Human Development Report 2003: A Compact Among Nations to End Human Poverty, United Nations Development Programme, p.113 as quoted in http://www.u4.no/themes/health/causesandconsequences.cfm#_ftn5

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Fraud A (criminal) act of deception

intended to result in personal or financial gain.

BriberyThe practice of offering

something (usually money) in order to gain illicit

advantage.

ExtortionThe act or an instance of coercing

someone by force, threats, or abuse of authority to give something valuable, such as money, information, excessive interest,

or the like.

CollusionWhere two or more people

act together to prevent / undermine the fairness of the procurement process

NepotismFavoritism shown to

relatives or close friends by those in power

EmbezzlementThe fraudulent appropriation

of funds or property entrusted to your care but actually owned by someone else.

Unethical Business PracticeNot conforming to approved standards of

social or professional behavior. For example, the diversion of pharmaceutical products or

the sale of expired medicines.

http://lnweb18.worldbank.org/SAR/sa.nsf/0/59570FEA7FBC122185256E1200819F2B?OpenDocument

http://www.pnphrdd.net/resouces/psosec/managing%20_corruption.ppt

In the pharmaceutical procurement cycle, these are the vulnerable key areas of corruption:

4.1.1. Identification- Unnecessary medicines/medical equipment requested- Excessive quantities requested

4.1.2. Planning and selecting Procurement Method- Tailor specifications to favor a supplier- Suppliers promote discriminatory/exclusive technical standards- Vague specifications/TORS so that contract changes or post contract negotiations are inevitable- Split Bids into Smaller lots- Claim Urgency or choose restrictive procurement method

4.1.3. Bidding Process- Restrict Information- Breach confidentiality- Unfair disqualification of potential bidders- Suppliers collude to fix prices

4.1.4. Evaluation/ Negotiation /Award- Disclose commercially sensitive information- Disqualify potential suppliers- Invite specialist evaluators late to meetings after evaluation has started- Suppliers try to influence evaluators.- Acceptance of late tenders- Preferential treatment to favorite suppliers- Accepting Suppliers Terms and Conditions of Contract- Tender Board circumvention

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Select method

Bidding Process

Awarding a tender

Contract ManagementMonitoring

Disposal

Identification

Planning

4.1.5. Contract Management and Monitoring- Failure to enforce quality standards/quantities or other performances standards of contract- Suppliers deliver low quantities/quality- Non receipts of goods , but still paid- Medicine and Medical equipment get diverted for private use or resale- Falsify quality or standard documents- Over or under invoicing- Bribes to contract supervisors

4.1.6. Reducing Corruption in Pharmaceutical Procurement: A Role for CSOsWhile the design of good institutions with oversight is crucial for the reduction of corruption, there is also a significant role for civil society. If community groups closely monitor pharmaceutical companies and regulators, there is a greater likelihood that corruption can be caught or even prevented out of fear of disclosure. Useful tools for addressing corruption include the Transparency International Corruption Fighters Tool Kits (2001 – 2004). See: http://www.transparency.org/tools/e_toolkit

4.8. Activity

4.9. SummaryThe module has discussed the following

- Definition of Corruption and types of corruption.- Levels of corruption- Causes of corruption- Identify vulnerable key areas of corruption in procurement cycle

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Disclose commercially sensitive information

Disqualify potential suppliers

Accepting Suppliers Terms and Conditions of Contract

Tender Board circumvention

Invite specialist evaluators late to

meetings after evaluation has started

Suppliers try to influence evaluators.

Acceptance of late tenders

Preferential treatment to favorite suppliers

1. Discuss areas prone to corruption in the PSM cycle and how it impacts access to medicines.

http://www.transparency.org/tools/e_toolkit

MODULE 5 :PROMOTING CITIZENS’ RIGHT TO HEALTH AND STRENGTHENING CIVIC ENGAGEMENT IN ENSURING ACCOUNTABILITY

5.1. General ObjectiveEnhance participants’ understanding of the right to health and the obligations/roles of citizens in ensuring transparency and accountability in PPSCM.


1. Understand the right to health and the “rights based” approach2. Understand “empowerment” and “social accountability”3. Understand the use of a Rights Based Approach (RBA) in promoting social accountability4. Understand the obligations of government and citizens alike to ensure accountability.

5.3. IntroductionHealth is internationally recognised as a universal fundamental right that must be enjoyed by every citizen of the world. The Rights Based Approach is a mechanism for ensuring effective citizen participation, equity, addressing vulnerability, quality and accountability. Empowerment is a pre-requisite for effective participation.Ensuring citizens access to quality health care is a responsibility of governments across the globe. This responsibility is enshrined in the UN universal declaration of human rights under article 25 (1) that states; “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” In the Abuja declaration, governments committed to allocate 15% of their national budgets to health and progressively monitor and report on progress as part of accountability. This provides a framework within which the right to health is supposed to be implemented.

5.4. Definition of Terms

5.1.1. Right to HealthWHO defines the right to health as “the right to the highest attainable standard of health ”. The right to health requires governments to develop policies and plans that ensure access to the highest possible standard of health for all. Governments, therefore, have the obligation to provide health care and protect vulnerable individuals and groups from third parties through regulation, monitoring and ensuring mechanisms for education and redress.

5.1.2. The Rights Based Approach (RBA)WHO defines RBA as the process of:

a) Using human rights as a framework for health developmentb) Addressing and assessing the human rights implications of any health policy, program or

legislation.c) Making Human rights an integral dimension of the design, implementation, monitoring and

evaluation of health related policies and programs in all spheres including political, economic and social.

A Rights Based Approach to programming, monitoring and evaluation is an effective mechanism for promoting participation of beneficiaries, accountability and improving health outcomes, especially in developing countries where effective and efficient use of resources is critical.

5.1.3. What is empowerment?The World Bank defines empowerment as ”expression of assets and capabilities of poor people to participate in, and negotiate with, control and hold accountable the institutions that affect their lives”. While there is no single institutional model for empowerment, there are four key and intertwined

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elements that act in together and that must guide institutional reform -- (i) access to information; (ii) inclusion and participation; (iii) accountability; and (iv) local organisational capacity.

5.5. Social accountability

5.1.4. What is Social Accountability?The concept of social accountability aims to develop a framework of how citizens demand and enforce accountability from those in power. It is an approach towards building accountability that relies on civic engagement whereby ordinary citizens and/or civil society organisations participate directly or indirectly in exacting accountability.Working towards better governance, social accountability tools can help address both demand-side and supply-side factors to service delivery. On the demand side, social accountability requires that citizens understand and put in practice their rights and responsibilities with respect to access and use of public services. On the supply side, it requires government officials and service providers to apply mechanisms and procedures to take account of citizens’ demand to respond with appropriate policies and solutions. Social accountability can therefore foster collaboration between government actors and citizens and result in improved basic service delivery. Mechanisms of social accountability can be initiated and supported by the state, by citizens or by both parties. Very often, though, they are demand-driven from the bottom-up.

5.1.5. Why is Social Accountability important?Social accountability can: improve governance, by allowing ordinary citizens to access information, voice their needs, and demand accountability from government officials and service providers. Social accountability practices enhance civic engagement with service providers and politicians in a more informed, organized, constructive and systematic manner, thus increasing the chances of effecting positive change.

5.1.6. How do you promote citizen’s participation?Citizens can influence the quality of service delivery by influencing decisions of policymakers. In exercising this influence however, citizens will require:(i) access to reliable information on their entitlements and the performance of services;(ii) capacity and opportunities to use the information (most often through collective action) and

transform it into action; and(iii) grievance redress mechanisms, formal channels for recipients of benefits, or users of services,

to demand their rights and give feedback to providers and policy makers.

5.1.7. Building Blocks of Social AccountabilityCitizens can hold government officials and service providers accountable through a variety of means. For example, citizens may form organisations (such as Civil Society Organizations) at different levels (i.e., local to national), and address different issues (i.e. service delivery, pharmaceutical procurement and supply chain management) and use diverse strategies (i.e., monitoring, participatory planning, civic education, media coverage). Social accountability approaches typically involve coalition building to more effectively articulate collective interests. Such approaches may include the following (Malena 2004):

Mobilizing around an entry point and the development of a strategy where a priority problem can be addressed.

Building an information/evidence base, that can facilitate evidence-based dialogue and serve to hold public officials accountable. Social accountability initiatives often involve obtaining both “supply-side” data/information (from government and service providers) and “demand-side” data/information (from users of government services, communities and citizens).

Going public, by bringing information and findings into the public sphere and generating public debate around them.

Rallying support and building coalitions, by informing citizens about their rights and responsibilities, engaging their interest and mobilizing them to build coalitions and partnerships with different stakeholders (i.e., like bureaucrats, media, parliamentarians, etc.) Specific efforts will most likely be needed to reach out to the poor and marginalized.

Advocating and negotiating change, through direct interaction and negotiation with concerned 34

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government entities or institutionalizing mechanism for continuous consultations and dialogue that help elicit a response from public officials and effect change over time.

5.1.8. Who is supposed to ensure social accountability?The government has the primary responsibility of ensuring that social accountability exists. The government fulfils this role by establishing effective and efficient agencies for monitoring and accountability, such as the office of the auditor general, an ombudsman, and Parliament.Civil Society Organisations, Non-Governmental Organizations, CBOs, opinion leaders, traditional leaders, citizens’ movements, the media and international development partners- donors should also emphasize the importance of social accountability in promoting good governance.

5.1.9. Factors that contribute to the success of Social AccountabilityThere are several salient factors that contribute to the success of social accountability interventions:

Political context and culture, recognizing that the parameters for social accountability are largely determined by the existing political context and culture.

Access to information, ensuring the availability, accessibility, and reliability of public documents and data.

The role of the media. Independent media can be a leading force in informing/educating citizens, monitoring government performance, etc.; local media (including private/ community radio) can provide an important channel for citizens to voice their opinions and discuss public issues.

Civil society capacity, taking into account the organisation of CSOs, the breadth of their membership, their technical and advocacy skills, including capacity to mobilize and effectively use media, their legitimacy and inclusiveness, and their level of responsiveness and accountability to their own members.

State capacity. A well functioning public service that has the capacity to respond to citizen demands is a prerequisite. Other elements of state capacity include inter alia: ability to produce records, the effective devolution of authority and resources; the willingness and capacity to build partnerships and/or coalitions; and, a political or administrative culture that values notions of public sector probity, accountability and equity.

State-civil society synergy, recognizing that accountability initiatives must include both state and societal actors and focus on the interface between them.

Institutionalization, this refers to the process whereby social accountability mechanisms become embedded and are systematically implemented by civil society, state, or a combination of both.

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5.6. Activity

5.7. SummaryThe following has been covered in this model

Meaning of Rights and Rights Based Approach Citizens Rights What, how, and why of social accountability Obligations of Government

5.8. Bibliography1. African Union, 2000. The Abuja Declaration By the African Heads of State and Government ;25

April 2000, Abuja, Nigeria2. United Nations, 1948. The Universal Declaration of Human Rights3. World Health Organisation, 2001. 25 Questions and Answers on Health and Human Rights,

Health and Human Rights Publication Series Issue No. 1, July 20014. World Bank, 2004. Social Development Paper No. 76, Participation and Civic Engagement,

Social Accountability – An Introductoin to the Concept and Emerging Practice.

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Exercise 1: Identify stakeholders and assign roles and responsibilities.

Exercise 2: Identify next steps and opportunities for civil society involvement in social accountability in PPSCM?

Success of Social Accounta

bility

Political context and

culture

Access to information

The role of the media

Civil society capacity

State-civil society synergy

Institutionalization

State capacity

MODULE 6 : SOCIAL ACCOUNTABILITY TOOLS

6.1. General ObjectiveTo build capacity of CSOs for monitoring and improving transparency and accountability in pharmaceutical procurement and supply chain management.

6.2. Specific ObjectivesBy the end of this session, the participant will be able to:

Know and describe some of the tools that are used in promoting social accountability Understand how these social accountability tools can be used to monitor PSCM and promote

accountability

6.3. IntroductionAccountability is a vital element of the right to health. Like all human rights, the right to health grants entitlements to some (e.g. citizens) and places legal obligations on others (e.g. state).Through systematic tracking of processes and activities, individual citizens and groups can ensure that beneficiaries receive timely and quality services that address their needs.The role of service users in monitoring service deliveryCitizens can exert their collective voice to influence policy, strategies, and expenditure priorities at different levels of policy making (national and local). Citizens can also exercise power as the end users of services (Client Power – WDR 2004) over service providers and hold them accountable for access, quantity and quality of services. Improved information about services being provided at the local level, as well as a choice of providers, can represent important elements of client power.How can duty bearers be accountable?The accountability of duty-bearers to citizens can be strengthened through mechanisms for poor people to voice their priorities and views. The path to enforceability is through various forms of interaction, including encouragement and complaints. Reforms that can increase duty-bearers' accountability to stakeholders include: a) citizen charters (patients' charter), b) increased transparency of various types of information on budgets, services, regulations, c) levels of performance and achievement of targets; and d) increased participation of consumer groups in policy and planning bodies.This module therefore, presents six tools that can be used to ensure that citizens are informed and that they understand ways in which they can demand accountability from duty bearers. These are commonly referred to as social accountability tools.

6.4. Social Accountability ToolsVarious tools exist for monitoring and enforcing accountability. There are also instruments that specify standards and entitlements that guide citizens and civil society organisation to understand what they should demand and sometimes processes and mechanisms for redress. These include specific clients/patients charters, sector or service standards, policies and guidelines. These vary from country to country.

6.5. Citizens’ Report Card (CRC)Citizen report card is a participatory and powerful tool to provide public agencies with systematic feedback from users of public services. By collecting feedback on the quality and adequacy of public services from actual users, CRC provides a rigorous basis and a proactive agenda for communities, CSOs or local governments to engage in a dialogue with service providers to improve the delivery of public services.CRC addresses critical themes in the delivery of public services (i.e. access to services, quality and reliability of services, transparency in service provisions, costs incurred in using a service. It provides a summative satisfaction score that captures the totality of critical services-related parameters.Unlike in the case of the Community Score Card (CSC) where findings are presented at interface meetings (where users and service providers come together to discuss the evidence and seek solutions), the citizen report cards’ findings are publicly disseminated and presented to government officials to demand accountability and lobby for change. Its focus is on service outcomes.

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6.1.1. What outcomes can be expected from CRC? Help public service agencies to facilitate open and proactive discussions on their performances. Empower citizen groups to play a “watch-dog” role to monitor public service agencies and local

governments. Enable line ministries and planning departments to streamline and prioritize budget allocations

and monitor implementation. Deepen social capital by converging communities around issues of shared experiences and

concern.

6.1.2. Components of the CRCA Report Card has four components:(a) Collecting quantitative information from users (citizens) and service providers;(b) Assembling this information in “easy access/comprehensible report cards”;(c) Disseminating the report cards to users and providers and providing them with practical information

on how best to use this information; and(d) Implementing repeat user and provider surveys to assess impact on service delivery outcomes.

6.1.3. Where and how is it applied?CRC data aggregates scores given by users for the quality and satisfaction with different services like health, or scores on different performance criteria of a given service, such as availability, access, quality and reliability. Typically, respondents rate or give information on aspects of government services on a scale, for example, 1 - 5. These ratings of representative users on the various questions are then aggregated and a satisfaction score expressed as a percentage.

6.1.4. An effective CRC undertaking requires a skilled combination of the following factors:

A commitment to gather credible data on clients’ perceptioni) Constructive and solution-oriented approach on the part of CSOs rather than confrontational

advocacyii) An understanding of the socio-political context of governance and the structure of public financeiii) Competence, professionalism and credibility of the group to undertake the CRC exerciseiv) Commitment by the public agency to engage in the process, listen to critical analysis and initiate

reformative action based on the findingsv) A media and advocacy campaign to share the findings with the publicvi) Steps aimed at institutionalizing the practice for iterative civic actions.

6.1.5. Stages of the CRCOverall, a CRC initiative goes through 6 key stages as illustrated below:

KEY STAGES OF IMPLEMENTING A CITIZENS REPORT CARD INITIATIVE

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Participation of different stakeholders at various stages: in the design of questionnaires where the performance indicators and key issues are developed

through focus group discussions with citizens during the survey execution, where qualitative interviews are used to support questionnaire

data, during dissemination where NGOs/CBOs are brought in to use the data for advocacy and

reform.

39

Be clear on the scope of evaluation - sector unit of service provisionIdentify credible institutions that can undertake the exercise

Identification of the scope, actors and purpose

Coduct FGDs to provide input to design the questionnairesDefine structure and size of questionnaireDesign of questionnaires

Determine the sample sizeDecide on the sampling frameChose respondents Sampling

Select and train survey enumeratorsSpot monitoring of interviews at random should be undertakenExecution of the survey

Analysis of findings and formulation of the "Report Card"Data analysis

Share preliminary findings with the concerned service providerDevelop post-survey publicity strategyDissemination

Take steps to institutionalize CRCs as a source of regular feedback on performance of service provider.

6.6. Community Score Card (CSC)

6.1.6. What is the Community Score Card?The Community Score Card is a community-based monitoring tool with a strong focus on empowerment and accountability through scoring of satisfaction and performance on selected indicators by both Consumers and Service Providers, followed by an interface meeting for immediate feedback on quality and adequacy of services provided in the community.

6.1.7. Attributes of a Community Score Card: Uses the community as the unit of analysis Conducted at micro, local, and/or facility level Most frequently used in rural settings Generates information through focus group interactions

40

Stage 1: Identification of scope, actors and purpose

Identify services and aspects of service provision to examine.A statement of purpose describes the reason and scope of the CRC. It is used to evaluate the success of the CRC and during the process,to shape (i) design the survey instrument; (ii) type of user feedback that is collected; (iii) level of analysis; (iv) policy implications; and (v) advocacy strategiesIdentify credible institutions that can undertake the exercise

Stage 2: Design of

Questionnaires

Conduct FGs with two constituencies -- providers of service and users--- to provide inputs to design questionnaireConduct FGs to pre-test the questionnaire before launchingDefine structure and size of questionnaire

Stage 3: Sampling

Determine sampling design, size and scope. Aim for greater representativeness rather a plain expansion of numbersOnce sample size has been determined, sample frame has to be decided. (Standard principle is to use multi-stage probability sampling with probability proportional to the size of population)Within sample households choose sample respondents

Stage 4: Execution of

Survey

Select and train a cadre of survey personnel. Undertake spot monitoring of interviews at random to ensure that recording of household information is done accurately.Go over the information collected and identify inconsistencies

Stage 5: Data Analysis

Consolidate and analyze data. Ensure accuracy in transferring raw data from survey questionnaires to computer program.Data subjected to standard error analysis and tests of significance.Analyze survey findings to assess citizen’s feedback along established parameters (i.e. quality, access, instances of bribery, etc.), the outcomes of which are then read like a “report card”.

Stage 6: Dissemination

of Findings

Prepare report on CRC findings; share with the concerned service providers. Ensure interface between the users and the service providers to constructively engage in a dialogue based on evidence, put pressure on service providers to improve their performance. A direct interaction between the two concerned parties can help to ensure an operational link between information and action.Ensure wide dissemination of findingsDevelop post-survey publicity strategy

Enables maximum participation and ownership by the local community Emphasizes immediate response from the community and encourages local problem-solving Provides immediate feedback to service providers Identifies potential reforms through mutual dialogue and collaboration between service

providers and users

6.1.8. The CSC Process

The application of a Community Score Card Process involves eight steps: planning; community mobilisation and sensitization; input tracking matrix; service providers’ self evaluation; community scoring of performance; interface meeting between services users and providers; advocacy and dissemination; implementation of recommendations. Below is an illustration of this process.

Experience shows that CSC initiatives, especially those that entail one-off exercises, do not usually succeed in promoting policy and process changes that affect longer-term improvements in service delivery unless they are scaled up. It is necessary to make effective use of collected feedback to facilitate effective scaling up (World Bank GAC in Projects).

Application of the steps of the CSC

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S/N STEP ACTIVITY1 Planning a. Create awareness of CSC among service providers and

other stakeholders.b. Collect supply side information on service delivery.c. Select participating communities and facilities.

2 Community Mobilization and sensitization

a. Identify and inform community members about the survey.

b. Organize community members and providers into focus groups.

c. Set a timetable for visiting the service units and meeting focus groups.

3 Input Tracking Matrix (survey team start to apply the CSC)

a. Develop input matrix with service providers and service users.

b. Help community members to decide upon specific indicators (including both standard indicators and the community's own indicators)

c. Help community and providers to choose general themes for assessment of the services.

4&5 Assessment by Providers and Consumers

a. Give scores against standard indicators selectedb. Provide rationale for scoringc. Discuss and agree, with participants, on solutions to key

issues affecting service delivery.d. Participants agree on actions to be taken and assign

responsibility to person(s) and/or organisations.e. Participants prioritize their issue of concern for the service

and identify representatives to present their priorities to an interface meeting for further consensus building.

6 Interface Meeting of Providers and Consumers of service

a. Representatives of focus groups present their scores (CSC and scoring matrix) and reasons for the scores.b. Service providers react and give feedback.c. Participants discuss and agree on key issues to be resolved by different stakeholders to improve service delivery. The output here is the Joint Action Plan.

7 Dissemination and Advocacy a. Publish results in a report and disseminate to stakeholders for advocacy and improvement of service delivery.

8 Implementation a. Implement Joint Action Plans

SIMILARITIES AND DIFFERENCES BETWEEN CITIZEN REPORT CARDS AND COMMUNITY SCORE CARDS

42

SOC

6.7. Public Expenditure Tracking Survey (PETS)

The Public Expenditure Tracking Survey (PETS) is a tool used to track the flow of public resources (including human, financial, or in-kind) from the highest levels of government to frontline service providers. PETS can help civil society and policy makers understand funding flows, identify areas of leakage, and make informed policy decisions based on their findings. PETs employs an extensive mapping exercise in order to understand the flow of funds through the different levels of government. Following the mapping of resource flows, budget data are collected and analyzed, and often complemented with a facilities survey and qualitative research. Although PETS can be a valuable tool for accountability, it is neither simple nor inexpensive to implement and requires attention to detail, from the design phase through to the dissemination of results. The use of PETS can provide several benefits:

help identify delays in financial and in-kind transfers, leakages rates, and general inefficiencies in public spending

amplify voice of CSOs and citizens by giving them an empirical tool to demand, on behalf of end-users, improvements in governance, management and delivery of services, e.g., from the standpoint of resource provision and reduction of financial waste (Griffin, et al. 2010)

build credibility through knowledge-based constructive engagement with governments and seek feasible changes on the local level

enable CSOs to shift from pure advocacy to an analytically-based approach that demands 43

Unit - household/individualMeant for macro levelMain output is demand side data on performance and actual scoresImplementation time longer (3-6 months)Feedback later, through media Information collected through questionnaires

Citizen Report Cards (CRC)Participatory surveys that provide

quantative feedback on user perceptions on the quality, adequacy and efficiency of public services. It is

an instrument to exact public accountability through extensive media coverage and civil society advocacy that accompanies the

process.

Unit – CommunityMeant for local levelEmphasis on immediate feedback and accountability, less on actual dataImplementation time short (3-6 weeks) Information collected through focus group discussions

Community Score Cards (CSC)

Qualitative monitoring tool used for local level monitoring and

performance evaluation of services by the communities. CSC process

inccludes techniques of social audit, community monitoring and CRC. It is

an intrument tp exact social and public accountability and

responsiveness from service providers. Interface meetings

between service providers and the community allows for immediate

feedback and thruogh this process, also serve as an instrument for

empowerment.

SOC

accountability for results and for delivery on promises already made

Steps to follow while conducting PETS1. Define the objective – make critical decisions about the study, including selecting the topic and

scope, developing research questions, and identifying target audiences2. Map resource flows – identify a list of sources from which data can be gathered and how resources

flow from one source to the other3. Collect and analyze data – Actual implementation of PETS. Train the survey team, conduct facility

visits, enter, clean and analyse data.4. Identify the issues – Use findings to identify the problems, the trends in problem occurrence and

why the problems are occurring5. Recommend solutions – make feasible, concrete and inexpensive recommendations6. Dissemination and advocacy – develop an advocacy and communications plan and involve target

audiences from the outset

Mechanisms for Citizens’ Feedback and RedressFeedback and redress mechanisms refer to the processes and systems through which information flows from the health facilities to the communities and vice-versa, and the subsequent follow-up actions taken to accommodate citizens’ input. Functional feedback and redress mechanisms provide a forum/platform through which participatory planning and evaluation promote accountability and good governance.

Mechanisms of feedback and redress include Suggestion boxes – usually situated at service centres Community dialogues – organised by government, facility service providers, or NGOs including

faith based organisations. Designated institutions and individuals such as local government council, persona designated to

represent citizen at various for a, Civil Society Organisations, etc.

6.8. Social AuditAlso termed Social Accounting, these are investigations or assessments carried out usually by citizens or an independent party to provide information on performance and accountability, against effective utilisation of public resources for the benefit of the general public. The information can then be used to measure efficiency and demand accountability. The results of the audit is also shared with all interested stakeholders through public gatherings, which are generally attended by users of the services as well as by public officials involved in the management of the service delivery unit.

6.9. Activity

6.2. SummaryThis module covered the following:

Social accountability tools and processes

6.10. Bibliography1. ANSA-Africa Network, 2010. Social Accountability in Africa. Practitioners’ Experiences and

Lessons.Cape Town: Idasa2. Using PETS to Monitor Projects and Small-Scale Programs, 2010. Margaret Koziol and Courtney

Tolmie, World Bank3. Survey To Establish Citizens’ Opinions And Satisfaction With Local Government Services And

Administration. 2010. European Union, ULGA, UNHCO. KampalaUganda.4. Social Development Notes, Participation and Civil engagement, 2004 . SwarnimWaglé, Janmejay

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Exercise 1: Identify any social accountability tools that have been used in your environment to monitor social accountability within the country and how they have been used.

Exercise 2: What are the advantages and disadvantages of any of the tools presented?

Singh and Parmesh Shah. World Bank5. Ministry of Health – Uganda, 2009. The Patients Charter

MODULE 7 :COMMUNICATION STRATEGIES FOR CSOs FOR POSITIVE CHANGE.(Adapted from Chapter 6- Research Matters in Governance, Equity and Health. www.research-matters.net)

7.1. General objectiveTo enhance the CSOs understanding on how to develop a good communications strategy for dissemination of information to the public on the issues related to pharmaceuticals procurement in East Africa.

45

7.2. Specific objectivesAt the end of the session, participants will be able to understand:

The meaning of a communications strategy The essential elements of a communications strategy How to develop a good communications strategy The ways to evaluate an implemented communications strategy Managing expectations

7.3. IntroductionCommunication is about fostering social awareness and facilitating public democratic dialogue. It is about contributing to evidence-based policy, and about building a shared understanding, which can lead to social change. It is about creating space for the voices of the poor to be heard, and, ultimately, it is about redistributing power. When it is done effectively, communication, not only benefits the ‘recipient’, but it also benefits the ‘sender’ as the ‘senders’ themselves can learn a lot throughout the process of sending information.Communication is crucial in development; whether in the form of information dissemination, guidelines, prescriptions, recommendations, advocacy, promotion, persuasion, education, conversation, roundtables, consultations, dialogue, counseling or entertainment.A communications strategy articulates, explains, and promotes a vision and a set of well-defined goals. It creates a consistent, unified “voice” that links diverse activities and goals in a way that appeals to partners or stakeholders. It is a means of elaborating how to network, participate, and interact with the world and influence stakeholders to participate through the methods and forums provided. The overall objective of the communications strategy is to facilitate information sharing. In this age of unparalleled choice, a communications strategy should be able to convince the target audience that the idea or approach (being communicated) is better than the alternative. However for civil society organizations, an effective communications strategy should also aim for a positive change.Every organisation requires a dynamic communications strategy. If organisations want to influence decisions, they must learn how to integrate communications from top to bottom, internally, externally, and across all their activities. Organisations need to see communications as a vehicle that is not only helpful or required but essential to achieving core goals.This module is arranged around ten Essential Elements of a good communications strategy (see also annex).

7.4. Essential Elements of a good communications strategyThe following are a series of steps to be taken when developing a good communications strategy. An effective communications strategy comprises of the following: Review, Objectives, Audience, Message, Basket, Channels, Resources, Timing, and Feedback.

7.1.1. Review (Performance and Perception)How has the organisation’s communication strategy been in the past? How effective has that strategy been? What are the audience’s perceptions of the messages conveyed?

7.1.2. Objectives (Making them SMART)What does the organisation’s communication strategy aim to achieve? Is the organisation’s communication strategy aligned with the SMART objectives? What, ultimately, do the organisations want from communications?The objectives are the key to the success of a communication strategy. All communication strategies must begin with a clear understanding of the objectives. Communication can be expensive in terms of resources and time and the more precisely the organisation can state its objectives for communicating, the better equipped the organisation will be to allocate and use its scarce resources Objectives should be: Specific, Measurable, Attainable, Results-Orientated and, Time-limited (SMART).

7.1.3. Audience (Primary and Secondary Targets)Who are the organisation’s audiences? Does the organisation have a primary and a secondary audience? What information do they need to take action on the organisation’s work?

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Understanding audiences is fundamental. There may be several and different “types,” of audiences, each with their own likes, needs and abilities. The better the organisation understands its audience, the better the chances for the organisation to influence that audience. If the organisation does not understand, appreciate or listen well to its audience, it will not be able to communicate its messages effectively with its audience.

7.1.4. Message (Problems, Possibilities, Policies)What is a message? Do we have one message for multiple audiences or multiple messages for multiple audiencesWhile an organisation may have only one message that is to be conveyed, it may want to modify this message for several different audiences. It is more than likely that the organisation will have three or four key messages, and will want to tailor each message to address the needs of the three or four audiences using three or four different tools.

7.1.5. Basket (Tools and Products)What kinds of communications will best capture and deliver the messages?The choice of the communications “basket” depends directly on the type and content of the message to deliver, available resources, and also – most crucially – on how the audience likes to receive information. What newspaper do they read? What radio station do they listen to? Where do they gather? How can the organisation marry scientific content with the right dissemination channel? The basket will contain different communication messages depending on the audience.The print and electronic materials include electronic newsletters; issue-specific fact sheets; policy briefs for decision makers and parliamentarians; speeches; databanks of speaking notes and slides for power point presentations; press materials and packages; brochures; booklets/books and reports; CD/DVD/Video material, and articles/op-eds.A communications “basket,” however, can go well beyond policy briefs, take-home messages and peer-reviewed papers to include face-to-face meetings such as conferences, town-hall meetings and informative plays (drama).

7.1.6. Channels (Promotion and Dissemination)What channels will the organisation use to promote and disseminate information?Having the right message and the right audience is one thing. Delivering them is another. The channel is every bit as important as the message itself. The channel is essential. The medium – be it TV, newspaper, or a meeting – dictates who receives the message. If someone must pay for a service (e.g. a newspaper), those who don’t pay won’t receive it. If someone must attend a meeting to receive the message, those who don’t attend won’t receive it. The messages must reach the right people to have any impact. And therefore the organisation must identify the right channel to reach the audiences.

7.1.7. Resources (Materials, Finances, People)What kind of budget does the organisation have for this? Will this change in the future? What communications skills and hardware does it have?Communication can be expensive. It requires high-quality materials and methods for creating and producing those materials. Furthermore it requires people with the appropriate skills to use and apply those methods; as well as an allocated budget. The organisation needs to be realistic about what it can actually achieve, and be aware of the many “hidden” costs related to certain tools.

7.1.8. Timing (Events, Opportunities, Planning)What is the timeline? What strategy be the most appropriate? What special events or opportunities might arise? Does the work (or future work) present possible dissemination opportunities?Setting realistic deadlines in developing the communications strategy can be difficult – especially when the organisation follows the objective of listening, learning and adapting. That said, there are some obvious deadlines and limitations if an organization wants to disseminate its messages: national policy dialogues, ministerial meetings, international conferences, purchased airtime, and so on. Furthermore, once the organization has aroused public interest in its work, it must have the information readily available and accessible.

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7.1.9. Branding – Creating one and sustaining itAre all of the organisation’s communications products “on brand”? How can the organisation ensure that it is broadcasting the right message?Consider the logos and products of Toyota, Nike, Coca-Cola and Barclays. These brands translate not only as car, shoes, drink, and bank (which they are) but also give us an association of status, quality, and size (what they’re like – the feelings their products create in us). A brand tells the world, at a glance, who and what the organisation is. It is what the organisation wants to be seen, known and remembered as. “Being on brand” means that whatever the organisation does, say or produce is consistent with the image and quality the brand represents. The organisation’s brand represents everything it does. (see also Annex).

7.1.10. Feedback (Evaluative Thinking)How will the organisation know when its communications strategy is 100% successful? What would have changed? How can it assess whether it used the right tools, was on budget and on time, and had any influence?The organisation must create a “feedback loop” mechanism that can shed some light on what is working and what is not working well. It is important to know how the target audience is receiving the organization’s messages. Some informal methods to measure how effective the communication is include:

Creating an impact log: This is an informal record compiled in-house that gauges how an organisation’s communication has been received. The log can comprise stakeholder feedback, a list of media references, and speeches citing the organisation’s work. This is qualitative and non-systematic, but at the same time it can be an excellent way to gauge the effectiveness of an organisation’s communications strategy.

Conducting a formal survey: Organisations should carefully and purposefully select a sample of people that could provide the type of information needed to reflect upon and improve its communications strategy.

Conducting key-informant interviews: Like a formal survey, this is a technique to gather more in-depth information from stakeholders on the organisation’s communications strategy.. These could also be done through a focus group.

7.5. Managing expectations

CSO’s understanding of what public expectations are, prior to delivery, is important as it helps to determine how to address their expectations after an intervention. Rising expectations are a direct challenge to perceptions of service quality and threaten to make demands that simply cannot be met. At the very least, public expectations cannot exceed available resources, statutory responsibilities and institutional capacities. CSO interventions through their communication strategies should ensure they do not cause excessive expectations. Understanding how expectations are formed, whether they really are rising, and how they can be more effectively managed is an important part of the communications strategy.2

7.1.11. How expectations are formedThe literature suggests that expectations are shaped by the following factors: individual needs; previous experience; word of mouth; explicit service communications (e.g. posted printed matter); implicit service communications (e.g. building appearance); personal beliefs and values; reputation of service; client group (e.g. expectations among the elderly are lower than among those who are younger and better-off ) etc.Literature also suggests that the influence of service reputation on expectations may be inflated where, as is common in the public sector, there is little information on competing services or little real choice between competing services.On personal beliefs and values, the importance of personal ‘views of government and politicians’ is also important. For example the public’s perception of honesty and integrity in their government will affect their assessment of the services they receive from these institutions. Therefore one important driver of public expectations is the ‘reputation of the government as a whole’2.

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Key factors affecting public expectations

7.1.12. Managing expectations as CSOAs a CSO that is communicating for positive change, it is important to consider and plan on managing these expectations. Ways to do this include:

1. Ensure availability, accessibility and accuracy of authentic information relevant to supplies of medicine, users and the public in general.

2. Liaise with mainstream public media to ensure accuracy and authenticity of relevant news coverage.

3. Issue regular updates and ensure effective dissemination, reaching out to users and the wider public in rural and urban areas. This could be done through official newsletters, official websites, issuance of press releases and/or organising press conferences.

4. Conducting/commissioning public satisfaction surveys (PSS)/studies to capture users' or public baseline awareness, expectations, satisfaction, perceptions and ratings in relation to medicine, demand, supply and consumption.

7.6. Activity

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Customer expectations

of service

Word-of-mouth communication

Previous experience

Explicit service communication

Views aboutgovernment

Values/beliefs

Exposure to demonstrativ

e effects

Implicit service communication

Personal needs

1. What are the issues for CSOs to communicate?2. What change would you expect to happen in your organisation if you implemented a

new communication strategy?3. What would be your targets for a communications strategy?

7.7. Summary

This module has discussed the importance of a communications strategy in civil society organizations as a means of effecting positive change. In particular, this module covered the following:

The meaning of communications strategy The essential elements of a communications strategy How to develop a good communications strategy The ways to evaluate an implemented communication strategy Managing expectations

7.8. Bibliography

1. IngieHovland (2005) Successful Communication: A Toolkit for Researchers and Civil Society Organisations. Research and Policy in Development Programme, 111 Westminster Bridge Road, London, SE1 7JD

2. Ricardo Blaug, Louise Horner and RohitLekhi (2006) Public value, citizen expectations and user commitment: A literature review. The Work Foundation, 3 Carlton House Terrace, London,SW1Y 5DG3.

APPENDIX 1: HOW TO USE THE MANUAL

1. Description of the sections of the manualThe manual contains seven (7) modules on procurement and supply chain related issues most of which are designed to be covered within one to four hours session during the training. Each of the modules starts with a statement of the general objectives and is followed by specific objectives. These are the objectives that should guide the training sessions. At the end of each module, there is going to be an exercise followed by a summary of the content covered. The modules as follows:Module 1: Policy, legal and regulatory frameworkModule 2: Pharmaceutical procurement and supply chain managementModule 3: Typical governance challenges in pharmaceutical procurement and supply chain management and their effectModule 4: Definitions and causes of corruptionModule 5: Promoting citizens right to health and CSOs effective participation in promoting accountability in PPSCMModule 6: Social accountability toolsModule 7: Communication strategies for CSOs for positive change

During the training, the resource person should try to make the sessions as interactive and participatory as possible. This can be done for example by asking participants either as individuals or in small groups to get their ideas on certain areas before the resource person presents the already prepared content.The following are the methods that are used at different points during training Questions and answers Case study Presentations Plenary sessions

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The resource person can use any other method deemed appropriate for effective delivery of the materials for example Buzz group, role play, brainstorming, sharing experience and field exercises

2. The skills required of the resource personThe resource persons are expected to develop skills to facilitate the training activities. Such skills required include:2.1 Ability to grasp and discuss the module2.2 Ability to link objectives to activities, resources and assessment and evaluation.2.3 Able to organize and operationalize training programme2.4 Sensitivity to the needs of the trainees2.5 Ability to create participatory, active and cooperative learning opportunities.2.6 Ability to encourage trainees to express their views and take ownership of the training2.7 Ability to counter resistance among trainees and to motivate them to appreciate how they might overcome perceived constraints.

3. Roles and responsibilities of the resource personWhile the resource person are considered as facilitators, their learning and taking responsibility for the planning, organizing, implementing, monitoring and evaluating the training activities is the major target of the manual. For this it is expected the resource person to:3.1 Being knowledgeable about all the sections of the manual, paying particular attention of the training objectives, activities, resources, assessment and evaluation, references and other details related to the training.3.2 Prepare all need materials and equipment3.3 Be effective in demonstrating all training methods and strategies.3.4 Guide the trainees to take ownership of the approaches during the training period3.5 Plan evaluation of the training program and the skills of the participants3.5 Report on the outcomes and impact of the training.

4. Adaptation, translation and reproduction of the training manualThis manual is meant to be generic training manual. Institutions, organisations, associations and other interest groups may adapt and translate the manual. The adaptation and translation would be expected to cover the following:4.1 Identification of relevant but related issues and concerns.4.2 Validation of the materials – the need for trials and pilot testing.4.3 Design of relevant teaching materials4.4 Utilization of materials in order to achieve the intended objective.4.5 Mobilization of technical and financial resources.The manual may be reproduced freely without infringing copyright, provided the reproduction is not for commercial use.

APPENDIX 2: UNITED NATIONS ANTI-CORRUPTION TOOLS

The following are some of the tools (presented in summarized form) that the UN recommends in preventing and combating corruption. (More details are available in the UN Anti-Corruption Toolkit 3 rd

Edition, Vienna, September 2004 p47-69.Tool 1. Assessing the nature and extent of corruptionSurveys, case studies, etc can be used to gather information about corruption. The assessment establishes a baseline against which future progress can be assessed.Tool 2. Assessment of institutional capabilities and responses to corruptionThis is intended to provide information about the extent to which institutions are affected by corruption and how far such institutions may be utilized in the implementation of anti-corruption measures. The judiciary is a major focus of this tool. How can the judiciary be used to fight corruption?Tool 3. Specialized Anti-Corruption AgenciesThere is a possibility of using, in countries, specialized Anti-Corruption Agencies, to adapt existing law enforcement institutions to fight corruption, or to use a combination of the two.

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Tool 4. Auditors and Audit InstitutionsAudit covers financial issues, ensuring conformity with established standards or reviewing the performance of institutions and individuals. Audit reports are usually made public and this helps to improve transparency.Tool 5. OmbudsmenAn Ombudsman is an official appointed by government or parliament who is supposed to receive and investigate complaints made by individual citizens. In most countries the mandates and functions of an Ombudsman includes corruption and maladministration attributable to incompetence, bias, errors or indifference. Ombudsmen can refer corruption cases to Anti-Corruption Agencies.Tool 6. Strengthening judicial institutionsThis can be done through training in professional competence and integrity as well as development or review of a judicial code of conduct.Tool 7. Civil Service Reform to strengthen service deliveryThe tool gives an overview of the long-term and sustainable policies needed to help build integrity within the public service, to curb corruption and to improve service delivery.Tool 8. Codes and Standards of ConductThis refers to rules that might be applied to key public sector groups such as police, parliament and judges.Tool 9. National Anti-Corruption Commissions, Committees and similar bodiesThese are meant to formulate a national anti-corruption strategy and to make adjustments, as required, during implementation of the strategy.Tool 10. National Integrity and Action Planning meetingsThis refers to bringing together of a broad-based group of stakeholders at meetings or ‘workshops’ to develop an understanding of the types, levels, locations, causes and remedies for corruption.Tool 11. Anti-Corruption Action PlansThese ones should set clear goals, timelines and sequencing for the achievement of specific anti-corruption goals.Tool 12. Strengthening of Local GovernmentsThe tool offers suggestions on how to facilitate vertical and horizontal integration of anti-corruption efforts and to encourage public participation in local government affairs.

Other UN ToolsTool 13: Disclosure of assets and liabilities by public officials.Tool 14: Authority to monitor public sector contracts.Tool 15: Curbing corruption in the procurement process (Providing a number of key principles to be followed to combat corruption in procurement)Tool 16: Results–or fact-based management to increase overall accountability. This makes it more difficult for corruption to thrive. It sets clear goals for achievements and the criteria for assessing if goals have been achieved.Tool 17: Use of positive incentives to improve employee culture and motivation.Tool 18: Access to information (Increasing public access to information is a powerful mechanism of accountability).Tool 19: Mobilizing civil society through public education and awareness raising (Education can empower the public to ‘oversee’ the state and this can contribute to transparency and accountability).Tool 20: Media training and investigative journalism.Tool 21: Social control mechanisms.This is where you have boards comprised of specialized NGOs sitting together with government representatives, giving them a chance to express concerns and needs. Helps to play a bottom-up monitoring role during implementation of reforms and projects.Tool 22: Public Complaints MechanismThis tool makes the point that citizens should be informed about how and where to report corrupt behavior.Tool 23: Customer Service ChartersThese ones set down standards regarding quality, timelines, cost etc that users can reasonably expect and against which performance should be measured. A customer service charter (also known as Client Service Charter defines the standards of services that can be expected in an organisation and the

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complaints procedure where services fall short of the stated standard. (www.ehow/facts 764z049_clients).

APPENDIX 3: COMMUNICATIONS STRATEGY TEMPLATE

Here, in one page, are the Essential Elements to guide your preparation.

1. Review: How have we been communicating in the past?2. Objectives: What do we want our communications to achieve? Are our objectives SMART?3. Audience: Who is our audience? What information do they need to act upon our work?4. Message: What is our message? Do we have one message for multiple audiences or multiple messages for multiple audiences?5. Basket: What kinds of communications “products” will best capture and deliver our messages?6. Channels: How will we promote and disseminate our products? What channels will we use?7. Resources: What kind of budget do we have for this? Will this change in the future? What communications hardware and skills do we have?8. Timing: What is our timeline? Would a staged strategy be the most appropriate? What special events or opportunities might arise? Does the work of like-minded organisations present possible opportunities?9. Brand: Are all of our communications products “on brand”? How can we ensure that we are broadcasting the right message?10. Feedback: Did our communications influence our audiences? How can we assess whether we used the right tools, were on budget and on time, and had any influence?(Source: adapted from WWF. [no year]. International Communications Department. Programme/Project Communications Strategy Template. Available at: http://smap.ew.eea.europa.eu/test1/fol597352/ International_Communications_Strategy_Template.pdf/download)

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http://www.ehow/facts

APPENDIX 4: CHECKLIST FOR COMMUNICATION BRANDING

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Before any of your products are disseminated, you must go through a checklist to ensure that your messages are of high quality and are “on brand”:

• Does your message, in two sentences or less, capture the importance of your work?

• Does your product show your honesty and trustworthiness?

• Does it show, in concrete terms, what you’ve achieved?

• Does it frame your issue and your research within the issue’s broader perspective?

• Does your message inspire? Does it convince an audience of its worth?

• Does it lead an audience to further resources?

Source: adapted from WWF. [no year]. International Communications Department.Programme/ProjectCommunications Strategy Template. Available at: http://smap.ew.eea.europa.eu/test1/fol597352/International_Communications_Strategy_Template.pdf/download

APPENDIX 5: RESOURCES - ORGANISATIONS AND WEBSITES(Adapted from “Successful Communication-A Toolkit for Researchers and Civil Society Organisations” IngieHovland:www.odi.org.uk/resources/download/155.pdf )ActionAid www.actionaid.org.uk Conducted a study of advocacy from 2001-2003, focusing on

empowerment. The early report of this study (on website) contains a model from Ros David (1998), which shows eight ways to influence a minister. Interestingly, one of these is ‘good research’, but the rest all relate to building links and applying political pressure. ActionAid puts strong emphasis on evaluating impact at the level of the end-user in the South, rather than in terms of policy or attitude change in the North.

BOND (British OverseasNGOs for Development)

www.bond.org.uk Guidance notes on advocacy (definition: ‘advocacy is the process of using informationstrategically to change policies that affect the lives of disadvantaged people’), and muchmore.

CDC (Centers for DiseaseControl and Prevention)

www.cdc.gov/communication/cdcynergy.htm

Have developed a tool called CDCynergy. ‘CDCynergy is a multimedia CD-ROM used forplanning, managing, and evaluating public health communication programs. Thisinnovative tool is used to guide and assist users in designing health communicationinterventions within a public health framework.’

CIIR (Catholic Institutefor InternationalRelations)

Catholic Institute for International Relations (CIIR) andInternational Cooperation for Development (ICD): CapacityBuilding for Local NGOs; Guidance Manual for GoodPracticeDownload the free manual in PDF format atwww.ciir.org/Templates/System/Basket.asp?NodeID=91675Also available free of charge on CD-Rom by e-mailingCIIR Publications at [email protected].

This comprehensive manual on capacity building for local NGOs can be used by trainers and development workers or by local NGOs in developing countries as a self-help manual. The manual was developed from practical capacity building work with organisations in Somaliland. It includes examples and exercises for users to work through. It should prove to be a valuable aid to organisations and individuals working in capacity building in developing countries – and to local NGOs seeking guidance on how to effectively set and achieve their objectives.

Citizen Science Toolbox

www.coastal.crc.org.au/toolbox/index.asp

‘Linking communities, scientists and decision-makers. The Citizen Science Toolbox is afree resource of principles and strategies to enhance meaningful stakeholderinvolvement in decision-making.’ List of tools and case studies.

Communication Initiative

www.comminit.com One of the most comprehensive sites on communication for development that exists. Resources, links, information, updates, and much more.

Communication forSocial Change

www.communicationforsocialchange.org

‘Our goal is to build local capacity of people living in poor and marginalised communities to use communication in order to improve their own lives.’ Many interesting publications.

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ConsortiumINTRAC (InternationalNGO Training andResearch Centre)

www.intrac.org Publications and training courses on participatory M&E, advocacy and policy influencing, supporting Southern advocacy, capacity building, strategic thinking, organisational leadership, managing organisational change, civil society strengthening, power and partnerships, impact assessment, and more.

ItrainOnline Knowledge Share Toolkit:http://tinyurl.com/415k3

‘Simple, quick, and proven to be effective methods for providing and promoting open, transparent discussion on topics, issues, activities and projects, and can be effectively used as training/facilitation techniques for workshops.’

NCC (National Council ofChurches), USA

www.ncccusa.org/about/comcompolicies.html#mediaeducation

The Church and the Media (by the Communication Commission of NCC) addresses what congregations might do to focus attention on the interaction of media, justice, violence and the church’s role in communication advocacy and media education.

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