Medicines Transparency Alliance in Ghana

Dr Alex Dodoo, Ph.D., MPSGH, MRPharmS, FPCPharm

Co-Chair, MeTA Ghana

What is the Medicines Transparency Alliance (MeTA)

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Outline

• Background and Concept• Problems of Access To Medicines• Why MeTA• Purpose and Strategies• Motivations for MeTA Stakeholders

09/04/23 MeTA @ Health Summit

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What is MeTA

• MeTA is an international initiative that aims to increase transparency in the registration, procurement, distribution and sales of essential medicines in developing countries

• Born out of lessons learnt from EITI (Extractive Industries Transparency Initiative)

– The principal international partners are:• UK Department for International Development (DFID)• The World Health Organization (WHO)• The Health Action International (HAI)• The World Bank

09/04/23 MeTA @ Health Summit

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The Problem• Essential medicines may be too expensive for

some people or a segment of the population• Good quality medicines are often unavailable• Excessive mark-ups in both the public and

private sectors• Perceived fraud and corruption within the

medicine supply chain• Poor management

Manufacturer Procurement Agent (s)

Wholesaler Distributor Retailer / health unit

Patient

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Why is this happening?• Market issues:

– Information asymmetries– Weak signalling from market

to producer– Imperfect competition– Collusion

• Governance issues– Procurement efficiency– Effective regulatory systems-

e.g. counterfeit medicines– Fragmented supply and

distribution systems– Perceived ‘rent seeking

behaviours’

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Patent

R&D and clinical trials

Manufacturing

Pricing

Distribution

Registration

Selection

Procurement & import

Promotion

Inspection

Conflict of interest

Evergreening

Counterfeit/substandards

Tax evasion

Falsification of safety/Efficacy data

Bribery

State/regulatory capture

Overinvoicing

Pressure

Unethicalpromotion

Thefts

Fraud

Cartels

Collusion

Unethicaldonations

The Players in the Medicine Field

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Purpose of MeTA

• To build transparency and accountability • To increase access to good quality affordable

medicines• To tackle …corruption and mismanagement • To work with all stakeholders – public, private and non-

governmental • To proactively engage civil society and the private

sector

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MeTA StrategyAdvocacy

Training

Research

Partnerships

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Ghana Drug Access Problem Ratio

Quality

40%

Accessibility

20%

Aff ordability

40%

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Characteristics Of Ghana’s Pharmaceutical Market

• 80% of products imported • Few local manufacturers - generics and producing under-

capacity• Big Pharma involved only in sales

– No manufacturing or drug development by big Pharma

• State system for medicine procurement for public sector use

• National Drug Policy, Standard Treatment Guidelines and NHIML to guide drug selection, procurement and reimbursements

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Key Challenges in enhancing Access1

Benefits of improved procurement are not translating into affordability and availability for patients (e.g. 2004 WHO/HAI Medicines Survey);

Slow progress of some key health indicators– i.e. Infant and child mortality, incidence of malaria and maternal health;

Low consumer awareness due to very little information on quality, availability and prices of medicines is available in the public domain,

Inconsistency across the public, private and mission sectors in terms of how standards (i.e. quality, availability and pricing) are developed and applied;

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Key Challenges in enhancing Access to Medicines 2

Non-adherence to treatment guidelines by prescribers and irrational use of medicines by providers persists despite improved guidance and education;

Supply chain performance problems from CMS downstream leading to high stock-out rate;

Vulnerability of NHIS to fraud due to inefficient record keeping and analysis

Counterfeit and/or substandard products

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MeTA Ghana pilot objectives Establishing mechanisms to strengthen the collection,

analysis and dissemination of data on medicines along the supply chain;

Facilitating peer oversight systems within and across health professions

Sustaining regular, open stakeholder dialogue; Developing long-term strategy or ‘master plan’ for MeTA in

Ghana.

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Strategies 1

Undertake studies to assess the level of transparency and accountability in medicines regulation, procurement, distribution and use.

Regular monitoring of medicine prices and availability as well as their rational use using WHO standard indicators.

Regular monitoring of medicines quality through sentinel testing using GPHF ‘minilabs’.

Publicize widely data on prices paid at various points along the supply chain, including those agreed at public tender.

Correlate procurement data to stock volumes and the availability of medicines to the consumer.

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Strategies 2

Undertake periodic annual studies to understand and/or explain provider and consumer behaviour.

Enhance role of chemical sellers in ensuring medicines availability, affordability and rational use through regulation, training and efficient monitoring.

Enhance capacity of CSOs & Media to empower them play more active role in medicines advocacy

Facilitate agreement by pharmaceutical companies to publicize their supply prices to match tender data.

Undertake periodic studies on policies concerning ethical promotion of medicines.

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Potential Benefits of MeTA to Ghana

Share good practices with other MeTA pilot countries Provide Ghanaian leadership on medicines transparency and

accountability across the West Africa region as model for both effective governance and market efficiency.

Provides opportunity for pricing and quality monitoring mechanism to inform the NHIS

Reduce and/or eliminate the risk of counterfeit and substandard medication in the supply chain.

Opportunity for enhanced national research capacity. Provides potential mechanism for government commitment to fight

inefficiency and corruption in the drug supply landscape.

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Risks and assumptions Mutual suspicions between government and private sector; All stakeholders nervous about change; Where are the enforcement mechanisms across the system?

Enforcement of regulations is weak. Civil society fragmentation needs to be addressed; assume that

new coalitions can be forged. Need to assume a degree of commitment to transparency by all

stakeholders and willingness to be mutually accountable. Timeliness and sustainability of financing. Need to ensure plans are realistic for pilot phase - not ‘over-

ambitious’.

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MeTA structures in Ghana MeTA Secretariat

• Will be hosted by MoH initially• Seeking office space

MeTA Annual Stakeholder Forum Larger workshop, broader representation; To report on progress, share data.

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MeTA structures in Ghana MeTA Governing Council:

Public sector: Ministry of Health, National Health Insurance Council, Ghana Health Services, Food and Drugs Board, Ministry of Trade, Attorney Generals’ Department, Ministry of Finance;

Professional bodies: Pharmaceutical Society of Ghana, Ghana Medical Association, Nurses and Midwives Council;

Civil society: CSOs (health and non-health), media, academic institutions, faith-based service providers.

Private sector: Pharmaceutical Manufacturers Association of Ghana, Association of Private Medical and Dental Practitioners

International community: World Health Organization, DFID/World Bank/HAI/Other Development Partners Representative.

Meets quarterly, with first meeting after national launch. Two co-chairs

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Inputs of Governing Council Oversee the activities of the initial phase of

MeTA in Ghana Scrutinizing data collected/disclosed on medicine

quality, price and availability Discuss what is revealed by data collected Make recommendations and follow up actions based

on data assessment Coordinate data disclosure and other MeTA activities

in country Agreeing progress reports and lessons to be shared

with other MeTA pilot countries and the international MeTA Forum