MEDICINES TRANSPARENCY ALLIANCE GHANA WORKING TOGETHER FOR BETTER ACCESS TO MEDICINES

Transcription

1 MEDICINES TRANSPARENCY ALLIANCE GHANA WORKING TOGETHER FOR BETTER ACCESS TO MEDICINES

2 Medicines Transparency Alliance Our challenges Over the last decade, there have been advances in drug management and use and in broadening access to healthcare in Ghana. However, there are still significant levels of disease, and quality healthcare remains out of reach for many. Medicines are still largely paid for out of pocket, and not all are covered by health insurance. Rational drug use or patients taking the right medicine, for the right condition, at the right dose for the right period of time, at the right cost, with the right information has been a key concern in Ghana for many years. There have not been effective policies on the financing and pricing of medicines. 2

3 GHANA Our response The Medicines Transparency Alliance (MeTA) began as a pilot in Ghana in The programme aimed to contribute to good governance, transparency and accountability across the medicines supply chain, through the engagement of all stakeholders with an interest in access to medicines. MeTA Ghana is a registered body with a constitution. Its highest decision-making body is a governing council, which is made up of 20 representatives of government, civil society and private sector agencies. The governing council oversees the work of an advocacy subgroup, a technical subgroup, and an administrative subgroup made up of members from government, the private sector, civil society and cooperating partners. The council, which meets quarterly, oversees the implementation of the work plan and monitors the performance of the national secretariat. Ghana is one of seven countries to adopt MeTA. The programme is also active in Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia. It is currently funded by the UK Government through the Department for International Development (DFID). Our achievements Creating a platform for multi-stakeholder dialogue on access to medicines, medicines quality, medicines prices, transparency and good governance of pharmaceuticals. Contributing to the formulation of a strong and effective medicines pricing policy. Ensuring that governance measures were included in Ghana s national medicines policy for the first time. Supporting efforts to remove taxes on imported raw pharmaceutical products. Building the capacity of medicines and therapeutic committees. Developing tools to help civil society organizations become better informed about issues around access to medicines, transparency and accountability. 3

4 Medicines Transparency Alliance Our journey Forming an alliance of stakeholders The establishment of MeTA in Ghana has marked the first time stakeholders from the public sector, the private sector and civil society have worked together on pharmaceutical issues. Representatives of each sector with technical expertise in pharmaceuticals, have come together via MeTA s national governing council. The governing council considers proposals from the MeTA technical subgroup, which is chaired by a WHO representative. The council debates the proposals and makes decisions on recommendations to be made to the Ministry of Health. If the council decides that the subgroup had proposed a programme that needed to be implemented, then the green light would be given for the subgroup to plan the programme and proceed, says MeTA Ghana Chairman and president of the Society of Private Medical and Dental Practitioners, Isaac Morrison. MeTA holds regular forums involving a broader group of stakeholders and the media, which allow it to reach a wider audience. Dr Morrison says the multi-stakeholder structure of MeTA has forced the sectors to work towards consensus. All the key players have various approaches to achieving the same objectives, he says. The stakeholder engagement brought civil society organizations, academia, the Ministry of Health and the private sector together, so that we could make trade-offs in our various entrenched positions and move forward. MeTA has helped introduce the idea of good governance into mainstream essential healthcare issues. The structure of MeTA has brought rigour to its policy recommendations, says the coordinator of MeTA Ghana, Brian Asare. The policy recommendations of the technical subcommittee are checked by the technical and stakeholder expertise of the national council, he says. MeTA has gained a reputation as a trusted ally of public health policy. It s like the Ministry of Health has an ally in MeTA a partner for developing policy, says Mr Asare. Because of the multi-stakeholder nature of MeTA, it is perceived not to have a conflict of interest when it is developing policy. 4

5 GHANA Strengthening policy and improving pricing MeTA has been closely involved in the Ministry of Health s revision of the national medicines policy. MeTA was given a position on the policy development committee and was represented by its chairman. Several stakeholder organizations of MeTA also sat on the committee. Brian Asare says MeTA recommendations particularly influenced the pricing section of the policy, which had not been very detailed in previous editions. MeTA s recommendations included different strategies for the pricing of high-volume medicines and for products under patent. The strategies recognized that negotiating prices too low can have an effect on the supply of medicines, by discouraging manufactures from producing, and suppliers from supplying. MeTA recommended that an official pricing technical committee be established, with broad stakeholder representation to enhance accountability and transparency. MeTA led some of the technical sessions to develop the implementation plan for the entire policy, and also developed a plan to implement the policies on pricing and the policy on transparency and accountability. For the first time, this country has produced a medicines policy that deals with this new issue of governance, says Dr Morrison, about the new third edition of the policy. The MeTA approach meant all stakeholders already had some buy-in by the time the policy went to government. Because the governing council is made up of the key stakeholder agencies, concerns about the policy have already been built in to the process, says Mr Asare. So by the time the document reaches the government for approval, there is not much resistance. MeTA has also been involved in the national selection of medicines for the Ghana list of essential medicines, and has contributed to the evaluation of applications from pharmaceutical companies for inclusion on the list. Addressing taxes on medicines In 2014, the Government of Ghana introduced a value added tax (VAT) on imported raw pharmaceutical materials of 17.5%. This lifted production costs for the local industry. Medicine prices for locally produced medicines were suddenly out of the reach of the ordinary person, says Dr Morrison. Domestic producers began to face competition from cheaper imports. In the face of growing concerns, the MeTA governing council agreed to support its members, the Pharmaceutical Manufacturers Association of Ghana and the Pharmaceutical Society of Ghana, to lobby a parliamentary subcommittee to reverse the tax. MeTA raised awareness of the consequences of the policy through high-level forums, which brought together the Minister of Health and the parliamentary subcommittee chairman for health, senior health officials and key sectors of civil society. Brian Asare says MeTA worked strategically, in collaboration with other stakeholders. Having officials engaging directly with the public and all stakeholders in the pharmaceutical sector, gave the issue the necessary weight needed to push it forward, he says. The government accepted the proposal, and in the 2015 budget included measures to exempt some active pharmaceutical ingredients from VAT. MeTA is planning to monitor the impact of the VAT changes on medicine prices. 5

6 Medicines Transparency Alliance Ensuring rational use of medicines Ghana has policies in place on the rational use of medicines, to ensure that patients get the right medicine, for the right condition, at the right dose for the right period of time, at the right cost, with the right information. These polices require health facilities to have medicines and therapeutic committees (MTCs), which are responsible for ensuring the implementation of therapeutic protocols and guidelines, such as standard treatment guidelines. In collaboration with Ghana Health Services, which is responsible for implementing health policies primarily in service delivery, MeTA conducted a baseline assessment to analyse how MTCs were functioning. The subsequent report was shared with the MeTA governing council together with recommendations. The MeTA council accepted the report and the recommendations for implementation, and has used these findings to build the case for investment in MTCs. It was agreed that if we are to improve access to medicines, we must improve rational use of medicines, says Dr Morrison. As a result of the assessment, MeTA saw an opportunity to strengthen the capacity of existing MTCs, and establish committees where they didn t exist. It is establishing a peer-review process between functional and non-functional committees and monitoring their progress. MeTA private sector representative, Doris Attafua, from Vicdoris Pharmaceuticals says MeTA s baseline assessment has had a positive influence on the management of the MTCs. It found in some facilities, a high proportion of patients were receiving more than one antibiotic at a time, she says. MeTA s work on MTCs has increased the emphasis on encouraging prescribers to be more careful about prescribing more than one medicine at once. 6

7 GHANA Building civil society capability and advocacy The MeTA governing council has recognized civil society s value in advocating for access to medicines, transparency and accountability in the supply chain for pharmaceuticals, and also that civil society needs support to navigate the complex field. Mr Asare says MeTA has sought to help build the capacity of stakeholders to be able to advocate from an informed position. MeTA assessed civil society organizations knowledge, attitudes, beliefs and practices on access to medicines, medicines governance and transparency. The range of views assessed included those on rational selection and availability of medicines; affordable medicine prices and sustainable financing of medicines; reliable health systems and supply of medicines of acceptable quality; rational use of medicines and promotion of pharmaceuticals and transparency. MeTA identified the gaps where civil society s knowledge was lacking and has sought to build capacity by developing a training manual for civil society organizations on access to medicines and regular public forums. MeTA has really helped advance the ideals of good governance and accountability in Ghana, says Dr Morrison. It has helped shift the attitudes of most of the MeTA members. Most are well placed or have the potential to ascend to high positions of authority within their governance structures, and I m sure that whatever they have learnt, they should be able to make that impact in whichever sphere or endeavor they work in. The ideals and the virtues of MeTA are not going to die out. MeTA has also established an up-to-date and well-resourced website for the use of stakeholders and the media. MeTA promotes transparency, says Mr Asare. So it s important that MeTA itself is also transparent. 7

8 Medicines Transparency Alliance What we ve learned Stakeholder interests and vested positions can be abandoned in the presence of robust evidence in a multi-stakeholder process. Building trust and cooperation between civil society, the private sector and government leads to strong and efficient policy-making. Gaps in knowledge are quickly highlighted when everyone is around the same table. The multi-stakeholder approach improves transparency. Well-informed stakeholders are better able to hold decision-makers to account. Sustainable change is more likely when all sectors have a stake in a policy. Key to how MeTA has worked Robust evidence gathered and analysed Dissemination of evidence and multi-stakeholder dialogue Policy or practice recommendations Action Advocacy and awareness raising MeTA s contribution to medicines pricing policy MeTA s technical subgroup gathered and analysed robust evidence. The subgroup submitted draft recommendations to the governing council. The governing council approved recommendations on medicines pricing, and submitted them to the national medicines policy process. The Ministry of Health revised the policy in line with MeTA recommendations. 8

9 GHANA MeTA s contribution to policy on transparency and good governance MeTA s technical subgroup gathered evidence on the need for transparency. A public forum on transparency, accountability and good governance was held with high-level political participation, and input was gathered from stakeholders. The MeTA technical subgroup drafted recommendations and submitted them to the governing council for consideration. The governing council approved the recommendations and submitted them to the national medicines policy process. The Ministry of Health revised the national medicines policy in line with MeTA recommendations. Training on transparency and good governance was delivered with technical support from WHO. MeTA s contribution to supporting the removal of VAT on imported raw pharmaceutical products The Pharmaceutical Manufacturers Association of Ghana and the Pharmaceutical Society of Ghana made a submission to the Ministry of Health advocating for the removal of VAT on pharmaceutical manufacturing inputs. MeTA s technical subgroup analysed the data on the impact of VAT on medicines prices in Ghana. The MeTA governing council debated the Pharmaceutical Society s proposal and the technical subgroup s analysis and agreed to support advocacy on removing the VAT. MeTA presented evidence on the impact of the VAT to a multi-stakeholder forum with high level political participation to encourage evidence-informed consensus building, and argues the case for reducing medicine prices. MeTA recommended removing the VAT on essential medicines. The government agreed to exempt some ingredients from the VAT. 9

10 Medicines Transparency Alliance MeTA s contribution to building the capacity of medicines and therapeutic committees In collaboration with Ghana Health Services, MeTA s technical subgroup conducted a baseline assessment to analyse how MTCs were functioning. The subgroup disseminated the report to the MeTA governing council. The governing council recommended that objectives should be set for improving MTCs and building their capacity. The subgroup implemented the objectives and recommendations from baseline assessment of MTCs. MeTA used the baseline assessment to build the case for investment in the sustainability of MTCs. MeTA s contribution to building civil society organizations capacity The MeTA technical subgroup conducted an assessment of civil society s knowledge, attitudes, beliefs and practices on access to medicines issues. The subgroup submitted the work and recommendations to the MeTA governing council. MeTA created a training manual for civil society organizations on access to medicines and related issues. MeTA held regular public forums with civil society organizations to raise awareness of access to medicines issues, including transparency and accountability. 10

11 GHANA MeTA Ghana members Government Mrs Martha Gyansa Lutterodt, MeTA Ghana Deputy Chairperson; Director, Pharmaceutical Service, Ministry of Health Ms Edith Gavor, Ghana National Drugs Programme Dr Lydia Dsane-Selby, National Health Insurance Authority Mr Samuel Boateng, Procurement and Supply, Ministry of Health Mr Brian Asare, MeTA Coordinator Civil society Mr Charles Allotey, Health Access Network Mr Kenneth Wujangi, Ghana Coalition of NGOs In Health Dr Kwabena Adusei Poku, Ghana Medical Association Academia Dr Daniel Kojo Arhinful, Noguchi Memorial Institute of Medical Research Professor Alex Nii Otoo Dodoo, MeTA Admin Subgroup Chairman; Associate Professor, Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School Professor Alexander Nyarko, Noguchi Memorial Institute Of Medical Research Professor David Ofori-Adjei, Ghana College of Physicians and Surgeons Mr Philip Anum, Ghana College of Pharmacists Private sector Mrs Doris Attafua, Vicdoris Pharmaceuticals Mr Moses Sasraku, Licensed Chemical Sellers Association Dr Paul A. Lartey, LaGray Chemical Company Dr Isaac C.N. Morrison, MeTA Ghana Chairman; President, Society of Private Medical and Dental Practitioners Mr Ted L. Bernasko, Pharmaceutical Society of Ghana; Pharmaceutical Wholesalers Association Partner agencies Mrs Edith Andrews Annan, MeTA Ghana Technical and Advocacy Subgroup Chairperson; WHO Ghana Country Office WHO/EMP/PAU/ World Health Organization 2016 Requests for permission to reproduce or translate WHO publications whether for sale or for non-commercial distribution should be addressed to WHO Press through the WHO website ( The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Photos: WHO/Naoki Takyo. Design and layout: L IV Com Sàrl, Villars-sous-Yens, Switzerland. Printed by the WHO Document Production Services, Geneva, Switzerland. 11

12 GHANA MEDICINES TRANSPARENCY ALLIANCE The Medicines Transparency Alliance (MeTA) initiative is grounded in the theory that shining a light on an often opaque system will illuminate problems, improve efficiencies and empower stakeholders to hold decision makers accountable. The hypothesis is that making information transparent and bringing stakeholders together to discuss it will improve access to quality medicines for those who need them. The global initiative began as a pilot in 2008 in seven countries, with the aim of establishing the multi-stakeholder platforms and collecting baseline data. The current phase, Phase 2, has focussed on making information transparent and using evidence to make policy recommendations. This document is one in a series of brochures that has been produced to share the highlights from the first three years of the second phase of the MeTA programme in each of the seven countries. The project has been funded by the UK Department for International Development. WHO, in collaboration with Health Action International, has managed the global programme and provided in-country support. As Phase 2 comes to an end in 2015, countries are considering options for long-term programme sustainability. To contribute, to get involved or for more information, contact: Dr Owen Laws Kaluwa WHO Country Office Ghana kaluwao@who.int who-country-office-ghana Abayneh Desta WHO Regional Office for Africa Republic of Congo destaa@who.int Gilles Forte WHO Essential Medicines and Health Products Department Switzerland forteg@who.int