Improving Pharmaceutical Sector Transparency and Accountability. Medicines Transparency Alliance- Ghana. Phase 2. Workplan

Transcription

1 Improving Pharmaceutical Sector Transparency and Accountability Medicines Transparency Alliance- Ghana Phase 2 Workplan Proposal Submitted To International Meta Secretariat December

2 ABBREVIATIONS...3 EXECUTIVE SUMMARY INTRODUCTION NEEDS ASSESSMENT, EXISTING SITUATION OBJECTIVES, GOAL, SPECIFIC OBJECTIVES EXPECTED OUTPUTS STRATEGIES EXPECTED OUTCOME EXPECTED IMPACT HOW WILL THE PROJECT HELP TO IMPROVE TRANSPARENCY & ACCOUNTABILITY? RISKS, EXTERNAL FACTORS MANAGEMENT ARRANGEMENTS FINANCIAL ARRANGEMENTS Administrative and CSO capacity building funding stream (IMS/HAI) Technical support and technical activity funding stream (HAI/WHO) Logical Framework/Workplan table

3 ABBREVIATIONS CMS - CSO - DFID - DTC - Central Medical Stores Civil Society Organization Department for International Development Drugs and Therapeutics Committee FDB - Food and Drugs Board GHS - GNDP - Ghana Health Service Ghana National Drugs Programme HAI - Health Action International IMS International MeTA Secretariat MA - Marketing Authorization MeTA MMB - MOH - MRA - MSH - NFPE - NGO - NHIA - RMS - WHO - Medicines Transparency Alliance MeTA Management Board Ministry of Health Medicines Regulatory Agency Management Sciences for Health Not for Profit Entity Non Governmental Organization National Health Insurance Authority Regional Medical Stores World Health Organization 3

4 EXECUTIVE SUMMARY Medicines are essential to the delivery of health care in any given population. The inadequate supply of medicines has always led to a loss of confidence in the health system. Like many other African countries the pharmaceutical sector in Ghana faces many challenges. Ghana therefore embraced the Medicines Transparency Alliance Initiative which sought to introduce transparency and accountability into the supply chain to improve access to medicines during the pilot phase. The second phase of MeTA was initiated after a successful evaluation of the 2 year pilot in Ghana. Analysis of the Pharmaceutical Sector profile of Ghana indicates several gaps requiring immediate actions: - No legal provisions requiring Marketing Authorization (MA) holders to continuously monitor safety of their products and report to Medicines Regulatory Authority (MRA) - Results of sample testing are not publicly available - No legal / regulatory provisions affecting pricing of medicines - No active national medicines pricing monitoring - No regulations for making retail medicine price information publicly accessible - Availability of key medicines at CMS low at 53% The overall aim of MeTA 2 is to improve governance & management, transparency and accountability in the country s medicines supply chain. The key objectives include: Promoting rational pricing, prescribing, and use of essential medicines and other health commodities to ensure affordability Promoting transparency and value for money in procurement and other supply chain management challenges Encouraging the disclosure of data on the availability, pricing, quality and registration status of medicines on the market Encouraging the engagement of multiple stakeholders in efforts to improve access to medicines Key activities to be undertaken in this phase include the following: Monitoring of prices, availability and quality of a basket of medicines by means of surveys, and studies, interviews with stakeholders etc. Dialogue for policy changes needed as a result of evidence gathered in surveys and studies Engagement of civil society organizations to develop and send the right messages on transparency and accountability to the general public The implementation of MeTA 2 in Ghana is expected to result in a vibrant multistakeholder process in which policy makers, private sector and civil society 4

5 organizations work hand-in-hand to strengthen the supply chain. Comprehensive data will be gathered and analysed to improve information flow and to increase transparency and accountability regarding the availability, pricing and quality of selected medicines and to develop policies to improve access to medicines in a transparent and accountable manner along the supply chain. Active resource mobilization at country level for MeTA activities will also be undertaken. 5

6 1. INTRODUCTION Medicines are essential to the delivery of health care in any given population. The inadequate supply of medicines has always led to a loss of confidence in the health system. Like many other African countries the pharmaceutical sector in Ghana faces many challenges. Ghana therefore embraced the Medicines Transparency Alliance Initiative which sought to introduce transparency and accountability into the supply chain to improve access to medicines during the pilot phase. The second phase of MeTA was initiated after a successful evaluation of the 2 year pilot in Ghana. Ghana MeTA 2 is seeking funding for a four year rolling workplan, starting in the second semester of 2012 from the International MeTA Secretariat. Activities pursued to meet Ghana s MeTA 2 objectives will take account of lessons learned during the MeTA pilot phase and the recommendations made in the evaluation of the MeTA pilot (2010). Background The total population of Ghana in 2009 was 23,837,000 with an annual population growth rate of 2.1%. The annual GDP growth rate in 2009 is 4.7 %. The GDP per capita was US$ 1, Ghana's economy has been strengthened by a quarter century of relatively sound management, a competitive business environment, and sustained reductions in poverty levels. Ghana is well endowed with natural resources and agriculture accounts for roughly one-quarter of GDP and employs more than half of the workforce, mainly small landholders. The services sector accounts for 50% of GDP. Gold and cocoa production and individual remittances are major sources of foreign exchange. Oil production at Ghana's offshore Jubilee field began in mid-december, 2010, and is expected to boost economic growth. In 2009 Ghana signed a three-year Poverty Reduction and Growth Facility with the IMF to improve macroeconomic stability, private sector competitiveness, human resource development, and good governance and civic responsibility 2. Ghana initiated a social health insurance scheme in 2004 to provide financial risk protection against the cost of basic health care for all residents in Ghana. In this scheme individuals who are registered with the scheme received health care and pharmaceutical care services without paying anything out of pocket. There is however a list of health services and pharmaceutical care services that are reimbursible under the national health insurance scheme. Pharmaceutical expenditure in Ghana accounts for about one-third of the total recurrent costs of the Ministry of Health. The National Health Insurance Authority has indicated that 80% of its recurrent cost is for re-imbursement to providers and up 1 World Bank Data (The World Bank) (2009), "World development indicators base", Available online: 2 Index Mundi-Ghana Economy Profile 6

7 to 60% of these costs are for re-imbursement for medicines. The high costs for reimbursements for medicines could be due to irrational use of medicines and wastage through an inefficient supply chain system. Several attempts have been made to improve the supply chain through decentralization from a Central Medical Stores approach to smaller budget management centres such as Regional Medical Stores and even yet small facility budget management centres. Problems of unaffordable medicine prices and substandard medicines still persist. It is hoped that in this second phase of MeTA attention will be paid to the development of a pricing policy and the strengthening of Drugs and Therapeutics Committees to influence prescribing practices and ensuring the availability of good quality efficacious medicines in health facilities. MeTA Ghana s activities during the pilot phase were guided by a two-year workplan agreed by the MeTA Ghana Council and approved by the global MeTA Management Board (MMB). Good progress was made against this workplan, with the majority of planned activities completed. Several workplan activities were undertaken over a longer period than planned, a few were postponed in the course of reprioritisation. MeTA Ghana can point to a number of significant achievements. For example: o An established multi-stakeholder Council, with good representation from both the public and the private sectors and from civil society. The Council met quarterly and maintained three (3) sub-committees that met more frequently. Council members were overseeing specific activities from the MeTA Ghana workplan and/or providing strategic advice to MeTA Ghana Secretariat staff, for instance on media relations and communication. o Completion of the MeTA Ghana baseline disclosure survey and a pharmaceutical sector scan. Other studies were undertaken during the pilot phase, such as the WHO/HAI medicines price component analysis, an incentives audit of wholesalers of medicines in Ghana, and a validation of National Health Insurance Authority (NHIA) data on dispensing practices in Ghana. These data have been disseminated, also through internet. o Expansion of the available data on drug quality in Ghana, through studies conducted by the Food and Drugs Board (FDB) using minilabs and confirmatory testing. The studies were financed by MeTA Ghana and the World Bank (using MeTA funds). The data have been disseminated and/or used. o Development of a CSO network working on MeTA issues, with approximately 100 organizations involved, spread over Ghana s 10 regions. Network members were engaged in community sensitisation efforts on medicines issues, using IEC materials developed by Ghana s MeTA CSO Group in collaboration with the MeTA Ghana Council. o MeTA Ghana as a not-for-profit entity (NFPE) with its own branding and website. The model requires further work to ensure it remains fit for purpose. 7

8 There are clear benefits in terms of MeTA s perceived neutrality and the shared ownership of its agenda by a wide range of stakeholders. 2. NEEDS ASSESSMENT, EXISTING SITUATION Monitoring of prices and availability of essential medicines The Government of Ghana recognizes that ensuring equitable, secure and sustainable access to essential medicines (including vaccines and other health commodities) is a core element of the national health strategy for improving health outcomes of the population. Efforts to improve access continue to face major challenges in a rapidly changing national and international policy environment. In the pursuit of improving access to health care the Government has introduced the National Health Insurance Scheme (NHIS). A key purpose of the NHIS is to share the risk and burden of pharmaceutical and health care costs across the population and therefore, improve equity of access. Medicine prices in Ghana continue to escalate because of the lack of a pricing policy to regulate prices. The objective of Ghana s medicines policy is to ensure the availability of adequate, good quality, safe, effective and affordable pharmaceuticals to all people in Ghana. According to the Pharmaceutical Sector Policy Note (World Bank, 2009), continuing stock-out problems occur due to funding problems, insufficient planning and lack of professional supply chain management skills mainly at the periphery. The available evidence suggests the need to improve availability and affordability of medicines in order to ensure equitable access to basic medical treatments, especially for the poor. Medicine pricing policies and affordability of essential medicines There is no pricing policy for pharmaceuticals in Ghana and as a result, there is no effective enforcement of existing regulation on public sector margins. There is no reliable and documented guidelines and information about margins and mark-ups at different levels in both the public and private sector supply chain systems. For example a 2008 study found that on average, Ghanaian patients pay about three times the international reference price as defined through MSH s Drug Price Indicator Guide. It is envisaged that getting the public, private and civil society organizations engaged in the discussions to disclose and use information generated from the pharmaceutical supply chain through the MeTA council and multistakeholder platform will help address some of the pertinent problems in increasing transparency and accountability in the supply chain and for providing mechanisms for pricing and thus making medicines affordable for Ghanaians. Promoting Rational Use of Medicines Using Drugs and Therapeutics Committees The rational use of medicines is one of the major objectives of Ghana's national medicines policy and interventions introduced to improve the use of medicines have resulted in some gains, although some challenges still remain. An important factor that hinders rational use of medicines is the lack of unbiased objective drug 8

9 information to the wide spectrum of providers. There is the need for focused programmes to tackle the problem in both public and private sectors. The experience show that in Ghana Drugs and Therapeutics Committees (DTCs) have been useful in promoting rational use of medicines where they exist although some discrepancies in the efficiency exist between the northern and southern sectors of the country. Assuring the quality and safety of medicines The quality and safety of essential medicines contribute to the desired health outcomes and this can be a major barrier in access to medicines. The occurrence of poor quality medicines in the health system could result from, shortages of medicines and other medical supplies, poor storage conditions in facilities, inappropriate transportation, inequity in the distribution of pharmacy personnel and the lack of supervision, monitoring, regulation of staff and service delivery. Available reports from the FDB suggest that although not of a high magnitude as pertains in other neighbouring countries of the sub-region, the problem of substandard and counterfeit or fake pharmaceuticals occur in both private and public facilities across Ghana and exposes in particular poor people who buy from unlicensed sellers. Enforcement capacities of the regulatory bodies are inadequate and have partly led to high levels of substandard and counterfeit medicines on the market. It is expected that the collaboration started with the Food and Drugs Board during the pilot phase will be harnessed to survey and/or discuss with relevant stakeholders the problem of counterfeit medicines circulating on the Ghanaian market. Medicines procurement and supply chain management Many players are engaged in medicines procurement and supply in the country. In the public sector a functioning procurement system is established that has resulted in some improvement in procurement procedures, but system challenges in quantification and inventory management still remain high. Findings from recent studies suggest that existing areas that call for improvement include quantification, inventory control management and improving transparency in the supply chain to the maximum extent possible such that information on the tender process and results of tendering are made public. Civil Society Capacity building to effectively involve them in medicines transparency issues. The Ministry of Health, WHO and Health Action International (African Region) have been engaged in multi-stakeholder collaborations over the years. In MeTA Phase 1 a network of civil society organizations were engaged in community sensitisation efforts on medicines issues, using IEC materials developed by Ghana s MeTA CSO Group in collaboration with the MeTA Ghana Council. In 9

10 phase 2, the knowledge, attitudes and practices in the area of medicines will be assessed and training will be provided for them to be able to communicate effectively about access to medicines issues. 3. OBJECTIVES, GOAL, SPECIFIC OBJECTIVES The overall aim of Ghana MeTA 2 is to improve governance & management, transparency and accountability in Ghana s medicines supply chain. Key objectives The key objectives are to: o Promote rational pricing, prescribing, and use of essential medicines and other health commodities to ensure affordability o Promote the availability of quality essential medicines and other health commodities o Promote transparency, accountability and value for in the supply chain o Encourage the disclosure of data on the availability, pricing quality and registration status of medicines on the market o Encourage engagement of multiple stakeholders including civil society organizations in efforts to improve access to medicines 4. EXPECTED OUTPUTS Output 1: Functioning multi-stakeholder groups reviewing data on access to medicines to inform policy change Output 2: Data on medicines availability, prices and quality collected and analysed Output 3: Transparency and accountability instituted in the supply chain Output 4: Civil Society Organization s engaged in transparency issues for access to medicines Output 5: Policy makers engaged in policy dialogue for policy change 10

11 5. STRATEGIES Output 1: Functioning multi-stakeholder groups reviewing data on access to medicines to inform policy change In MeTA Phase 1 a multi-stakeholder platform was created to promote better decision making. The aim was to create trust between the stakeholders to provide solutions for mutual gain for all. Although a lot of data was generated, few of the reports were discussed and most of the recommendations were not implemented. This phase will see an improved level of data generation and discussion and implementation of recommendations. Key Activities Quarterly meetings of Governing council and the subgroups Bi-annual multi-stakeholder forum with media presence Proactive dissemination of existing data (on quality, availability and pricing) NHIA Validation study Private Sector Mapping Level 2 and Household survey Wholesaler incentives study Status of implementation of key recommendations from previous studies In-country Resource mobilization and advocacy development partners Transparency organizations Oil and gas/ mining companies Output 2: Data on medicines availability, prices and quality collected and analysed In this phase of MeTA medicine prices and availability will be monitored across the country and information gathered from the monitoring of prices will be discussed and shared with policy makers with the aim of developing a medicines price policy to improve access to medicines and also to support the National Health insurance in their re-imbursement schemes Key Activities Surveys on medicines prices and availability outsourced to MMAP Consultant Sentinel survey to monitor quality of selected medicines Dialogue with policy makers on findings- MOH, NHIA, FDB etc Development recommendations for medicines pricing policy 11

12 Output 3: Transparency and accountability instituted in the supply chain MeTA phase 2 will be launched in grand style to create awareness and sensitize the general public. MeTA will work in close collaboration with the Ministry of Health Procurement and supply system and also with private and mission sector players to institute transparency and accountability in the supply chain through consensus data disclosure and implementation of recommendations to improve the supply management system for medicines and other health commodities. There is ample evidence to show that drugs and therapeutics committees are useful in promoting rational use of medicines where they exist and promote cost containment mechanisms especially for insurance schemes. Drugs and therapeutics committees in health facilities will be strengthened to monitor Rational Use of Medicine indicators and peer review meetings will be organized for the DTCs to learn from each other. MeTA will work in collaboration with the Ministry of Health and the private sector through their professional associations to promote the rational use of medicines concepts and the training and institutionalization of DTCs as partners to improve prescribing and use of medicines by health workers and consumers. Key Activities Launch of MeTA Phase 2 Reactivation of MeTA Ghana website- Link with IMS website Dissemination of information on surveys on website and in stakeholder fora Quarterly monitoring of rational use of medicine indicators by DTCs Peer Review meetings for DTCs Regular write-ups in media in Agreement with relevant stakeholders Publication of results from surveys in the media in agreement with relevant stakeholders Development of documentaries and fact sheets with continuous engagement with the media Output 4: Civil Society Organization s engaged in transparency issues for access to medicines The National Coalition of NGOs in Health play an important role in the functioning of the health sector. It is important to know the knowledge gaps of a section of its members on access to medicines issues. The Knowledge, attitudes, beliefs and practices study will help identify the basic knowledge gaps about pricing, availability and the quality of medicines. The knowledge on issues of transparency and accountability of the supply chain can also be assessed so that 12

13 the organization can be equipped with the right information to undertake their advocacy role. Key Activities Assessment of CSO capacity needs through a rapid appraisal to identify the knowledge gaps (KAP) Training and capacity building for the Coalition of NGOs in Health of issues related to MeTA Support to CSO s to develop key messages for dissemination Support CSOs to develop key messages for communities, health workers and policy makers Dissemination of key messages to communities, health workers and policy makers Organize CSO meetings with key stakeholders - health workers and policy makers Output 5: Policy makers engaged in policy dialogue for policy change It is important to engage policy makers on issues of access to medicines. Very often it is assumed that policy makers have all the answers to the problems of the society; however when one talks to policy makers it may be observed that they have little information about the problems as we see them. MeTA will engage policy makers at different levels with the data generated and discuss recommendations from the reports to advocate for changes in policy. Key Activities Organize briefing meetings with policy makers (Chief Director) including parliamentary select committee on health Organize briefing meetings with wholesalers and manufacturers on prices and availability Organize briefing meetings with Media, Organize briefing meetings for NHIA, Food and Drugs Board procurement and supply directorate etc. Document actions for policy change agreed or made with policy makers Publish in the media recommendations and agreements made 6. EXPECTED OUTCOME Medicines procurement, pricing, distribution and other policies and practices are changed on the basis of a multi-stakeholder review of robust evidence 13

14 Outcome indicator 1: MeTA council demonstrably uses robust pharmaceutical sector data to monitor and review access to medicines At least one source of data on access to essential medicines reviewed by MeTA council and findings of review documented. Outcome indicator 2: MeTA council demonstrates commitment to principles of transparency through collection, publication and dissemination of robust information on pharmaceutical price and availability Data for outcome indicator milestone verified independently and published in sources available to key stakeholders Outcome indicator 3: Policy makers in MeTA countries in this case Ghana use multi stakeholder policy dialogue recommendations to develop new or review access to medicines policies Review from outcome 1 used to identify new policy requirements or policy amendments. Outcome indicator 4: MeTA Ghana has new or revised policies on access to medicines that are demonstrably informed by robust pharmaceutical sector information and policy research evidence Number of policy changes made based on information from MeTA operations 7. EXPECTED IMPACT Increased availability and affordability of quality assured essential medicines in selected countries 8. HOW WILL THE PROJECT HELP TO IMPROVE TRANSPARENCY & ACCOUNTABILITY? Multi-stakeholder engagement in facilitating a disclosure regime that will enable medicines information to be shared in a way that will establish / increase transparency among relevant stakeholders through discussion within the MeTA Governing Council followed by dissemination of data and related interpretation via the Ghana MeTA website and other communication activities (particularly those undertaken by the Ghana NGO s in health Group). Supporting the development of a pricing policy for the Ministry of health. 14

15 Reducing the threat presented by counterfeit and substandard products in the pharmaceutical supply chain, through multi-stakeholder engagement with the relevant regulatory authorities. Consolidating the multi-stakeholder gains instituted during the MeTA pilot phase and also through the fora to be held twice a year to help fight inefficiency and corruption across the drug supply chain through improved transparency and mutual accountability. Enhancing Ghanaian leadership on medicines transparency and accountability across the African region; this feeds into Ghana s emerging broader regional role on medicines access. It is hoped that Ghana will become a recognised model for both effective pharmaceutical sector governance and market efficiency. 9. RISKS, EXTERNAL FACTORS The implementation of MeTA phase 2 is not without risks and also based on a few assumptions. The following constitute some potential risks and assumptions that could affect the smooth implementation of the phase 2 interventions in Ghana and proposed steps to mitigate them. The latent, mutual suspicion in the pilot phase between the Ministry of Health, civil society organizations and the private sector requires further work. This could be overcome with continuous engagement among the stakeholders. All stakeholders are nervous about change. The change management process must be managed very well with capacity building actions for council members and other identifiable groups. The initiative assumes that enforcement mechanisms exist across the medicines manufacture, import, procurement and distribution systems, but historically enforcement of regulations is weak. This requires commitment and capacity building actions across the chain. MeTA assumes that new coalitions can be forged, but civil society fragmentation and the best ways of achieving meaningful multi-stakeholder alliances need to be addressed. Working with the Ghana Coalition of NGO s in Health as a bigger platform is likely to bring value for money for the CSO work There is an assumption of a degree of commitment to transparency by all stakeholders and a willingness to be mutually accountable. This would require a higher commitment from the members of the Governing council in particular and the stakeholders in general. 15

16 10. MANAGEMENT ARRANGEMENTS a) National multi-stakeholder Forum b) National multi-stakeholder MeTA Council c) Coordination office (2 x 50% fte?) hosted by WHO Ghana Roles & responsibilities National MeTA structure (MeTA Council): A national multi-stakeholder group Core principles of MeTA Planning national implementation Identifying specific country needs, analyse and report on these draft proposal with four year rolling workplan developed to be submitted to the International MeTA Secretariat International MeTA Secretariat (IMS): Informing Ghana MeTA about guidelines, procedures and best practices. Supporting Ghana MeTA with the development of MeTA processes and a country workplan and budget. Technically assessing the proposed workplan and budget, and recommending (full/partial/conditional) approval Enabling money transfer once the workplan has been approved. Encouraging, requesting and receiving regular reporting of MeTA activities. Providing technical assistance (upon request and if feasible/possible). Assisting Ghana with implementation of their workplans and financial reporting to the International MeTA Secretariat (upon request). Providing financial reports of expenditure of MeTA funds Ghana to the IMS and DFID The multi-stakeholder engagement and governance structure for MeTA Ghana with inclusion of the arrangements set up during the pilot phase has been reviewed. Starting 2012 the MeTA Ghana Council has elected a new chair and one deputy chair. The size and composition of the MeTA Council will be proposed, discussed and endorsed by a sitting to precede the submission of the final proposal to the IMS. The MeTA 2 GC will determine whether there is a need to re-establish subcommittees taking into consideration the limited resources at the second phase. The Council determines which accountability structures are required (for instance a small executive committee) in order to meet best management practice norms & standards 16

17 of Not-For-Profit Entities. The Council can also decide on an ad-hoc & evidenced basis, whether to put working groups and/or sub-committees together as and when necessary. The options for engagement of civil society essential to MeTA Ghana s success - will be looked into and the mode decided upon. CSOs representation on the Council ideally will occur through a viable network or alliance of same (a stronger governance focus to complement predominant health sector focus). The Ghana Coalition of NGOs in Health (GCNH; reportedly 500+ members) might be one of the suitable candidates. Commitment of the private sector is indispensable, but that counts for engagement of the public sector (MOH-GHS) as well. As a matter of fact these two stakeholders need to have a balanced representation in MeTA Ghana s governance structure. Secretariat In view of the limited resources coupled with an extended time frame, MeTA 2 Ghana needs to redefine secretarial roles & responsibilities. Staffing will be reasonably less but not at the expense of desired capacity that will ensure efficiency. While the WHO will continue to provide technical support, two officers will be engaged, probably not more than a PT (50%) to coordinate Ghana MeTA 2. The Coordinator (0.5 FTE i.e. two and a half days a week) will serve as MeTA s first point of contact and as external representative, and will manage the delivery of MeTA Ghana s work plan. An administrative assistant (0.5 FTE i.e. two and a half days a week) might need to be added to the Coordinator to support the latter with & in a variety of activities. Among others, the Secretariat will be responsible for buying in services to cover the required accountancy and audit reporting. These services include: o Accountancy (anticipated 8 hours a month spread over two days); o Independent Audit (anticipated 4 hours a month, to check books and files, and attend Administrative Sub-Committee meetings); o Website management services (on average 8 hours a month for routine servicing/website maintenance, plus additional database development work). The WHO Ghana office will host the Secretariat. Potential arrangements will be explored during the transition phase and incorporated in the rolling workplan. 11. FINANCIAL ARRANGEMENTS 17

18 1. Administrative and CSO capacity building funding stream (IMS/HAI) 1.1 Fund management structure MeTA Ghana has a bank account into which all funds transferred for administrative and CSO capacity building purposes will be deposited. Bank accounts would be reconciled on a monthly basis and supervised by the administration sub group. The MeTA Ghana secretariat agrees to use independent external auditors of the funds upon request by the International MeTA Secretariat or DFID. 1.2 Expenditure Expenditure on the MeTA project would be in line with the approved workplan. Expenditure would be backed up with corresponding receipts. Each disbursement will be given a unique reference number. All expenditure would be approved prior to outlay by the Country MeTA Secretariat and records of approvals retained. There will be a dual signatory system to authorize expenditures with alternate signatories to enable activity to continue in the absence of one of the primary signatories. 1.3 Accounting All receipts would be filed securely in a sequential manner. Records would be maintained for all disbursements on the project Records of receipts and disbursements would be made available for inspection and audit if required. The template provided to record all receipts and disbursements of MeTA funds would be used. The MeTA Country Secretariat would carry out periodic reviews of expenditure against work plans as part of the regular progress review of the project. 1.4 Reporting The Country MeTA Secretariat agrees to provide quarterly financial and technical reports according to the reporting format agreed with the IMS (WHO/HAI). The quarterly reports will require the following details summary of actual expenditure for each activity in the work plan against the approved budget as well as a forecast for expected expenditure on the activity for the remaining period. Quarterly expenditure reports from countries will be reviewed by the IMS. If necessary, a detailed list of expenditures as well as copies of bank reconciliations will be requested to provide further evidence/support to the figures reported in the summary report. 18

19 2. Technical support and technical activity funding stream (HAI/WHO) 2.1 Fund management The WHO country office will manage funds for technical support and activities. 2.2 Fund transfer Upon approval of work-plans, WHO Headquarters will proceed with the transfer of funds to the WHO Country Office. 2.3 Expenditure Expenditure on the MeTA project will be in line with the approved workplan. Expenditure will be made to the recipient in accordance with WHO rules and procedures. 2.4 Accounting Accounting will be in accordance with WHO rules and procedures. 2.5 Reporting The WHO Country Office will provide biannual financial and technical reports according to the reporting format agreed with WHO Headquarters. Key Reference Documents 1. Ghana Pharmaceutical Sector Profile (2012) 2. Pharmaceutical Sector Scan Policy Note Pharmaceutical Sector WHO Level 2 and Household Surveys Pharmaceutical Sector Strategic Plan (w.i.p.) 6. Commodity Security Master Plan (2012; w.i.p.) 7. MeTA Ghana pilot evaluation report (2010) 8. MeTA International powerpoint presentation (June 2010) a. Sector Medium Term Development Plan Health Sector Independent Review report DVD s produced to date: malaria, pricing, generics, antibiotics, dispensing 19

20 Annex Logical Framework/Work-plan table ACTIVITIES, DELIVERABLES Output Objective Activity Responsibility Outcome Means of verification 1.Functioning multistakeholder groups reviewing data on access to medicines to inform policy change Functioning MeTA Council to develop and submit annual workplan 1. Develop and submit 1 year work-plan with budget 2. Review composition of MeTA Council 3. Discussion of Surveys undertaken in phase 1 to take recommendations forward in quarterly MeTA Council meetings and MeTA Forums GC Chair and Deputy MeTA councils produce an annual work-plan approved by the International Secretariat Quarterly Council meetings and biannual MeTA forums Meeting minutes Work-plan document Stakeholder interest GC, IMS 2. Data on medicines availability, prices and quality collected and analysed Obtain data on procurement, availability, price and quality of selected medicines. 1. Governing Council agree on 20 to 30 tracer medicines that will be monitored over time based on relevant selection criteria such as top GC MMAP Study Protocol Meeting minutes Public sector Private Sector Mission sector CSO 20

21 diseases, high volume and high prices. 2. Endorse MMAP tools for monitoring medicines on price, availability and quality 3. Development of medicine pricing policy 2.1 This will b edone in Yr 2 Data generation on medicines quality in collaboration with the Food and Drugs Board 1. Monitoring of medicines quality using sample of tracer medicines at sentinel sites MeTA secretariat, Food and Drugs Board Report on Quality monitoring studies GC Meeting minutes, Study Protocol Public sector Private Sector Mission sector CSO 3.Transparency and accountability instituted in the supply chain Awareness and sensitization of the General Public 1. Launch of MeTA phase 2 IMS, GC, Coordinator and secretariat MeTA PHASE 2 Launched Launching Report Sensitization and awareness creation Strengthening of DTCs to provide information on rational use of medicines 1. Quarterly monitoring of rational use of medicine indicators 2. Peer Review meetings for DTCs GC, Technical sub group Report on number of facilities with functional DTCs Reports Public sector Private Sector Mission sector CSO 3.1 Disseminate results and Increase awareness on availability and affordability of medicines 1. Develop and disseminate fact sheets about pricing availability and rational use of MeTA Secretariat MMAP Study Coordinator MeTA Website active and regularly updated Information from reports Reports. Web site update Public sector Private Sector Mission sector CSO 21

22 medicines in media and to stakeholders 2. Maintenance and update of website with current information from surveys and messages developed disseminated using appropriate messages and methods to stakeholders 4. Civil Society Organization s engaged in transparency issues for access to medicines Assess civil society capacity needs in the area of providing information on medicines 1. CSO capacity needs assessment on knowledge, attitudes and practices of medicines use 2. Training In gaps identified 3. Development of key messages for dissemination by CSOs GC Coordinator and Coalition of NGOs in health Capacity of CSOs to contribute fully to workplan implementation. Reports Public sector Private Sector Mission sector CSO 5. Policy makers engaged in policy dialogue for policy change Engage policy makers in issues of transparency and accountability in access to medicines 1. Briefing meetings with: NHIA, FDB, manufacturers, wholesalers and retailers, Chief Director of MOH, Parliamentary Select committee on health on results from surveys on price and availability and on quality of medicines 2. Document actions for policy change agreed GC, coordinator and advocacy subgroup Review and changes in policies based on improving access to medicines in a transparent and accountable manner Meeting minutes Number of policy recommendations based on dialogue with policy makers Public, private sectors, Policy makers and general public 22

23 with policy makers 3. Publish in media recommendations and agreements made with policy makers 23

24 ACTIVITY WORK PLAN WORK PLAN MeTA Ghana Activities Detail Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Comments Operating the secretariat Council meetings Stakeholder meetings Engagement of Civil Society coalition in transparency, accountability and access to medicines issues Conduct Medicines Availability and pricing Surveys Needs Assessment and Training of CSOs in transparency, accountability and on access to medicines issues Set up Office Activate and Update Website Bi-annual Publications Launch of MeTA phase 2 Venue and refreshments Venue Refreshments and T&T National Multi-Stakeholder Meetings for CSOs on issues of access, transparency and accountability Endorse MMAP tools for medicines availability & pricing Share & Discuss MMAP survey results Dialogue with Policy Makers on MMAP results CSO Needs Assessment on knowledge, attitudes and practices of medicines use Training of CSO Coalition Group in Gaps identified Periodic dissemination of information gathered 24

25 Development of key messages for dissemination by CSOs to communities Development of pricing policy TWG meetings Consensus building Dissemination Strengthening of Drugs and Therapeutics Committees Survey at sentinel sites for medicines quality evaluation Policy Dialogue on access to medicines. Dissemination Monitoring of RUM indicators additional Peer Review Meetings fundraising from NHIA, WHO other partners Evaluation of medicines In collaboration quality with FDB Engagement of policy makers Documentation of recommendations/policy changes Publications in media 25

26 COUNTRY LOGFRAME IN LINE WITH GLOBAL LOGFRAME NO Global Log. Output Ref Output Output indicator Outcome Target (2015) Means of Verification 1 1 Functioning multistakeholder group on access to medicines 2 4 Capacity of Civil Society strengthened to support improvements in transparency and accountability in access to medicines 3 2. Discuss innovative MMAP survey reports on medicine availability and prices 4 3 Strengthen Drugs and Therapeutic Committees to undertake RUM activities in health facilities No. of stakeholder meetings held No. of CSO engagement meetings No. of reports discussed Number of facility DTCs institutionalized and functional MeTA council demonstrably uses robust pharmaceutical sector data to inform policy CSO participation in community monitoring & sensitization on access to medicines Reports used to inform policy Rational prescribing and cost savings on medicines to patients improved At least 12 meetings Minutes/ reports of meetings At least 7 sensitization and advocacy activities Reports of engagements, no. of participants 12 reports Minutes reports; evidence of discussion All regional and district hospitals DTCs in operation and institutionalized and functional Reports Impact Increased availability and affordability of quality assured essential medicines in Ghana. Increased sensitization & monitoring of community medicines prices availability and use by CSOs Increased reporting and discussion on availability and prices of medicines Peer training and practice for improved medicines use and cost benefit to patients Assumptions Stakeholder commitment to process available Additional fundraising by CSOs MMAP survey reports and technical support Additional fundraising through MOH and other partners 26

27 NO Global Log. Output Ref Output Output indicator Outcome Target (2015) Means of Verification 5 2, 3 Public dissemination of information from MeTA surveys on prices, availability and quality of medicines MeTA website updates, Talk shows, print media (newspaper articles) Public awareness medicines prices, availability and quality and rational use of medicines MeTA website plus at least 20 media houses reached Recordings of talk shows, radio spots, Monitoring reports Impact Increased public awareness on access to medicines issues Assumptions Additional fundraising from other sources 6 5 Increased multistakeholder engagement on medicines transparency and accountability Number of engagements with policy makers, wholesalers, retailers, NHIA and the Chief Director s office as well as with Development partners Policy makers in Ghana use multi stakeholder policy dialogue recommendations to develop new or review access to medicines policies At least one additional policy recommendation drafted in Ghana with the contribution of MeTA. Reports Increased availability and affordability of quality assured essential medicines in Ghana 27

28 Annex 2 1. Name of Coordinator and contact details Ms Gertrude Dorcas Laryea C/O Maamobi Polyclinic Ghana Health Service Tel: ; gertrudelaryea@gmail.com 2. Name of the MeTA entity submitting the proposal MeTA Ghana c/o WHO Ghana 3. List of participating stakeholders in multi-stakeholder forum, preferably with , mobile, telephone and fax To be inserted 28