Challenges of Multi-stakeholder processes: the experience of the Medicines Transparency Alliance

Andrew Chetley

Communication and Capacity Strengthening Director

International MeTA Secretariat

18 June 2009, Tracing Pharmaceuticals in South Asia: Dissemination Workshop, Edinburgh

Medicines Transparency Alliance (MeTA): The challenges of multi-stakeholder working

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Outline

What’s an MSP? What’s a MeTA? Why is MeTA an MSP? What’s new in all of this? What has MeTA learned? What are the big challenges? Will this help poor people access medicines?

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What’s an MSP?

Multi-stakeholder process/initiative/approach Brings all those with an interest in or who will be

affected by an issue into a new form of communication, decision finding (and maybe decision making)

3 or more stakeholder groups Transparency, accountability, participation,

equity, dialogue

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Why an MSP?

To deal with complex issues Useful where there are “governance gaps” Where “steer and negotiate” is needed Where movement has been bogged down To facilitate negotiation, broaden participation, share

knowledge Correct market failures Identify global public needs

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What’s a MeTA? International alliance: DFID, WHO, World Bank (plus 7 pilot countries: Peru, Ghana, Uganda, Zambia, Jordan,

Kyrgyzstan, the Philippines)

Test the hypothesis that multi-stakeholder dialogue will develop creative solutions to problems of access to medicines

Country-led, focus on disclosure of information in 4 broad areas: Price, Quality, Availability, Promotion.

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Why? Complexity of medicines supply…

Contra-ceptives and

RHequipment

STIDrugs

EssentialDrugs

Vaccinesand

Vitamin ATB/Leprosy

BloodSafety

Reagents(inc. HIV

tests)

DFID

KfW

UNICEF

JICA

GOK, WB/IDA

Source offunds for

commodities

CommodityType

(colour coded) MOHEquip-ment

Point of firstwarehousing KEMSA Central Warehouse

KEMSARegionalDepots

Organizationresponsible

for delivery todistrict levels

KEMSA and KEMSA Regional Depots (essential drugs, malaria drugs,

consumable supplies)

ProcurementAgent/Body

CrownAgents

Governmentof Kenya

GOK

GTZ(procurement

implementationunit)

JSI/DELIVER/KEMSA LogisticsManagement Unit (contraceptives,

condoms, STI kits, HIV test kits, TBdrugs, RH equipment etc)

EU

KfW

UNICEF

KEPI ColdStore

KEPI(vaccines

andvitamin A)

Malaria

USAID

USAID

UNFPA

EUROPA

Condomsfor STI/

HIV/AIDSprevention

CIDA

UNFPA

USGov

CDC

NPHLS store

MEDS(to Missionfacilities)

PrivateDrug

Source

GDF

Government

NGO/Private

Bilateral Donor

Multilateral Donor

World Bank Loan

Organization Key

JapanesePrivate

Company

WHO

GAVI

SIDA

NLTP(TB/

Leprosydrugs

Commodity Logistics System in Kenya (as of July 2006) Constructed and produced by Steve Kinzett, JSI/Kenya - please communicateany inaccuracies to skinzett@cb.jsikenya.com or telephone 2727210

Anti-RetroVirals

(ARVs)

Labor-atorysupp-lies

GlobalFund forAIDS, TB

and Malaria

PSCMC(CrownAgents,GTZ, JSI

and KEMSA)

BTC

MEDS

DANIDA

Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,Dispensaries come up and collect from the District level

MEDS

Provincial andDistrictHospital

LaboratoryStaff

Organizationresponsible fordelivery to sub-district levels

KNCV

MSF

MSF

JSI/DELIVER

KEMSA

JSI

WHO

Source: SSDS Inc for the World Bank

innovation new and different voices

equity

dynamic dialogues

transformation

different perspectives

problem solving

mutual accountability

changing business practice

social justice

new partnerships

transparency

… and more complexity

What’s new about MeTA?

“Learning to engage in dialogue means to move from hearing to listening.”

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Lessons from MeTA

Right mix Enough time Clear aim and approach Sufficient resources Facilitation Learning and flexibility

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Challenges

Will mutual accountability flow? Will civil society have a strong voice? Will the private sector engage? Will governments let go of some control? Is there a clear outcome, or only gradual change over

time that might have happened anyway? (What can we measure?)

Can everyone win?

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Will poor people in these countries have greater access to medicines?

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info@metasecretariat.org www.MedicinesTransparency.org