Medicines Transparency Alliance (MeTA)

JORDAN

Dr Taher Abu El SamenChairman, MeTA Council & Secretary General, High Health Council

World Health AssemblyGeneva, 19 May 2009

JORDAN

• Population: 5.8 million

• GNI per capita: $2,850 US (2007)

• Health expenditure 10.4 % of GDP (30% of this spent on medicines)

• Total Medicine Expenditure $ 338 Million

25% Medicine expenditure/ public sector 75% Medicine expenditure/ private sector

• Number of local medicines manufacturers: 16

• Medicines expenditure growth 17% per annum compared to GDP growth of 3.3%

Positive Steps Towards Transparency

In the last few years the Jordanian government took positive steps to contain cost, improve quality, efficiency and transparency of medicines supply chain:

Enforcing role of High Health Council Drug & Pharmacy Law (2001) Adoption of NDP (2002) Establishing JFDA (2003) Establishing Joint Procurement Directorate (2004) Establishing a Rational Drug Unit (RDU) within

JFDA (2005)

Reasons for Jordan to be

one of the MeTA pilot country 1. All regulations relating to registration & pricing of medicines &

registered medicines prices publicly disclosed on JFDA website

2. Transparent laws, regulations and procurement prices publicly disclosed on JPD website

3. HAI/WHO medicine price survey conducted in 2004 and joint workshop with JFDA held in 2007 to recommend policy changes

4. Commitment to form a comprehensive national Health Insurance scheme (access, quality, equity)

5. Aim to be a model in the region- share learning & collaboration in medicines policies and regulations

MeTA in Jordan

• Formal Agreement to pilot MeTA in May 2008

• MeTA started working in August 2008 by forming the MeTA Council

• Council elected the SG of the HHC as its Chairperson and to participate as Jordan’s representative on the MeTA International Advisory Group (MIAG)

• MeTA Council drafted its internal rules, formed three Working Committees and developed activities for priority areas of work in the Jordan MeTA workplan

• MeTA Workplan approved by MeTA Management Board and MOU signed in March 2009

MeTA Structures in JORDAN • National multi-stakeholder MeTA Council - highest policy and decision

making body. Membership:

PUBLIC: MoH, RMS, JFDA, JPD, University Hospitals

PRIVATE: Local manufacturers, multinationals & agents, Health Insurance

CSO: National Consumer Society, International CSO (HAI), Pharmacy and Medical Associations

ACADEMIC: (pharmaco-economist)

Non- voting representative from each of World Bank (WB), World Health Organization (WHO) and Health Action international (HAI), with presence of MeTA national consultant in Jordan

• MeTA Secretariat - coordinating role, hosted by High Health Council • Ministry of Health: Supporting the project, Ministry of Planning

facilitator of project

JORDAN MeTA Work Plan

• MeTA Council developed a workplan within a framework for integration or collaboration of all the players in the Jordan pharmaceutical sector

• The framework is based on the structure of the National Drug Policy (NDP) 2002 document

• Workplan consists of three elements

1. Base Line Data collection and dissemination

2. Capacity Building

3. Priority Area Activities - Working Committees

1. Baseline Data

Activities to generate baseline data within MeTA workplan:

1. Private Sector Mapping (conducted March 2009)

2. Supply Chain Mapping (conducted April 2009)

3. HAI/WHO medicine price/availability/affordability survey (planned Summer 2009)

4. WHO Level II pharmaceutical sector assessment (ongoing)

5. Drug Utilisation database - CSO Alliance (planned July-Dec 2009)

Data/findings will be disclosed on Jordan MeTA website & discussed in Public Forum October 2009

2. Capacity Building

• UK NICE/WB training workshops (ongoing) Using evidence based medicine for transparent

• selection of essential medicines list• developing and promoting STGs • improving rational drug use

• CSO Advocacy and communication workshop- learning how to be involve in policy decision making process

• CSO capacity building to capture data on medicines utilisation

3. MeTA Working Committees

• Evidence Based Medicine Committee

• Rational Drug Use (RDU) Committee

• Civil Society Organisation Committee

Evidence Based Medicine Committee

• Review constitutions, TORs and SOPs of various committees involved in selection of drugs in Rational Drug List (RDL) - requires COI declaration and COI guidelines

• Review criteria for adding and deleting drugs to and from the RDL

• Review classification of drugs (restricted, unrestricted, authorized and unauthorized) in RDL

• Organize one national training workshop to raise awareness of concepts of evidence-based medicine (EBM) and pharmaco-economics

• Policy makers and technical experts training courses

• Organize workshop to promote concepts of transparency and accountability in pharmaceutical supply chain among health care staff

RDU Committee • Perform gap analysis and situation analysis for availability and use of

standard treatment guidelines (STGs)

• Review utilization and perception of the existing STGs - Knowledge, Atitude and Practice (KAP study)

• Develop STGs based on best available evidence (based on NICE pilot for one specific drug class )

• Organize one national workshop to build consensus and get feedback

from all stakeholders on specific drug class STGs

• Develop and implement strategy to stimulate acceptance and use of STGs (based on pilot for one specific drug class).

• Disseminate STGs and produce educational material as posters and other materials to be used in healthcare facilities

RDU Committee cont.

• Organize workshop to promote rational use of medicines among patients and consumers

• Organize workshop to promote rational drug prescription

• Organize workshop to promote adherence to the RDL by prescribers and institutions

• Training: send some potential trainers to next Promoting Rational Drug Use in Community course (PRDUC)

CSO Committee

• Start with mapping exercise of civil society and patient organizations to build database with all groups active in Jordan

• Contact & meet with identified Societies/ Patients’ Groups to introduce MeTA and CSO Alliance to them

• Create a national alliance of civil society and patient organizations, hold introduction meetings and elect Alliance representatives to MeTA Council

• Build capacity for Civil/Patients’ Society Organisations and involve them in decision making processes

• Create website for CSO Alliance and publish all data and information relating to the CSO Alliance and its contribution to the MeTA Council in Jordan

CSO Committee cont.

• Obtain research reports and document case studies on drug utilisation, availability, usage and waste. Make practical recommendations on potential for improvement on the existing in-country situation regarding rational drug use by consumers

• Prepare case studies on existing marketing and advertising practices

• Build a data base including comparative data on existing prices of medicines in Jordan between private and public sectors and on availability of generics, branded generics and originators and make this information available on MeTA Council and CSO Alliance websites

Monitoring and Evaluation

Monitoring responsibility of the MeTA Jordan Council

• Monthly progress reports of three working committees and MeTA Jordan Secretariat

• Quarterly reports by MeTA Council to International MeTA Secretariat, also reports will be published on national & international MeTA websites

• Financial reporting by national MeTA secretariat according to DFID’s financial reporting guidelines

• External monitor from another MeTA pilot country on annual basis at MeTA Forum – facilitate collaboration between MeTA pilot countries (South-South collaboration)

• National CSO Alliance to be involved in monitoring and evaluation by conducting patient survey at beginning and end of the MeTA phase I pilot

Challenges

• Assuring commitment & engagement of ALL stakeholders

• High medicine prices in private sector, low availability in public sector

• Clarity and understanding of MeTA’s objectives to Jordan’s MeTA Council stakeholders at ALL levels of their organisations

• Lack of good quality information and data

• Lack of Civil Society Organisations’ Capacity

• Resistance to change

Challenges cont.

• The concept behind MeTA processes within each country has to be country-led, this caused the process in Jordan to be slower as all the MeTA Council members had to jointly agree on a workplan

• Increasing multi-stakeholder dialogue was a challenge for us

• How to make the MeTA approach SUSTAINABLE

Lessons learned to date

• Getting to an agreed agenda that provides multiple win situations was a huge challenge; the multi-stakeholder process has not been a easy task

• We should include more than one member representing the private sector in the MeTA Council

• The international MeTA Secretariat support is very important, which we had in Jordan throughout the whole process to date

Key Successes

• The full support from the Jordanian Government, MOH • The full support from the International MeTA Secretariat

(visits by the MeTA Secretariat helped us to focus on the workplan and content issues)

• WHO/Jordan country office was very supportive• DFID, WHO/HQ , WB and WHO/EMRO regional office were

very supportive• Cooperation between all stakeholders and the Council

members from all sectors were highly committed to moving the MeTA process forward

• The private sector in Jordan is supportive the project

Thank you for your time!

Dr Taher Abu El SamenEmail: taherhhc@yahoo.com

• Jordan MeTA website (will be launched 31 May 2009)• MeTA: www.MedicinesTransparency.org