Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential?

1
Win-Win or Lose-Lose?Why is multi-stakeholder
involvement essential?
Saul Walker Senior Health Advisor UK Department
for International Development
2
Overview

• Pharmaceutical sector goals in tension
• All stakeholders can be irrational
• Health sector weaknesses facilitate irrational
  behaviour
• Complexity of system makes dynamic
  multi-stakeholder approach necessary
• No perfect resolution - can support more open,
  robust and accountable processes

3
What do we want to achieve in the pharmaceutical
sector?

• Improved health outcomes
• Patient (and provider) satisfaction
• Equity
• Quality, safety and efficacy
• Rational use and cost-effectiveness
• Sustainability
• Innovation
• Competitive markets?
• Local industry?

4
Competing Pharmaceutical Policy Objectives?
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Adapted from Dennis Ross-Degnan (HMS)
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lobbying
standards
Drug Industry

marketing
promotion
Adapted from WHO
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System weaknesses

• Inequitable financing
• Inability to afford full courses or purchase of
  low quality products
• Poorly designed payment systems
• Incentives for over supply or high-cost medicines
• Incentives/opportunities for diversion
• Salary supplementation
• Weak LMIS to monitor products

• Weak information systems
• Poor procurement and distribution
• Limited use of evidence in planning
• Weak regulation
• Inappropriate promotion of medicines
• Low quality crowds out good quality
• Donor practice
• Unpredictable financing, vertical programmes and
  multiple missions
• Weak HR and Training
• Poor practice, low consumer confidence

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Potential for Poor Health Outcomes
Donors Domestic political concerns Regulations Fo
reign/industrial policy
Country Governments Low budget allocation Competin
g objectives Vested interests Political outlook
International Agencies Profile/funding Overlapping
agendas Organisational structures/politics Politi
cal outlook
People/Civil society Overconsumption/self
medication Poor adherence Disease specific
groups Funding/profile etc Belief systems
Pharmaceutical companies Profit focus
(short/long) - marketing Opportunity
costs Intellectual property Strategies for market
share/volume
Wholesales, distributors, retailers Profit focus
(short/long) Opportunity costs Strategies for
market share/volume
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Multi-stakeholder processes

• Clear goals and values
• Health improvement, equity etc
• e.g National Medicines Strategy, NICE
• Stakeholder positions and interests
• politics and Politics
• Agree basic rules of the game
• How debate takes place
• Agree can disagree

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Multi-stakeholder processes

• Improve information
• Agreement on facts
• Identify opportunities for alignment
• Win-wins (e.g quality)
• Balance, persuade or overcome
• Think systems
• A fix here, an unexpected consequence there
• Accountability using information

Cant align everyone, on everything all of the
time
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Alignment on Transparency
Donors Good governance agenda Increase access to
medicines Support responsible business Increase
aid effectiveness
Country Governments Demonstrates commitment to
good governance ? donor confidence Improved
procurement and supply Better public health
outcomes
International Agencies Good governance
agenda Promote ethical pharmaceutical
procurement and supply Improve health outcomes
Civil Society Increased information Place at the
table Supportive environment for
advocacy Financial and other support Improved
dialogue with public and private sectors
Pharmaceutical companies Accurate information
on pricing Proactive role Better procurement and
forecasting Achieve public health
objectives Reduce pressure for inappropriate
behaviour
Wholesales, distributors, retailers New support
for building capacity Improved market
operation Tackle corruption wasteful practices
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Medicines Transparency Alliance

• Strengthen transparency and accountability
  through sharing robust data and multi-stakeholder
  working
• Seven pilot countries
• Formed multi-stakeholder groups (Govt, private
  sector, civil society)
• Agreed work plans focused on improving and
  sharing information
• Completed baseline studies
• Began to share information and develop policy
  options together
• 5 countries completed multi-sector working
  analyses
• (www.medicinestransparency.org/meta-countries)

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Medicines Transparency Alliance

• Multi-stakeholder working took time to develop
• Dynamics varied by country strength of
  constituencies, familiarity with working
  together, priority issues
• Common issues developing shared vision,
  ownership of processes, responsibilities,
  resourcing and communication
• Multi-stakeholder analysis improvements in
  sector communication and participation, issue
  focused alliances
• Abstracts 1108, 1025, 1013, 967

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Medicines Transparency Alliance

• Phase 2 approved June 2011
• Can MeTA deliver more accountability and better
  health outcomes?
• Move from data collation to analysis and use
  test strength of multi-stakeholder approach
• International secretariat role WHO EMD and HAI
  Global

Source Kerstens, Saad and Bannenberg (ICIUM
1108)
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Questions

• How to build sufficient acceptance of basic
  rules?
• Concept of conflict of interest in different
  cultures
• How to work in weak systems?
• Lack of routine data, LMIS and regulatory
  capacity
• Can the complexity and dynamism of sector be
  managed?
• Information desert to information overload
• How to balance short political timeframes and
  long solution lead-times?
• Intermediate results, change management
  approaches
• How do we address the reality of power
  imbalances?
• Governments, donors, companies, constituencies

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Acknowledgements

• Dr Tim Reed
• Dr Michael Reich
• Samia Saad
• Dr Willbert Bannenberg
• Dr Andreas Seiter
• Dr Anita Wagner
• Dr Dennis Ross-Degnan
• MeTA team

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