MEDICINES TRANSPARENCY ALLIANCE JORDAN...medicines . transparency alliance . jordan. paving the way. to better access to medicines. 15150_jordan.indd 1 02/09/2015 15:52

MEDICINES TRANSPARENCY ALLIANCE

JORDAN

PAVING THE WAYTO BETTER ACCESS TO MEDICINES

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JORDAN

Like all countries, Jordan faces the difficult task of delivering fair access to medicines within its financial means. As MeTA began, the government was procuring medicines at well-above international prices. More than one third of the country’s health budget was spent on medicines, a high proportion by international standards. Despite the high government spending, consumers still made significant out-of-pocket payments for medicines as well. Most medicines were bought in the private sector, at above public sector prices. Transparency in the medicines supply chain was weak: the Jordan Food and Drug Administration (JFDA) had not been required to publish the list of registered pharmaceutical products, and members of committees assessing and deciding on registration of medicines did not have to declare conflicts of interest. The situation demanded a comprehensive package of policy responses to pave the way for improved access to essential medicines.

challengesOur

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Jordan launched a MeTA pilot in 2009. Its mission was to contribute to good governance, transparency and accountability across the medicines supply chain by engaging all stakeholders with an interest in the outcome of the medicines market. MeTA was established as a small unit of the JFDA, overseen by a six member advisory board which was chaired by the Minister of Health with representatives from the JFDA, the Transparency Association, the parliamentary health committee, and the World Health Organization.

MeTA has been methodical in its work. It has collected evidence with technical support from WHO and identified its priorities. It has set up a strong multi-stakeholder structure which has been critical to its successes. All participants have committed to improving transparency and access to medicine, recognizing and respecting their different interests and identifying areas of common interest. For the first time in Jordan, patients and representatives from civil society organizations (CSOs) are part of the formal policy-making dialogue. Their views now have more weight, enabling dialogue with representatives from professional associations, the private sector and government. The involvement of all sectors has meant that MeTA’s recommendations have been well-received and that there is a commitment to ensure they are implemented and enforced.

Jordan is one of seven countries to participate in MeTA. The programme is also active in Ghana, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia. It is currently funded by the UK Government through the Department for International Development.

responseOur

achievementsOur

✔ We collected and disseminated evidence required for robust policy making.

✔ We revised the National Medicine Policy which has been adopted by the Minister of Health.

✔ We developed a policy on the disclosure of information which has been approved and implemented.

✔ We developed an Essential Medicines List.

✔ We introduced conflict of interest declarations on JFDA committees.

✔ We built the capability of CSOs and improved their voice in the policy-making dialogue.

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Medicines Transparency Alliance JORDAN

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How MeTA Jordan transformed policy makingAs elsewhere, the power of the private pharmaceutical sector in Jordan has been much greater than that of civil society. MeTA has sought to redress the imbalance. The MeTA steering committee organized for capacity in the CSO sector to be built, with workshops and training on advocacy, campaigning, negotiating, rational use of medicines and generics. It then institutionalized CSO representation by forming the Jordanian CSO Health Alliance, which united health and human rights CSOs to advocate for patients’ right to health. With CSOs now formally involved, MeTA Jordan became the first forum in Jordan to bring together all stakeholders in medicines from the government, the private sector and civil society. Their constant and frank exchange of views led to consensus and understanding.

MeTA established six technical working groups to address priorities in the pharmaceutical sector. Those priorities were: national policies, inefficiencies and cost containment in the pharmaceutical sector, access and equity, evidence-based advocacy with high-level policy makers, public education and monitoring and evaluation. The head of the MeTA unit at the JFDA, Dr Jaber Jaber, says MeTA brought cohesion to the JFDA’s policies. “MeTA has helped us structure our work,” he says. “Our work was fragmented before, but using the MeTA structure, it is now clearer to all stakeholders what our goals are. It has helped to define our priorities and highlight the need for transparency across the whole chain – from regulation, to safety, to procurement.”

journeyOur

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

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Medicines Transparency Alliance JORDAN

Revising policiesMeTA’s six technical groups developed an agenda of policies in need of reform. Chief among those was the National Medicine Policy (NMP). It had last been revised in 2002, and had largely been forgotten as a document that should underpin medicines policy. MeTA supported the JFDA to revise the policy in consultation with all stakeholders. The new NMP was adopted by the Minister of Health in September 2014, and an implementation task force was established to ensure that the new version would not be ignored, and that it would be monitored with target indicators to measure progress.

MeTA’s approach and contribution to revising policies

• Pharmaceutical Sector Scan,• Determinants of unavailability of essential medicines at public healthcare facilities,• Pharmaceutical Situation Assessment Level II,• WHO Household Survey Level II,• Review of NMP 2002,• Review of Rational Drug lists.

• Expert committees on NMP and rational drug use policy formed and held regular meetings.

• Disseminated desk research of NMP and Rational Drug Use Policy to expert committees.

• Held targeted consultations, focus groups and broad round table discussions with stakeholders to discuss evidence gathered.

• Circulated revised NMP draft for comment.• Consensus obtained on NMP and Rational Drug Use Policy.

• Revised NMP and submitted to Ministry of Health. • Developed recommendations for Rational Drug Use Policy, including for the

formation, functions and responsibilities of the Pharmacy and Therapeutics Committees; and for new education policies, including the update of pharmacy curriculum to reflect key concepts like rational use principles and essential medicines.

• Made recommendations on the mechanisms of addition and deletion of medicines to the Essential Medicines List.

• Ministry of Health adopted NMP – MeTA formed committee to develop activities, responsibilities, budget and timeline to implement the NMP.

• Ministry of Health adopted Rational Drug Use Policy – Pharmacy and Therapeutic Committees reformed with updated terms of reference.

• Minister of Health expressed the government’s commitment to address gaps and develop policies in response to MeTA’s Pharmaceutical Situation Assessment Level II and WHO Household Survey Level II.

• Essential Medicines List revised.• Capacity building workshop held to develop communication, advocacy and

knowledge on rational drug use and generics among Jordanian CSO Health Alliance.• Pharmacoeconomics course carried out.

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Working together for transparencyMeTA supported the development of a disclosure policy to improve the availability of medicines information in the public domain. As a result, the JFDA now publishes online information such as lists of registered drugs and public sector procurement prices.

In another first to increase transparency, CSOs were given a seat on medicines committees, such as registration and procurement. “The committees used to have representatives from academia, government and industry, but CSOs were not included,” says the Secretary General of the Jordanian CSO Health Alliance, Dr Fadia Samara. “CSOs were not on the public policy map before MeTA – MeTA put us on the map. We are now called to have our say all the time.” Dr Jaber says MeTA highlighted the absence of conflict of interest declarations on committees. “All members, whether from government or external, now have to declare conflicts of interest and will be excluded from decisions if they are conflicted,” he says.

MeTA’s approach and contribution to improving transparency

• Reviewed public availability of information.

• Expert committee on disclosure policy formed and regular meetings held.• Consensus obtained on disclosure policy.

• Recommended new regulatory measures, including the application of transparency in the medicines registration process.

• Made recommendations for disclosing information on medicines registration and quality assurance, availability, price, and medicines promotion policies and practices.

• JFDA accepted CSO involvement in JFDA technical committees and in public education on health programs.

• JFDA accepted and acted on MeTA’s recommendations for disclosure of information on the JFDA website. The information that is now publicly available is: details of process for registering and de-registering medicines; list of registered products by therapeutic class, patent status, and registration date; list of medicines submitted to registration; regulations concerning GMP criteria and certification processes for domestic and foreign manufacturers; list of GMP compliant manufacturing plants of suppliers/manufacturers; list of members of national pharmacy and therapeutic committee; Essential Medicines List; public sector procurement prices of key essential medicines; regulations and procedures for testing the quality of products in the market; regulations and procedures for monitoring and reporting adverse events; reports of adverse events identified in post-marketing surveillance studies; Pharmaceutical Products Quality Reporting Form; Adverse Incident Reporting Form.

• Established forum for patients groups to raise awareness on patients’ rights to access medicines.

• Developed brochures, television and social media campaigns with statements of rights for patients and citizens.

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Medicines Transparency Alliance JORDAN

Lower prices, greater availabilityThere is evidence that MeTA has already improved access and affordability to medicines in Jordan. A 2009 MeTA health facilities survey found medicine prices in Jordan were much higher than in similar and even wealthier countries, because the JFDA had been pricing new medicines based on the median price in a selection of high-income countries. The survey’s finding prompted JFDA to address pricing. It formed a multi-stakeholder committee to investigate the issue, and the committee recommended a change to the reference countries. Medicine prices have now fallen. A Pharmaceutical Situation Reassessment survey conducted in 2014, showed average prices of 50 branded medicines in Jordan had fallen from 19 to 14.51 times the international reference price from 2009. For generic medicines, the ratio dropped from 9.75 to 9.07.

Stakeholders believe that the policy reform as well as the development of the Essential Medicines List will reduce Jordan’s expenditure on medicine, which has been high by international standards. The National Health Accounts show that pharmaceutical expenditure was 36.3% of the health budget in 2008 and 26.75% in 2012. “80% of the medicines budget is spent on 20% of medicines,” says the Secretary-General of the Jordanian Association of Pharmaceutical Manufacturers, Dr Hanan Sboul. “Being more rational about procurement means more medicines can be bought for Jordan. It will make spending more rational and increase access.”

Indeed, availability of essential medicines in the public sector has improved since the establishment of MeTA. A 2014 Pharmaceutical Situation Reassessment found 15 key medicines were available in 86.7% of pharmacies in the public sector, a rise from 79% in 2009. The availability of 50 key medicines in the public and private sector has risen to 75% from 62.9%.

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✔ 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.

learnedWhat we’ve

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Medicines Transparency Alliance

MeTA Jordan membersGovernmentHigh Health CouncilJoint Procurement DepartmentJordan Food and Drug AdministrationMinistry of HealthRoyal Medical ServicesUniversity hospitals

Civil society sectorJordanian CSO Health Alliance: Arab Association to Raise Awareness of Drugs, Association for Cerebral Palsy, Association of Friends of the Kidney, Association of Friends of the Liver, Diabetes Care Association, Multiple Sclerosis Society, National Association for Consumer Protection, Jordan Cancer Society, Jordan Society for Thalassemia and Haemophilia, Jordanian Quality Association, Jordanian Society for Common Organ Donation, Jordanian Society for the Development of Laws, Jordanian Society for Health Education, Jordanian Society for Psychological Rehabilitation, Jordanian Women’s Union, Vinyl Ketone Association and White Beds Society for the Elderly.

Business sectorDrugstores Owners AssociationImporters of Medicines AssociationJordanian Association of Pharmaceutical Manufacturers Medical AssociationPharmacy Association

AcademyJordan UniversityJordan University of Science and TechnologyThe Hashemite University

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WHO/EMP/PAU/2015.4

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JORDAN

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:

MEDICINES TRANSPARENCY ALLIANCE

Maria-Cristina ProfiliWHO Country OfficeJordan

+962 6 [email protected]

www.medicinestransparency.org

Gilles ForteWHO Essential Medicines and Health Products DepartmentSwitzerland

+41 22 791 [email protected]

www.who.int/medicines

Marthe EverardWHO Regional Office for the Eastern MediterraneanEgypt

+20 2 [email protected]

www.emro.who.int

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