7 contact person: goodwell lungu secretary general ... · meta zambia 4 year country work plan...

MeTA Zambia 4 year Country Work plan Submitted by the MeTA Council 7th December 2012

1st January, 2013 – 31st December 2016 Contact Person: Goodwell Lungu Secretary General, Transparency InternationalZambia, Mobile: +260 977 455 455 e-mail: [email protected]

Final MeTA National Work plan for Zambia

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Table of Contents

Acknowledgements………………………………………………………………………….....2

Abbreviations……………………………………………………………………………………3

2. Existing Situation Analysis ......................................................................................................................... 7

4.0 Description of MeTA - Zambia Work plan ........................................................................................ 18

4.1 Goal ..................................................................................................................................................... 19

4.2 Objectives ....................................................................................................................................... 19

4.3 Expected Outcomes ...................................................................................................................... 19

5. Risks/External Factors ............................................................................................................................. 23

5.1 Risks ................................................................................................................................................... 23

5.2.2 Willingness to change ............................................................................................................ 23

5.2.3 Human Resource Issues ....................................................................................................... 24

5.2.4 Dealing with outcomes .......................................................................................................... 24

5.2.5 Financing change ................................................................................................................... 24

5.3 External Factors ............................................................................................................................... 24

5.3.1 Pressure from the community .............................................................................................. 24

5.3.2 Pressure from donor institutions .......................................................................................... 24

6.0 Financial arrangements ................................................................................................................... 25

7.0 Budget ............................................................................................................................................. 25

8.0 Monitoring system .......................................................................................................................... 25


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Acknowledgements

We would like to thank the national secretariat, Transparency International Zambia (TIZ)

for its support towards MeTA work.

Special thanks also go to the following members drawn from the four sub-committees

of the pilot phase who worked so hard in drafting the activity based budget: Mr

Masautso Phiri, Trustee at Media Institute of Southern Africa (MISA Zambia), the late

Mr Davy Nanduba, former Deputy Director of Pharmaceutical Services at MOH (now

replaced by Mr Masautso Phiri) ; Mr Billy Mweetwa Pharmacist at CIDRZ (now with

WHO local office in charge of MeTA issues) ; Mrs Ruth Mudondo, member of Zambia

Pharmaceutical Business Forum (ZPBF); Ms Violet Kabwe( HERA, MeTA Consultant

for the Pilot); Mr Frank Nga’mbi, Member of Zambia Pharmaceutical Business Forum

(ZPBF);. Hon. Lazarus Chota from APNAC, Mr Goodwell Lungu from TIZ.

Special appreciations also go to the team that consolidated and provided technical in

put into the work plan This team consisted of:

Mr. Christopher Mbinji

Mr. Maybin Mumba

Last but not least, appreciation goes to the members of the MeTA Council, who

attended the October 2011 multi-stakeholder meeting to review and adopt the draft one-

year country work plan.


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Abbreviations

ADDO Accredited Dispensing Drug Outlet

APNAC African Parliamentary Network Against Corruption

CHAI Clinton HIV/AIDS Initiative

CHAZ Christian Health Association of Zambia

CHESSORE Centre for Health, Science and Social Research

CIDRZ Centre for Infection Disease Research in Zambia

CIDA Canadian International Development Agency

CPs Cooperating Partners

CSO Civil Society Organization

DfID Department for International Development

DHMT District Health Management Team

DSBL Drug Supply Budget Line

EFZ Evangelical Fellowship of Zambia

FHT Family Health Trust

GGM Good Governance for Medicines

GMP Good Manufacturing Practices

HAI Health Action International

LMS Logistics Management Systems

LMIS Logistics Management Information Systems

MeTA Medicines Transparency Alliance

MISA Media Institute of Southern Africa

MOH Ministry of Health

MPs Members of Parliament

MSL Medical Stores Limited

NDP National Drug Policy

NHSP National Health Strategic Plan

NGO Non-Governmental Organizations

NPO National Pharmaceutical Officer

PRA Pharmaceutical Regulatory Authority

PSZ Pharmaceutical Society of Zambia

TIZ Transparency International Zambia

UNZA University of Zambia

WB World Bank

WHO World Health Organization

ZARAN Zambia Aids Law Research & Advocacy Network

ZPBF Zambia Pharmaceutical Business Forum

ZYAFAC Zambia Youths Association in the Fight Against Corruption


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Executive Summary

The Medicine Transparency Alliance (MeTA) is an international multi-stakeholder

initiative, involving government, civil society organizations and the private sector aimed

at promoting increased transparency and accountability in the supply of essential

medicines, and ensuring equitable access for low income and disadvantaged people in

developing countries such as Zambia. MeTA’s focus is on strengthening the capacity to

collect, analyze, disseminate and use data on medicine procurement, quality,

availability, pricing, promotion and use to improve transparency and accountability in the

way medicines are selected, regulated, procured, distributed, supplied and later

prescribed to and used by patients; with the overall goal of increased access to quality

assured essential medicines for all people.

In Zambia MeTA Phase Two started through two teleconferences in 2011 with DFID

and HAI/WHO. Once modalities were agreed Zambia prepared a Proposal for

transitional funding of £5000 and the new MeTA Council was put in place by October

21, 2012.

MeTA phase two work plan is designed in such a way that some of the inadequacies

reflected in Ministry of Health reports of periodic shortages, high prices, lack of

transparency and accountability in procurement of medicines; are to be addressed

based on the evidence gathered during the pilot phase of the project. Other problems

recognised are the challenges affecting access to medicines in Zambia that include

sustainable financing, supply chain management mechanisms and the weak Medicines

Information Management System (MIMS).

Thus activities for one year are restricted to starting from where the pilot phase ended

through reviews of three MeTA research studies (Accredited Dispensing Drug Outlet

(ADDO), & Counterfeit and Substandard Drug Survey; Private Sector Mapping Study;

and Prices in public, Not for Profit and Private Sector and Disclosure Survey in Zambia).

These studies findings will be the basis for dissemination of information for Awareness

Campaign and high level Policy dialogue with the ministries of Health and Commerce.

And for year one activities MeTA Zambia has set the following objectives to be achieved

during implementation:

1 Enhance and Capacity Build Civil Society through helping establish MeTA –

Zambia as a registered organization. This will involve establishing the

secretariat, employing Project Coordinator and Project Administration

Assistant who will run the day-to-day project while working with MeTA

Executive, Council and local WHO office.


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2 Enhance information awareness on results of the three studies under taken to

multi-stakeholders i.e. Ministry of health, private sector, Parliamentarian

Health Committee, General Public, Civil Society Organizations and

professional bodies in order to promote transparency and accountability in

pharmaceutical sector in Zambia with the final goal of increased access to

quality assured essential medicines in line with MoH policy on health for

all. The approaches to disseminate information will through radio

programs, live TV debates and focus group discussions. These activities

will also lead to policy dialogue around increasing access to essential

medicines through domestication of transparency and accountability

practices throughout the National Supply Chain Management.

3 Promote transparency and accountability in public procurement of

pharmaceutical practices for in public health institutions in Lusaka,

Solwezi, Kitwe and Ndola districts. The approach for sensitizing key

decision makers in procurement process will be focus group discussions

on the following topics prices, disclosure, transparency and accountability

to addressed access to quality assured medicines in public health

institutions.

4 Build capacity of Civil Society in awareness campaigns on the issues of

pricing, quality of essential medicines and availability based on the

outcome studies conducted in the pilot phase of MeTA Project. The

districts to be covered are Lusaka, Ndola and Solwezi, with the out mate

goal of empowering SCOs in advocacy around the issues of pricing,

quality and availability, as these play key role in ensuring increased

access to essential medicines for all now widely accepted as a

fundamental human right.

5 Promote policy dialogue at the highest level through information

dissemination to MPs. This will be through presentation to members of

Parliamentarian Committee on Health. The ultimate goal is to sensitize

parliamentarians on the need to domesticate transparency in the laws and

policies formulated to govern National Supply Chain for Essential

Medicines in Zambia to promote increased access for all.


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The log frame has been attached as Appendix 1; the budget is Appendix 2, the list of

participating stakeholders as Appendix 3 and MeTA CSO Coalition as Appendix 4.

MeTA Zambia intends to review its work plans annually from year 2013 – 2015.


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Background

The Medicine Transparency Alliance (MeTA) is an international multi-stakeholder

initiative whose aim is to promote increased transparency in the supply of essential

medicines, and ensure equitable access for low income and disadvantaged people in

developing countries. MeTA’s focus is strengthening countries capacity to collect,

analyze, disseminate and use data on medicine quality, availability, pricing and use.

This will help improve transparency and accountability around the way medicines are

selected, regulated, procured, distributed, supplied and then prescribed to and used

by patients.

The super goal of MeTA is to improve health outcomes for poor people in these

countries. The MeTA goal is to ensure access to affordable essential drugs in

developing countries (Millennium Development Goals {MDG} 8, Target 17). The UK’s

Department (DfID) is supporting the initiative financially during Phase Two, but with

the prospects of other donors coming on board.

2. Existing Situation Analysis

Key Players in the Pharmaceutical Sector

Zambia is a country of about 13 million people where access to quality assured

medicines is still a challenge though a lot of strategies to address these challenges

are in place through key stakeholders like government, private sector, Civil Society,

professional bodies, and local and international cooperating partners. The majority of

the population in Zambia access health services mainly through the public sector

especially for the pre-urban and rural poor population. The private sector does also

play a key role in providing health services at various stages of the sector, which

includes manufacturing (on a small scale), importing, storage, distribution and patient

care. The Zambia supply chain for pharmaceuticals in the country still needs to be

developed further in order to support provision of quality assured essential medicines

to all.

The government has put some measures in place to regulate the pharmaceutical

sector to ensure quality assured essential medicines reach the poor. This is being

done with a statutory body called Pharmaceutical Regulatory Authority (PRA), which

mostly looks into quality of medicines authorized on the Zambian market. However,

little efforts have been made so far in terms of regulating the price of essential

medicines in the country, which at time results in high prices for these essential

products hence limiting access indirectly. MeTA – Zambia working in a multi-

stakeholder approach would like to bring to attention the issue of fair pricing based

on the studies under taken in the country so as this factor is addressed in order to

ensure increase access to essential medicines. The public sector will also need to be

strengthened in the area of transparency and accountability through out the National

Supply Chain especially in the stages of forecasting, quantification and procurement.


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MeTA Zambia under phase II is taking the involvement and engagement of key

stakeholders in the pharmaceutical sector as the corner stone of the project, to

increase transparency and accountability in the pharmaceutical sector. Some other

keys stakeholders are Zambia Business Forum, Pharmaceutical Society of Zambia,

General Practitioners’ Association, Planned Parenthood Association of Zambia,

Churches’ Health Association of Zambia, Centre for Infectious Disease Research in

Zambia and Society for Family Health to mention but a few.

2.1 National context

Currently reflected by the Ministry of Health leadership there is periodic shortage,

high prices, and lack of transparency, accountability, sustainable financing and

supply chain management mechanisms, in addition weak Medicines Information

Management System (MIMS) as major challenges to access to quality assured

essential medicines in Zambia. The quality and safety of medicines are often

compromised due to lack of good storage and distribution infrastructure and

inadequate control systems. The MeTA project under phase II will therefore, mainly

prioritize the issues around increasing access through advocating for increased

transparency and accountability in the National Medicines Supply Chain in Zambia.

In this regard the following are the expected outcomes:

1.0 Build a strong Civil Society in Zambia which is well vested in issues of

Medicines transparency and accountability as part of means to increasing

access to quality assured medicines for socially and economically

disadvantaged population, though capacity building of MeTA Zambia to be

ready to register as a stand alone legal entity.

2.0 Increased availability and access to affordable quality assured Essential

Medicines in a multi-stakeholder process (MDG 8, Target 17), with a focus on

the poor and disadvantaged through advocacy on essential medicines fair

pricing structure, promoting increased transparency and accountability in the

Public Essential Medicines Supply Chain.

3.0 Improved transparency and accountability in medicines procurement for

hospitals in five districts (Lusaka, Solwezi, Livingstone, Kitwe and Ndola) in

four provinces (Lusaka, Copperbelt, North Western and Southern) by

engaging the procurement officers and controlling officers.

4.0 Increased participation of Government, Private Sector, CSOs and the general

public in medicines issues in five out of ten provinces of Zambia through

information dissemination based on the study outcomes of MeTA pilot phase

of the project in Zambia.

5.0 Create an informed society, policy makers and implementers through TV,

Radio, public debates on issues of pricing and access to essential medicines

in the Zambian context.

The Ministry of Health in Zambia under the new government of the Patriotic Front

(PF) government has prioritized access to medicines highly as part of the national


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development agenda. This year the government is working on a strategy to improve

access to essential medicines through public institutions called National Essential

Medicines Supply Chain Strategic Plan and MeTA Zambia will is part of this strategy

through hosting the price list database for comparison basis to ensure value for

money. The government of Zambia is also working with private sector to increase

access to quality assured Essential Medicines through promoting private

participation to serve the rural communities a concept based on one of the project

MeTA – Zambia undertook during Pilot Phase. MeTA Zambia Pilot Phase works

have helped shape New Health Policy that will guide the implementation of Public –

Private Partnership to take services to rural poor communities.

2.2 Proposed Activity Areas for Zambia’s MeTA Work Plan

The activities for the one-year plan for MeTA Zambia have been developed based on

the overall achievements of the pilot phase. In this regard the Research and Survey

Committees will design messages to help multi-stakeholder approach advocacy for

Policy changes that will promote transparency and accountability in the

pharmaceutical sector both in public and private to ensured increased access to

quality assured Essential Medicines.

The activities are placed in four broad areas namely the review of research studies,

the awareness campaigns, policy dialogue and capacity building for Civil Society

Organisations.

2.2.1 Review Research Studies

Under this section three research studies will be reviewed and analyzed to develop

key messages to be disseminated to the community, parliamentarians, line

ministries, private sector and statutory bodies. The Research Committee will be

responsible for this task and the Communications Committee will be responsible for

developing and printing of brochures and fact sheets (output 2) out of key messages

from the studies.

The following Studies will be reviewed and analysed –

a. Report on Medicines Prices in the Public, Non-Profit and Private sectors

in Zambia

The research targeted 48 medicines from selected from the National Essential

Medicines List, by MeTA Zambia. The medicines were divided into “branded” i.e.

made by the original patent holder, and “generic” i.e. an equivalent of a branded drug

produced by another company under a different name. The 48 medicines were

further classified into anti-malarials, anti-fungals, anti-biotic, analgesics and other

pharmacological classes. Data were collected from a total of 40 pharmacies: 2 public

dispensaries; 18 wholesale outlets and 20 private retail outlets within Lusaka district.


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The study revealed that the selected medicines were reasonably available in both

the private pharmacies and public dispensaries. Private retail outlets had a mean

availability of 62.2% across all categories and availability range of 53.7% (other

drugs) to 77.3% (anti-fungals). On the other hand, public dispensaries had a mean

availability of 74.4% across all categories and availability range of 58.8% (anti-biotic)

to 86.8% (other drugs). The public institutions were therefore generally better

stocked than the private ones by a margin of 14.2%. About 92% of the medicines

studied were imported from outside the country with India being the leading exporter

at 72% of the total imported medicines. It is followed by China (11%) and the

Netherlands (6.7%) among other countries.

The study results further showed that all medicines were accessible freely from the

public dispensaries, while private pharmacies sold medicines with profit mark-ups

range of 28-73%. With the Food Poverty Line at ZMK 80,000, per adult per month, it

is clear that families have difficulties purchasing their medicines translating to ZMK

2,600 per day. The top major causes of illness are malaria, diarrhoea and

pneumonia for which medicines were part of the study. The first line treatment for

malaria is artemether/lumefantrine (coartem) with an average price of ZMK 29,961.

This price is 11 times higher than the ZMK 2600 Food Poverty Line per day per adult

for 29% of the population in Lusaka province. Amoxyl, a first line treatment for

Respiratory Tract Infections had a mean cost of ZMK 5,384 while benzyl penicillin

used in treatment pneumonia costs about ZMK 3,584. These medicines are relatively

affordable but for the 29% extremely poor in Lusaka province, these prices could

make the difference between life and death.

b. Disclosure Status of the Zambian Pharmaceutical Sector

Zambia like other MeTA pilot countries are developing strategies to promote greater

transparency and accountability regarding policies, practices, and outcomes in the

pharmaceutical sector. A survey looking at four areas; Medicines registration and

quality assurance; Availability of medicines; Price of medicines, Policies and

practices concerning the promotion of medicines, was conducted and Data was

collected and analysed.

For each core area, disclosed information covered policies – the laws and

regulations that are in place; practices – suggested procedures followed and actual

practices; and results –achievements in the core area. The objectives of describing

the current disclosure status of information in the core areas were to: (1) enable the

Zambia MeTA Council to prioritize potential activities to facilitate progressive

disclosure over time; and (2) create a baseline against which changes in

transparency and disclosure during pilot implementation can be measured.

c. Private Sector Mapping Report


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The private sector in Zambia is made up of a diverse range of entities, with

significantly different perspectives and interactions with issues of ATM. Contrary to

quite a number of other countries in Africa and the world, the private sector

(medicines volume and private doctors’ consultations) is minimal and constitutes

around 10%-15% of the total health care sector. NGOs and the Government are

omnipresent.

With the current size and structure of the Private Sector in Medicines supply, its role

in helping towards MeTA's objective can only be limited. This sector is dominated by

trading medicines and not by manufacturing and distribution mainly to the

“high/middle” income urban regions.

The achievement of a sustained and meaningful improvement in access to

medicines would imply a significant increase in the size of the medical market in

Zambia. Currently the private sector supplies only 10% to 15% of the total healthcare

products and services. and this increase in market could lead to an important

increase in the private sector market share The Private Sector needs to become not

only a player in the “upper” (private) segment of the market, but also in the “middle”

segment. The Public and Private sectors can than collaborate and compete with the

aim of improved access at affordable price

Such an evolution of the private sector and its role in the total National Medicines

Supply framework can only take place as part of a (Strategic) Government Industrial

or Medicines Policy.

As such there is no doubt that an early and enthusiastic cross-sectoral

representation in the MeTA initiative is of paramount importance. With the

fragmented nature of the health care structure in Zambia, not different from other

countries, easy engagement of all players in the process is a significant challenge.

This report outlines who the key private sector stakeholders groups are, assesses

their current engagement and representation in the MeTA Zambia process, and

presents a summary analysis of some key issues relating to MeTA and its aims in

the Zambian context as recorded during interviews with the various private sector

stakeholder group representatives. Interviews also took place with Government and

NGO stakeholders.

This report builds on other reports, such as the country visit report of Marianne

Schumann March 2009 and the 2008 Supply Chain report by Prashant Yadav and

Boniface Fundafunda “ Matching Demand and Supply for Pharmaceuticals in a Multi-

Donor Environment: The Drug Supply Budget Line in Zambia”.

Based on analysis of the private sector stakeholders’ interests and concerns, this

study suggests a number of private sector priorities which may inform an overall


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strategic direction for MeTA Zambia, and through their adoption, encourage a more

active multi stakeholder engagement and ownership.

The following position papers, which were given to the Government of the Republic

of Zambia during the pilot phase, will also be evaluated, reviewed and information

disseminated.

a. Illegal drug stores and the Accredited Dispensing Drug Outlet (ADDO)

model of Tanzania

Zambia is a large country with a size of approximately 752,614 square

kilometers and population of approximately 12 million. There are 80+? Registered

pharmacies but unfortunately most of these are located mainly along the line of rail

and major towns, leaving the vast majority of rural areas serviced only by the drug

Stores. The Drug Stores draw their permit to operate through different Act of

Parliament than those regulating Pharmacies. The Drug Stores are outlets that are

permitted to operate within a very restricted medicines range. Mostly General Sales

medicines range. The Drug Stores become illegal drug stores when indulging in the

stocking and sell of Pharmacy and Prescription Only medicines range, for which they

would require a license from PRA and operate under the supervision of a

Pharmacist. Please take note that some of the medicines that an Illegal Drug store

stock may have been obtained from legal Pharmaceutical Wholesalers. (Illegally)

and some from brief case suppliers. This problem has contributed to the many illegal

drugs stores that are currently operating all across the nation of Zambia. There are

currently 251 registered pharmacists in Zambia.

The Zambian government, along with the PRA and the National Drug Policy (NDP)

are working hand in hand to strengthen the control of medicine in the country. The

upgrade of the Zambian Drug Stores may require financial inputs. Will this be

feasible in the Zambian context? The population of Tanzania is 41million and largely

rural with a reasonable economic growth. Zambia`s population is only 12million. We

have a school of Pharmacy graduating at least 35 Pharmacists every year. Would it

be possible therefore to improve accessibility of medicines in the rural areas through

other means?? E.g. Motivation of Private Pharmacies into the rural areas. Rural

Areas tax free zones, Incentives schemes, Pharmacist Retention etc. However it’s

important to mention that there is already an initiative being piloted by the World

Bank, Zambia Access to ACT Initiative (ZAAI) some member organizations of MeTA

like MSH are involved in this initiative that seek to increase access ACT using the

Accredited Dispensing Drug Outlet (ADDO) Model.

b. Counterfeit and Substandard Medicines

This position paper makes the following recommendations - The first step is to

increase knowledge and understanding in Zambia amongst CSO, policy makers and

line ministries and other key role players, as regards to counterfeits and the dangers


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that surround coming up with anti-counterfeit legislation. However, emphasis should

be on strengthening the regulatory implementation, legislative and regulatory

infrastructure, enforcement, technology and communication systems in the country.

• The Ministry of Health and all stakeholders involved in this issue must ensure

that all drugs meet the set established international standards and national

standards. Sub-standard medicines do more harm to the people’s health and

it is unethical to give such medicines to the people. As we have learnt from

the experiences of Uganda and Kenya.

• The Zambian Government should try by all means to establish quality control

good laboratories for monitoring of all pharmaceuticals. The locally

manufactured and those imported or donated. Mainly, this is to safeguard the

lives of people.

• Strengthen drug regulation system of PRA by decentralizing the inspectorate

unit-open units throughout the country’s medicine entry points directly or

indirectly through government wings like ZRA and Immigration etc.

• Establish National Drug Quality Control Lab to test all drugs prior to

distribution of any drugs and medicines in Zambia.

• All drugs should be bought only from duly registered Pharmacies (PRA, local

Councils and the Police must work towards closing all illegal drug stores in the

Country.

• All donations regarding medicines and drugs must be approved by PRA prior

to donations and should be drugs duly registered in Zambia and the donations

should only be duly registered Health Institutions.

• Sensitive the general public to buy drugs only from duly registered

Pharmacies.

• Collaborate with all stakeholders to curb counterfeiting.

• There is need to strengthen the multi-faceted stakeholder approach regarding

transparency and accountability in the medicine supply chain.

The following studies will be evaluated, analysed and reviewed during the second

year. In the case of the Pharmaceutical Sector Scan its development and updating

will be a continuous process from the second year onwards.

c. Challenges faced by local Pharmaceutical Manufacturers

This study on the challenges of local manufacturers has brought out a number of

interesting issues which require the immediate intervention of policy makers to

address them. Paramount among these is the fact that the tax regime in Zambia

favours importation of medicines as opposed to local manufacturing. The rationale

for importation is merely that it ultimately leads to cheaper prices for consumers

(affordability) since these products are imported cheaper and tax free from the

source. On the other hand though, the local manufacturing sector is not in a position

to satisfy the demand for medicines even if they were offered exclusive contracts.


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This vicious cycle can only be broken with the introduction and implementation of

government policies which seek to deliberately promote local production such as

access to cheaper credit (possibly via a scheme like Citizen Economic

Empowerment, guaranteeing a certain percentage that is locally purchased, banning

certain imports, etc).

While the market share which local manufacturers control has little or no bearing on

the availability of medicines (the bulk is imported), it appears to have an impact on

their affordability especially OTC medicines. Such high margins justified or not, have

serious life or death consequences on the poor. This is particularly so considering

that despite increases in supply of medicines (a large portion of the medicines

budget goes into purchasing Anti Retro Virals for HIV/AIDS and anti Tuberculosis

medicines), the public health facilities still have serious shortages of essential

medicines for the usual ailments. Only those with money can therefore access the

expensive medicines which are provided through private retail outlets

d. Pharmaceutical Sector Scan

The Pharmaceutical Sector Scan is intended to assemble a core set of existing

information about a country’s pharmaceutical sector and to highlight key information

gaps. It will assess how medicines for primary care are supplied and used.

Medicines for hospital inpatient care, while important, are not the focus of this sector

scan. Data on primary care medicines may already exist in a variety of different

government and private sector institutions or they may have been reported in

previous national or international surveys.

The Pharmaceutical Sector Scan will assist national MeTA stakeholder groups in

their efforts to improve transparency in the pharmaceutical sector and to set priorities

for future activities. Collating a large body of relevant information about medicines in

a standardized, user-friendly format will facilitate systematic analysis and point to

areas where key information gaps exist.

To complete the Pharmaceutical Sector Scan, individuals designated by the MeTA

stakeholder group or the MeTA Secretariat will scan a range of public and private

sector institutions to assemble existing country-level data, assess their validity, flag

inconsistencies between sources, and provide the most up-to-date summary of

existing information. The information in the sector scan will be saved in a structured

set of tables, organized by topic

2.2.2 Awareness Campaigns

The Awareness campaign will cover issues of access, affordability, pricing, quality,

efficacy and availability of medicines. This will encourage citizens to demand

medicines that affordable, of high quality medicines


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The awareness campaign will be conducted on two radio stations – Zambia National

Broadcasting Corporations (ZNBC’s) Radio 4 which covers the whole country and

Radio Solwezi in North Western Province. However, phase two will focus on five

provinces of Lusaka, Central, Copperbelt North Western and southern Provinces.

Three provinces – Lusaka, Central and North western were in the pilot phase while

Copperbelt and Southern are new additions. MeTA Zambia intends to add new

provinces each year until all the ten provinces of Zambia are covered. All the 26

programmes on the two radio stations will be analysed and evaluated in terms of

presentation and participation of the audience and reports will be prepared for use

during subsequent years.

The awareness campaign will also be conducted on ZNBC TV through three live

debates to be broadcast from Lusaka, Kitwe and Livingstone fortnightly over a period

of six weeks. Each programme will include the participation of an invited audience

from the district/province of key stakeholders from Government, the Private Sector,

Civil Society organization and private citizens who will contribute to the debates

through questions and comments. Reports for use in subsequent years will be

prepared analyzing and evaluating the TV live debates, the presenters, discussants

and the participation of the audience.

The Communications Committee will be responsible for organizing the Radio and

Television tasks while a team led by the chairperson will be responsible for getting

the commitment participants from the three stakeholders (Output 2).

Two different awareness and sensitization meetings will be organized. The first will

target procurement officers at hospitals in each district and will focus on

transparency and accountability in procurement procedure. The five districts covered

are Lusaka, Solwezi, Kitwe, Ndola and Livingstone. These meetings will be filmed to

provide MeTA Zambia with a video record that can also be used in documentary

production. A team led by the chairperson will be responsible for this task (Output 3).

The second group of awareness and sensitization meetings will target Civil Society

Organisations that formed the CSO Coalition during the pilot phase and Community

Health leaders. Three meetings will be held in Solwezi, Ndola and Lusaka. These

meetings will be filmed to provide MeTA Zambia with a video record that can also be

used in documentary production (Output 4).

2.2.3 Policy Dialogue

Under the pilot phase MeTA Zambia used Policy dialogue to reach government, the

private sector and civil society in order to build the multi-stakeholder consensus. This

led to improved knowledge among the stakeholders, policy makers and

implementers about MeTA Zambia’s purpose and objectives. Under the policy

dialogue MeTA Zambia was also involved in lobbying Cabinet Office, line ministries


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and Members of Parliament who introduced a motion on the floor of the House

MeTA core principles and issues of Health in Zambia.

To build on the achievements of the pilot phase year one of phase includes meetings

with Parliamentary Sessional Committees and line ministries. In this regard MeTA

Zambia has targeted four Parliamentary Sessional Committees of Health, Legal

Affairs and Human Rights, Information and Broadcasting and Government

Assurances. The two line ministries targeted are Health and Commerce and Industry

in order for MeTA

Zambia to influence government policy change (Output 5).

MeTA Zambia has also planned high level meetings with senior officials from the

Ministry of Health, Ministry of Commerce and Industry and Cabinet Office. Besides

MeTA Zambia is now a member of the Ministry of Health’s Procurement Committee

(Output 5).

2.2.4 Capacity Building for CSOs

Under the pilot phase MeTA Zambia implemented several training programmes to

build Capacity and knowledge among MeTA CSO Coalition members (See

Appendix 4). The training programme included Advocacy, Drug Supply

Management, Government Structure, Policy Formulation and Analysis, Budget

Tracking in Medicines and Research training Skills.

However, listed here are some of the CSO Coalition members namely Zambia Aids

Law Research and Advocacy Network (ZARAN), Transparency International Zambia

(TIZ) Treatment Advocacy and Literacy Campaign (TALC), Family Health Trust

(FHT), Society for Family Health (SFH), CARITAS, NZP plus, Citizens Forum,

Churches Health Association of Zambia (CHAZ), Media Institute for Southern Africa

(MISA) Zambia and Planned Parenthood Association of Zambia (PPAZ). Though

issues in medicines procurement processes, supply chain systems and regulatory

issues have been extensively covered during the pilot phase under which 50,000

British Pounds was spent MeTA Zambia would like to continue to enhance CSO

knowledge of these issues.

The main activity here is the exploration of the registration process of MeTA Zambia

to be created as a civil society organization (Output 4). This is linked to the

employment of the part-time Coordinator and the Administrative Assistant. It is also

linked to the establishment of the National Secretariat and the holding of multi-

stakeholder meetings, executive and subcommittee meetings in line with the MeTA

Core Principles (Output 1).

3. Governance of MeTA Zambia

3.1 Registration of MeTA Zambia


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During the Pilot MeTA Zambia was run under the umbrella of TIZ and thus was not

registered as a stand-alone organization. It is planned to start the process of

registering MeTA Zambia as an international non-governmental not for profit

organization during the first year and to complete the registration process in the

second year.

3.2 National Secretariat

During the Pilot MeTA Zambia run a secretariat under TIZ. It employed a coordinator

and an intern. In the second phase MeTA Zambia will establish a stand-alone

secretariat to service the work of the MeTA Council, the executive and its sub

committees. This aim is to facilitate effective implementation of the MeTA Zambia

year -one and subsequent four-year work plan Dec 2013 -2015. MeTA Zambia will

employ a part-time Coordinator and an Administrative Assistant. These positions are

provided for in the budget. The staff will be assisted and guided by the MeTA Zambia

Executive Committee and its three subcommittees.

3.2.1 Administration

During the pilot phase MeTA Zambia shared rentals with TIZ for premises where it

was housed. For MeTA Zambia to establish an effective administration office

accommodation must be found. In this regard and despite the limitation of funds

under phase two MeTA Zambia is exploring ways and means of achieving this.

These include approaches to the Ministry of Health (MOH) as government

contribution to MeTA Zambia and other stakeholders and cooperating partners

including the local office of the World Health Organisation (WHO) in Zambia. The

WHO has offered premises for MeTA Zambia meetings subject to availability of such

space.

3.2.2 Salaries and Allowances

Provision has been made in the budget for allowances of a part-time Coordinator

and a salary for one full time Administrative Assistant to run the secretariat.

3.3 Management Structure

The Management Structure for MeTA Zambia includes the National Secretariat, the

decision making Executive Committee (with its Sub Committees) and the

policymaking MeTA Council (which also has power to elect the Executive

Committee). There is also the MeTA Forum which is an annual discussion forum that

has possibilities of being turned into an Annual General Meeting with powers to elect

MeTA Council members.

3.3.1 Executive Committee

The Executive Committee comprises five members from Government, the private

Sector and Civil Society In line with the multi-stakeholder principle of MeTA. Ideally

the Executive Committee is expected to meet monthly/


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The first Executive Committee comprising Mr Lazarus Chota as chairperson, Mr

Chikuta Mbewe as vice chairperson, Mr Goodwell Lungu as the Secretary General,

Ms Ruth Mudondo and the late Davy Nanduba (replaced by Masautso Phiri) as

members were elected during the first MeTA Council meeting of October 21, 2011.

3.3.2 MeTA Council

The MeTA Council comprises 15 members from Government, Private Sector, Civil

Society and Cooperating Partners. The Council will oversee the implementation of

the work plan and monitor the performance of the national secretariat. Ideally, the

Council will meet quarterly during the years 2012 – 2015.

The first Council meeting of October 21, 2011 discussed and approved the proposal

to reduce subcommittees from four to three, namely Finance and Administration,

Research and Policy and Communication. Election of members to these sub

committees was deferred to a later date. These committees will take into

consideration the need for right skill sets to meet the goals of each committee.

The second MeTA Council meeting whose agenda included the approval of the log

frame and the work plan was held in February 2012 while the third council meeting

was on 28 November 2012.

3.3.4 MeTA Forum

The MeTA Forum is a platform for a larger multi-stakeholder group from

Government, Private Sector and Civil Society to meet, discuss and share

information. The Forum will also focus on future developments in the Pharmaceutical

Sector and receive feedback from the general public on issues of transparency and

accountability including issues of pricing, procurement, accessibility, availability, and

affordability of medicines.

The Forum will meet annually and has the potential of becoming the Annual General

Meeting of MeTA Zambia at which MeTA Council members could be elected.

Membership of the Meta Forum will consist of the 15 council members, more than 50

persons from a cross section of society and a wider pool of stakeholders.

4.0 Description of MeTA - Zambia Work plan

At the start of MeTA Project Phase Two a Core Group was created to address the

process of initiating continuation phase. The Core Group held several meetings that

resulted in the new MeTA Council on October 21, 2011 and the implementation of

the transitional phase. At least eight (8) multi-stakeholder Core Group meetings were

held after the Council was mandated to develop the work plan

.


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4.1 Goal

Contribute to increased access to affordable quality assured Essential Medicines by

December 2015 in co-operation with pharmaceutical companies (MDG 8, Target 17),

with a focus on the poor through advocating for policy changes which will promote

increased access to medicines in Zambia based MeTA Zambia findings.

4.2 Objectives

a. To contribute towards increased availability and access to affordable quality

assured essential medicines in a multi-stakeholder process (MDG 8, Target

17), with a focus on the poor and disadvantaged by 2015

b. To improve transparency and accountability in medicines procurement for

hospitals in five districts of four provinces of Zambia by 2016

c. To increase participation of Government, Private Sector, CSOs and the

general public in inmproving transparency and accountability in the medicines

supply chain in five out of ten provinces of Zambia by 2016

4.3 Expected Outcomes

Increased availability and access to affordable quality assured essential

medicines in a multi-stakeholder process (MDG 8, Target 17), with a focus on

the poor and disadvantaged

Outcome Indicator 1 – Number of activities in the National Medicines policy

implementation plan supported towards promoting availability and access to

affordable quality assured essential medicines in a multi stakeholder process.

Outcome Indicator 2 – Proportion of a set of core indicator 50 Essential Medicines

available according to MOH list.

Improved transparency and accountability in medicines procurement for

hospitals in five districts of four provinces of Zambia

Outcome indicator 1 – 95 procurement officers and controlling officers engaged on

issues of transparency and accountability in five districts of four provinces of Zambia.

Increased participation of Government, Private Sector, CSOs and the general

public in medicines issues in five out of ten provinces of Zambia

4.4 Expected Outputs

The following expected outputs 1-5 are due for implementation for the first year 1st

October l 2012 to 31st July 2013 while expected output 6 is for the second year 2013.

Other expected outputs for the years 2013 and beyond will be stated as the activities

are reviewed for each year.


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Expected Output 1 Multistakeholder groups and implementation

Activity 1.1 MeTA Secretariat established, staff recruited, executive,

subcommittees, MeTA Council and MeTA Forum created and meetings conducted

and accomplished.

Activity 1.2 Website re-activated. Information on MeTA objectives, MeTA study

results and key messages disseminated to the public through MeTA Zambia website

Output Indicator 1.2.1 – Number of members of the public and organisations using

the MeTA Zambia website and issues raised

Expected Output 2 Information Data and Dissemination

Activity 2.1 Review and Analysis of Pilot Studies

Three research studies and two position papers reviewed and analysed. Materials

recommended for write ups as brochures and or fact sheets for dissemination to the

public through radio, TV and community sensitisation.

Activity 2.2 Conduct awareness campaign on pricing, quality and availability of

medicines on radio and TV

Awareness campaigns conducted for the public and communities on pricing, quality,

access, and availability of medicines and citizens demand affordable and quality

medicines on ZNBC Radio 4 with focus on four provinces of Lusaka, Central,

Copperbelt and Southern and on Radio Solwezi in North Western.

Awareness campaigns conducted for the public and communities on pricing, quality,

access, and availability of medicines and citizens demand affordable and quality

medicines through live TV debates on ZNBC TV from Lusaka, Kitwe and

Livingstone.

Output Indicator 2.2.1 - Number of persons from TV and radio stations trained.

Presenters one for TV and two for Radio and TV trained and both ZNBC Radio 4 and

Solwezi Community Radio air 13 programmes each on MeTA issues over a three

month period. The programmes include phone-in and text messages.

Output Indicator 2.2.3 - Number of live MeTA debate programs on National TV

Three live TV debates conducted fortnightly on ZNBC TV from Lusaka, Kitwe and

Livingstone over a six-week period. The programmes include live multi-stakeholder

audience, phone-in and text messages.

Expected Output 3 Transparency and Accountability Improved

Activity 3.1 Conduct Annual MeTA Forum meeting


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To improved awareness on transparency and accountability for 60 MeTA Forum

members in local pharmaceutical sector covering both private and public institutions,

throughout the project lifespan.

Output Indicator 3.1.1 - Number of MeTA forum members meetings on transparency

and accountability on medicine issues

Annual MeTA Forum meetings held for each year from 2012 - 2015

Activity 3.2 Conduct Awareness on Transparency and accountability in

Procurement of Medicines in Lusaka District

Output Indicator 3.2.1 – Number of procurement officers attending awareness

meeting

Meeting held targeting 20 procurement officers and controlling officers at hospitals

in Lusaka highlighting issues of transparency and accountability in medicines

procurement. MeTA Zambia’s role in procurement of medicines in Zambia

emphasised.


Procurement of Medicines in Solwezi District

Output Indicator 3.3.1 Number of procurement officers attending awareness meeting

Meeting held targeting 15 procurement officers and controlling officers at hospitals in

Solwezi highlighting issues of transparency and accountability in medicines


emphasised.


Procurement of Medicines in Kitwe District

Output Indicator 3.4.1 Number of procurement officers attending awareness

meeting


Kitwe highlighting issues of transparency and accountability in medicines


emphasised.


Procurement of Medicines in Ndola District

Output Indicator 3.5.1 Number of procurement officers attending awareness meeting


Ndola highlighting issues of transparency and accountability in medicines


emphasised.


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Procurement of Medicines in Livingstone District

Output Indicator 3.6.1 Number of procurement officers attending awareness

meeting


Lusaka highlighting issues of transparency and accountability in medicines


emphasised.

Expected Output 4 Civil Society Capacity Development

Activity 4.1 Exploring process for registration of MeTA Zambia, type of

organisation, meetings and consensus building consultations and visits

Output Indicator 4.1.1 Number of consensus building meetings held, constitution

drafted and agreed on

At least five meetings held with various stakeholders especially with Government,

Private Sector and Civil Society. Constitution developed, debated and agreed on

especially on powers MeTA Zambia’s organs

Activity 4.2 Conduct awareness campaign on pricing, quality and availability

of medicines for pilot phase CSO Coalition and community health leaders

Output indicator 4.2.1 Number of meetings held with Pilot phase CSO Coalition

and Community Health leaders.

Three meetings involving held in Lusaka, Ndola and Solwezi involving pilot phase

CSO Coalition and Community Health leaders.

Expected Output 5 Policy Dialogue

Activity 5.1 Participate and continue policy debate on medicines issues with

sessional committees of Parliament

Output Indicator 5.1.1 - Number of meetings held with policy makers and

implementers of Parliamentary Committees on MeTA objectives

Four meetings held with sessional committees of Parliament, namely Health, Human

Rights, Information and Government Assurances.

Knowledge of MeTA objectives among policy makers and implementers who are

members of four sessional committees of Parliament improved in order to influence

advocacy and policy change

Activity 5.2 Participate and continue policy debate on medicine issues with

line ministries

Output Indicator 5.2.1 - Number of meetings held with policy makers and

implementers in line ministries on MeTA objectives


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Two meetings held with line ministries of Health and Commerce to discuss policies,

which will promote equity and improved access to quality, assured essential

medicines by all through pricing structures, production, distribution and rational use.

Knowledge among policy makers and implementers in the Ministries of Health and

Commerce about MeTA objectives improved in order to influence advocacy and

policy change

Activity 5.3 Conduct high level policy discussion for senior officials from

MOH, Commerce and Industry, Private Sector and CSOs

Output Indicator 5.3.1 Number of high-level meetings held with MOH, Commerce

and Industry, Private Sector and CSOs

One meeting held and resolutions made on policy issues.

Output 6

This output is not included in year one. It will be included either in year two or three.

Output indicator 6.1- Number of MeTA data collection tools developed or reviewed

Not applicable for year one.

Output indicator 6.2- Number of Multi-stakeholders MeTA progress data review

meetings held and reports produced on research conducted.

Not applicable for year one.

5. Risks/External Factors

5.1 Risks

The public sector is not traditionally accustomed to operating in an open

environment. For the MOH, the risk of being transparent and open would be that it

would find itself ‘exposed’ to queries for which the civil service structure is not exactly

set up to deal with. Hence there is potentially a risk that the MoH might be slow to

take on all/some of the MeTA principles.

5.2 Challenges

5.2.1 Changing systems

While MoH management may wish to introduce wide- ranging changes to

operational systems, the biggest challenge may be in the area of managing change.

5.2.2 Willingness to change

Another challenge may be the willingness of staff to conduct business in a different

way that demands transparent and accountable ways of working.


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5.2.3 Human Resource Issues

The critical shortage of pharmaceutical personnel in both public and private sectors

has the potential to impact negatively on the MeTA programme, as there might not

be adequate capacity to own and adhere to the MeTA initiative. The already anxious

and demoralized personnel due to the lengthy re-structuring process in the MOH

further compound this situation.

5.2.4 Dealing with outcomes

MeTA principles suggest that recipients of services will demand various rights, data,

information, etc. The MoH and PRA may face a challenge of having to meet these

new needs.

5.2.5 Financing change

These challenges also apply to cooperating partners for MoH in implementing and

managing the health sector. To what extent are donor institutions, the local and

international NGOs willing to face up to transparent, accountable and responsible

ways of operations is a challenge yet to be tested.

The global financial meltdown is another big challenge, which could reduce funding

from international donors to help health sector operate efficiently and meet these

need principles of transparency and accountability.

5.2.6 Limited Information

There is limited information to the public on matters of transparency and

accountability in medicines supply chain and procurement systems.

5.3 External Factors

5.3.1 Pressure from the community

The public and private health sectors shall face external demands for changes in

operations in line with positions being taken under MeTA. There will be pressure to

conform and live up to espoused standards in all sectors (public, private and donor

communities). That external pressure will require positive and constructive

engagement by all parties, with the public.

5.3.2 Pressure from donor institutions

While a number of donors remain to get on board the MeTA initiative, the objective of

MeTA is to have all current and potential donors on board. Recipient governments

on MeTA will be expected to put in place arrangements that improve on

accountability, transparency as part of Good Governance for Medicines. Those

failing to do so are likely to face steps that may lead to reduction in support.


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6.0 Financial arrangements

The International MeTA Secretariat is providing £71,500.00 for the period January

1st 2013 to July 31st 2013. Arrangements for the transfer of funds to the National

Secretariat are detailed in the Memorandum of Understanding between the

International MeTA Secretariat and local MeTA Council (through the

Finance/Administration sub-committee).

MeTA Zambia will open its own account managed by the secretariat. The

establishment of its own account is expected to create smooth operations for MeTA

Zambia and help capacity build Civil Society in Zambia around transparency and

accountability in contributing to increased access to quality assured medicines.

7.0 Budget

Note that the lists for office supplies and Internet facilities have been zero-rated. The

two amounts are shown in the budget as contingencies and could be used for the

same items if needed. If such a case arose MeTA Zambia would apply to the

International Secretariat to release the funds or else the funds could be used for

other activities, in which case MeTA Zambia would be required to apply with a

budget for the new activities. The budget is attached separately as an excel

document. See Appendix 2.

8.0 Monitoring system

The ultimate output and outcomes will be the objectives of the five-year country work

plan to be achieved. The International MeTA secretariat will work with the national

MeTA secretariat at country level and will use these objectives as indicators for

evaluation of the project.

• National secretariat routine monitoring:

o Financial monthly reporting by MeTA national secretariat to MeTA

Finance/Admin sub-committee and Executive Committee

o Progress reports of the working sub-committees quarterly to the MeTA

Council

o Quarterly reports of MeTA Zambia national secretariat to MeTA Council

and the International MeTA secretariat

Annex 1 Budget

Annex 2 Log frame

Annex 3. MeTA Zambia Council Members

Annex 4 CSO Coalitions (Pilot Phase)


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References

1. Zambia Sixth National Development Plan - 2011 to 2012

2. National Drug Policy –

3. Millennium Development Goals

4. Pharmaceutical Private Sector Mapping Study in Zambia – MeTA Zambia

Nov 2010

5. Evaluation of MeTA Phase I Project – MeTA Zambia 2011

6. Recommend Retail Price Study – MeTA Zambia 2009 – Nov 2010

7 contact person: goodwell lungu secretary general ... · meta zambia 4 year country work plan...

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