win-win or lose-lose? why is multi-stakeholder involvement essential?
DESCRIPTION
Win-Win or Lose-Lose? Why is multi-stakeholder involvement essential?. Saul Walker Senior Health Advisor UK Department for International Development. Overview. Pharmaceutical sector goals in tension All stakeholders can be “irrational” - PowerPoint PPT PresentationTRANSCRIPT
Slide 1
Win-Win or Lose-Lose?Why is multi-stakeholder involvement essential?
Saul Walker
Senior Health Advisor
UK Department for International Development
Slide 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
Slide 3
What do we want to achieve in the pharmaceutical sector?
• Objectives can be in tension over time
• All stakeholders may hold beliefs that conflict with these objectives
• Relation to objectives dynamic and contextual
• Improved health outcomes• Patient (and provider) satisfaction• Equity
• Quality, safety and efficacy• Rational use and cost-effectiveness• Sustainability• Innovation
• Competitive markets?• Local industry?
Expanding Equitable Access
Available to the poor
Keeping Costs Affordable
To patient and to the health system
Effective interventionsLevels of care, innovation
4
Competing Pharmaceutical Policy Objectives?
Adapted from: Dennis Ross-Degnan (HMS)
Political cycles
Economic policies
External drivers
Organisational politics
Slide 5
taxe
s
Consumers Providerspayments
treatment
Government (MOH)
info
rmat
ion
standards, payments
Drug Industry
standardslobbying
$$
mar
ketin
g promotion
oversight
Consumer Organizations
lobbying
support
informationstandards, education
Professional Organizations
lobbying
3rd Party Payers
payments payments, controls
coverageprice
informationinformation
Adapted from WHO
Slide 6
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
Donors
Domestic political concernsRegulationsForeign/industrial policy
Pharmaceutical companies Profit focus (short/long) - marketingOpportunity costsIntellectual propertyStrategies for market share/volume
Wholesales, distributors, retailersProfit focus (short/long)Opportunity costsStrategies for market share/volume
International AgenciesProfile/fundingOverlapping agendasOrganisational structures/politicsPolitical outlook
Country GovernmentsLow budget allocationCompeting objectivesVested interestsPolitical outlook
People/Civil societyOverconsumption/self medicationPoor adherenceDisease specific groupsFunding/profile etcBelief systems
Potential for Poor Health Outcomes
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
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
Can’t align everyone, on everything all of the
time
Pharmaceutical companies Accurate information on pricingProactive roleBetter procurement and forecastingAchieve public health objectivesReduce pressure for inappropriate behaviour
Wholesales, distributors, retailersNew support for building capacityImproved market operationTackle corruption & wasteful practices
DonorsGood governance agendaIncrease access to medicinesSupport responsible businessIncrease aid effectiveness
International AgenciesGood governance agendaPromote ethical pharmaceutical procurement and supplyImprove health outcomes
Country GovernmentsDemonstrates commitment to good
governance – ↑ donor confidence Improved procurement and supplyBetter public health outcomes
Civil SocietyIncreased informationPlace at the tableSupportive environment for advocacyFinancial and other supportImproved dialogue with public and private sectors
Alignment on Transparency
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)
Slide 12
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
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)
Slide 14
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
Slide 15
Acknowledgements
Dr Tim Reed
Dr Michael Reich
Samia Saad
Dr Willbert Bannenberg
Dr Andreas Seiter
Dr Anita Wagner
Dr Dennis Ross-Degnan
MeTA team
Slide 16
Leading the UK government’s fight against world poverty
Tel: +44 (0) 20 7023 0000Fax: +44 (0) 20 7023 0016Website: www.dfid.gov.ukE-mail: [email protected] Enquiry Point: 0845 300 4100If calling from abroad: +44 1355 84 3132
LONDON1 Palace StreetLondonSW1E 5HE
EAST KILBRIDEAbercrombie HouseEaglesham RoadEast KilbrideGlasgowG75 8EA