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MeTA Uganda Workplan 2012-2015 Proposal Submitted to International MeTA Secretariat SEPTEMBER 2012
MeTA Uganda
Workplan 2012-2015
Proposal
Submitted to
International MeTA Secretariat
SEPTEMBER 2012
2
CONTENTS
Acronyms ........................................................................................................................................ 3
EXECUTIVE SUMMARY .................................................................................................................... 4
INTRODUCTION ............................................................................................................................... 4
BACKGROUND ................................................................................................................................. 4
Overall Goal of MeTA Uganda ........................................................................................................ 5
Purpose of MeTA Initiative ............................................................................................................. 5
INTRODUCTION ............................................................................................................................... 6
BACKGROUND ................................................................................................................................. 6
MULTI-STAKEHOLDER COLLABORATIONS ...................................................................................... 8
Overall Goal of MeTA Uganda ........................................................................................................ 9
Purpose of MeTA Initiative ............................................................................................................. 9
Proposed approach to implementation of the MeTA Initiative in Uganda ................................ 9
DESCRIPTION OF MeTA WORK PLAN .............................................................................................. 9
ACTIVITIES, DELIVERABLES ............................................................................................................ 18
ACTIVITY WORK PLAN ................................................................................................................... 20
LOGFRAME IN LINE WITH GLOBAL LOGFRAME ............................................................................ 22
GOVERNANCE PLAN ...................................................................................................................... 23
FINANCIAL ARRANGEMENTS ........................................................................................................ 25
RISK ASSESSMENT ......................................................................................................................... 25
SUMMARY BUDGET ...................................................................................................................... 26
Detailed budget is attached .......................................................................................................... 27
MONITORING SYSTEM .................................................................................................................. 27
REFERENCES .................................................................................................................................. 28
ANNEX 1 ........................................................................................................................................ 29
MeTA Uganda Contribution – successes and challenges of Pilot Phase .................................. 29
ANNEX II ........................................................................................................................................ 32
MeTA COUNCIL AND SECRETARIAT .......................................................................................... 32
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Acronyms
CSO CIVIL SOCIETY ORGANIZATION
DANIDA DANISH INTERNATIONAL DEVELOPMENT AGENCY
DFID DEPARTMENT FOR INTERNATIONAL DEVELOPMENT
EMHS Essential Medicines and Health Supplies
GDP Gross Domestic Product
HAI Health Action International
HC HEALTH CENTRE
HEPS COALITION FOR HEALTH PROMOTION AND SOCIAL DEVELOPMENT
HSD HEALTH SUB DISTRICT
HSSIP Health Sector Strategic Investment Plan
IMS International MeTA Secretariat
IP INTELLECTUAL PROPERTY
JMS Joint Medical Store
MAUL MEDICAL ACCESS UGANDA LIMITED
MeTA Medicines Transparency Alliance
MMR MATERNAL MORTALITY RATE
MSH MANAGEMENT SCIENCES FOR HEALTH
MoFPED Ministry of Finance Planning and Economic Development
MoH Ministry of Health
MTEF MEDIUM TERM EXPENDITURE FRAMEWORK
NDA National Drug Authority
NGO NON-GOVERNMENTAL ORGANIZATION
NHE National Health Expenditure
NHIS National Health Insurance Scheme
NMS National Medical Stores
NPSSP National Pharmaceutical Sector Strategic Plan
PFP Private for Profit
PNFP Private Not for Profit
RUM RATIONAL USE OF MEDICINES
UGX Uganda shillings
UNHCO UGANDA NATIONAL HEALTH USERS/ CONSUMERS CONSUMERS’ ORGANIZATION
UNHS Uganda National Household Survey
UNMHCP UGANDA NATIONAL MINIMUM HEALTH CARE PACKAGE
WHO WORLD HEALTH ORGANIZATION
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EXECUTIVE SUMMARY
INTRODUCTION
This proposal is presented to the International MeTA Secretariat (IMS) by the MeTA Uganda
council for funding for a three year work plan 2012-2015.
BACKGROUND
Uganda has a population of 33 million people. According to the 2009/10 Uganda National
Household Survey (UNHS), 24.5 percent (7.5 million people) of the population live below the
poverty line, down from 56 percent in 1992, 38 percent (9.8 million people) in 2002/03, and 31
percent (8.4 million people) in 2005/06. GDP per capita was estimated at UGX 662,582 (FY
2010/11).
According to HSSIP 2011-15, attempts have been made to ensure availability of medicines:
training at all levels, including provision of support to NMS and JMS to improve on Information
technology, support to expand the storage capacity of NMS, improved coordination of
procurement of commodities through implementation of the three year rolling procurement
plan for EMHS, upgrading pharmacy section to a division, establishment of the position of
dispensers at all HC IVs, curriculum development and increasing outputs for pharmacy schools,
staff recruitment and improved funding and procurement of EMHS. The creation of and
capacity building for medicines and therapeutic committees is ongoing in hospitals and HSDs.
Tools for promoting rational use of medicines like the Essential Medicines List and the Uganda
Clinical Guidelines were regularly updated and are available in more than 90% of facilities.
While these attempts are being made, availability of and access to medicines in the public
sector continues to be a major problem. Only about 30% of the EMHS required for the basic
package are provided for in the budget. Global Initiatives provide the bulk of resources needed
for malaria, HIV and AIDS, tuberculosis, vaccines and reproductive health commodities. In
2006/7 the contribution from the global initiatives was US$2.39 per capita out of the US$4.06
per capita spent on EMHS. Delays in procurement, poor quantification by and late orders from
some facilities and poor records keeping are among the management issues that contribute to
shortage and wastage of medicines.
MeTA Uganda, the first broad multi-stakeholder initiative to improve access to medicines was
launched in March 2009. The initiative for the first time brought together the government
through the Ministry of Health and its medicine institutions (NDA, NMS, and PSU), the private
sector including wholesalers, manufacturers, faith based institutions and the civil society.
At national level the initiative has been proven to work and key successes for Uganda during
the pilot phase include the following:
5
• The first forum in Uganda to bring all stakeholders in medicines on the same table
• Increased engagement and involvement of CSO in advocacy for access to medicines.
• Inclusion of private sector and CSO’s in the National Pharmaceutical Sector Strategic
Planning process
• Increased media coverage of medicines issues
MeTA Uganda will over the next three years focus on 4 critical elements of the pharmaceutical
supply system namely:
a. Availability of and access to medicines and information about medicines; relating
amongst others to the areas of selection, procurement modalities, efficiency in the
supply system and ensuring value for money
b. Cost of medicines to consumers involving amongst others the options of pricing
policies, regulating mark-ups and value for money
c. Quality of medicines, involving quality standards and registration, procurement and
importation procedures.
d. Rational use of medicines by prescribers and users
MeTA sees an important role for patients/consumers/CSO in the provision of health services
generally and pharmaceutical services in particular. In that respect, therefore, access to
relevant information by CSOs is considered of great importance.
Overall Goal of MeTA Uganda
To increase access to essential medicine especially by the poor and vulnerable
Purpose of MeTA Initiative
To contribute towards improving governance, transparency and accountability, in procurement,
supply and management of medicines in Uganda
6
INTRODUCTION
This proposal is presented to the International MeTA Secretariat (IMS) by the MeTA Uganda
council for funding for a three year work plan 2012-2015.
BACKGROUND
Uganda has a population of 33 million people. In 2009/10, Uganda’s total export earnings from
goods were estimated at US$ 2.8 billion (MOFPED 2010), below the estimated import
expenditures of US$ 4.2 billion, reflecting a trade deficit of US$ 1.4 billion. The national external
debt stock stands at US$ 4.1 billion, and its ratio to GDP is projected to reach 11.4 percent in
2011/12. Domestic revenue collection was estimated at UGX 5,110 billion (12.9 percent of GDP)
in FY 2010/11, while total expenditure stood at UGX 9,203 billion (23.7 percent of GDP)
according to MOFPED, 2011.
According to the 2009/10 Uganda National Household Survey (UNHS), 24.5 percent (7.5 million
people) of the population live below the poverty line, down from 56 percent in 1992, 38
percent (9.8 million people) in 2002/03, and 31 percent (8.4 million people) in 2005/06. GDP
per capita was estimated at UGX 662,582 (FY 2010/11).
The Country therefore still has poor health indicators, with total fertility rate at 6.7, neonatal
mortality at 29 per 1000 live births, Infant mortality at 76 per 1000 live births, under 5 mortality
rate at 137 per 1000 live births. There is also a high maternal mortality ratio (MMR) at 435 per
100,000 live births. The burden of communicable diseases is still high with 95% of the country
endemic to malaria. Lots of lives are lost with an estimate of 320 lives lost per day due to
malaria while HIV prevalence is still high at 6.4%. It is estimated that 72% of the population
access a health facility structure within 5km radius.
The Government of Uganda provides free health care to the population through public health
care facilities. The Private Not for Profit (PNFP) sector also receives government support to
improve access to health care by the population. Access to essential medicines and health
supplies (EMHS) is limited by a number of factors including inadequate government financing,
household poverty, high cost of medicines, inefficient national procurement and distribution
systems, inadequate skilled health workers, lack of innovation, limited technology transfer,
research and development, Intellectual Property (IP) barriers and inadequate information
sharing among the stake holders.
According to HSSIP 2011-15, attempts have been made to ensure availability of medicines:
training at all levels, including provision of support to NMS and JMS to improve on Information
technology, support to expand the storage capacity of NMS, improved coordination of
procurement of commodities through implementation of the three year rolling procurement
plan for EMHS, upgrading pharmacy section to a division, establishment of the position of
dispensers at all HC IVs, curriculum development and increasing outputs for pharmacy schools,
7
staff recruitment and improved funding and procurement of EMHS. The creation of and
capacity building for medicines and therapeutic committees is ongoing in hospitals and HSDs.
Tools for promoting rational use of medicines like the Essential Medicines List and the Uganda
Clinical Guidelines were regularly updated and are available in more than 90% of facilities.
While these attempts are being made, availability of and access to medicines in the public
sector continues to be a major problem. Only about 30% of the EMHS required for the basic
package are provided for in the budget. Global Initiatives provide the bulk of resources needed
for malaria, HIV and AIDS, tuberculosis, vaccines and reproductive health commodities. In
2006/7 the contribution from the global initiatives was US$2.39 per capita out of the US$4.06
per capita spent on EMHS. Delays in procurement, poor quantification by and late orders from
some facilities and poor records keeping are among the management issues that contribute to
shortage and wastage of medicines. A survey (MoH 2008a) shows that even though 72% of the
households were close to a public health care facility, only 33% of the households believe that
medicines are available in public health care facilities. Medicines are 3-5 times more expensive
in the private sector compared to the public sector procurement costs. For many people,
medicines in the private sector are not affordable and this constitutes a major obstacle to
households accessing medicines. Another study (MoH 2008b) shows that only 45.7% of the
public health facilities had key essential medicines; the situation was better in mission facilities
at 57.5% and private facilities at 56.3%. The private medicines outlets including dispensing
hospitals and clinics, pharmacies and drug shops are poorly regulated due to inadequate
legislation, enforcement and capacity of the NDA and health professional councils. Irrational
use of medicines is widespread due to dispensing by untrained or insufficiently trained
personnel. Efforts to recruit pharmacy staff have been made at different levels, but serious
shortfalls continue to prevail.
Households constitute a major financing source of the NHE at 49.7% and followed by
development partners at 34.9%, central government at 14.9% and international NGOs at 0.4%.
Households spend about 9% of their expenditure on health, although no user fees are paid in
lower level government health units and general wings of publicly owned hospitals. However,
the private sector charges user fees. When medicines are not available in the public sector,
patients buy from the private sector. Private health insurance is limited to a few in the formal
employment sector but health expenditure remains high for most households. The
establishment of the National Health Insurance Scheme may play a major role in health
financing (HSSIP 2011-15).
In recent years, government’s contribution as a proportion of government’s discretionary
expenditure has been relatively stable around 9.6%. It thus remains below the Abuja
Declaration target of 15%. There is inadequate funding to provide the UNMHCP in all facilities
as envisaged: the per capita cost was estimated at USD 41.2 in 2008/09 and will be rising to
USD 47.9 in 2011/12 (or 2.75 billion UGX) yet the health budget according to the MTEF was
estimated at USD 12.5 per capita in 2008/09, demonstrating a shortfall of almost USD 29 This
trend has important implications for service delivery during the HSSP III period as it will imply
the need for further priority setting, based on the UNMHCP. If the population growth is not
8
controlled, the current population growth rate will have an escalating effect on the total health
envelope required.
MULTI-STAKEHOLDER COLLABORATIONS
Uganda has had a long history of collaborative activities in the area of access to medicines. The
Ministry of Health has worked with DANIDA since the mid-eighties in the area of medicines
management including rational use of medicines (RUM). A tripartite collaborative arrangement
that includes WHO, HAI-Africa (represented at country level by HEPS) and Ministry of Health
that started in 2002 has been involved in a number of activities monitoring access to medicines.
MeTA Uganda, the first broad multi-stakeholder initiative to improve access to medicines was
launched in March 2009. The initiative for the first time brought together the government
through the Ministry of Health and its medicine institutions (NDA, NMS, and PSU), the private
sector including wholesalers, manufacturers, faith based institutions and the civil society.
At national level the initiative has been proven to work and key successes for Uganda during
the pilot phase include the following:
• The first forum in Uganda to bring all stakeholders in medicines on the same table
• Increased engagement and involvement of CSO in advocacy for access to medicines.
• Inclusion of private sector and CSO’s in the National Pharmaceutical Sector Strategic
Planning process
• Increased media coverage of medicines issues (more in annex 1)
The external evaluation of the Medicines Transparency Alliance (MeTA) Pilot phase which
ended in December 2010 recommended its continuation (Phase 2) in the seven countries that
implemented the pilot including Uganda. As a result, DFID has provided support to the World
Health Organization (WHO) and Health Action International HAI (Global) to act as the
International MeTA Secretariat (IMS) and facilitate implementation of MeTA phase 2 in the
seven pilot countries. Uganda through the country MeTA co-chairs accepted participation in the
MeTA 2 in 2011 whereupon funds were provided to support a transition process to develop a
three year work plan between 2012 and 2015. It is expected that the activities of MeTA will
augment efforts of government to improve access to medicines in both the public as well as the
private sector. The initiative is in line with the objectives of the Uganda Health Sector Strategic
Investment Plan (HSSIP) and the National Pharmaceutical Sector Strategic Plan (NPSSP) which
aim at ensuring the availability and accessibility at all times of adequate quantities of
affordable, efficacious, safe and good quality essential medicines and health supplies and their
rational use. MeTA Uganda will over the next three years focus on 4 critical elements of the
pharmaceutical supply system namely:
e. Availability of and access to medicines and information about medicines; relating
amongst others to the areas of selection, procurement modalities, efficiency in the
supply system and ensuring value for money
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f. Cost of medicines to consumers involving amongst others the options of pricing
policies, regulating mark-ups and value for money
g. Quality of medicines, involving quality standards and registration, procurement and
importation procedures.
h. Rational use of medicines by prescribers and users
MeTA sees an important role for patients/consumers/CSO in the provision of health services
generally and pharmaceutical services in particular. In that respect, therefore, access to
relevant information by CSOs is considered of great importance.
Overall Goal of MeTA Uganda
To increase access to essential medicine especially by the poor and vulnerable
Purpose of MeTA Initiative
To contribute towards improving governance, transparency and accountability, in procurement,
supply and management of medicines in Uganda
Proposed approach to implementation of the MeTA Initiative in Uganda
The MeTA Uganda strategy has been guided by the principle of a multi-stakeholder approach to
improving governance, transparency, and accountability, and recognizing the importance of
access to information in improving efficiency of supply systems, the market structure, and
responsible business practices. The multi-stakeholder approach means that two or more
stakeholders jointly implement an activity in the area of their competence and comparative
advantage, share the results and analysis, and engage all other stake-holders in deciding how to
move forward. A member of the secretariat is assigned to a project to oversee its progress and
report regularly to the secretariat.
The MeTA Council takes the overall responsibility of work plan implementation and therefore
activity progress reports are part of the council meetings.
DESCRIPTION OF MeTA WORK PLAN
The MeTA Uganda work plan reflects the MeTA global project focus on strengthening capacity
to collect, analyze, utilize, and disseminate data on medicines quality, availability, pricing and
use with a view to improving system efficiency and outcomes.
The following areas proposed by MeTA Council at close of MeTA pilot phase as priority areas to
improve access to medicines have been identified for the MeTA phase II Uganda workplan. The
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ideas have been developed by stakeholders with a major interest and core competence. A
consultant collated the ideas for stakeholder consensus.
Below are the activities:
1. Access to Medicines
1.1 Monitoring of medicine availability and prices:
This activity is part of the long collaboration on access to medicines in Uganda.
MoH/WHO/HAI (HEPS) have since 2002 conducted surveys to monitor access to
medicines. The surveys have been used to inform on-going MoH interventions to
improve access to medicines including in the development of the HSSIP and the NPSSPII.
Quarterly surveys have been conducted on availability and prices of a basket of 40
essential medicines in 4 regions of Uganda in the Public, PFP and mission sectors using
the WHO/HAI methodology.
The previous surveys were both costly and took a long time between data collection and
report production and therefore immediate interventions could not be done. The
activity has been revised to minimize the time between data collection and report
dissemination. This activity will depend on a new innovative tool from HAI using cell
phone technology to enter data with automated analyses and graphical displays of
findings. Data will be collected on a quarterly basis to provide information from about
60 facilities across Public, PFP and mission sectors including providing time series.
In the first quarter, a survey will be conducted to assess the feasibility of using cell
phones for carrying out medicine price and availability monitoring. This will help to
define the appropriate technology and survey design for Uganda in order to participate
in the pilot led by HAI. WHO/HAI will provide technical support for carrying out the
feasibility study.
In addition to quarterly surveys conducted, MeTA secretariat will look out for surveys
conducted by other stakeholders on availability and prices of medicines to inform the
MeTA council and plan for dissemination.
Objectives:
1. To document the availability of selected medicines in the public, private and mission
sectors
2. To document the price variations of selected medicines within the private and
mission sectors
3. To monitor the affordability of treatment for indicator conditions for ordinary
Ugandans
4. To inform the policy dialogue around availability and cost of selected medicines
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Data Collection
The data collection on a quarterly basis using cell phone technology across about 60
facilities in 4 regions of Uganda in the three sectors of Public, PFP and mission sectors.
Data analysis and report production
The collected data will be relayed using cell phone and automated analyses will be
generated. A report containing price and availability trends of medicines across the
three sectors, affordability calculations for treatment of common diseases will be
generated.
Advisory group meetings
An advisory group composed from the MeTA Council will deliberate on findings and
advise on dissemination and policy options.
Dissemination
The reports will be disseminated by various means including: a stakeholders’ meeting,
email and post. The reports and will be accessible on the HAI Africa, HEPS Uganda and
other CSOs, MOH and WHO websites. The target audiences will include the MeTA
Council, MoH Technical Working Group on medicines procurement and management,
media, pharmacies, CSOs and NGOs, private clinics, retail pharmacies, public hospitals,
mission health facilities, procurement agencies, consumers, government officials and
policymakers, the health professional organizations and societies, and the donors of the
health sector that are supporting procurement of medicines
1.2 Empower citizens on the concept and monitoring of essential medicines.
This activity will be conducted by CSO partners on the MeTA CSO steering committee
through district coalitions. The aim of the activity will be for the community to own
services and hold duty bearers accountable. The rationale of the activity is based on the
NPSSP II policy strategy to promote, support, and sustain interventions that ensure
efficient and effective medicines and health supply logistics management. The objective
is to ensure functional system for monitoring utilization of funds at local levels. It is
acknowledged that this activity is resource intensive and that MeTA funding alone
cannot be enough to pull it off. Accordingly therefore, MeTA funding will kick-start the
trainings in 3 districts and the CSOs will take on the responsibility of raising funds from
other donors to fill the gap.
Whereas MoH is currently undertaking training of health workers on medicines
management, the role of communities cannot be underscored in a functional health
system. Citizens ought to understand their rights, entitlements as well as exercise their
responsibilities and through their community leaders, they need to understand the
referral structures of the health system, the roles of their health and other leaders, the
concept of essential medicines, generics as well as how to monitor and report on
medicines. This will help bridge the gap between the duty bearers and the consumers by
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enabling the consumers to engage with duty bearers but also for the consumers to
know the services they are entitled to, where to get them and what to do when rights
are violated like the right to access medicines and other health commodities.
The specific objectives of this activity:
1. To train community leaders on concept and monitoring of essential medicines
2. To develop community accountability platforms by facilitating dialogue between
community members and service providers
The activities:
• Training of community leaders including VHTs, HUMCs, and opinion leaders in 10
districts: Using participatory reflection and action techniques, the SSO partners
will train and facilitate community leaders in 10 districts to identify key barriers to
access to essential medicines in their communities, jointly agree priorities and
actions to address the barriers. Trainings will emphasize health rights, entitlements,
responsibilities, structure of health system, roles of health providers, duties of
leaders, concept of essential medicines, as well as simple monitoring
methodologies. Training will be conducted at sub-county level and will have a one-
day program targeting 40-50 health leaders including the VHT members, VHT peer
leaders, HUMC members, opinion leaders in the communities.
Baselines on CSO knowledge and policy level engagement will be developed during
the trainings.
• Routine gathering of information for advocacy: Selected community leaders will be
facilitated with airtime and on weekly basis send information on medicines and
health status in their areas. This information will be compiled by CSOs at a monthly
level and discussed at MeTA CSO steering committee meetings and consequently
MeTA council. The information will also be useful for national level advocacy.
• Facilitate communities to engage with duty bearers: SSO partners will hold
dialogues in the project districts that will bring together health workers, district
leaders and community members to identify and prioritize their problems as
regards access to medicines and develop action plans on how to mitigate the
challenges.
CSOs increasingly play an important role in the functioning of the health sector.
Although it is not easy to find realistic modalities for their participation, the capacity
building on the concept of access to and monitoring of medicines received during the
pilot phase of MeTA and involvement in campaigns on access to medicines in particular
the Stop Stock outs campaign has raised the profile of involvement of CSOs in decision
making on medicines. Many organizations now have clear interest in monitoring the
pharmaceutical supply system in order to make sure medicines are available and
affordable to the population.
It is clear that MeTA has had an important role and it will be appreciable to provide
further support to trickle down to the grassroots.
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2. Cost of medicines
A price component study will be undertaken by MoH/WHO/HEPS in the second year on
medicine price components and mark-ups at various stages of the supply chain within the
three sectors of public, mission, and private. The study will inform policy on the need to
control prices paid for medicines. The pricing information will be part of the database
system and will be dynamically maintained at established intervals.
The private sector accounts for 60 per cent of health care delivery and yet medicine prices
in Uganda are beyond the reach of many. According to MoH 2008a, private sector
originator/ brand medicines were found to be sold at 5.2 times their international reference
prices (by MSH) and the lowest price generic medicines were generally sold at 3.16 times
their international reference prices. Medicines in the mission sector were 2.88 times their
international reference prices.
The price paid for a medicine comprises a number of price components, the manufacturer’s
selling price (MSP) being just one of them. As medicines move along the supply chain, from
the manufacturer to the patient, additional costs are added to the MSP.
The methodology will be adopted from WHO/HAI Medicine Price, Availability, Affordability
and Price Components Manual 2nd Edition 2008. Specifically, the study’s intention will
attempt to answer the following questions;
a) What percentage of the price paid for medicines is the manufacturing selling price,
and what percentage are add-on costs along the supply chain?
b) How do these prices vary between different regions, between sectors and between
medicines?
c) What price components have the most significant impact on medicine prices?
d) What are the existing pharmaceutical policies, and do they currently regulate supply
chain price components?
e) What changes could be made to policy to reduce cost, while guaranteeing a
functioning supply chain?
Activities:
Data collection at the central level will involve gathering of information on national policies
that affect pharmaceutical prices.
The study’s second part will comprise collecting the actual price components of selected
medicines as they move along the supply chain.
Five medicines reflecting the burden of disease of the country will be selected for pricing
data to be collected. Medicines selected will enable comparison between originator brands
14
and lowest priced generic equivalents, locally manufactured versus imported. Three study
districts will be selected to represent the geographical regions of the country. The data
collected on the components of medicine prices will be analyzed according to five common
stages of the supply chain that all medicines traverse as they move from manufacturer to
patient:
• Manufacturer’s selling price + insurance and freight (Stage 1);
• Landed price (Stage 2);
• Wholesale selling price (private), Joint Medical Stores price (mission) or National
Medical Stores price (public) (Stage 3);
• Retail price (private) or dispensary price (public) (Stage 4); and
• Dispensed price (Stage 5).
Dissemination of findings
The MeTA Council will deliberate on findings and advise on dissemination and policy options.
The report will be presented to inform policy dialogue.
The reports will also be disseminated by various means including: a stakeholders’ meeting,
email and post. The reports and will be accessible on the HAI Africa, HEPS Uganda and other
CSOs, MOH and WHO websites. The target audiences will include the MeTA Council, MoH
Technical Working Group on medicines procurement and management, media, pharmacies,
CSOs and NGOs, private clinics, retail pharmacies, public hospitals, mission health facilities,
procurement agencies, consumers, government officials and policymakers, the health
professional organizations and societies, and the donors of the health sector that are
supporting procurement of medicines
3. Rational Use of Medicines
3.1 Operationalizing Medicine and Therapeutic Committees to promote Rational Medicine
Use in hospitals in Uganda
Health systems in most African countries are faced with a huge disease burden and yet have
very limited funds for expenditure on the needed drugs. In Uganda, the public health system
spends about USD 8-10 per person per year on their healthcare needs. Ensuring the optimal use
of these limited funds is one of the major challenges facing health managers. A number of
studies in both developed and developing world have shown that drug use is a complex
process. Errors that affect the effectiveness of the therapy may be attributable to failure of
patient to adhere to the treatment or to the prescription and dispensing process (DCP).
In Uganda Medicines and and Therapeutic Committees were set up in hospitals to advise on
medicines management and use to achieve rational use of medicines. However, these
15
committees remain majorly dormant. Lack of information flow on medicines availability from
the pharmacy stores to prescribers and vice versa affects the prescribing habits and therefore
impacts on quality of treatment. Also at management level reconcilitaion of available funds
with priority medicine needs for example using the Vital-Essential-Necessary (VEN) method is
not done.
MeTA Uganda is therefore proposing to re-invigorate Medicine and Therapeutic Committees in
hospitals to spearhead rational medicine use strategies in Uganda. The activity will be
undertaken by Makerere University (Mak) Pharmacy Department in conjuction with MoH.
The National Health System in Uganda has five levels: health sub-district supported by district
health services and regional referral hospitals, national referral hospitals and finally Ministry of
Health and other national level institutions. Regional referral hospitals offer tertiary level health
care in Uganda.
Each regional referral hospital has a pharmacy department that spearheads the role of
pharmaceutical management. The pharmacy department works in collaboration with the other
medical, surgical departments and administration to ensure quality medicines are available and
are being used rationally. As a result of the multitude of this responsibility, Ministry of Health
recommends that regional referral hospitals institute and maintain functional medicine and
therapeutic committees. Such a committee will significantly improve drug use and reduce costs
in the hospital in the following ways;
• providing advice on all aspects of drug management
• developing drug policies
• evaluating and selecting drugs for the formulary list
• developing (or adapting) and implementing standard treatment guidelines
• assessing drug use to identify problems
• conducting interventions to improve drug use
• managing adverse drug reactions and medication errors
• Informing all staff members about drug use issues, policies and decisions.
Objectives
• To assess the state of pharmaceutical management and rational drug use in selected
regional referral hospitals using the rapid pharmaceutical management assessment
tool
• To design and implement interventions which involve mentoring and participatory
health worker orientation to improve functioning of medicine and therapeutic
committees
Methods and materials
This activity will be a two stage process. First, a baseline assessment will be carried out.
WHO/MSH methodology for investigating medicine use in health facilities will be adapted. The
assessment will focus on the known medicine use indicators such as prescribing indicators,
dispensing indicators, and health facility indicators. Additionally, structure and functionality of
the Medicine and Therapeutic Committees will be assessed. Tools for this assessment will be
developed by a team of individuals with experience in drug use studies and health systems in
Uganda. This tool will be pre-tested and assessed for face, content and construct validity prior
16
to data collection. Data collection will employ both quantitative methods and qualitative
approaches to gather underlying factors and explanations for some of the observations. Results
of the baseline assessment will guide the process of determining, prioritizing and implementing
the interventions with a view to improving and realizing the critical role played by Medicine and
Therapeutic committees to improve or promote rational medicine use at hospitals in Uganda
The second stage of the process (intervention stage) will employ a quasi-experimental design
with intervention and control sites. Interventions will be implemented in selected sites. Lastly
an end-line assessment will be done to evaluate if there is a difference between the
intervention and control sites in aspects of therapeutic management and rational drug use. The
study team will also employ cost-effectiveness analysis to determine cost implications. The
report of the study will be shared with MeTA council and disseminated to inform policy.
3.2 Create awareness and empower communities on RUM
In 2010 MoH released a communication strategy on rational use of medicines (RUM). However,
the strategy has not been adequately disseminated and used by stakeholders. MoH will work
with consumer groups to publicly disseminate RUM material. This activity will build on RUM
campaigns undertaken by MoH and CSOs in 2010 in Arua and Mbarara districts with funding
from MeTA.
The activity is scheduled for the third year of the project but additional fundraising may enable
it to start earlier.
The activities here will include:
• Development of both audio and visual material with messages on RUM for different
audiences/ communities according to the communication strategy
• Behaviour change communication campaigns will then be held through talk shows, radio
spots and posters
4. Quality of medicines
4.1 Assessment of quality of medicines provided by drug outlets in the countryside
Quality of health care is a composite output of good quality medicines and other attributes.
Developing countries such as Uganda have made numerous efforts to build robust health care
systems that assure optimum health care provision to their populations. However, they are
faced with constraints of limited resources to fund ever increasing drug needs. This coupled
with shortage of health workers worsened by brain drain calls for constant monitoring and
surveillance of the health care availed to the people.
The National Drug Authority is mandated by law, to ensure the quality, safety, and efficacy of
all pharmaceutical products marketed in Uganda in addition to cosmetics, chemical devices
and household chemicals. Once a product has been granted marketing authorization by the
17
NDA Board, the quality of consequent batches of the product either locally manufactured or
imported is to be assessed regularly.
However, due to many factors such as financial constraints, porous borders in some parts of the
country, drug donations and lack of skilled personnel to handle drugs, the quality of medicines
available to the most poor in remote areas cannot be guaranteed.
In an effort to mitigate the above profound effects of poor quality medicines especially in
remote parts of the country, interventions to augment existing regulatory and oversight
infrastructure of Ministry of Health are paramount.
The specific objectives:
1. To assess quality of selected medicines obtained from drug outlets to determine if
they meet specific quality standards.
2. Build confidence of the public on quality of medicines through information
disclosure
Design
This activity will be undertaken by Pharmacy Department, Makerere University in collaboration
with NDA. NDA has already authorized three officers to assist MeTA and the project team. The
project does not aim to do work mandated by the NDA but to supplement efforts and to act as
entry point for discussions on quality of medicines and how to involve the various stakeholders.
The screening drug quality project will assess four widely used medicines i.e. a selected
Arteminisin Combination Therapy (ACT), amoxicillin, ciprofloxacin and cotrimoxazole sampled
from six sentinel sites. For the selected medicines, all the dosage forms including pediatric and
adult dosage forms will be studied.
Sentinel sites will be selected while considering the following criteria; public and private, formal
and informal; give priority to the following order ports of entry, wholesalers or distributors,
pharmacies, retail drug outlets, hospitals and clinics, national health program warehouses, and
street vendors. The six sentinel sites will be set up in 3 districts of Arua, Mbale, and Mbarara.
A two-level approach will be applied in testing the quality of medicines. This is based on the
premise that full-scale pharmacopeial testing is expensive and can be performed only in well-
equipped laboratories. Screening tests, which are less technically demanding than conventional
tests, are useful for reducing the risks of distributing falsely labeled, spurious, or counterfeit
products.
The first level will be for physical appearance in packaging, colour, shape, disintegration. A
medicine that does not meet set standards will be forwarded to second level for testing using
minilabs. Once a medicine fails the minilab test it will be forwarded to the third level for full
laboratory analysis by NDA.
18
ACTIVITIES, DELIVERABLES
No Objective Activity Responsibility Outputs Means of
verification
Stakeholder
interest
1.1 Monitoring of medicine
availability and prices
1. Data collection, analysis
2. Report production
3. Advisory group meetings
4. Dissemination
MoH/WHO/HEPS Report on
medicines
Reports
Evidence of
dissemination
Government,
Private sector,
CSOs
1.2 Empower citizens, through
district coalitions, and
opinion leaders to own
services and hold duty
bearers accountable
1. Trainings
2. Routine collection of
information on medicines
and health status
3. Community dialogues
CSOs No. of
communities
trained
No. and reports
of trainings and
community
dialogues
Reports CSOs, MoH,
NDA, NMS
2 Price component study will
be undertaken by
MoH/WHO/HEPS on
medicine price components
and mark-ups at various
stages of the supply chain
within the three sectors of
public, mission, and private
1. Data collection
2. Data entry and analysis
3. Report production
4. Dissemination
MoH/WHO/HEPS Report on
medicines
Reports
Evidence of
dissemination
Government,
Private sector,
CSOs
3.1 Operationalizing Medicine
and Therapeutic Committees
to promote Rational
1. Needs assessment survey
2. Training/ mentorship at
hospitals
MUK/MoH Survey Report
Number of
health workers
Reports Government,
Private sector,
CSOs
19
Medicine Use in hospitals in
Uganda
3. Monitoring
4. Report production
mentored
Monitoring
reports
3.2 Dissemination of MoH
Communication strategy on
RUM
1. Production of radio spots
2. Production of IEC material
3. Airing of radio spots
4. Talk shows
MoH/CSOs Sample IEC
material
Recordings of
talk show,
Monitoring
reports
Recordings,
Sample
materials
Government,
Private sector,
CSOs
4 Assessment of quality of
health care provided by drug
outlets in the countryside
1. Data collection and
analysis
2. Report production
3. Dissemination meeting
MUK/NDA Survey Report
on quality
Minutes of
dissemination
meeting
Reports Government,
Private sector,
CSOs
20
ACTIVITY WORK PLAN
WORK PLAN MeTA Uganda 2012-2015 2012 2013 2014 2015
Activities Detail Q4 Q1
Q2 Q3
Q4
Q1 Q2
Q3
Q4
Q1 Q2 Q3
Comments
Operate secretariat Procurement of Equipment
Bi-annual Publications
Hold Council meetings
Venue hire & refreshments
CSO steering group meetings
Hold Stakeholder meetings Conference of 50 stakeholders
Conduct quarterly medicines
price monitoring surveys
Advisory commitee meetings
Conduct survey
Dissemination
Empower communities to own
services and hold duty bearers
accountable
1-day trainings of community
leaders in 10 districts (MeTA
will fund 3 districts)
Additional
Fundraising Feedback mechanism to
deliver timely info on stock
status/ related issues:
Community dialogues
Monitoring visits
Price component study Survey
Advisory Group meetings
21
Dissemination
Operationalizing Medicine and
Therapeutic Committees to
promote Rational Medicine Use
in hospitals in Uganda
Needs assessment survey
Intervention
Monitoring and Evaluation
Dissemination
Create awareness and empower
communities on RUM
Radio talk shows
additional
fundraising
Produce and air radio jingles in
4 districts
Assessment of quality of
medicines provided by drug
outlets in the countryside
A. Assessment of quality of
medicines
Survey
Dissemination of report
22
LOGFRAME IN LINE WITH GLOBAL LOGFRAME
No Global Log.
Output Ref Output Output indicator Outcome Target (2015)
Means of
verification Impact Assumptions
1 1.1 & 1.2
Functioning multi-
stakeholder group on
access to medicines
No. of stakeholder
meetings held
Recommendations by
multi-stakeholders to
inform policy
At least 30
meetings
Minutes/
reports of
meetings
Increased availability
and affordability of
quality assured
essential medicines in
selected countries
MoH
leadership in
process
available
2 1.3, 2.1
Community trainings and
dialogues on access to
medicines
No. of trainings and
dialogues held
CSO participation in
monitoring and
discussion on access
to medicines
Atleast 10
trainings
Reports of
trainings, no.of
participants
Increased debate and
monitoring of
medicines by
communities
Additional
fundraising by
CSOs
2
2.1, 2.2, 2.3,
3.1, 3.2, 5.1,
5.2
Reports on medicine
availability and prices
No. of reports
produced
Reports used to
inform policy 6 reports
Reports,
Evidence of
dissemination
Increased reporting
and discussion on
availability and prices
of medicines
HAI financial
and techical
support
3
2.1, 2.2, 2.3,
3.1, 3.2, 5.1,
5.2
Report on Price
components No. of reports
Reports used to
inform policy 1 report
Reports,
Evidence of
dissemination
Price regulation
policies Political will
4
2.1, 2.2, 2.3,
3.1, 3.2, 5.1,
5.2
Demonstration of rational
prescribing in hospitals
No. of hospital
staff mentored
Improved rational
prescribing and cost
savings on medicines
100 hospital
staff mentored Reports
Peer learning for
improved medicine
use and cost savings in
hospitals
5
Public dissemination of
MoH Communication
strategy on RUM
Radio spots, talk
shows, IEC material
Public awareness on
rational use of
medicines
3 districts
reached
Recordings of
talk shows,
radio spots,
Monitoring
reports
Increased public
Availability of
funds from
other sources
6 1.1
Increased multi-
stakeholder working and
disclosure on quality of
medicines
Reports, No. of
stakeholder meetings
Recommendations by
multi-stakeholders to
inform policy and
practice
3 reports, 3
stakeholder
meetings
Reports/
minutes
Increased information
on quality of medicines
NDA
facilitation of
the process
23
GOVERNANCE PLAN
The National Stakeholder Forum
The MeTA Council is supported by and engages with a National Stakeholder forum which
meets once a year to explore key MeTA-related issues in the sector, share and disseminate
information from MeTA activities, and contribute to the process of analysis, recommendations,
advocacy for change in policy, and in formulation of activities. The forum is made up of wider
players in the medicine sector that include government, faith based institutions, manufacturers,
importers, wholesalers and retailers, service providers, herbalists, and the civil society.
The MeTA Uganda Council
The MeTA Council is the governing body is constituted of core set of institutions that include:
Ministry of Health, National Drug Authority, Pharmaceutical Society of Uganda (representing
the professionals, the pharmacists), National Medical Stores, Joint Medical Stores, CSOs
represented by HEPS Uganda and UNHCO, private sector institutions are represented by
Medical Access Uganda limited, Surgipharm Limited and Kampala Pharmaceutical Industries
represents the Uganda Pharmaceutical Manufacturers Association (UPMA), academia is
represented by MUK and WHO represents the development partners. The council is responsible
for overseeing all the management and financial activities of MeTA participating stakeholders
and the National Secretariat. The chair to the National MeTA Council is on a six-month
rotational basis among the three key stake-holders.
The council has 12 members from the three key stakeholders: Government, Private Sector and
Civil Society Organisations.
Secretariat
A National Secretariat comprises of three members approved by the National Council to
represent the key stakeholder groups. The secretariat members oversee implementation of
activities and meet on a weekly basis to deliberate on prevailing issues affecting the
pharmaceutical sector and provide agenda for council meetings. The secretariat (3 members)
will receive a stipend based on 4 days-time and effort per month.
Coordination
A coordinator is contracted to assist the National Secretariat. Appointment of coordinator is
made by National MeTA Council.
24
The coordinator runs the secretariat on a day-to-day basis providing communication,
coordination and documentation. Additional roles include administration, operation and
functioning of the national secretariat, regular meetings of the Council (estimated 6/year) and
annual stakeholder meetings.
A communication’s person has been proposed to work 4 days-time a month to ensure proper
documentation and communication of all MeTA work and to spearhead annual newsletter.
Linkage with Ministry of Health Structure
The MeTA Co-chair from the Government side is the secretary to the Technical Working Group
on Medicines Procurement and management (TWGMPM) thereby facilitating the interface
between existing MoH structures and the MeTA Council, as well as feeding and guiding
initiatives that may bear an influence on matters of policies into regular MoH structures and
mandates.
At the National level, MoH through the TWGMPM will receive regular reports of the agreed
activities by the MeTA National Council. Briefs from the MeTA group on issues that require the
attention of the TWGMPM will be presented at their meeting as and when necessary. It is
envisaged that the secretariat and members of the TWG interface with the National
stakeholder forum that will take place at least twice a year.
Contribution from other key stake-holders
HEPS will be responsible for mobilization and capacity building of the CSOs in advocacy for
improved governance, transparency and accountability in procurement, supply and
management of medicines in Uganda.
The National Drug Authority has provided room for the secretariat.
The WHO country office will play an advisory role and has provided space for council meetings.
25
FINANCIAL ARRANGEMENTS
Financial management has been managed through financial guidelines developed by the IMS
during the pilot phase and in line with DFID guidelines. HEPS Uganda is the fund holder for
MeTA; providing financial advice, book keeping, periodic and financial reports to the
secretariat. The fundholding fee as agreed upon during the pilot phase is seven percent.
Disbursement will be based on agreed activities and subsequent disbursements based on
submission of accountability of the previous activities including a draft report of the activities
carried out. Request of funds by the National Secretariat is by approval of the National Council
basing on the agreed work plan budget lines.
RISK ASSESSMENT
Multi-stakeholder engagements are inherently fragile in nature and require concerted
coordination, communication and motivational efforts for sustainability. Lessons from the
MeTA pilot phase have provided solutions to maintaining the momentum of stakeholders. The
stewardship and overall ownership by the Ministry of Health is essential in ensuring an
adequate level of engagement by stakeholders.
26
SUMMARY BUDGET 2012-2015 (GBP) Activities Budget line Total
Yr 1
Total
Yr 2
Total
Yr 3
Grand
Total (3
years)
Operate the Secretariat
Salary Coordinator
10,895
10,895 10,895 32,684
Stipends for Secretariat members 4,358 4,358 4,358 13,074
Salary for Communication's personnel 3,632 3,632 3,632 10,895
Stipend for council meetings 1,263 1,263 1,263 3,789
Office running costs 2,526 2,526 2,526 7,579
Communication 632 632 632 1,895
Transport 789 789 789 2,368
Equipment 1,316 - - 1,316
Publication 1,579 1,579 1,579 4,737
Misc 316 316 316 947
Sub-Total 27,305 25,989 25,989 79,284
Hold Council meetings Venue hire & refreshments 1,053 1,053 1,053 3,158
CSO steering group meetings 526 526 526 1,579
Sub-Total 1,579 1,579 1,579 4,737
Hold Stakeholder meetings Travel 2,632 2,632 2,632 7,895
Venue hire lunch & refreshments 4,211 4,211 4,211 12,632
Sub-Total 6,842 6,842 6,842 20,526
Conduct quarterly
medicines price monitoring
surveys
Advisory commitee meetings - - - -
Conduct survey 7,632 7,632 7,632 22,895
Dissemination - - - -
Sub-Total 7,632 7,632 7,632 22,895
Empower communities to
own services and hold duty
bearers accountable
1-day trainings of community leaders in
10 districts (MeTA will provide funding for
3 districts) 2,763 - - 2,763
Feedback mechanism to deliver timely
info on stock status/ related issues: 2,842 2,842 2,842 8,526
Community dialogues - - - -
Monitoring visits - - - -
Sub-Total
5,605.26
2,842.11 2,842.11 11,289.47
Price component study Survey - 3,184 - 3,184
27
Advisory Group meetings - - - -
Dissemination - - - -
Sub-Total - 3,184 - 3,184
Operationalizing Medicine
and Therapeutic
Committees to promote
Rational Medicine Use in
hospitals in Uganda
Needs assessment survey 7,901 - - 7,901
Intervention - 2,941 - 2,941
Monitoring and Evaluation - 3,132 - 3,132
Dissemination - 1,316 - 1,316
Sub-Total
7,901 7,388 - 15,289
Create awareness and
empower communities on
RUM
Radio talk shows - - 1,957 1,957
Produce and air radio jingles in 4 districts
- - 12,696 12,696
Sub-Total 0 0 14,652 14,652
Assessment of quality of
medicines provided by drug
outlets in the countryside
a) Assessment of quality of medicines
Survey
12,279
12,279
12,279
36,837
Dissemination of report 1,316 1,316 1,316 3,947
Sub-Total
13,595
13,595 13,595 40,784
TOTAL for ACTIVITIES
70,459
69,051 73,131 212,641
Administrative fee 7% 4,932 4,834 5,119 14,885
GRAND TOTAL
75,391
73,884 78,250 227,526
Detailed budget is attached
MONITORING SYSTEM
A logical framework and activity work plan are attached along with budget.
28
REFERENCES
1. Annual Health Sector Performance Report, 2006/07, 2007.08
2. Health Sector Strategic Investment Plan III 2010/11-2014/15
3. Health Sector Strategic Plan mid-term review, 2008
4. Medicines price Monitors by the Uganda Country Working Group (UCWG: MoH/ WHO/
HAI-HEPS
5. MeTA Country Work Plan Guidelines VS.6 January 2009
6. MeTA Phase one Proposal
7. Ministry of Finance, 2010. Background to the budget 2010/11
8. Ministry of Finance, 2011. Background to the budget 2011/12
9. Ministry of Health.MoH. (2008). Access to and use of meedicines by households in
Uganda. Kampala: Ministry of Health.MoH.
10. Ministry of Health.MoH. (2009).Human resources for health bi-annual report. Kampala:
Ministry of Health.MoH
11. National Medical Stores and Joint Medical Stores Medicines Catalogs
12. Ouagadougou Declaration on primary health Care and Health Systems in Africa 2008
13. Private Sector Mapping Uganda Mission report, December 2008.
14. Statement by Director General Ministry of Health at the Launch of MeTA , 15th May
2008
15. TWG MPM meetings and Minutes
16. Uganda Bureau of Statistics- Demographic Survey report
17. Uganda Civil Society Medicines Access Alliance work Plan and Budget 2008-2010
18. Uganda MeTA Scoping mission report, April 2008
19. World health Organization Medicines Strategy 2004-2007
29
ANNEX 1
MeTA Uganda Contribution – successes and challenges of Pilot Phase
A national MeTA Council, the first of its nature in the pharmaceutical sector, comprising
fourteen members from three key stake holder groups, (government, private sector and civil
Society organizations) including development partners (WHO, DANIDA) was established.
Through the process of continuous engagement and dialogue it fostered information sharing
across and within the sectors with the following important outcomes:
i. For the first time in its planning process the Ministry of Health invited the private
sector and civil society organizations to participate in the week long review of the first
National Pharmaceutical Sector Strategic Plan (NPSSP I) the outcome of which informed the
development of second 5 year NPSSP II (2009/10 to 2013/14).
ii. National Drug Authority (NDA) database of registered drugs is now searchable
online www.nda.or.ug
The database of registered drugs is now searchable online as a result of one MeTA’s work
plan activities. This has been advertised in the newspapers along with the SMS information
service whereby clients can inquire about the registration status of a drug, pharmacy, drug
shop or manufacturer. This has generated so much interest among members of the general
public who are providing NDA with feedback on its operations especially with regard to
medicines registration and quality. According to the Public Relations Office there is a tenfold
increase in SMS inquiries reaching the office and an average of 40,000 hits per month on the
website. The website is updated monthly.
iii. Improved access to information by the private sector e.g. MoH procurement
plan, medicines price monitor
During the private sector mapping study one of the gaps identified by the sector was a lack
of information on the pharmaceutical sector (and market) and unclear modalities of
obtaining this information. With the formation of MeTA the private sector has used the
platform to articulate issues and has since obtained and used the information generated and
produced by the process. For example the price monitoring and availability reports have
informed of the need to generate evidence on margins and mark ups which has led to a
further study on price components and the project with NDA to ascertain the volume and
value of imports. Thus the private sector now has an avenue for access to information that
30
was not easily obtainable such as the medicines price monitor and the three year rolling
procurement plan of the Ministry of Health. This information on the pharmaceutical market
can and is being utilized in variable ways to increase access to medicines.
iv. Increased public debate and reporting on medicines-related issues such as stock
outs
MeTA has provided an umbrella organization for Civil Society Organizations and a platform
for gaining audience with other key players in health. They are now better organized and
coordinated and their capacity has been built to enable them present their issues in a more
professional and business-like manner.
The same forum afforded the CSO’s an opportunity to meet with the Ministry of Health and
National Medical Stores over the looming stock outs of medicines in the country in a
campaign dubbed “STOP STOCK OUTS”. This was a more productive method of advocating
and articulating issues.
It has been observed that there was increased media reporting on medicines-related issues
since the year 2009 when the capacity building workshop was held and there is evidence
that the government has responded to this in various ways at different levels such as
changing the strategy of financing of essential medicines.
v. Recommendations from the forum on NMS/JMS/NDA improving efficiencies by
sharing information on quality assurance data
During the MeTA national stakeholders forum it was discovered that the NDA, National
Medical Stores (NMS) and Joint Medical Stores (JMS) all conduct product quality assurance
testing and that the results are not shared. As a direct result of disclosure of test results by
JMS at the forum a recommendation was made that the three entities share information
amongst themselves in order to improve efficiencies and not duplicate efforts. Discussions
on the modalities of doing so are currently on-going. This is a good example of a public-
private partnership which aims to improve transparency amongst government entities.
Some of the challenges faced include the following:
i. Variable participation in the process: Given that MeTA is a voluntary governance
initiative in which there are no direct incentives to the stakeholders it inevitably
meets with competing priorities. One way to ensure participation has been to agree
on a calendar for council meetings and to allow for flexibility as well.
ii. High member expectations of policy change in the pilot phase: the overall goal of
MeTA is to promote information sharing that would ultimately lead to policy change.
31
However, in the pilot phase MeTA has been able to use information generated and
shared for advocacy and recognizes that it will take longer for policy change to be
realized: the pilot phase was too short.
iii. Disclosure is still a challenge as some institutions are still discussing how much
information to disclose to the general public: one of the lessons learnt in the pilot
phase is that there is a need to package information appropriately for the public. As
such some institutions are yet to automate their systems in order to disclose
information and are generally in the process of carrying out a risk-benefit analysis of
disclosing certain information to the public. MeTA is following the discussions closely.
iv. Limited public visibility for MeTA: Increased stakeholder engagement and
communication of activities and outputs will showcase MeTA work to the public and
increase public visibility as well as debate on access to medicines.
32
ANNEX II
MeTA COUNCIL AND SECRETARIAT
NATIONAL SECRETARIAT
No. Name Sector Email address
1 Vacant position COORDINATOR
2 Morries Seru Government [email protected]
3 Fred Kitutu Private [email protected]
4 Denis Kibira CSO [email protected]
NATIONAL COUNCIL
Name Organisation Email address MeTA Function
1 Martin Oteba MoH
Co-chair of MeTA
Council.
2 Nazeem Mohamed
Kampala
Pharmaceutical
Industries Ltd
[email protected] Co-chair
3 Rosette Mutambi HEPS Uganda [email protected] Co-chair
4 Dr. Fred Sebisubi MoH [email protected] Council member
5 Kinny Nayer Surgipharm [email protected] Council member
6 Robinah Kaitiritimba UNHCO [email protected] Council member
7 James Tamale PSU [email protected] Council member
8 Ivan Kintu CSO/Nacwola [email protected] Council member
9 Helen Ndagije NDA [email protected]/
[email protected] Council member
10 Andrew Cohen Wasswa JMS [email protected]
Council member
11 Sowedi Muyingo Medical Access [email protected] Council member
12 Joseph Mwoga WHO [email protected] Council member
###
