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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]
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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
Final MeTA National Work plan for Zambia
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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
Final MeTA National Work plan for Zambia
17
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/
Final MeTA National Work plan for Zambia
18
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
.
Final MeTA National Work plan for Zambia
19
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.
Final MeTA National Work plan for Zambia
20
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
Final MeTA National Work plan for Zambia
21
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.
Activity 3.3 Conduct Awareness on Transparency and accountability in
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
procurement. MeTA Zambia’s role in procurement of medicines in Zambia
emphasised.
Activity 3.4 Conduct Awareness on Transparency and accountability in
Procurement of Medicines in Kitwe District
Output Indicator 3.4.1 Number of procurement officers attending awareness
meeting
Meeting held targeting 20 procurement officers and controlling officers at hospitals in
Kitwe highlighting issues of transparency and accountability in medicines
procurement. MeTA Zambia’s role in procurement of medicines in Zambia
emphasised.
Activity 3.5 Conduct Awareness on Transparency and accountability in
Procurement of Medicines in Ndola District
Output Indicator 3.5.1 Number of procurement officers attending awareness meeting
Meeting held targeting 20 procurement officers and controlling officers at hospitals in
Ndola highlighting issues of transparency and accountability in medicines
procurement. MeTA Zambia’s role in procurement of medicines in Zambia
emphasised.
Final MeTA National Work plan for Zambia
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Activity 3.6 Conduct Awareness on Transparency and accountability in
Procurement of Medicines in Livingstone District
Output Indicator 3.6.1 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.
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
Final MeTA National Work plan for Zambia
23
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.
Final MeTA National Work plan for Zambia
24
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.
Final MeTA National Work plan for Zambia
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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)
Final MeTA National Work plan for Zambia
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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