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MeTA Jordan

MeTA Jordan. Country Overview Public Sector Private Sector Civil Society. MeTA Jordan. Dr Taher Abu ElSamen MeTA Council Chair HHC Secretary General. Multi-stakeholder process (1). The Multi-stakeholder process in Jordan started by:

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MeTA Jordan

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  1. MeTA Jordan Country Overview Public Sector Private Sector Civil Society

  2. MeTA Jordan Dr Taher Abu ElSamen MeTA Council Chair HHC Secretary General

  3. Multi-stakeholder process (1) The Multi-stakeholder process in Jordan started by: Establishing the MeTA Council based on a multi-stakeholder membership , the MeTA Council is represented fully by multi-stakeholder, public and private sectors and the CSO, and they all agreed on a national country workplan

  4. Multi-stakeholder in MeTA Council WHO WB DFID MeTA Int. Partners

  5. Multi-stakeholder process (2) MeTA Jordan used the national forum Nov. 2009 as an opportunity to re-motivate and engage stakeholders especially the private sector and the CSOs. The diversity of the represented attendees gave a unique flavor for the forum especially during the discussion session The one day multi-stakeholder collaboration for MeTA pilot countries workshop carried out by Wageningen University in January 2010 was a success, 70 attendees from all MeTA Countries attended, since it supported the multi-stakeholder dialogue and collaboration by encouraging the active participation of key stakeholders from public, private and CSOs Conducting the data disclosure survey was an opportunity not only to collect data but also to work together as a multi-stakeholder, share information and exchange ideas which created more interest and commitment for future activities

  6. Multi-stakeholder process (3) MeTA Jordan will carry out the stakeholder mapping and communication audits in July 2010 through the IDS (part of Component 3 of the MeTA baseline assessment) to help map out the local communication partners and individual consultants. The work aims to create ‘communication’ or ‘learning’ spaces where MeTA representatives have a chance to reflect on their experiences and share these with a view to encouraging innovation and change Having MeTA in Jordan was an opportunity to get key people working in the pharmaceutical sector engage together in a multi-stakeholder membership and including patients along the way MeTA Jordan stakeholders reached a stage that they need skills to help them communicate with representatives of institutional partners who may come from very different positions

  7. Multi-stakeholder process (4) MeTA Jordan stakeholders are thinking strategically to develop a clear brand identity for MeTA and to recommend development of communication tools and messages to support the multi-stakeholder process The International MeTA Secretariat offered countries to identify and communicate the barriers and ensure that the appropriate guidance and support is mobilised within MeTA to address them

  8. Multi-stakeholder Milestones Establishing a multi-stakeholder MeTA Council MeTA Jordan national forum invited multi-stakeholder Nov. 2009 One day multi-stakeholder collaboration for MeTA pilot countries workshop in January 2010 Conducting the disclosure survey with stakeholders working together The planned stakeholder mapping and communication audits to take place in July 2010 through the IDS MeTA Jordan stakeholders have identifies the skills neded to help them communicate with representatives of institutional partners who may come from very different positions, planned between July and Sep. 2010

  9. Overall challenges in multi-stakeholder process A new concept and idea, it needs more time for people to accept and understand Lack of experience of multi-stakeholder process and the need for different communication skills for members Inter-personal /inter-institutional communication skills for MeTA Council Members was a challenge, (active listening etc training is needed) There are currently issues related to Council members listening to each other and putting their point across in a non- confrontational way People are not all used to operating in a forum where people represent organizations with such different positions and they need support on consensus building

  10. Major achievements and successes for MeTA in Jordan (1) • The Government is highly supportive of the MeTA process it supported and hosted MeTA at the HHC, a governmental institution, this gave the whole process an official identity and led to have the diverse public sector more engaged • MeTA was launched in Jordan as a high profile national event in May 09 • The highly committed MeTA Council Members started realizing the concept of transparency, they agreed on a national workplan based on the NDP, they agreed to publish all outcomes on Jordan MeTA web site, participated in the data disclosure survey and issued the first MeTA newsletter on April 2010 • Jordan had hosted a session at the WHA on transparency and good governance May 09

  11. Major achievements and successes for MeTA in Jordan (2) The MeTA process has opened channels of communication between different stakeholders and between different countries. Common understanding of each of the other stakeholder perspectives was identified, the fact that there are common priorities and one objective between stakeholders became more clear MeTA council private sector representative attended the private sector meeting in London June 09 Pharmaceutical Baseline Assessment Survey-Level II and a WHO/HAI surveys took place Supply Chain Mapping assessment took place in March 09 A Successful National Forum Nov 09

  12. Major achievements and successes for MeTA in Jordan (3) In terms of CSO building capacity area: The CSO committee has drafted a CSO workplan where it is derived form the three major priorities in the overall national MeTA workplan in Jordan, “Build capacity of (CSOs) to monitor and increase accountability of all stakeholders with respect to the prices, availability, selection and quality of medicines in the public and private sectors A nucleus of a CSO coalition has started to form and a MoU was signed with the Int. MeTA Secretariat in November 2009 and a specific CSO workplan was approved accordingly the voice of patient is now becoming heard by the Government policy makers The very first activity was conducted to map and identify CSOs to assess their ability and willingness to work together and to engage them with the MeTA council, this activity has set the baseline work for the CSOs in Jordan

  13. MeTA Major achievements and successes for MeTA in Jordan (4) In terms of CSO building capacity area: Workshop on building capacity of CSOs in order to strengthen their ability to monitor and increase accountability of all stakeholders regarding medicines prices, availability, selection and quality of medicines CSOs have Participated in the Harvard Flagship course and have participated in the country exchange visit to the Philippines Conduct a training on advocacy and communications in improving access to essential medicinesThe CSO level of engagement with the MeTA process is moving forward gradually At the start of the process there was limited activities and meeting but since November they become more engaged

  14. Major achievements and successes for MeTA in Jordan (5) In terms of evidence based medicine: • Reviewed TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL), reviewed criteria for adding and deleting drugs to and from the RDL, and finally reviewed classification of drugs (Restricted, Un-Restricted, Authorized and Un- Authorized) in RDL • Introduce the pharmaco- economics concept and its importance for RDL addition and deletion to the local industry and generic importers • A series of training sessions on pharmaco-economics to PTC

  15. Major achievements and successes for MeTA in Jordan (6) In terms of RDU: NICE has Pilot the development of an evidence-based care pathway, first step was (STG Gap Analysis in the public sector and second step was developing essential Hypertension STG) for all public primary health care facilities Conducted a Promotional for Rational Drug Use workshop

  16. Overall Challenges (1) At Pharmaceutical level: Poor forecasting and estimation of medicines needs which led to low availability of medicines in public sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket and all this is seen as our fault and Irrational Use of Medicines Willingness of the private sector to share information, such as information related to prices, promotional activities and quality High pharmaceutical promotion / hard to control even some patient group's budgets are partially supported by pharmaceutical companies No base line data to measure outcomes

  17. Overall challenges (2) At the MeTA Level: Short period, the two year MeTA pilot is not enough to present and measure the impact on the availability and RDU,, as much as we worked and contributed as a sector the outcome will be noticed through years to come We started the MeTA process with no base line data to rely on, the base line data to be collected started after the MeTA process commenced Changes in MeTA Council representatives positions/agendas can hinder their participation in medicines policy changes and creates a gap between Council members Private sector is poorly represented in the MeTA Council

  18. Overall challenges (3) MeTA has acted as a coordinating body for the pharmaceutical sector, also the MeTA process has opened channels of communication between different stakeholders and between different countries The international and the national MeTA Secretariat coordination role is integral for the MeTA process to move forward The Consultants Technical Advisory role is of a high value for the MeTA process and in improving quality of implementation of the national workplan The multi-stakeholders ( public, private and CSOs) process in very hard, it takes time to have the stakeholders understand each other's perspectives and identify that there were in fact common priorities and one objective to work on together

  19. Overall Challenges (4) At the MeTA Level: CSOs are still not represented in drug related committees like the Pricing Committee or Higher Drug Committee Difficulty in attracting new CSO groups to join the MeTA CSO coalition and there is an absence of coordination or sharing of expertise and experiences among the various CSOs Limited participation of CSO representatives in MeTA Baseline Data Disclosure Survey and no coordination for the CSOs work Poor role of the CSOs in the decision making process with limited role in patient counseling

  20. Lessons Learned (1) To continue exploring national opportunities for pursuing MeTA post-pilot in Jordan Looking for sustainability when MeTA ends in the country, we need to keep searching for other fund and contact other international partners like EU Opening channels with media to engage external stakeholders with the MeTA process and raise public awareness To recommend activities and present a prioritised workplan to the International MeTA Secretariat for discussion as soon MeTA has acted as a coordinating body for people working in the pharmaceutical sector

  21. Lessons Learned (2) CSO engagement with the MeTA process complements the overall picture and highlights patients’ need. Capacity for CSOs to engage more effectively needs to be built A budget for a CSO coordinator should have been listed in the CSO workplan and there should be an organized structure for the CSO coalition To engage parliament in the MeTA council process The stakeholders started to understand each others perspectives

  22. Lessons Learned (3) We have learned the Importance of Data Disclosure, many outputs we were keen to participate in towards disclosure, we agreed to publish all outcomes on Jordan MeTA Web site and learned that we should involve media more The MeTA process has opened channels of communication between different stakeholders and between different countries MeTA has acted as a coordinating body for the pharmaceutical sector players and stakeholders The Data Disclosure survey was a useful exercise that improved communication and sharing/disclosing of information- a core MeTA principle

  23. Thank you for Listening Dr Taher Abu El Samen Email: taherhhc@yahoo.com Mobile number: +962 79 726 7444 Website: www.meta.jo

  24. Public Sector Presenter Name Job Title

  25. MeTA Overview of Public Health Sector in Jordan Jordan is characterized by a diverse and fragmented public sector. It consists of: MOH, Royal Medical Services, Jordan University Hospital, King Abdullah the Second University Hospital, King Husain Cancer Center and Prince Hamzeh Hospital The public sector covers about 72% of the population Pharmaceutical expenditure as a percent of total health expenditure is 34.0%, where public accounts for 11.3% Public pharmaceutical expenditure as a percentage of total pharmaceutical expenditure accounts for 33.3%. Pharmaceutical expenditure is growing at 17% per annum compared to GDP growth of 3.3% The public sector is represented at the Jordan MeTA Council by 9 members out of 18 Source: Jordan National Health Accounts (NHA) 2007

  26. Comparison of Jordan Public Expenditure on Medicines with other Countries

  27. MeTA Level of Public Sector Engagement The Government/ public sector has supported MeTA since the start of MeTA The public sector actively participates in all MeTA activities at the level of the Council, subcommittees and established task forces that work on activities in our national workplan MeTA Council representatives of the Public sector have acted as facilitators for the Baseline Pharmaceutical Assessment Household and Health Facility survey level II, as well as the Pharmaceutical Sector Scan The Public Sector is fully committed and are the main drivers for the MeTA process in Jordan

  28. MeTA Level of Public Sector Engagement cont. MeTA is hosted at one of the public health sector institutions/ the High Health Council (HHC) The elected MeTA Chair is the Secretary General of the HHC Representatives from public sector were nominated to participate in the household and health facility survey level II technical committee. Representative pharmacists from public sector institutions participated in facility survey data collection Most of public sector representative at the MeTA Council actively participated in the baseline data disclosure survey

  29. Summary Analysis at start of MeTA The needs and issues in the public sector at the start of MeTA focused on three main areas: Improving Availability in the public sector through adapting and using transparent evidence based decision making for the Rational Drug List (RDL) Promoting Rational Drug Use through encouraging best practice and developing STGs The need for reliable Data to be used in forecasting etc. especially with the lack of Health IT within the public sector

  30. Major Milestones Developed national Standard Treatment Guidelines (STGs) for essential hypertension for all public primary health care facilities (Expected Output: implementation of pilot STG after discussing implementation strategy with MoH) Reviewed TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL) (Expected Output: adoption of revised criteria for SOPs and Conflict of Interest declarations and increased accountability) Reviewed criteria for adding and deleting drugs to and from RDL (Expected Output: adoption of revised criteria and increased transparency in medicines selection processes) Reviewed classification of drugs (restricted, unrestricted, authorized and unauthorized) in RDL (Expected Output: adoption of revised classifications using transparent evidence based medicine criteria to inform decisions)

  31. Major Milestones cont. For reliable data on medicines availability and use they advised to have the Pharmaceutical Baseline Assessment Survey-Level II and a WHO/HAI surveys to take place and contributed data to them Supported and contributed to a Supply Chain Mapping Assessment Promoted a Rational Drug Use workshop amongst public sector health workers Advised that a series of training sessions on pharmaco-economics take place for health professionals -to date two training sessions have already taken place Promote good practice and work on the development of conflict of interest (COI) declaration and management system for all committees to improve accountability

  32. Successes The Government is highly supportive for the MeTA initiative in Jordan as mentioned earlier The public sector is committed to MeTA and they believe in the MeTA main objective and the five core principles The Government has supported MeTA and hosted the initiative at one of the governmental institutions -the HHC. This gave the whole process an official identity and led to the fragmented public sector working together towards improving availability through adapting/using evidence based decision making for the Rational Drug List (RDL) and promoting RDU through encouraging best practice

  33. Challenges At the level of the Pharmaceutical Sector: Poor forecasting and estimation of medicines needs which leads to low availability of medicines in public sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket Direct local purchases by institutions (prices of the private sector) instead of sticking to procuring jointly through JPD Irrational Use of Medicines and absence of national STGs in different disease areas Weak role and capacity of pharmaco- vigilance system Lack of private sector transparency

  34. Challenges cont. General Challenges: The two year period for MeTA pilot is too short and not long enough to measure outcomes and impact on the availability of medicines in the public sector and on Rational Drug Use Changes in MeTA Council representatives positions/agendas can hinder their participation in effecting medicines policy changes and creates a gap between Council members

  35. Lessons Learned 1. The main lesson learned is the importance of partnership AND the multi-stakeholder process: That public sector can be more effective in dealing with issues within the medicine supply chain in terms of availability, distribution, RDU when working with the private sector and civil society organizations (CSO), since the private sector secures the country with medicines and the CSO speak on behalf of patients’ and consumers’ and their needs The MeTA process has opened channels of communication between different stakeholders and between different countries MeTA has acted as a coordinating and facilitating body for the pharmaceutical sector players and stakeholders

  36. Lessons Learned cont. 2. We have learned the Importance of Data and Data Disclosure Participated fully in the Pharmaceutical Sector Data Disclosure Survey Contributed fully in the Pharmaceutical Baseline Assessment Survey-Level II: Facility and household and included the Pricing Survey within the baseline assessment facility survey Participated in the Pharmaceutical Sector Scan Survey Agreed to publish all outputs and data on Jordan MeTA Web site and learned that the media should be more involved Identified gaps and formulated recommendations for the Jordan pharmaceutical sector (based on existing pharmaceutical reform sector studies (WB 2004) and publish on the Jordan MeTA Web site

  37. Thank you Name of presenter: Job Title: Email: Mobile number: +962 Website: www.meta.jo

  38. Private Sector Dr Ibrahim Al Abbadi Scientific Research Documentation Office Director The University of Jordan

  39. MeTA Overview of Private Health Sector in Jordan 60 private hospitals and many specialized private clinics 16 High quality local pharmaceutical manufacturing (branded generics) Value of Jordan pharmaceutical market (2008) is 350m USD 80% (in value) corresponds to imported medicines 84 medicines’ local agents and around 160 subagents 1829 registered pharmacies Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009)

  40. Overview of Private Health Sector in Jordan Cont. Chain pharmacies started operating in Jordan since 2001, the biggest is Pharmacy One with 45 branches Pharmaceutical expenditure as a percent of total health expenditure is 34.0% where the private sector accounts for 22.7% Distribution of pharmaceutical expenditure as a percentage of total pharmaceutical expenditure where the private accounts for 66.7% Reference: Jordan National Health Accounts (NHA) 2007 and Jordan Supply Chain Mapping report (2009)

  41. MeTA Jordanian Pharmaceutical Exports million US $ The Target is 1 billion $ in 2011 Source: Jordan Association of Pharmaceutical Manufactures(2010)

  42. Summary Analysis at start of MeTA The main issues for the private sector at the start of MeTA were: To get engaged more in the strategic planning process for the pharmaceutical sector in our country, and to get engaged more with the public sector and to share data and information on availability and patients needs

  43. Major milestones The private sector represented by the local industry association as one of the MeTA council members The Medical and Pharmacy associations are represented in the MeTA council Participated in most of MeTA activities on the level of the council membership , the level of subcommittees and on the level of established task forces that are working on activities listed on our national workplan The MeTA council representatives of the private sector acted as facilitators for the baseline pharmaceutical surveys Encouraged the private sector mapping report to be conducted To conduct a workshop to promote ethical promotion guidelines

  44. Major milestones Cont. Introduce the pharmaco-economics concept and its importance for RDL addition and deletion to the local industry and generic importers An introductory meeting about MeTA and its concept to the medical associations and professional associations Contributed in reviewing the criteria for adding and deleting medicines into the RDL , TORs and SOPs for the RDL committees, revised the classification criteria of drugs (Restricted, Un-Restricted & Authority required) listed in the RDL MeTA Council Private sector representative (local pharmaceutical industry), attended Private Sector meeting in London June 2009 Agreed with the MeTA Council to publish all outcomes on Jordan MeTA Web site

  45. Successes The private sector is represented by the local pharmaceutical industry, Jordan Pharmacy Association and Jordan Medical Association The private sector participate in regular meetings and in most activities The private sector represented by the local industry will participate in a study about the FTA impact on access to medicine in Jordan Were involved in reviewing criteria for adding and deleting drugs to and from the RDL and the TORs and SOPs of various (therapeutic area-related) committees involved in selection of drugs to be included in Rational Drug List (RDL) and the classification of drugs (Restricted, Un-Restricted, Authorized and Un- Authorized) in RDL

  46. Challenges At Pharmaceutical level: Poor forecasting and estimation of medicines needs which leads to low availability of medicines in public sector where this will reflect on us as a private sector High Health expenditure 9.05% of GDP where 34% out of it is spent on medicines with 2/3 expenditure is out of pocket High prices of some essential medicines since the private sector is securing the country with medicines

  47. MeTA Challenges Cont. Private sector is not fully represented in the MeTA Council Private sector low level of disclosing data and low willingness to share information, such as information related to prices, promotional activities and quality Few patients associations budgets are partially supported by pharmaceutical companies High pharmaceutical promotion / hard to control

  48. Challenges Cont. Short period, the two year MeTA pilot is not enough to present and measure the impact on medicines availability and RDU, as much as we worked and contributed as a sector the outcome will be noticed through years to come In order to present as a sector that we contributed to the main issues identified we needed more time to have this contribution measured by data to be presented to the whole public Lack of adherence to ethical promotion guidelines

  49. Lessons Learned The need to engage our private sector more in the MeTA process MeTA has acted as a coordinating body for the pharmaceutical sector players and stakeholders The MeTA process has opened channels of communication between different stakeholders and different countries CSO as one of the stakeholder engagement with the MeTA process complements the overall picture and highlights patients’ need Reach a common understanding on concepts of pharmaco-economics , transparency, evidence-based medicine (EBM) and accountability

  50. MeTA Lessons Learned Cont. To engage parliament in the MeTA council process and to involve the media more We started to understand each of the other stakeholder perspectives and identified that there were in fact common priorities and one objective between us to work on together The Data Disclosure survey was a useful exercise that improved communication and sharing/disclosing of information which is a core MeTA principle We have learned the importance of data disclosure and sharing information

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