Medicines Transparency Alliance (MeTA) African Civil Society Skills Building Workshop

This report documents a skills building workshop held by Medicines Transparency Alliance (MeTA) in Uganda in February 2008 for civil society organisations (CSOs) based in Ghana, Uganda, and Zambia. It explores the major topics covered, the processes that were used, some of the key outcomes and lessons, and highlights the initial plans made by country groups. The workshop was supported by the Department for International Development (DFID) United Kingdom, the World Health Organization (WHO), and the World Bank, and hosted by the Coalition for Health Promotion and Social Development (HEPS). It brought together 22 participants from 20 organisations – 7 from Ghana, 5 from Zambia, and 10 from Uganda.

The organisational process for the workshop included identifying participant organisations through scoping studies. The opening sessions explained the MeTA process and elaborated on the role that CSOs might be playing in MeTA. The workshop followed a daily pattern throughout most of the week - except for a series of field vists to the National Drug Administration, the National Medical Stores, the Joint Medical Stores and a number of local health care facilities, and private pharmacies- with initial knowledge sharing sessions first, followed by a skills development session. In the afternoon, an open space period enabled participants to share experience and discuss issues that emerged during other sessions. This was followed by a final session each day for participants' to work in country groups to analyse the country situation and identify possible approaches they would like to take when they returned home.


The workshop covered issues which constrain access to medicines and explored how a focus on transparency and accountability can address some of these. It helped participants explore issues in supply chain, identify points of transparency, and understand affordability issues. It particularly looked at the inefficiencies and waste in the supply system and flagged the role of civil society in encouraging greater transparency and accountability, including issues around availability, accessibility, acceptability, affordability, and rational use. A number of skills development sessions provided opportunities for participants to sharpen their abilities in research, communication and advocacy, and influencing and negotiating. They also explored how to monitor prices, improve collaboration and networking, make use of a rights approach to access to medicines, engage with the media, interpret data, develop policy briefs, and understand equity issues. A key feature of all the skills sessions was the emphasis on building on the experience of the participants and sharing that experience.


Outcomes included new alliances based on shared experiences and shared areas of concern among civil society and public officials, as well as the awareness of common issues across countries and organisations. The end-of-day sessions used a planning framework to develop workplans with each country-based group setting a goal, objectives, and a timeline and budget. The peer review of the workplans helped to identify ways in which they could be strengthened. In particular, participants were able to draw attention to gaps in other plans where greater emphasis was needed on supporting activities to encourage transparency and accountability in the medicines supply chain.


Results by country are as follows:

1. Ghana - Goal: to improve consumer access to essential medicines. Objectives: to advocate for reduction in prices of essential medicines by “10%” by 2010; to advocate for increase availability of essential medicines by “15%” in rural communities by 2010: and to strengthen the capacity of CSOs on access to essential medicine.
2. Uganda - Goal: to increase access to essential medicine especially for the poor and vulnerable people in Uganda. Objectives: to mobilise and build the capacity of CSOs to advocate for increased access to essential medicines; to increase awareness on policies and practices on access to essential medicines; to undertake advocacy to influence policy formulation and implementation, and monitoring and evaluation: and to increase CSO representation on decision making structures at all levels.
3. Zambia - Goal: to contribute towards improving governance, transparency, and accountability in the supply chain of medicines in Zambia. Objectives: the joint development of a workplan through a meeting of a wider group of CSOs, meetings with other stakeholders who were involved in MeTA, development of a baseline assessment of the situation in the country, and a series of follow-up meetings with stakeholders to share findings and identify an advocacy agenda and strategy.

Lessons learned include the following:

• Issues to do with access to medicines cannot be separated from governance, transparency, and accountability.
• In all three countries, there was observed to be a very high level of inequity in access to medicines.
• Networking was found to be a powerful tool to achieve greater results.
• Transparency and accountability issues were the focus of CSO country plans on access to medicines.
• Peer review of work by others brought more focus and better understanding of an issue.
• Engaging with government and the private sector is not easy, and CSOs have to be strategic in order to achieve desired outcomes.
• Engaging with the private sector was not covered in detail. This is an area that needs more work in the future.
• A consistent theme that emerged throughout the workshop in many different sessions was concern about the willingness of governments to recognise civil society organisations as equal MeTA partners. This was seen as an area where further effort might need to be made at national level in the future.
• Establishment of a virtual forum to enable CSO participants in the workshop to remain in touch and to share experiences is recommended.
• Regional organisations, such as Health Action International Africa (HAI Africa) and the Ecumenical Pharmaceutical Network (EPN) should be invited to participate in this network as a means of linking country and regional level activities.