Assessing the baseline pharmaceutical sector situation in MeTA pilot countries
Posted on 17 November 2009
By Catherine Vialle-Valentin and Dennis Ross-Degnan
National multi-stakeholder groups in the MeTA pilot countries are engaging in unprecedented dialogue to improve pharmaceutical sector transparency, accountability and efficiency. The groups’ ability to monitor progress towards their objectives is a critical issue. No easy benchmarks exist to gauge the success of such initiatives. To aid in this process, MeTA pilot countries are carrying out a broad-based assessment of the national pharmaceutical situation early in the process of implementing MeTA. These assessments will be repeated after the MeTA process has had time to unfold. These ‘pre’ and ‘post’ assessments will use standardised tools and measures that fit different environments and remain consistent overtime. In recent months, our World Health Organization (WHO) Collaborating Center in Pharmaceutical Policy at Harvard Medical School has worked with members of the MeTA Secretariat to develop three components of a MeTA assessment tool kit.
The first assessment tool is a Data Disclosure Survey. This structured questionnaire, currently being completed by MeTA Councils in all seven pilot countries, assesses a key aspect of the Alliance’s agenda: who is accountable for what and how transparent are policies, practices, and outcomes in the four core areas of medicines availability, price, quality, and promotion. The information gathered by this survey is intended to facilitate engagement and discussion among MeTA Council members and other stakeholders. Establishing communication and trust among diverse stakeholder groups is a crucial part of MeTA’s pilot phase. We anticipate that the process of completing and reviewing this survey will trigger meaningful exchanges about data disclosure, transparency, and accountability.
The Pharmaceutical Sector Scan is the second assessment tool. It is a framework for compiling key data about the pharmaceutical sector in a universally applicable format. Performing a country scan will provide a clear, accurate and standardised snapshot of the medicines situation at a given moment. The framework has to convey how various public and private systems contribute to the supply and use of medicines. Synthesizing and presenting very diverse pharmaceutical sector institutions and complex processes is no simple task. The MeTA Pharmaceutical Sector Scan is based on several existing questionnaires commonly used to describe pharmaceutical situations which have been adapted to the specific needs of MeTA. A prototype is now in the hands of local experts in three pilot countries for testing. They will collect and assess the validity of existing data, documenting all data sources. We expect that MeTA Councils will use the results from this tool to highlight problems, identify information gaps, and set priorities for action. We look forward to users’ feedback to help us improve upon the current tool.
The last assessment tool is derived from two surveys developed by WHO to measure access to and use of medicines. This tool has the unique advantage of collecting information directly at the end-user level. It gives an indication of the degree of community access to essential medicines, which, we believe, is the most direct and important endpoint of interventions aimed at the pharmaceutical sector. Surveys are administered to health care facilities and households in the surrounding geographic areas. The facility survey measures medicines availability, quality, prices/affordability, and components of medicines price, while the household survey measures medicines access and knowledge. Both surveys help identify economic and geographic disparities, socio-cultural barriers, and key information gaps.
Reliable country data are necessary to design and evaluate medicines policies. MeTA’s efforts to monitor progress in pilot countries are congruent with WHO’s global strategy to develop universal tools that measure country pharmaceutical situations. As MeTA triggers lasting advances in access to medicines, evaluation tools will continue to play a crucial role in informing country policy makers and international partners on the effectiveness of their interventions.
Catherine Vialle-Valentin, MD, SM, is Research Associate in the Department of Population Medicine at Harvard Medical School, and Epidemiologist at Harvard Pilgrim Health Care Institute.
Dennis Ross-Degnan, ScD, is Associate Professor in the Department of Population Medicine at Harvard Medical School, and Director of Research of the Harvard Pilgrim Health Care Institute.