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					MeTA Jordan

Dr Taher Abu ElSamen
MeTA Council Chair
HHC Secretary General




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Multi-stakeholder process

The Multi-stakeholder process in Jordan started by:


        Establishing the MeTA Council based on a multi-stakeholder
         membership , the MeTA Council is represented (fully/ cant
         considered fully as the private sector is poorly represented) by
         multi-stakeholder, public and private sectors and the CSO


        The Stakeholders jointly agreed on a national country workplan
         for 21 months



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     Multi-stakeholder in MeTA Council




MeTA Int. Partners                              WHO   DFID   WB
  4/15/2011   Medicines Transparency Alliance
Multi-stakeholder process cont.
        The national forum Nov. 2009 created 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, the multi-stakeholder training on January
         aimed to improve dialogue and collaboration
        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

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Multi-stakeholder process cont.
    MeTA Jordan will carry out the stakeholder mapping and
     communication audits in July to help map out the local
     communication partners and individual consultants
    Having MeTA in Jordan was an opportunity to get key people
     working in the pharmaceutical sector engaged together in a multi-
     stakeholder membership and including patients along the way
    MeTA Jordan stakeholders has reached a stage of realizing that
     they need skills to help them communicate with representatives
     of institutional partners who may come from very different
     positions has




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Multi-stakeholder process cont.
    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




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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


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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

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    Major achievements and
    successes for MeTA in Jordan




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Major achievements and successes
for MeTA in Jordan
        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
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Major achievements and successes
for MeTA in Jordan
    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


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Major achievements and successes
for MeTA in Jordan
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
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Major achievements and successes
for MeTA in Jordan
    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
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                                                                           MeTA
Major achievements and successes
for MeTA in Jordan
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



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Major achievements and successes
for MeTA in Jordan
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




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                                   Overall Challenges




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Overall Challenges
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

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Overall challenges
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

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Overall Challenges
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



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                                      Lessons Learned




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Lessons Learned
    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
    To engage parliament in the MeTA process
    The stakeholders started to understand each others perspectives
    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
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Lessons Learned
    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
    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 and for people working in the
     pharmaceutical sector
    We have learned the Importance of Data Disclosure, many
     outputs we were keen to participate in towards disclosure it was a
     useful exercise that improved communication, sharing and
     disclosing of information, a core MeTA principle we agreed to
     publish all outcomes on Jordan MeTA Web site and learned that
     we should involve the media more

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Lessons Learned
   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 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

   The international and the national MeTA Secretariat coordination
    role is integral for the MeTA process to move forward

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




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