Promoting transparency, accountability, and access through a multi-stakeholder initiative: lessons from the medicines transparency alliance
Informa UK Limited - 2017
Tóm tắt
Barriers to expanding access to medicines include weak pharmaceutical sector governance, lack of transparency and accountability, inadequate attention to social services on the political agenda, and financing challenges. Multi-stakeholder initiatives such as the Medicines Transparency Alliance (MeTA) may help overcome these barriers. Between 2008 and 2015, MeTA engaged stakeholders in the pharmaceutical sectors of seven countries (Ghana, Jordan, Kyrgyzstan, Peru, Philippines, Uganda, and Zambia) to promote access goals through greater transparency. We reviewed archival data to document MeTA activities and results related to transparency and accountability in the seven countries where it was implemented. We identified common themes and content areas, noting specific activities used to make information transparent and accessible, how data were used to inform discussions, and the purpose and timing of meetings and advocacy activities to help set priorities and influence governance decisions. The cross-case analysis looked for pathways which might link the MeTA strategies to results such as better policies or program improvements. Countries used evidence gathering, open meetings, and proactive information dissemination to increase transparency. MeTA fostered policy dialogue to bring together the many government, civil society and private company stakeholders concerned with access issues, and provided them with information to understand barriers to access at policy, organizational, and community levels. We found strong evidence that transparency was enhanced. Some evidence suggests that MeTA efforts contributed to new policies and civil society capacity strengthening although the impact on government accountability is not clear. MeTA appears to have achieved its goal of creating a multi-stakeholder shared policy space in which government, civil society, and private sector players can come together and have a voice in the national pharmaceutical policy making process. Assuming that transparency is in place to leverage accountability, the success of MeTA’s efforts to promote accountability by the government as well as other stakeholders in the pharmaceutical sector will depend on how well efforts are sustained over time.
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Tài liệu tham khảo
World Health Organization. WHO essential medicines and health products annual report 2015. WHO/EMP/2016.2. Geneva: World Health Organization; 2016.
Wagner AK, Graves AJ, Reiss SK, Lecates R, Zhang F, Ross-Degnan D. Access to care and medicines, burden of health care expenditures, and risk protection: results from the world health survey. Health Policy. 2011;100(2-3):151–8.
United Nations. The millennium development goals report 2015. New York: United Nations; 2015.
Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, Van Damme W. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692–704.
Kohler J. Mapping of good practices of anti-corruption interventions in the health sector. New York: UNDP Democratic Governance Group; 2011.
Bassat Q, Tanner M, Guerin PJ, Stricker K, Hamed K. Combating poor-quality anti-malarial medicines: a call to action. Malar J. 2016;15:302.
Vian T. Exploring the construction of transparency: an analysis of health managers’ narratives. Global Health Gov. 2012;V(2):1-24
Brinkerhoff DW. Accountability and health systems: toward conceptual clarity and policy relevance. Health Policy Plan. 2004;19(6):371–79.
Brandsma G, Schillemans T. The accountability cube: measuring accountability. J Public Adm Res Theory. 2013;23(4):953–75.
Transparency and Accountability. http://www.medicinestransparency.org/key-issues/transparency-and-accountability/. Accessed Apr 3 2017.
Rose-Ackerman S, Tan Y. Corruption in the procurement of pharmaceuticals and medical equipment in China: the incentives facing multinationals, domestic firms and hospital officials. Pacific Basin Law J. 2015;32(1):1–53.
United Nations MDG Gap Task Force. Taking stock of the global partnership for development. Millennium development goal 8. MDG Gap task force report 2015. New York: United Nations; 2015.
Brockmyer B, Fox J. Assessing the evidence: the effectiveness and impact of public governance-oriented multi-stakeholder initiatives. Transparency & accountability initiative. London: Open Society Foundation; 2015.
Dentoni D, Bitzer V. The role(s) of universities in dealing with global wicked problems through multi-stakeholder initiatives. J Clean Prod. 2015;106:68–78.
Mena S, Palazzo G. Input and output legitimacy of multi-stakeholder initiatives. Bus Ethics Q. 2012;22(3):527–56.
Kohler JC, Ovtcharenko N. Good Governance for Medicines Initiatives: Exploring Lessons Learned. U4 Issue No. 3. Bergen, Norway. 2013.
Buckland-Merrett GL, Kilkenny C, Reed T. Civil society engagement in multi-stakeholder dialogue: a qualitative study exploring the opinions and perceptions of MeTA members. J Pharm Policy Pract. 2017;10:5.
Vian T, Kohler JC. Medicines transparency alliance (MeTA): pathways to transparency, accountability and access. Cross-case analysis and review of phase II. Geneva: World Health Organization; 2016.
Medicines Transparency Alliance. Medicines transparency alliance: a review of the pilot. London: UK Department for International Development; 2010.
Martin J, Schurmann M. The medicines transparency alliance: programmatic review of MeTA phase II. Final report. Geneva: World Health Organization; 2016.
Scott C. Figuring out accountability: selected uses of official statistics by civil society to improve public sector performance. Q squared working paper No. 37. Toronto: Centre for International Studies of the University of Toronto; 2007.
Piotrowski S. Transparency and secrecy: a reader linking literature to contemporary debate. Lanham: Lexington Books; 2010.
Cassell C, Symon G. Qualitative methods in organizational research: a practical guide. Thousand Oaks: Sage Publications; 1994.
Hartley JF. Case studies in organizational research. In: Cassell C, Symon G, editors. Qualitative methods in organizational research: A practical guide. Thousand Oaks: Sage Publications; 1994.
Patton M. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks: Sage Publications; 2002.
Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications, Inc.; 1994.
e-Pact Consortium. Medicines transparency alliance (MeTA) evaluation: testing MeTA’s underlying intervention logic. Oxford: e-Pact Consortium; 2015.
Data Disclosure Survey. http://www.medicinestransparency.org/?id=588. Accessed Apr 3 2017.
Disclosure status of pharmaceutical sector data: Part of Component 1 of the MeTA baseline assessments. http://apps.who.int/medicinedocs/en/d/Js18077en/. Accessed Apr 3 2017.
Cucciniello M, Porumbescu GA, Grimmelikhuijsen S. 25 years of transparency research: evidence and future directions. Public Adm Rev. 2016;77(1):32–44.
Camargo CB. Using power and influence analysis to address corruption risks: The case of the Ugandan drug supply chain. U4 Brief 6. Bergen, Norway. 2012