Background: The goal of the public procurement of pharmaceuticals is to purchase sufficient quantities of high-quality pharmaceuticals at cost-effective prices for a given population. This goal can be undercut if corruption infiltrates the procurement process. Good procurement practices can help mitigate the risks of corruption and support equitable access to affordable and high-quality medicines. Objectives: This paper aims to 1) examine manifestations of corruption in the pharmaceutical procurement process and key factors behind them, and 2) identify how to design and implement effective anti-corruption, transparency and accountability mechanisms within this process. Methods: This paper was informed by a narrative literature review from 1996 to the present. The search focused on publications that addressed the issue of pharmaceutical procurement and governance and corruption issues. Our search included peer-reviewed literature, books, grey literature such as working papers, reports published by international organizations and donor agencies, and some media articles. Some documents used in this paper were already known to the authors. Results: Procurement is highly vulnerable to corruption particularly in the health sector. What is more, corruption in the procurement process does not appear to be limited to any one level of government or type of health system. The better integration of accountability, transparency and anti-corruption mechanisms in the procurement process is needed to reduce the risk of corruption. Conclusions: Lessons learned suggest that anti-corruption, transparency and accountability mechanisms in the pharmaceutical procurement process, such as open contracting and integrity pacts are helpful towards reducing the risk of corruption.
Background: 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.
Access to safe, effective, good-quality medicines can be compromised by poor pharmaceutical system governance. This system is particularly vulnerable to inefficiencies and to losses from corruption, because it involves a complex mix of actors with diverse responsibilities. A high level of transparency and accountability is critical for minimizing opportunities for fraud and leakage. In the past decade, the Good Governance for Medicines programme and the Medicines Transparency Alliance focused on improving accountability in the pharmaceutical system and on reducing its vulnerability to corruption by increasing transparency and encouraging participation by a range of stakeholders. Experience with these two programmes revealed that stakeholders interpreted transparency and accountability in a range of different ways. Moreover, programme implementation and progress assessments were complicated by a lack of clarity about what information should be disclosed by governments and about how greater transparency can strengthen accountability for access to medicines. This article provides a conceptual understanding of how transparency can facilitate accountability for better access to medicines. We identified three categories of information as prerequisites for accountability: (i) standards and commitments; (ii) decisions and results; and (iii) consequences and responsive actions. Examples are provided for each. Conceptual clarity and practical examples of the information needed to ensure accountability can help policy-makers identify the actions required to increase transparency and accountability in their pharmaceutical systems. We also discuss factors that can hinder or facilitate the use of information to hold to account those responsible for improving access to medicines.
Background Access to affordable quality essential medicines is crucial if universal health coverage and the Sustainable Development Goals are to be achieved. Multistakeholder initiatives might help to overcome barriers to access such as weak pharmaceutical sector governance and lack of transparency and public accountability. The Medicines Transparency Alliance (MeTA) is a multistakeholder initiative implemented in the pharmaceutical sectors of seven countries (Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda, and Zambia) between 2008 and 2015. In this study, we aimed to assess whether MeTA has had an effect on transparency (defined here as the degree to which access to information is available and citizens are informed about how and why government decisions are made) and accountability in the pharmaceutical sector in the seven pilot countries. Methods We applied case study methods to examine MeTA's efforts to increase transparency and accountability in the seven pilot countries. We reviewed archival data that focused on MeTA Phase II (August, 2011, to December, 2015), although we also noted key events and data from Phase I. We included: country-level semi-annual progress reports, work plans, Department for International Development (DFID) annual review reports, MeTA global meeting notes and presentations, country-level technical study reports, stakeholder forum reports, country policies, and content from web sites and social media. We compared information between countries to identify commonalities and differences in strategies and tactics used to promote MeTA's goals and, where possible, identify how these strategies might link to project results, particularly with regard to improving access to medicines. Findings We found that the pilot countries used special studies and analyses, open meetings, and proactive information dissemination strategies to expand transparency. Additionally, MeTA fostered multistakeholder policy dialogue to bring together different actors to discuss evidence on access to medicines barriers and progress. We found strong evidence that transparency was improved, for example, through the promotion of proactive dissemination strategies by the government, as well as open public meetings to discuss medicines access issues. Furthermore, MeTA's efforts contributed to new policies, such as revised national medicines policies (for example, in Ghana, Kyrgyzstan, and Uganda) and the elimination of taxes on imported raw material for medicines, as happened in Ghana. Interpretation Our study provides evidence that transparency can be improved in the pharmaceutical sector through multistakeholder initiatives, and that increased availability of information, coupled with communications between the various stakeholders, could facilitate progress towards access-to-medicines goals and result in greater government accountability. Longer-term outcomes will depend on the sustainability of initiatives, which is furthered predominantly through country ownership of such programmes, and specific actions to ...
Background Weak governance over public sector pharmaceutical policy and practice limits access to essential medicines, inflates pharmaceutical prices, and wastes scarce health system resources. Pharmaceutical systems are technically complex and involve extensive interactions between the private and public sectors. For members of public sector pharmaceutical committees, relationships with the private sector can result in conflicts of interest, which may introduce commercial biases into decision-making, potentially compromising public health objectives and health system sustainability. We conducted a descriptive, qualitative study of conflict of interest policies and practices in the public pharmaceutical sector in ten countries in the World Health Organization (WHO) South-East Asia Region (SEAR) (Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste) between September 2020 and March 2021. Results We identified 45 policy and regulatory documents and triangulated documentary data with 21 expert interviews. Key informants articulated very different governance priorities and conflict of interest concerns depending on the features of their country’s pharmaceutical industry, market size, and national economic objectives related to the domestic pharmaceutical industry. Public sector pharmaceutical policies and regulations consistently contained provisions for pharmaceutical committee members to disclose relevant interests, but contained little detail about what should be declared, when, and how often, nor whether disclosures are evaluated and by whom. Processes for preventing or managing conflicts of interest were less well developed than those for disclosure except for a few key procurement processes. Where processes for managing conflicts of interest were specified, the dominant strategy was to recuse committee members with a conflict of interest from relevant work. Policies rarely specified that committee members should divest or otherwise be free from conflicts of interest. Conclusions Robust processes for conflict of interest prevention and management could ensure the integrity of decision-making and build public trust in pharmaceutical processes to achieve public health objectives. Upstream approaches including supportive legislative frameworks, the creation of oversight bodies, and strengthening regulatory institutions can also contribute to building cultures of transparency, accountability, and trust.
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