Access to Medicines – African Civil Society Role and Response

Open Society Institute (OSI) Access to Essential Medicines Initiative hosted a regional meeting with all the ‘Stop the Stock-out Campaign’ partners, key African health and human rights groups, donors and other key partners in December 7 – 10, 2009 in Lusaka Zambia.

The meeting was among other things to strategize on the next steps for the campaign. In 2009 the Stock-out Campaign received a lot of attention. Journalists were interested by the novel news angle that the use of innovative technology provided.

The campaign that took place in five African countries namely Kenya, Uganda, Zambia, Zimbabwe and Malawi made several milestones. Most importantly, the campaign empowered patients and consumers by the knowledge that they were entitled to access essential medicines. Civil society activists also realized that they could monitor drug availability and challenge the status quo through advocacy.

Through lobbying and advocacy the campaign held governments and policy makers to account for denying the reality about stock outs of essential medicines in public health facilities and failing to take action. Drug supply agencies were shamed into becoming more transparent, efficient and accountable. Politicians and policy makers started to respond publicly to this pressure.

In 2010 the Campaign will use this public attention and heightened profile to continue pushing for concrete government response to end the stock-outs.

Some in country focuses in 2009
Kenya
In Kenya, activists decided to target, amongst others, the central medicines supply agency for their advocacy campaign. The Kenya Medical Supplies Agency (KEMSA), under the Ministry of Medical Services, is mandated to procure and supply quality medical supplies to public health facilities. It is also required to replenish stocks of medical supplies in all public health facilities in the country. Inefficiencies and lack of transparency at the level of the central medicine supply agency were identified as a major bottleneck in Kenya. KEMSA became the target of major activist communication calling for increased transparency in the medical supply chain/system and adequate oversight of KEMSA.
The campaign was first met with flat out denial by the Ministry of Medical Services, which issued a press statement denying the very existences of stock-outs (“There are no stock-outs of essential drugs experienced in the country as reported by the media.”). After 5 months of campaigning and the Pill Check Week, the Minister of Medical Services Prof Anyang Nyongo, admitted on a Kiswahili radio station that there were stock-outs in public health facilities in Kenya. He also confirmed to lawmakers that extra funds would be used to purchase essential medicine.

Malawi
In Malawi, the team decided to focus on improving procurement efficiency and strengthening the management of the medicine supply chain in order to improve availability in all districts with low access. The elections in Malawi provided a great opportunity to get the issue of access to essential medicines onto the election agenda at local levels and to pressure politicians to provide answers on how they will stop stock outs in their districts if elected.

Campaign partners targeted aspiring members of Parliament and presidential candidates. They issued a “Medicines for All pledge” and asked communities to demand commitment and accountability from MPs on accessing essential medicines. Community members called on all aspiring Members of Parliament to sign the “Medicines for All Pledge” to stop the stock-outs. The pledge committed politicians to:
• Pledge to stop the stock-outs and support drugs policies that ensure that all Malawians have access to essential medicines regardless of where they live.
• Promise to maintain and improve poor people’s access to basic essential medicines.
• Pledge to support actions designed to strengthen distribution of these drugs.
• Promote transparency and accountability so that there is public disclosure on medicines supplies.

This movement was widely supported by print, television and radio coverage. The team held a panel discussion with key aspiring MPs from the three key political parties on the “Medicines for All Campaign”. The debate was recorded by Zodiac Radio and aired for two hours. The Stock-out Campaign also prompted the Minister of Health to react and position himself publicly. At the Health Sector SWAp, in his opening remarks, the minister felt obliged to account for the performance of the Ministry in providing essential medicines and called out to Martha, one of the leaders in the Stop the Stock-outs Campaign: “Martha Kwataine, Are you here?” he said “are you listening?”; a clear sign that the message in the Campaign on drug stock-outs had reached the ears of the powerful.

Uganda
The Ugandan team made an interesting use of World TB Day to put the issue of drug stock-outs on the agenda. Their statement read: “As people around the globe mark the World Tuberculosis (TB) Day, we the partners of the Stop Stock-Outs Campaign in Uganda are extremely concerned that even at this very moment there is a stock-out of anti-TB drugs at Mulago Hospital, Uganda’s national referral hospital.”

Their communication went on to denounce the shortages of essential medicines that prevail at national referral hospitals and lower level health facilities, which had continued for more than seven months, and how the Ugandan Government was failing in its duty to provide quality essential medicines under the International Covenant on Economic, Social and Cultural Rights. The partners of the Stop Stock-outs Campaign in Uganda asked the Government to take action to make available quality TB medications at Mulago Hospital and all other public health facilities in the country where there were stock-outs; revise the medicines procurement, supply and distribution mechanism; and ensure the timely availability of TB and other essential medicines to those who need them.

The Uganda Stop Stock-outs team’s statements about TB drugs stock outs at Mulago hospital caught significant press attention, including in the regional weekly paper “The East African” and in ASNS (Africa Science News Service). As a result of the wide media coverage of the stock-out issues (and especially the TB medications), the Ministry of Health came out openly and acknowledged the drug shortages taking place in the country on prime-time TV news.

Zimbabwe
The Zimbabwean teams were only able to start their campaign work in late summer 2009. Partners have decided amongst other issues, to campaign on documenting and responding to corruption in the drug supply system as well as pushing for resource mobilization. To that end, participants in the campaign decided to engage the Parliamentary Portfolio Committee on Health (PPCH) to ensure the prioritization of health evidenced by increased allocation of resources.

The Pill Check Week
To keep and feed the momentum created by the launch in February 2009, it was then decided to identify a common week during (22 – 26 June) which teams of people would go out to pharmacies and document which of a list of 10 Essential medicines were out of stock. Through a simple text message sent via mobile phones to a central computer, an interactive map was created on the stoptockouts.org campaign website, which visually showed the extent of stock-out as encountered by people in the field. This creative use of the mobile phone technology attracted significant attention from national and regional journalists, and soon led to an opening up of the debate on stock-outs. Prior to this mainstream media had largely ignored the problem.

How the SMS pill check week was done:
Activists in Kenya, Uganda, Malawi and Zambia started surveying clinics in their respective countries, checking stock levels of essential medicines. These included first-line anti-malarials, zinc tablets, penicillin, and first-line anti-retrovirals (ARVs) for the treatment of HIV/AIDS. Each of these medicines is essential in varying degrees to fighting disease and illness, and is widely used in the four countries. After visiting clinics and pharmacies, activists used their mobile phones to report their results by using structured, coded text messages (SMS): “x,y,z” – where the x represented their country code (Kenya, Malawi, Uganda or Zambia), y their district or city, and z the medicine which they found to be out of stock. The messages were received by “FrontlineSMS”, a free open source software. When a stock-out SMS report was received, “FrontlineSMS” was configured to run an automatic script which sent the stock-out report to the Campaign website where it was visually displayed on an interactive map. This map showed specific reports by location, building up “hot spots” of activity – the bigger the hotspot, the greater number of stock-outs and the greater the problem in that area.

African Union level
With the support of PHP’s Access to Essential Medicines Initiative, HAI-Africa and Oxfam Pan African office and the Treatment Access Movement organized a workshop at the African Union (AU) level to brief Ambassadors, AU staff and other stakeholders and examine strategies for reducing stock-outs of medicines in public health facilities, and improving access to essential medicines in Africa. The meeting kicked off with a roundtable discussion with key continental and sub-regional policy makers relevant to ensuring access to medicines, and drawn from the African Union, the Southern Africa Development Committee (SADC), the East African Community (EAC) and the Economic Community of West African States (ECOWAS).
Of specific interest was the angle offered by the set of commitments made by the Member States of the African Union since 2001. The commitments that most directly impact the ability of African citizens to access essential medicines are the pledges made to:
• Allocate 15% of national budgets to health
• Strengthen health systems to ensure that essential medicines are in stock
• Enact and utilize appropriate legislation, trade regulations and TRIPS flexibilities to ensure that essential medicines are available and affordable
• Support the Pharmaceutical Manufacturing Plan for Africa, which is aimed at realizing the economic production at volume of quality generic medicines.

The lack of progresses against these set of continental commitments and declarations related to access to medicines was highlighted. Participants urged African governments to eliminate stock-outs from all public health institutions by providing a dedicated national budget line for essential medicines, ensuring complete autonomy of central medical stores, and providing effective representation of civil society on the boards of national and regional procurement agencies.

To see more materials about the meeting click on the links below:
http://accessmedicines.wordpress.com/
http://health.accel-it.lt/en/seminars/

Els Torreele of OSI making a presentation at the Meeting