The access to medicines meeting kicked off in Lusaka this morning with an assessment of the successes of the campaigns over the past year. Roxana asked a panel, to name one key success from their campaign. Here’s a paraphrased summary of the discussion:
Successes of the stockouts campaign:
Sandra Kiapi – Uganda: The Campaign was very successful in engaging media and educating them about the problem of stockouts in the country. The message got to the key policy makers. The president set up a unit to curb drug thefts in health care facilities.
Q: What was it that you did that made the media interested in talking about this?
A: Personal stories of people affected really got the media’s attention.
Tafadzwa Chigariro, Zimbawe: Zimbabwe started rather late so hasn’t engaged leadership at policy level. We decided to focus the campaign on the issue of resources. The government has adopted the Abuja commitments for the budget for 2010 – allocating 15% to health.
One of the things we did was to collaborate with other civil society organisations. We also mobilised communities to demand the 15% commitment. We also included community representatives at our meetings.
Emma Wanyonyi, Kenya: When we launched the campaign in February, there was a lot of denial. There was a lot of media coverage and the government denied. Over a period of months and with the dissemination of the findings of the pill check week the government began to appreciate what we were saying. And the government admitted then that there was a problem.
It’s important to have data but how you collect the data and present it, can make a difference. In the pill check we had people going out to facilities and sending the information via text message to us. The data came from the public, so it was a bit more credible.
Saiti Chikwapulo, Malawi: We talked about medicines for all as our main message, and we took advantage of opportunities during the election period. People took up the campaign messages with their candidates during the election. We urged candidates to make messages publicly as part of their election bids and then we followed up afterwards. We had set ourselves to have issues of health and medicines as one of the 3 key agenda items for our politicians and we were able to do this, making it one of the 3 key issues for debate.
Harrison Mwima, Zambia: One of the successes we had in Zambia was that the government opened the doors for us to discuss the stop stockouts issues. During our launch, we had the communications officer of TALC who gave the scenario in eastern province where people must walk 200km to access drugs – so we got support from the government. One of the biggest problems is drugs not reaching their intended destinations and the health ministry has committed to look into the distribution system in Zambia.
Question: Malawi – what have the politicians done since the elections and how do you monitor that?
Saiti: We had elections in May and the financial year runs from July. So the first business after elections was to enact the national budget. So we asked for commitments – we engaged members of parliament through portfolio committees to ensure budget commitments. We also had alliance meetings with MPs – using those who had signed the pledge as a cohort to engage others who had not signed the pledge.
Then we engaged them in about Aug/ Sept – during an alliance meeting – and we also engage them through the Health SWAP review meetings, and stockouts get looked at as part of that.
Question: Kenya – A lot of the data was from the wider public. Can you explain how people knew about it to be involved and how did you verify the quality of the information? Is there anything you can give back to the public to make the cost of the sms worth it to them?
Emma: Before the pill check week we had engaged the media through radio programmes and TV shows, so we used this to publicise the pill check week. We also had 3 public fora – in Nairobi, Kisumu and Mombasa. On the quality of the data – we sometimes had some concerns about validity of the data, but our aim was really to create a broad picture. Giving back – most people targeted were low-income earners. So for next time we’re looking at a system where the sms will be free, so we bear the cost of the sms. But we’re also trying to sensitise the public so that they see this as their problem – the benefit is the long term goal of ensuring medicines are available.
Question: Kenya: – how important is it for government to admit there is a problem?
Emma: It was a positives step for the government to admit the problem because then we can hold them to account. Once they admitted the problem they became open to us, and we plan to take advantage of that opening. One example is that we are asking for civil society representation on the medicines agency board. There is general agreement on this so we just need to push to make it happen.
Goodwell: Zambia question – how did the pill check project go in terms of number of responses received – by sms. How many districts did the campaign take place in? Did the pill check show problems with all 10 medicines – being out of stock?
Harrison: TALC and NZP+ are doing the stop stockouts campaign. Talc is in 7 provinces and NZP+ throughout the country. We focused on Mongo, Chipata and Lusaka itself because of limited resources.
Question: A Comment on issue of budget analysis – the only way you can find out if the commitments are met is if government is putting money where their mouth is, so budget analysis is crucial.
Q: There have been many media articles on stockouts in Uganda and recently we saw the president sacking the permanent secretary. How does this connect to the stockouts campaign?
Sandra: The sacking of the permanent secretary may have been a political move because of internal wrangles within the ministry of health. Recently parliament gave autonomy to the central medical stores. There is speculation that one reason for her sacking was that she was opposed to this. We have welcomed the new distribution system – this should help to curb the stock-outs as there is now a one-stop centre for procurement and distribution so it should help us to be able to pinpoint the problems. We are in touch with the national medical stories and we will monitor the new system to ensure that it works.
Saiti: In Malawi, to us the pill check week added value to the process. We recorded results and then engaged players in form of sessions to disseminate our research findings – we went down to local levels to do this.
Q: Is there any evidence at local level showing success in improved access to medicines.
Emma: There’s no evidence yet as to improved access, but certainly awareness has grown thanks to our campaigning. Now the next step would be to translate this awareness into something tangible.
James: Yes there has been success. We have had the minister in front of the camera admitting to stockouts (though the other health minister has denied it!). The issue is now who is telling the truth? But the people experiencing the stockouts on the ground now get in touch with us to alert us and ask us to take it up.
If you had one dream what would it be?
Sandra: Communities and health consumers taking ownership of the campaign.
Tafadzwa – At regional and international level, I’d like to see our governments and civil society working together at regional level around trade and pricing issues.
Emma: In Kenya we’ve had some discussion around reforms within the Kenya Medicines Supply Agency. A task team has come up with very concrete recommendations so the dream for me would be that the government in the next year, will implement these recommendations.
Saiti: In Malawi my dream is that we establish an equity watch – a formal monitoring system – harnessing the importance of partnerships, to monitor access to medicines.
Harrison: My dream is to strengthen the pill sms campaign. We undertook a lot of sensitisation around this and people are aware of what they are supposed to do. If we can strengthen this we can have the basis to tackle the government on the ground.
