Medicines Transparency Alliance (MeTA): Pathways to Transparency, Accountability, and Access: Cross-Case Analysis and Review of Phase II

The Medicines Transparency Alliance (MeTA) initiative, implemented in seven countries (Ghana, Jordan, Kyrgyzstan, Peru, the Philippines, Uganda and Zambia) from 2008 to 2015, worked under the assumption that increasing transparency and accountability in the pharmaceutical sector would improve access to medicines by improving decision-making. This study investigates the activities undertaken to increase transparency and foster accountability, and how these two goals are related to each other and to program outputs and outcomes. Focusing mainly on Phase II of MeTA (August 2011 – December 2015), we used case study methods and reviewed archival data to document transparency and accountability mechanisms. After completing the individual cases, we then conducted cross-case analysis to examine themes and note similarities and differences across countries. We found that in most countries, MeTA did not explicitly define transparency or adopt a deliberate transparency model or strategy (e.g. open meetings model or right to information strategy). Based on our review of documentation we inferred that countries implicitly conceptualized transparency as collecting and sharing relevant data on access to medicines with stakeholders from government, civil society, and the private sector. Most countries used a combination of approaches to operationalize transparency: promoting proactive dissemination strategies on the part of government, and helping to facilitate open public meetings. Country MeTA programs also disseminated information through traditional and new media, and through citizen education. In our examination of accountability across countries, we also found that there was not a common explicit definition of accountability. Nonetheless, we were able to categorize accountability strategic and tactical approaches that MeTA stakeholders advanced into four broad categories: multi-stakeholder policy dialogue/consultation, civil society capacity building (through the creation of networks or coalitions), institutionalization of information access (through permanent offices or routinization of data collection), and citizen education. Some of these approaches were necessarily interlinked. For instance, the capacity building of civil society organizations (CSOs) enhanced their knowledge and skills so they could analyze relevant information and to participate actively in multi-stakeholder dialogue/consultation. MeTA has clearly produced transparency outputs and supported accountability outputs in its pilot countries, to varying degrees. What is less clear is its impact on access to medicine outcomes in each country. Moving forward, the sustainability of MeTA’s efforts will likely depend on how well outputs have been institutionalized, such as the regular public release of medicine prices and posting of procurement tender information. The involvement of civil society organizations in pharmaceutical policy monitoring and advocacy should ideally continue and even be further developed, as well as multi-stakeholder forums that can provide a space for the voices of all stakeholders in the pharmaceutical policy process.