Medicines Transparency Alliance (MeTA) in Jordan

MeTA is, first and foremost, a collaboration. Speaking at a meeting of the MeTA International Advisory Group in September 2008, Dr. Taher Abu El Samen, Secretary-General of Jordan's High Health Council and Chairman of the Jordan MeTA Council, said that one of the first steps had been identifying common issues on which all three sectors - public, private, and civil society - could share information and collaborate. He also emphasised that MeTA is a global alliance and that there is a need for "continuous communication and shared learning" between and across pilot countries, as well as with the International Secretariat. Two public MeTA Forums are planned for October 2009 and February 2010 that will widen the multi-stakeholder group and facilitate public debate and participation.

The following were identified by key stakeholders in discussions as potential priority areas under Phase I of MeTA:

1. Achieving better transparency, disclosure, and dissemination of medicine price information to the public, starting with findings of a survey carried out by the World Health Organization (WHO)/Health Action International (HAI) in 2004;
2. Capacity building of civil society to increase disclosure and accountability through training workshops to include:
   • media training
   • code of ethics for professional associations
   • code of ethics for medical and pharmacy students;
3. Ethical medicines promotion (the Jordan Food and Drug Administration (JFDA) was finalising guidelines in November 2007)
   • by multinationals, especially during public sector procurement tenders
   • by committees during procurement tenders and essential drugs list selection through better accountability and declaration of conflicts of interest
   • by local manufacturers selling in the Jordanian private sector;
4. Dissemination of information to both prescribers and patients on the quality of generics
5. Improved rational use of medicines led by the newly formed Rational Drug Use (RDU) at the JFDA, especially with a focus on physician prescribing behaviour and standard treatment guidelines; and
6. Evidence-based decision-making in the Rational Drug List (RDL), which involves reviewing current committees' terms of reference (TORs) related to the process of reviewing medicines to be included in the RDL, as well as training in conducting and using economic evaluation.

The MeTA Council was formed with representation of each of the following key stakeholders: the Government, private sector, civil society organisations (CSOs) and professional organisations, and academia. In addition, the Council includes four nonvoting members comprising a representative each from the World Bank (WB), World Health Organization (WHO), and Health Action International (HAI), as well as the MeTA local consultant. The Council serves as the main decision-making body and the highest policymaking and consultative body for MeTA. Its duties will be to oversee the overall implementation of MeTA programmes/projects in Jordan, review progress against workplan objectives, and decide on any other matters pertaining to the implementation of all MeTA programmes in Jordan.

At the Council's first meeting in August 2008, members identified three priority areas of work from those listed above (CSO capacity building, evidence-based decision-making in the RDL, and improved rational use of medicines), as well as the need to: revisit any existing studies and data on medicines to identify information gaps that need further research, build capacity to collect data, and find better ways of monitoring the effectiveness of medicines using transparent measurement criteria.

Health, Access to Medicines, Rights.

Unlike some other countries participating in MeTA, Jordan has a growing local generics pharmaceutical industry that accounts for about a quarter of the value of the local pharmaceutical market and has a significant export potential. However, prices of medicines in private retail pharmacies are high, and low-income groups and the chronically ill cannot afford some treatments.

According to the 2004 WHO/HAI report, for the whole Eastern Mediterranean region, the picture is of "reasonably efficient public sector procurement; unreliable availability of essential medicines in the public sector; people having to pay for their own medicines in the private sector, often at high and frequently unaffordable prices; and the need for stronger government action to introduce or improve national medicines policies and effective pricing policies."