Can a multistakeholder initiative improve transparency and accountability in the pharmaceutical sector? Evidence from the Medicines Transparency Alliance

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 promote transparency in the pharmaceutical sector as good practice and clarify how information is used to hold institutions and leaders accountable for performance. Funding: World Health Organization through a grant from the UK Department for International Development