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Southern African Regional Programme

on Access to Medicines and Diagnostics

CIVIL SOCIETY MEETING REPORT

How can we work in partnership to improve access


to Medicines & Diagnostics in Southern Africa?

21 - 22 March 2010, Nairobi, Kenya


TABLE OF CONTENTS 2

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Record of the consultation

1. Establishing a common agenda to improve access in Southern Africa 3

2. Objectives of the consultation 3

3. Who was there 3

4. The meeting proceedings 4

5. Record of small group discussions & recommendations 4

6. Defining potential Partnerships for Action (PACTs) 5

7. Key points of consensus 6

8. Actions for the next steps 6

9. Conclusions 6



ANNEXES

A. Overview of Sarpam 7

B. SADC Pharmaceutical Business Plan 2007 - 2013: Summary 9

C. Participants List 10

D. Record of Open Agenda Discussions 11

E. First Draft CS-Led Partnership for Action (PACT) Framework 23

F. The SARPAM Civil Society Reference Group 25



G. Manifesto For Civil Society Action on Access to Medicines in southern Africa 26

H. Case Study: Partnership In Action 28

I. Workshop Evaluation 38

SARPAM Contact details


Record of the consultation 3

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
1. Establishing a common agenda to improve access TO MEDICINES in Southern Africa

The Southern African Regional Programme on The meeting started with an open agenda for
Access to Medicines & Diagnostics (SARPAM) is participants to define their own priorities to address
being designed through a process of consultation the challenge: “How can we work in partnership to
and information-gathering during an inception improve access to medicines and diagnostics in the
phase that started in January 2010. During the Southern Africa region?”.
period, Partnerships for Action (PACTs) are
being explored to improve the availability, Over 2 days, participants started the process of
affordability and quality of essential medicines engaging with each other as African Civil Society
and diagnostics across the SADC region. These to initiate a regionally focused Civil Society Action
PACTs should support implementation of the SADC Network that will focus on what Civil Society in the
SADC region can do to support implementation of
Pharmaceutical Business Plan to the end of 2013.
the SADC Pharmaceutical Business Plan.
SARPAM offers the potential to strengthen the
Strong commitments to action were made by those
capacity of regional institutions and civil society
present to lead a Partnership for Action (PACT)
to implement joint plans that will achieve agreed
that will promote greater transparency in the
results through multi-stakeholder action across
regional pharmaceutical marketplace and more
countries in the region.
effective sharing and use of pharmaceutical market
information.
The Responsible Action Consortium managing
SARPAM (on behalf of the U.K. Department A Reference Group of Civil Society focal persons
for International Development) facilitated this was constituted to take this process further with the
consultation for Civil Society in March 2010. SARPAM programme management team.

2. Objectives of the consultation

Through initial email-based discussions, regional • Learn about SARPAM and the possible
and national CS representatives shared ideas on contributions it could make to the Access
how they could potentially contribute towards agenda;
improving access to medicines through more • Interact with other CSOs working directly or
intensive focus on the southern Africa region. indirectly on pharmaceutical and treatment
access issues within the SADC region;
The subsequent consultation was called at short • Define a Civil-Society led Partnership for Action
notice to take advantage of the fact that a number (PACT) in which each organization’s potential
of key Civil Society representatives would be contributions are mapped out;
in Nairobi for other meetings. This offered an • Engage with a process for assessing the support
opportunity for these individuals to engage in an that each organization needs to make their
intensive process to: contributions as partners in the PACT;
• Map out the agenda for Civil Society to improve • Learn a methodology for developing further
access to medicines and diagnostics in southern Partnerships for Action.
Africa;

3. Who was there

The 25 participants (Annex C) represented a good cross-section of regional Civil Society Organizations (CSO)
and Faith Based Organizations (FBO) working on different Access issues, including: advocacy and campaigns;
legal and trade; research; service delivery; professional standards and research.
Record of the consultation (continued) 4

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
4. The meeting proceedings

The meeting was implemented through an broad areas. These were further discussed as the
innovative facilitation approach1 that provided an meeting schedule for in-depth discussion was
open space for participants to set and prioritise developed.
their own agenda for addressing the question of • All key issues were incorporated into a full
how to work in partnership to improve access to schedule of small meetings held in parallel.
medicines & diagnostics in southern Africa. This Eleven group meetings were carried out over
(un)conferencing approach effectively allowed the two days that created rich interactive
many issues and priorities to be identified and put discussions and debates.
onto the agenda for civil society action on access • Participants were encouraged to freely
to medicines. A more detailed description of this move between groups to cross-pollinate the
discussions and to ensure that they were making
process appears at the end of this report (Annex H).
maximum contributions and to get the most out
of these discussions.
Through this process:
• Each discussion was recorded on a template and
• Each participant raised two to three issues,
these notes are available in Annex D, exactly as
which were all shared in the group.
reported by participants.
• Next, the participants grouped the issues into

5. Record of small group discussions & recommendations

Following the rich agenda that was set by participants, • Regularly produce evidence based decision
individuals self-selected into small group discussions papers that can be used for action
over a number of parallel sessions. People were 4. Partnerships (between SARPAM stakeholders)
all highly engaged in these short discussions • Partnerships should be formalized by either
that yielded an impressive array of insights and having MoU2 or Compacts to which members
suggestions on each topic. Each group captured make firm commitments
key points on a template and these can be found in • Agreed principles of engagement (defined in a
Annex D. Manifesto to which CSOs and FBOs sign up to)
• SARPAM should help to provide platform
for building partnerships, one of which is to
1. Supply Chain Management
ensure CS are involved in all PACTs.
• Emphasized the necessity to monitor and
5. TRIPs and Trade
evaluate the procurement and supply chain
• CS should advocate for maximizing TRIPs
and to prepare, evaluate and share reports and
flexibilities and for increased availability of
lessons.
patent-free essential medicines
• Use of strengths within the CSO/FBO
• Information is needed on situation of TRIPs in
community for information and technical
the 15 countries; implication for post 2016; use
support
of TRIPs flexibilities by the industry (private
2. CSO/FBO Networking
sector) and on patent pool impact. This should
• Map and develop a comprehensive strategy to
be made available and discussed at relevant
network CSO/FBO networks involved in ATM
forums.
• Have common campaign issues that tap into
strengths of each CSO/FBO 6. Capacity Building (CB)
3. Research and Sharing of Research Findings • A complete understanding of the SARPAM
• Establish the SARPAM InfoHub as a platform programme and the SADC Pharmaceutical
that strongly links the Civil Society Action Business Plan is necessary to identify CS’s areas
Network with the Access to Medicines of action and capacity building needs
Research network • CS can be both recipients and implementers of
CB activities.

1. The PACT Methodology and case study of the workshop process is being developed as part of a toolkit on how to establish Partnerships for Action
(to be published by SARPAM in October 2010.
2. MoU/Compacts: An MoU is typically a bilateral agreement where the parties can seek external arbitration if either party defaults on the agreement,
whereas a Compact is a multi-party agreement that needs to be enforced through mutual accountability.
Record of the consultation (continued) 5

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
7. Quality of Medicines • Advocate for sustainable financing of
• Support for regional standards and accredited programmes that support communities e.g.
quality control facilities. the WHO community care giver plan
• Involvement of CS in pharmacovigilance and 10. Good Governance
raising profile of quality issues. • Promote drug supply systems that are robust
and transparent and have measurable
8. Private Sector Engagement
indicators.
• CS platform can open debates on positive
• CSOs can act as critical watchdogs and
engagement of the private sector including
lobbyists.
participation in PACTs and other stakeholder
11. Human Rights and Access to Medicines
opportunities e.g. MeTA
• CSOs can carry out evidence-based advocacy
• CS advocate for increased Corporate Social
• CS be strategic in aligning their competencies
Responsibility (CSR) at country levels
for maximum impact, including building
9. Community Involvement
capacity for operational research.
• Study and identify best ways to work with and
support true community representation in the
different countries
• Link with and build capacity of Community
Based Organizations (CBOs).

6. Defining potential Partnerships for Action (PACTs)

On the second day, participants discussed possible by 2011; and the re-establishment of the SADC
intervention areas in which CSOs/FBOs could take Pharmaceutical Task Force (in which CSO are
more effective joint action with an intensified focus members).
on southern Africa. They made the case for a range • Establish a system for CS to continuously evaluate
of proposals for joint action through the PACT Pharmaceutical Supply Management. Actions areas
mechanism, including to: could include: monitoring the supply chain as
• Establish a mechanism that will support pooled well as the prices and availability of medicines at
and bulk procurement initiatives for essential facility level.
medicines. This would require: engagement of the • Advocate for development, harmonization and
SADC Secretariat to recognize the role of FBOs implementation of treatment and diagnostic
e.g. in service delivery; analysis of the reasons for guidelines in Southern Africa.
failures of cross border bulk/pooled procurement
This process produced consensus that the most
attempts; and inclusion of FBOs in discussions on
useful immediate PACT that Civil Society should
a SADC pooled procurement market survey. lead is to promote greater transparency in the
• Strengthen the capacity of CSO/FBOs working regional pharmaceutical marketplace and more
on access in the region to effectively support effective sharing and use of market information.
implementation of SARPAM. Action areas
proposed could include: increasing capacity Initial mapping of the PACT Framework for this
of CSO/FBOs to handle medicines and access identified the highest priority results that could be
issues; providing oversight through professional jointly pursued, the range of partners that could work
pharmacy networks/associations; harmonizing together and some initial ideas of what each partner
the CS actions; targeting the maximization of the organization might be able to specifically contribute
towards achieving these results. This draft framework
utilization of the current TRIPS flexibility (to 2016)
follows in Annex E.
as provided for in WTO agreement.
• Establish a collaboration platform between SADC The group agreed that this framework for the PACT
and regional CSO/FBOs. Action areas proposed would need to be worked up further and the SARPAM
could include: promotion of transparency and programme management team was charged to
accountability by applying the MeTA principles; complete this task in collaboration with a Civil Society
supporting at least 3 SADC countries to join MeTA Reference Group (see section 6 below).
Record of the consultation (continued) 6

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Having the means to gather and disseminate online collaboration site in the SARPAM InfoHub.
information, hold discussions and share documents Use of short message service (SMS) was discussed as
was considered a key requirement for successfully a possible way of keeping everyone in the network
implementing this PACT. Participants agreed to use updated.
of the Civil Society Action Network newsgroup and

7. Key points of consensus

Participants agreed to: 2. All CS and faith-based organizations committed


1. Establish a regional Civil Society Reference to working through SARPAM should sign up to
Group, to which the following individuals were a Manifesto for Civil Society Action on Access to
nomintated: Gichinga Ndirangu (HAI); Donna Medicines, based on principles of engagement that
Kusemererwa (EPN); Tapiwanashe Kujinga were developed by a sub-group of participants
(PATAM); Franco Wandabwa (ANECCA); and (see Annex G).
Tasangana Matika (Seatini/Equinet). Terms 3. Send 2 CS representatives (Franco Wandabwa
of Reference for the group were discussed and Cryson Miyoba) to attend the Pharmaceutical
immediately after the meeting and adopted by Market Analysis Study Readiness Retreat in Cape
the Reference Group members (see Annex F). Town.

8. Actions for the next steps

1. Complete the drafting of a manifesto 5. The SADC Pharmaceutical Business Plan and
(responsibility of the SARPAM secretariat CS SARPAM’s one page summary to be sent to
Technical Lead and CS Coordinator) that, all meeting participants by email (SARPAM
following consultation with the Reference Group, Secretariat).
should be sent to all meeting participants to
6. The PACT methodology to be written up and sent
present this to their organizations for signature.
to all participants for use in their own meetings.
2. Preliminary report of the consultation to be sent 7. SARPAM Secretariat, in collaboration with the
to participants within a week of the meeting. Reference Group, to complete the development
of the agreed PACT.
3. CS Technical Lead to communicate with the
participants and other CS who could not attend 8. Assessments of what each Civil Society
the meeting on the next steps to take forward the organization’s capacity needs are to effectively
PACT. contribute to the PACT will be carried out by the
SARPAM Secretariat. This will result in Enabling
4. CS Reference Group to consider and recommend
Plans and resource requirements being scoped
how best to gather and disseminate information
out and presented to DFID for Implementation
between the CS, including pilot testing the SMS
Phase funding (to be incorporated into the
methodology.
SARPAM Inception Report).

9. Conclusion

The objectives of the consultation were achieved. However, as not all regional CS representatives were able
to attend, it will be important to share the report and to continue the conversations that were started. The
enthusiasm needs to be kept through regular communication and interactions, led by the SARPAM Civil
Society Lead (Eva Ombaka), supported by a Civil Society Coordinator and in collaboration with the Civil Society
Reference Group.
ANNEX A | OVERVIEW OF SARPAM 7

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
The Southern Africa Regional Programme on Access to Medicines and Diagnostics (SARPAM) launched in January
2010. SARPAM is founded on the belief that effective collective action and innovation will improve Access to
Medicines across the regional economic community. Working with member state governments, civil society,
regional institutions, international agencies, research networks and the private sector, SARPAM will support the
good work being done through existing partnerships and initiatives, as well as identify new Partnerships for Action
that will achieve ambitious results.

The programme offers new resources in the form of targeted funding, technical assistance, partnership building
and networking opportunities. As the primary sponsor of this new initiative, the UK Government hopes that
SARPAM will develop into a platform for collaboration and partnership that will attract a broad support base over
the next 4-5 years. This will create significant opportunities to substantially improve the marketplace for good
quality essential medicines.

SARPAM offers to support and strengthen the capacity of regional institutions to implement plans that will benefit
from multi-country action. The SADC Pharmaceutical Business Plan endorsed by regional Ministers of Health
in 2007 is the leading example of this. Civil Society Organizations within the region will be supported to lead
Partnerships for Action that have the potential to positively influence the pharmaceutical market, including the
demand for medicines and their rational use.

A regional InfoHub will be established to make transparent pharmaceutical market intelligence and evidence
for policy accessible to all stakeholders in the region. SARPAM will be undertaking an intensive Pharmaceutical
Sector Market Analysis during the first 9 months of 2010 to provide a baseline data set. A regional Evidence for
Action Network will be supported as part of the Global Access to Medicines Research Network to set the agenda
for research and to make research findings available as global public goods.

The Responsible Action Consortium, led by Re-Action! (Southern Africa) has been contracted by DFID to manage
implementation of SARPAM. This includes establishing a network of development professionals to work with the UK
government southern Africa regional team so that priorities on Access to Medicines within SADC can be more effectively
responded to and local capacity can be built.
ANNEX B | SADC PHARMACEUTICAL BUSINESS PLAN 2007 - 2013: SUMMARY4 8

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
The Southern African Development Community (SADC) was formally launched
on 17th August 2002 under a Treaty, and consists of 14 Member States with an
estimated total population of 200 million people. In its programmes and operations,
SADC is guided by a clear mission statement, which is “To promote sustainable and
equitable economic growth and socio-economic development through efficient
productive systems, deeper co-operation and integration, good governance,
and durable peace and security, so that the region emerges as a competitive and
effective player in international relations and the world economy”.

SADC has identified the need to develop and implement a Pharmaceutical Programme in line with the SADC
Health Protocol and the SADC Health Policy. The purpose of the programme is to enhance the capacities of
Member States to effectively prevent and treat diseases that are of major concern to public health in the Region.
The Programme mainly addresses issues that concern access to quality medicines in all Member States. The SADC
Pharmaceutical Business Plan has been developed within the context of global, continental and regional policy
frameworks, protocols and commitments. Based on a SWOT analysis, the Plan identifies priority areas, objectives
and major activities that will be implemented both at regional and national levels to improve access to quality and
affordable essential medicines including African Traditional Medicines.

The overall goal of the SADC Pharmaceutical Business Plan is to ensure availability of essential medicines including
African Traditional Medicines to reduce disease burden in the region. Its main objective is to improve sustainable
availability and access to affordable, quality, safe, efficacious essential medicines including African Traditional
Medicines. In order to achieve the overall goal and the main objective, the following strategies will be pursued:

i) Harmonizing standard treatment guidelines and essential medicine lists;


ii) Rationalizing and maximizing the research and production capacity of local and regional pharmaceutical
industry of generic essential medicines and African Traditional Medicines;
iii) Strengthening regulatory capacity, supply and distribution of basic pharmaceutical products through
ensuring a fully functional regulatory authority with an adequate enforcement infrastructure;
iv) Promoting joint procurement of therapeutically beneficial medicines of acceptable safety, proven efficacy
and quality to the people who need them most at affordable prices;
v) Establishing a regional databank of traditional medicine, medicinal plants and procedures in order to
ensure their protection in accordance with regimes and related intellectual property rights governing
genetic resources, plant varieties and biotechnology;
vi) Developing and retaining competent human resources for the pharmaceutical programme;
vii) Developing mechanisms to respond to emergency pharmaceutical needs of the region; and
viii) Facilitate the trade in pharmaceuticals within SADC.

In line with the SADC Protocol on Health, the Implementation Plan for the Protocol and the SADC Health Policy
Framework, the SADC Pharmaceutical Business Plan will be coordinated and implemented through the approved
SADC structure. The Business Plan has spelt out clear roles and responsibilities of all stakeholders that will

4. Adapted from SADC PHARMACEUTICAL BUSINESS PLAN, SADC SECRETARIAT, 27 JUNE 2007, p. 3-5.
ANNEX B | SADC PHARMACEUTICAL BUSINESS PLAN 2007 - 2013: SUMMARY 9

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
be involved in the implementation process. At the political level, the implementation of the Plan will be
monitored through the established institutional framework.
The implementation of the Plan will require substantial resources including human, material and financial from
different sources. The Plan is estimated to cost US$16 million. To ensure ownership and sustainability, Member
States will be required to budget for implementation of some of the interventions that need ongoing financial
support. The SADC Secretariat will make all efforts to mobilize resources from key stakeholders including
International Co-operating Partners.

A monitoring and evaluation framework has been included in order to review activities during implementation
process. The Secretariat will facilitate capacity building on monitoring and evaluation. Appropriate technical
and financial reports will be produced during and after implementation of program specific activities outlined
in the Pharmaceutical Business Plan.
ANNEX C | PARTICIPANTS LIST 10

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Name & SURNAME Organization Email Address
1 Aarti Patel SARPAM aarti@sarpam.net
2 Albert Petersen EPN albpetersen@googlemail.com
3 Cesar Mufanequico PATAM matram@tvcabo.co.mz
4 Christa Cepuch HAI christa@haiafrica.org
5 Cryson Miyoba CHAZ cryson.miyoba@chaz.org.zm
6 Desegan Padayachee Re-Action! desegan@re-action.co.za
7 Donna Kusemererwa EPN dkusemererwa@epnetwork.org
8 Eva Ombaka SARPAM e.ombaka@gmail.com
9 Franco Wandabwa ANECCA fwandabwa@rcqhc.org
10 Ginchinga Ndirangu HAI AFRICA gichinga@haiafrica.org
11 Joanne Collinge Meropa joannec@meropa.co.za
12 Joseph Mhando Tanzania/academia jmhando@yahoo.com
13 Mike Upio CME Nyakunde mikupionzenib@gmail.com
14 Nalishebo Mwape CHAZ nalishebo.mwape@chaz.org.zm
15 Olivier Musongya CBCA oliviermusongya@ymail.com
16 Orgenes Lema MEMS orgenesl@mems.or.tz
17 Phillip Mokoena TAC phillip@mail.tac.org.za
18 Redemptor Atieno HAI redemtor@haiafrica.org
19 Rose Ng’oma CHAM rosek@cham.org.mw
20 Sharon White Re-Action! sharon@re-action.co.za
21 Shaun Conway SARPAM shaun@sarpam.net
22 Tapiwanashe Kujinga PATAM tapiwanashek@gmail.com
23 Tasangana Matika SEATINI wmatika@hotmail.com
24 Titus M Kahiga FIP rep –Kenya tkahiga@gmail.com
25 Wilbert Bannenberg HERA / MeTA / SARPAM wilbert.bannenberg@gmail.com
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS 11

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Civil Society Capacity building

Participants

Donna, Tapiwanashe, Aarti, Christa, Mike, Cryson

Main points discussed

• Need information on SARPAM – how does SARPAM support capacity?


• Discussion on SARPAM – so we can buy into the bigger picture
• Better understanding of capacity
• Linkages between organizations e.g. management systems (JSI), sharing information lessons, even
opportunities for capacity building
• Address all issues: governance, infrastructure
• CS requires capacity building but also has capacity to build in other organizations including goods

Recommendations

1. Consider internal opportunities


2. Involve CS in capacity building initiatives within the region as the actual implementers
3. CS needs information on SADC Pharmaceutical Business Plan (PBP)
4. Review manifestos vis a vis -definition of Civil Society – ensure capture different groups
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 12

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Community involvement in Access to Medicines

Participants

Redemptor, Mike, Aarti, Eva, Cryson, Nalishebo, Franco, Phillip, Donna

Main points discussed

• (DRC) organize through social insurance some money, make contracts with health centres and hospitals
– get treatment for a year
• Two evaluations (June / December) communities are involved
• Community participation is through chiefs. One issue brought to the attention is that medicines were
not free. Issue is with representation through chiefs – is like the government – not true representation
of community (e.g. in DRC the Chief is civil servant). In Zambia, the Chief is part of the community, has
headman who is responsible for smaller communities therefore true representation – chief is community
– therefore is representative of CS
• Use of public forums in different countries e.g. in Kenya local CBO’s used to mobilize communities for
stock-out campaign – managed to get information from the ground.
• CBO’s need assistance for transport and a stipend for lunch
• Traditional healers are also important – with regard to rural settings (SA). Sick people go there first.
• Community caregivers – critical for monitoring stock outs, to identify patients in the home – provide
basic services – these are volunteers
• District / Community Clinic committees – link community to formal health care systems – play a critical
role in some settings – Political forces affect those that are made strong – after capacity building
• Use of caregivers is dependent on the specific priority of countries. Need to be careful e.g. SA created a
monster-recruit caregivers – NGOs provide better package than government (unhelpful competition) –
therefore government and the NGO world need to agree
• FBOs as part of community
• Community caregiver programme is received / recognized differently in different countries – issue is
controversial. Scheme worked well in WHO / UN supported areas – also works well in specific programmes
which are supported by outside agencies.

Recommendations

1. Need to understand relationships for community mobilization in specific situations


2. CBO’s are a major ally – build their capacity
3. Provide capacity support to traditional healers regarding HIV symptoms, referral systems – get their
integration – create a platform for engaging traditional healers. Look at linkages with CBO capacity
building
4. Recognition of the impact and role of community caregivers who are volunteers – provide support and
to integrate into the public health system
5. Advocate to implement the community caregivers policy. Also consider funding mobilization that is part
of the government for sustainability
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 13

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Civil Society Networking

Participants

Tapiwanashe, Redemptor, Nalishebo, Orgenes, Phillip

Main points discussed

1. Broadly there are a number of CSOs and networks that are working on access to medicine. Mapping
exercise needed
2. Regional networks identified are:
− PATAM
− HAI Africa
− ANECCA
− Enquinet
− EPN
3. There are many others working at country level
4. Need to identify key issues for advocacy
− Stop Stock-outs
− CEPA
− Anti Microbial Resistance (AMR)

Recommendations

1. Conduct a CSO / network mapping on ATM


2. Come up with an umbrella campaign on ATM
3. Agree on various components for the campaign
4. Identify lead organization / networks for each component
5. Develop a comprehensive media strategy for ongoing CSO / network communication
6. Network consumer society organization in this region
7. Ideal to have an umbrella campaign that encompasses the components and the SADC business plan
and the member organizations can link up to it
8. The umbrella campaign to have particular components that are led by CSOs / networks with capacity
and experience
9. Lead CSOs / networks to organize capacity development in order to fulfill SARPAM objectives
10. A comprehensive media strategy will help member CSOs / networks to network within the campaign
11. Setting up an email list, website and development of campaign materials
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 14

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Quality of Medicines

Participants

Nalishebo, Orgenes, Cesar, Redemptor, Joseph, Phillip, Titus

Main points discussed

• Quality is a standard not a concept


• CSOs to promote the availability of quality affordable medicines
• Need to develop regional standards
• CSOs to assist in issues to do with pharmaceutical vigilance, counterfeit medicine in improving quality
• Capacity building of regulators authorized to differentiate between generics and counterfeits
• CSO”s to work like quality watchdogs in dealing with pharmaceutical vigilance issues
• Advocating for CSOs to be involved in the procurement processes
• Recognize, reward and protect the achievements of the regional pre-qualified factories e.g. factory in
Uganda
• Anti-counterfeit Acts to be developed but these should not affect access
• CSOs to give support to the regional accredited laboratories

Recommendations

1. Advocate for recognition, rewards and protection of the regional WHO accredited laboratories
2. Support the concept of regional quality control laboratories, fund and supervise
3. Advocate for regional mini standards
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 15

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Research & information on Access to Medicines

Participants

Aarti, Shaun, Franco, Albert, Eva, Christa, Joseph, Cesar

Main points discussed

• What drives evidence is the questions we ask. Could we have a ‘FAQ’ established as a knowledge base?
• What do we mean by research? Compiling information and evidence on AEM, Advocating for sharing
and transparency of information. Existence of correct information. As CS we should contribute to the
existence of accurate information – we can also do research (operational, action-oriented, etc). Use CS to
gather information to triangulate what already exists. (e.g. L2 and L1 WHO surveys)
• We need a database (open access) which grows across the region, also internationally. Get collective
evidence on what is going on.
− What info do we collect and how to get into the database?
− How to create a community of users around it? How to get it out?
• EPN is mapping pharmaceutical personnel in various (SADC) countries. Use this methodology and
compare to public sector in SADC countries?
• DFID is sponsoring the ‘ATM Research Network’. What role can CS have in this formalized network? Could
we inform the agenda? Can we provide the relevant academic research questions? CS may be the subject
of (or may implement) the research. CS can assist each other: networking, training, identifying research
areas, getting funds for research etc.
• Information for advocacy purposes information for policy purposes. Know what to do with the results to
impact ATM.
• Domesticate the research to make it useful for country context
• Role of CS in dissemination of research findings – ‘Evidence briefs’ or ‘one pagers’ or ‘decision briefs’ etc.
Based on research: “here are the findings and here are the recommendations signed by those involved”.
Use as basis for advocacy and decision making.
• Important to have links between academic institute and CS.
• National level partners on SARPAM: communications, links, dedicated time, etc. SARPAM “evidence for
Action’ network exists – ensure it is linked to the SARPAM “CS” network
• Use the international networks and their resources, funding, abilities, time, to analyze data and evidence
AEM – access to essential medicine
L1, L2 – Level 1, Level 2 Surveys (WHO)
FAQ - Frequently Asked Questions

Recommendations

1. Set up the SARPAM observatory to include a clearing house on information on research, data studies,
reports, tools in SADC (with a FAQ capability)
2. Mechanism to establish a CS linking facility to the ‘ATM Research Network’
3. CS develop one-page evidence-based ‘decision papers’ (for action, dissemination, influence policy, etc)
that will become widely recognized as having scientific, political and civic support
4. Ensure the SARPAM ‘Evidence for Action’ network is well linked to the SARPAM ‘CS’ Network
5. Advocate for transparency of information
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 16

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Good Governance

Participants

Titus, Michael, Tasangana, Cryson, Gichinga, Jo-Anne, Wilbert, Donna

Main points discussed

What is good governance? We need definitions!

• Corruption • Selection
• Transparency and accountability • Procurement Budgets
impacting the
• Regulation • Price
whole supply
• Political environment • Finance Distribution
chain
• Efficiency / effectiveness • Use of Drugs
• Outcomes • Availability

CONCLUSION

• Civil Society needs to engage in good governance and can play an important role as a watchdog and
lobbyist

Strategy

• Insist on robust drug supply systems that are well planned, needs based and evidence based
• Ensure that there are measureable (SMART) and relevant indicators that civil society can monitor
• CSO then should act as a critical watchdog
• Insist on greater transparency, which will lead to more accountability
• The process will reduce vulnerability for corruption, promote more and better regulation, leading to more
efficient systems and better access to better medication

Recommendations

1. Civil Society to involve itself in governance of the supply chain


2. CSOs to act as a critical watchdog in procurement, quality, price and availability
3. Promote robust, transparent systems
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 17

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Human Rights & Access to Medicines

Participants

Rose, Cesar, Christa, Tapiwanashe, Wilbert

Main points discussed

• Assessing Human Rights access to medicine in countries


• Access to life
• Access to medicine as a right
• Everyone has the right to health and medicine
• Right to health
• Access to medicine and human rights
• SADC protocols and tools to be used for advocating for access to medicine
• Country constitutions as a starting point for advocating for access to medicines
• RSA – inequalities due to unequal opportunities, commercialization of health. Language we use and
how we communicate – very important
• Zimbabwe – need our governments to take a rights-based approach to health care and needing all the
people (TAC in SA an example of a success story)
• In- country systems i.e. SADC tribunal not being utilized
• How litigation has been used to ensure access to medicine and legislation
• How can we get 2 billion people access to medicine – right to health care, including right to medicine?
• Rights and responsibilities – making essential medicines a public good – involvement of private sector
to consider medicines as public goods
• Governments have signed a declaration of human rights
• There is a hierarchy that exists in terms of holding
• Health human rights and access to medicines

Recommendations

1. Evidence based advocacy - need to build capacity in operational research – so that evidence is based
to hold governments accountable
2. Empowering users through capacity building
3. Legal campaigns – mobilize legal instruments
4. Being strategic, aligning and harmonizing all our competencies together and having a common
ground for our work
5. Document the evidence properly so that it can be shared across
6. Comparing the countries
9. Lead CSOs / networks to organize capacity development in order to fulfill SARPAM objectives
10. A comprehensive media strategy will help member CSOs / networks to network within the campaign
11. Setting up an email list, website and development of campaign materials
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 18

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Partnerships (within SARPAM)

Participants

Donna, Cryson, Phillip, Tasangana, Shaun, Aarti, Mike, Orgenes, Eva, Tapiwanashe

Main points discussed

• An understanding of term partnership


• Who are partners?
• Define the term partnerships in more clear terms with regard to partnerships with SARPAM – what are
roles and the benefits for partners?
• Recognize there are other players involved in ATM and we need to include them so there is collaboration,
not competition
• Discussion of key areas of the SADC Pharmaceutical Business Plan

Recommendations

1. Partnerships are formal, structured with MoUs and/or COMPACTS3


2. Ensure CS is always involved in all PACTs. SARPAM to provide platform for building partnerships, especially
with governments.
3. Establish regional network and Reference Group from CS.
4. Establish a CSO-led PACT.
5. Recognize a list of principles for engagement with SARPAM.
6. CS representatives to sign–up to a formal commitment (Manifesto).
7. Write up from this meeting for representatives to share with their organizations.
8. SARPAM to provide overview of SADC PBP to wider group.

3. MoU/Compacts: An MoU is typically a bilateral agreement where the parties can seek external arbitration if either party defaults on the agreement,
whereas a Compact is a multi-party agreement that needs to be enforced through mutual accountability.
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 19

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic
Supply Chain Management

Participants
Franco, Malishebo, Albert, Joseph, Cesar, Titus, Christa, Wilbert, Redemptor

Main points discussed


• Compare supply chains in the region (countries) – Similarities? Differences? Bottlenecks?
• What are the barriers?
a) No coordinated, national level policies (poor implementation and procedures)
b) Weak institutions (PSM, quality assessment, CMS, NMRA’s)
c) Poor infrastructure to support medicine delivery (roads, cold chain, storage)
d) Weak stock management procedures
e) Insufficient / irrational financing for PSM activities (prioritizing)
• Corruption
• Civil strife (political environment, war)
• What is the role of CS? Capacity building on PSM issues? M and E of core indicators?
• Strengthening supply chains of Mission DSO’s & Government CMS’s
• Use of IT?
• Transparency / disclosure of information and data (e.g. quantification, etc)
• Think tank on PSM (regional level), sharing information / best practices
• Priority setting along PSM e.g. selection of EM’s
• Pooled procurement – quantification of needs, negotiations with suppliers (promote among
countries at regional level). 3 studies done (4th study ongoing by Africa development Bank) in
SADC show it can be done…. never implemented - WHY?) Possible reasons: Bureaucracies,
Procurement kingdoms, No shared dollars, No harmonised NMRA, No exchange of information
(informed buying)
• What could CS do? Campaign against bureaucracy! Implement the recommendations of the above
studies
• Stock outs -
- Match disease patterns and stocks at any level
- Promote local production
- Do we know the most appropriate PSM system to meet requirements / demands? Is there a
success story (No….!)

SAAB – SA Access Barometer SSO – Stop Stock Outs


FBO – Faith Based Organizations (mission) PSM – Procurement Supply Management
CMS – Central Medicine Stores NMRA – National Medicines Regulatory Authority
DSO – Drug Supply Organization

Recommendations
1. CS coalition (umbrella regional) (establish the SARPAM Coalition)
2. M&E by CS of PSM (e.g. SSO campaign – extend to SADC) “SAAB report”
3. CS “Policy Audit” – annual report card
4. Study the barriers to implementation of the recommendations from the PP studies (and network
among those organizations working on governance: (META, HAI Africa, NEPAD, and AU?)
5. Involve / Engage CS in technical issues (with technical support as necessary ) share lessons from
FBOs e.g. Quantification methods / exercise at national level
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 20

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic
TRIPS and Trade

Participants
Franco, Albert, Tasangana, Wilbert

Main points discussed


• Compulsory licensing to countries to provide countries – patent pool negotiations

Status of Trips
• Middle income countries have to be compliant by 2000 while low income countries have to be by
2016. African countries are producing or are in the forefront of producing first line. By 2016 LDC’s will
be needed to be aligned with TRIPS. German government supporting countries that want to go for
complete licensing. Complete licensing is always point of patent laws. If old activists get involved it
could be watered down.
• Why countries always sign and complaining Health system / ministry is always weaker compared to
the trade ministry.
• Activists have to be careful when discussing issues of TRIPS. Most countries are TRIPS compliant.
Correct and right information need to be given.
• Need to have a paper (research) for the 14 countries on the correct state in terms of compliance.
In Europe there is a lot of case studies by pharmaceuticals but there is a need for comprehensive
information and facts from Africa.
• Make links with legislators / seminars on TRIPS. Need to have meeting with health and trade committees
at national and regional level. Need for information to be presented in a language for the lay people.
• T. Matika (Seatini/Equinet) will share a document presented to SADC on TRIPS.

Patent Pool
• There was a meeting in Germany and there was an agreement about the fact that information needed
to be clarified about the process. Middle income and low income countries are already pressed to
enter the patent pool. Need more information on issues of patent pool

Trips
• Move and encourage countries like South Africa for the adaptation and implementation of the
competition law. We need to analyze the scenario between now and 2016 to see how TRIPS roll out.
A question which we must also follow is to see what will happen in 2017. Analysis results need to be
produced so it can be presented to CS Organizations.

Recommendations:
1. African civil societies need to take up advocacy and be a watchdog of maximum flexibilities and
minimizing TRIPS + (restrictions).
2. Need for an overview study / research among the 14 countries on the current state of TRIPS and
compliance (quick/rapid assessment).
3. More information needed to be provided on patent pool and how it is going to work and what benefits
it provides to SARPAM before moving forward.
4. Meetings with regional policy bodies and countries on TRIPS where briefs are provided.
5. Briefing to health and trade ministry people on discussion of TRIPS.
6. Patent free essential medicines for SARPAM members should be pushed for by CSOs in the region.
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 21

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Private Sector Engagement

Participants

Shaun, Orgenes, Tasangana, Gichinga, Titus, Joseph

Main points discussed

• Definition of private sector differs in different countries (e.g. Private for profit, Private not for profit).
• Private sector has an important role to play, especially private providers of health service.
• A lot of suspicion of private for profit. Tends to be excluded from public sector initiatives.
• Efficiencies and innovation of private sector. Often more effective governance in private sector.
• Good examples of private sector initiatives e.g. Access to malaria products initiative (AMP), ADDO
(accredited drug outlets- MSH).
• What is the evidence for lack of private sector accountability or delivery?
• Distinguish between prices of medication vs. cost of treatment. Private sector can be more cost
effective.
• Trend is towards National Health Insurance, which requires private sector.
• Private sector has not taken full advantage of TRIPS provisions because of lack of government support
(e.g. For comparison licensing). This impedes access.
• In some countries there is over regulation of the private sector. Control vs. collaboration.
• Need positive engagement (rather than negative engagement).
• Define the problems to be solved/challenged for innovative response.
• Define rules of engagement for ethical practice.
• CS can lobby multinationals to do more and deliver more social benefit.
• Normal tendering process does not allow for blended value offers (including social contribution).

Recommendations

1. Invite private sector in all SARPAM Partnerships for Action.


2. Assess to what extent private companies have taken advantage of TRIPS- for better use of TRIPS
flexibilities?
3. CSO Platform for open debate and positive engagement on role of private sector –with government
facilitation
4. Play an honest broker role in a 3 party forum with Government and MNCs. Possible link to MeTA.
5. Advocate for delegated corporate social responsibility by MNCs to country level.
ANNEX D | RECORD OF OPEN AGENDA DISCUSSIONS (continued) 22

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Topic

Draft Manifesto for Civil Society Action on Access to Medicines in Southern Africa
(Developed through a meeting of: Gichinga, Shaun, Eva, Phillip, Titus)

Purpose

A document that defines how we collaborate, as CSOs, in the context of SARPAM. Obligations, responsibilities
(of CSOs and of SARPAM) and commits partner to SARPAM

Principles

• Participate in partnerships for action where contributions will add value


• Commitment to the purpose and objectives of SARPAM (plus principles) of SADC pharmaceutical
business plan.
• Sharing information and resources to assist others (grow together) – open collaboration
• Active participation
• Accepting and accountability contributions from everyone
• Allow leadership of the organization/s with the best composition on specific issues
• Mutual respect and recognition of roles and contributions, shared benefits

Obligations

• Participate in the platform (CS Action Network). Open consultation


• Invite in participating by other regional and national stakeholders
• Allow contribution by all to a common agenda
• Sign up to the commitment to each PACT that the organization participates in.

Responsibilities

• Shared responsibility
• Acceptability against agreed commitments
• Work within national legal frameworks
• Consult members

Eligibility

• Regional CSO or affiliate of a regional CSO (but not be exclusive)


• Agree criteria such as working on ATM, membership base, funding source, etc

Recommendations:

1. Use MeTA definition of CSO


2. Establish advisory / Reference Group to co-ordinate
3. Include statement of recognition of reason for CSO participation in manifest
4. Draft manifesto taken back to organizations by meeting representatives
5. Signatories will be listed as partners of SARPAM
RESULTS SEATINI
ANECA EPN FIP HAI AFRICA META PATAM TAC
(To-Be Achieved) (EQUINET)

Improved We can assist with


Regional Internal the organization of
a Organization Organization SARPAM as a vibrant
of CS structure

SEATINI can identify


Some of our
Provide information
members are
information on the (existing) on
Information involved in ATM
b competencies that essential drugs list
Sources Identified work and can
are available within and market pricing
provide baseline
the membership including
information
availability

Work through our


technical team to EPN can 3 prospective SEATINI can
Some of our
carry out data provide relevant Supervise META countries collect data related
country members
Data gathering / research information from national level sur- united for META essential drugs list
c can collect data as
Collection at regional level the network to vey, manager Global Forum and market
they are already
with emphasis support set up of for data collection London pricing including
working on that
on Peadiatric monitoring system 29 June- 1 July availability
medicines

EPN can support We can share the


SADC countries
Data collection from information that SEATINI can share Share evidence
Information and CSO meet at
d member countries PATAM has based information on or case studies via
Sharing Zambia Forum
specifically from on ongoing essential drugs list MSF / ARASA
1st week June
FBO sector activities

Being a member-
Regional
ship organization
SEATINI can carry mobilisation in
Spearhead a with members in Network
out advocacy addressing
regional advocacy a number of SADC stock-outs,
Advocacy PATAM’s 7strengths work through advocacy gaps on
e campaign on access countries EPN can campaign
based on Info lies in advocacy Parliamentary stock-out, drug
ANNEX E | First Draft CS-led Partnership for Action (PACT) Framework

to medicines in provide information partners in


Portfolio prices and
SADC region on PSM / supply SADC
Committees availability
systems in the
(TAC / ??)
countries
23

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
RESULTS SEATINI
ANECA EPN FIP HAI AFRICA META PATAM TAC
(To-Be Achieved) (EQUINET)

1. Audit of existing
technical
personnel
2. Information
sharing through
member Training
Build capacity of organization. 1. Agenda PATAM can
ANECCA members 3. Examination of 2. Methods help with policy
f Training on paediatric level of training 3. Tools development as we
formulations and on access matter. 4. Training have members with
medicines 4. Advocacy on Materials technical capacity
those in training 5. Provide Trainer
on access matter.
5. Examine
relevance of
existing training
to access issues

Use current and


available evidence Push for policy
Policy Policy / strategy
g to develop / review review / develop-
Development development
policies on ment via ARASA
medicines

Stakeholder
h Engagement

i Dissemination

Regional Data-
j bases / InfoHub
ANNEX E | First Draft CS-led Partnership for Action (PACT) Framework
24

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
ANNEX F | The SARPAM Civil Society Reference Group 25

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Terms of reference

Membership
The CS Reference Group comprises 5 members from regional Civil Society and Faith Based Organizations
established at their meeting in Nairobi in March. The members are:
• Tapiwanashe Kujinga
• Donna Kusemererwa
• Tasangana Washington Matika
• Franco Wandabwa
• Gichinga Ndirangu

This Reference Group is not a decision-making body and the members are not considered to be
representing their constituencies, but rather to be providing advice in their individual professional
capacity.

The group acknowledges its diversity in affiliation and activity and membership in the group does not
limit the individual’s freedom in carrying out their work as defined by their organization.

Role
The group’s main role is to provide strategic advice and technical guidance to the SARPAM secretariat,
specifically the CS Technical Lead and the Coordinator, on matters relating to output 3 of the SARPAM
programme. The group will however not be held accountable for programmatic work.

The members will, as appropriate, promote SARPAM within their constituencies and will contribute to
building Civil Society in the region as recognized and reputable groups taking action on improving
access to medicines and diagnostics.

Specific tasks
In the inception period of the SARPAM programme, the group will specifically:
• Advise the SARPAM secretariat on the completion of the write up on the proposed PACT area.
• Review and give advice on the partnership manifesto before its submission to the participants and
civil society organizations.
• Consider and recommend best ways to gather and disseminate information across CS, including
pilot testing the SMS methodology.
• Be a sounding board for the SARPAM Secretariat on activities as defined in output 3 of the SARPAM
log-frame.

Time
No specific time limit was set for the members to serve on the group. It is therefore assumed that they
will serve during the SARPAM inception period and should the programme be approved to continuation,
will continue until another meeting of CS when a new decision can be made.
ANNEX G 26

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
FOR CIVIL SOCIETY ACTION ON ACCESS TO MEDICINES IN SOUTHERN AFRICA

Preamble

The Southern Africa Regional Programme on Access to Medicines and Diagnostics (SARPAM) provides an
opportunity to make a critical difference to people’s lives within the Southern African Development Community
(SADC) region and to encourage and support change that will address the complex issues relating to access
to medicines and diagnostics. One of the key outputs of the programme is an increased voice and influence of
civil society reflected in policies on access to medicines and diagnostics in Southern Africa.

Experience from the Medicines Transparency Alliance (MeTA) countries has shown that Civil Society (CS) has
a vital role in keeping pharmaceutical companies, health professionals and government civil servants and
organizations transparent, honest and accountable and CS organizations, along with the private sector and
governments as equal partners, are key actors to jointly seek solutions.

We, representing the Civil Society with interest in increasing access to medicines in the Southern Africa
region are signatories to this manifesto as follows:

Purpose:

This document defines how we, the partaking civil society and faith based organizations (CSOs and FBOs)
collaborate, in the context of SARPAM. It specifies the intent, obligations, responsibilities and expectations of
SARPAM and our commitments as partners in SARPAM.

Commitments:

We commit to:
• Participate in partnerships for action (PACT) where our contributions will add value
• Support the purpose and actively participate in pursuit of the objectives of SARPAM and the principles of
the SADC Pharmaceutical Business Plan.
• Share information, expertise and resources, and foster open collaboration and consultation in order to
assist each other towards mutual growth and success.
• Be accountable to our CS partners on issues that we commit to carry out.
• Allowthe partner CS organization(s) with the best experience and most appropriate mandate to lead others
when working jointly on specific issues.
• Mutually respect and recognize roles and contributions of each partner to a common agenda and to share
benefits.
• Participate in the platform, Civil Society Action Network, by contributing ideas, comments, advice and
documents as may be appropriate or requested.
• Invite and support the participation of other regional stakeholders in order to increase capacity to achieve
our objectives
• Sign up and adhere to the commitment to each PACT that our organization(s) participates in.
27

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Responsibilities:

We accept shared responsibility, acceptability and accountability against these agreed commitments. We
further accept to work within national legal frameworks and to consult members regularly.

Eligibility:

We commit to the acknowledgement of diversity, broad representation and inclusivity. Therefore


invitation for signatories are extended (but not limited) to:
• Established and recognized regional CSOs and FBOs or affiliates of such organizations.
• Any organization which meets minimum criteria for membership such as working on or interest in access
to medicines (ATM), membership base, funding source, etc.

Expectations

We expect the Responsible Action Consortium managing the Southern Africa Regional Programme to:
• Use MeTA definition of Civil Society in this relationship.
• Facilitate the work of the Reference Group that has been established by the CS.
• Support the CS in implementing the agreed programme of work as may be necessary.
• Facilitate relationship-building between the CS and the SADC secretariat, governments, private sector,
donors and other partners committed to increasing access to medicines in the region.
• Keep an accurate record of signatories to this manifesto and to list them as partners of SARPAM

Name and Stamp of CS Organization Responsible Action Consortium Stamp

Signature Signature

Date Date
ANNEX H | Case Study: Partnership in Action 28

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Purpose

The purpose of this case study is to illustrate how the PACT approach was applied to achieve the following
purpose:

To forge a civil society partnership to improve access to medicines in


southern Africa

A key principle of the PACT approach is that the participants take ownership of the PACT content and
conversations. Although there is a framework that the PACT follows, the agenda, the conversations and
agreements are incubated and driven by the participants. The following diagram illustrates the process:

Preparing the
1 Environment

Introducing the
2 approach
Arrival Opening Purpose How?

Defining the open


3 agenda
Marketplace
of topics

List open
PACT
4 Conversations
agenda
discussion
topics

Review
5 progress
Reflection Closing
Exercise

Relate to
Re-focus agenda
6 for 2nd session
SARPAM and
SADC PBP

List open
PACT
7 Conversations
agenda
discussion
topics

Planning Proposals for Agreement


8 for Action action on results Definition
of PACTs
& partners

Define results and PACT


9 partner contributionss Matrix

Final
10 CLOSE Summary Clarify next
steps
Closing
Exercise
reflections by
participants
ANNEX H | Case Study: Partnership in Action (continued) 29

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
1 Preparing the Environment

The scene

A large meeting room and in the centre a circle of empty chairs.

On the periphery, five tables each with seating for 10 people, a refreshment station and a stationery
desk.

On the walls, some posters and a banner bearing the SARPAM logo with the words: “How can
we work in partnership to improve access to medicines in southern Africa?”

When participants arrive, they move in and seat themselves at random in the main seating area.

2 Introducing the approach

The Civil Society Technical Lead, SARPAM members and


head of the civil society programme, briefly welcomes
everyone to the workshop, describing it as the first step
in a process that aims to “change the situation for the
people of southern Africa through improved access
to essential medicines”. The SARPAM director and
the facilitator from Re-Action!, the lead company in a
consortium responsible for implementing SARPAM, are
Poster describing the purpose of the meeting
introduced.

In a short introduction to SARPAM, the SARPAM Director


covers DFID’s central role in SARPAM, explaining the
thinking behind the nine-month inception phase for
SARPAM (“a pregnancy that we hope will deliver a live-
born child”) and the dual nature of SARPAM – working
with the SADC Secretariat and SADC member states on
the one hand, and with civil society structures on the
other. The Director emphasises the regional nature of Facilitator illustrating the “agenda”
SARPAM and how this mandate could be taken up by
CSOs. “The rules of the game are not focusing at the
individual country level.”

The workshop facilitator takes the lead and highlights


the central question: “How can we work in partnership
to improve access to medicines in southern Africa?” She
gestures to a blank wall and says: “This is our agenda for
the next two days . . . this is your journey, your process –
and you set the agenda.”
Facilitator beginning the open space
facilitation process
ANNEX H | Case Study: Partnership in Action (continued) 30

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Ticket to ride . . . openness, choice, new beginnings.

The facilitator gives each person in the circle a “ticket” for


the two-day journey – a card containing an affirmation
in the first person. “My intuition is powerful, I have the
freedom to choose, I let go of the past.” Participants are
invited to read out the message on the “ticket”.

Posters describing the workshop principles

With the mood set, the facilitator outlines the four principles of the workshop:
• Show up and choose to be present.
• Be open to the outcome – not attached to it.
• Pay attention to what has heart and meaning.
• Tell the truth without blame or judgment.

3 Constructing the agenda

The facilitator requests every participant to identify any issues or opportunities that s/he would like
to discuss during the course of the workshop, to write each item on an individual sheet of A4 paper
and to put his or her name on it.

A rush of ideas
Participants duly take sheets of paper, write down their subjects, and read them out loudly.
• “I’m interested in the supply chain – how do we get drugs out of the storerooms and into
communities.”
• “My interest is sharing advocacy strategies for access to essential medicines.”
• “I propose talking about a coalition to influence policy on the affordability of medicines.”
• “I’m interested in TRIPS and medicines – and the impact of free trade agreements.”
. . . and so on.

They then stick their suggestions on the blank wall


indicated earlier – which now carries a sign reading
“Community Notice Board”.

The facilitator explains that each one of these


subjects will be the focus of a meeting, which will
be chaired and run by the originator of the topic.
A rush of ideas from the participants Participants can sign up for any meeting they are
interested in.

Two laws for participation in meetings are explained to the group:


• The Law of the Bumble Bee and the Butterfly – which sanctions people flitting discussion
between groups to “pollinate” or add value.
• The Law of the Two Feet – which encourages participants to move out of a discussion group
where they are not engaged and join another.
ANNEX H | Case Study: Partnership in Action (continued) 31

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Everyone goes to inspect the Community Notice Board,
with a view to merge topics or add new ones where there
are gaps. Participants begin to identify common ground
between their own proposals and those of others. They
move individual sheets of paper so that clusters or lists of
related topics emerge and in this way, meeting themes
are defined.
The Community Notice Board

10 central discussion themes emerge:


• Capacity building
• Networking among CSOs (“Partnership” is later
extracted as a different topic)
• TRIPS and trade issues
• Good governance and research (Research is
later defined as a separate topic)
• Supply chain
• Medicines quality Trading for time and venue begins
• Community involvement
• Private sector engagement.

The agenda is now finalised and trading for time and venue begins. With the group’s permission, the
facilitator helps rationalise the process of allocating time slots and meeting venues.

4 PACT Conversations

Engaging the issues . . . and each other

Four time slots are carved out for meetings, with between two and four meetings running at the same
time.

For the remainder of the first day and the first hour on Day 2, the meetings on participants’ self-
selected themes continue. Each group is chaired by an individual who proposed one of the original
topics that was “collapsed” into the theme. Main discussion points and recommendations are captured
on a standard reporting form. These forms are posted on the Community Notice Board and, from
time to time, the facilitator reminds participants to consult the board to see what other groups have
debated and concluded.

The groups are very stable and participants intensely involved. The meetings are small enough for
everyone to have a say and hardly anyone makes use of the “Law of the Two Feet”.

Participants engage in discussion at meetings around self-selected themes


ANNEX H | Case Study: Partnership in Action (continued) 32

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
5 Review progress

The first day concludes with a game – a modified version of charades – and reflection on the day. Asked
to describe their experiences, participants venture:

• “It was different.”


• “Fast.”
• “We said at the beginning this would take us two weeks. It took us one day.”
• “At the beginning there was more opportunity for our voice to be heard. This time we felt the
workshop was owned by us.”
• “People felt a little bit more information was needed about SARPAM. Who we are and what will
happen when we leave this room.”

A game of charades and reflections to The facilitator reflects on the learning from the
conclude Day 1 day from her lens

The facilitator comments on how things appeared through her lens:


• The agenda-setting was extremely rapid and amazingly rich.
• People were intensely engaged in discussion; almost no use was made of the Law of the Two Feet.

The facilitator touches on aspects of a number of discussions and mentions that the meeting on
partnership had come up with the idea of a manifesto that would be the foundation of the civil
society (CS) partnership within SARPAM.

A discussion on how the process should unfold, follows. Participants express a need to focus and move
towards an action plan:
• “I have fears we could be as inactive as the SADC Pharmaceutical Business Plan.”
• “We need a bit more structure, a little better idea of where the destination lies.”

The facilitator confirms that most of Session 2 will be devoted mostly to prioritisation and action
planning.
ANNEX H | Case Study: Partnership in Action (continued) 33

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
6 Re-focus agenda for 2nd session

The Facilitator opens the next session. She creates a space for participants to reflect on the previous
session and give feedback on their thoughts for the progress of this session.

After that, seated in the central circle, they receive a


detailed outline of SARPAM which DFID has initiated and
funded as a “partnership venture, not a new entity”. The
informal presentation covers the broad objectives of the
programme, the specific work of the inception phase, the
rationale for the inception phase, the main players in the
Responsible Action Consortium, the budget allocation by
SARPAM Director outlines the partnership DFID, and the respective collaborations with civil society,
venture the SADC Secretariat, and governments in the region.

7 PACT Conversations

Participants gather in three discussion groups to complete the PACT meeting schedule from Session 1.

8 PLANNING FOR ACTION

The participants’ response is positive, captured in the comment: “I want to suggest we look at ourselves
as the drivers of this agenda. We must own the platform.”

The facilitator invites participants to examine the


recommendations of the various meetings (posted on
the walls) and to frame those that appeal most to them
as proposals for joint action. This proposal can be an
individual or joint effort, but the proposer(s) should
canvas support for the idea. Every participant has ten
votes (represented by red sticker-dots) which they can
Support for various proposals indicates by red use as they like to indicate support for various proposals.
stickers or votes

Some participants are active in canvassing support for their proposals while others simply paste
them on the notice board and hope the ideas will speak for themselves. After all proposals have been
pasted up the process of discussing their merits begins.

The SARPAM Director chairs this session, where necessary providing information about how the
proposal relates to other actions that SARPAM will undertake in the inception phase.
ANNEX H | Case Study: Partnership in Action (continued) 34

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
A taste of the proposals
• Develop a framework for collaborative work with SADC (because “it is more productive to be at the
table than to shout from the sidelines”).
• Conduct a human resources mapping exercise, focusing on pharmacists.
• Advocate for the harmonisation of diagnostic processes and treatment guidelines for selected health
conditions.
• Establish a system for civil society data collection and “watch-dogging” of prices, supply chains and
availability of medicines in facilities.

As the discussion proceeds, some proposals are combined


and others are eliminated. The wording of some of the
frontrunners is changed to make proposals more inclusive
and suited to the different cultures of various civil society
groupings.

In the end, the first CS Partnership for Action is defined as


Participants identify proposals for joint action follows:

To establish a joint civil society system for gathering information on pricing of selected medicines,
supply chain effectiveness and availability of these medicines at facility level.

The Director indicates that this will strengthen one of the main deliverables of SARPAM during the
inception stage: an analysis of pharmaceutical markets across the SADC region.

9 Define results and partner contributionss

Activities and responsibilities

At this point a giant matrix on the wall behind the


chairperson becomes the focus of attention. Participants
are asked to:
• Complete the left hand column by proposing categories
of key activities needed for the partnership project
that they have adopted. These are then put into time Matrix on the wall to denote key activities and
sequence. responsibilities
• Identify appropriate organizations inside and outside
the room who could be valuable contributors to this
“partnership for action” (PACT), and spread these across
the top row.

Each of the activities and potential partner organizations is


written on a large Post-it note and slotted into the matrix
in the relevant cell. Each organization is given a different Participants discussing contributions to the
colour code. first CS partnership

Those organizations in the room are then asked to outline more specifically what they might
be able to contribute in terms of the various categories of activity. These details are written on Post-it
notes in the organization’s colour and posted into the relevant cell on the matrix.
ANNEX H | Case Study: Partnership in Action (continued) 35

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
The effect is illustrated below. An organization that posts a note under training, for example, might say:
“Produce training materials and supply trainers.”

The column for organizations not represented at the workshop, obviously, remains blank and their
commitments will be established at a later stage.

Activities EPN HAI Patam Aneca Seatini etc . . .


Internal organization

Identify existing info


Data collection
Information sharing
Advocacy
Training
Policy development

The matrix has effectively become the foundation of a plan of action and two months of planning have,
indeed, been accomplished in two days.

10 CLOSE

The CS Technical Lead facilitates the closing discussion


and directs attention to three key tasks:

• Organising the partner organizations so that the


process can move forward.
• Framing the purpose and objectives of the partnership
in language that is clear and acceptable to all.
• Creating channels for continued communication.
CS Technical Lead facilitates closing discussion

OrganiZing the CS PACT


The CS Technical Lead appeals to the group for assistance with organizing the partnership internally. A
task team is created with four key regional organizations (HAI Africa, EPN, Patam and Aneca) identified
as its core members. Each organization will determine who will represent it.

It is further agreed that one person from these organizations or one of their member organizations will
represent the CS PACT at a meeting in Cape Town on 29/30 March where the broader SARPAM market
analysis process will be discussed in detail.

Framing the PACT’s purpose and member responsibilities


Apart from attending to the objectives of the CS Pact, the task team would consider and strengthen
the recommendations of the workshop group on partnerships. They would revise, complete and
circulate the draft manifesto for PACT members, a document intended to be mutually binding
among partners.
ANNEX H | Case Study: Partnership in Action (continued) 36

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Communication
Participants suggest that SARPAM needs a dedicated, well-functioning website as a channel for communication.

The SARPAM Director explains the facility of the Frontline SMS system which will eventually be toll-free for
users. Participants with mobile phones that are functional in Kenya are invited to register immediately on the
SMS system.

Clarify Next Steps


Immediate next steps
• The task team will meet soon.
• The draft manifesto and statement of responsibilities will be circulated to all participants together with a
summary of the meeting.
• Each participant should meet with his/her organization to discuss its commitments to the PACT and
prepare a detailed description of the role it could play (within the planning framework developed).
• The SARPAM secretariat will talk one-on-one with each organization to establish resource requirements
in the inception phase and beyond.

Closing Exercise
Completing the picture
The facilitator resumes facilitation and invites everyone to reflect on the two-day experience and the amount
of work achieved. She asks each participant to take the jigsaw piece s/he was given at the start of the day and
to help build a puzzle on the table in the middle of the circle.

The jigsaw gradually takes shape – and resembles the SARPAM banner: How can we work in partnership to
improve access to medicines in southern Africa?

Closing Jigsaw game The puzzle takes shape

Asked to comment on the jigsaw, people note there are pieces missing, and it’s a bit uneven and insecure,
but the image and the words are quite recognisable. As they speak they realise this is a metaphor for the
partnership-building and project-planning process they have just undertaken.

In a final symbolic act, individuals close the circle by shaking hands with the person on either side.
ANNEX H | Case Study: Partnership in Action (continued) 37

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
Final Words by the Lead Team
The SARPAM Director observes that any partnership is only as strong as the weakest link and says the two-days
have inspired confidence by “the high standard of contribution, the quality of thought and the maturity of
reflection”.

The CS Technical Lead closes the meeting, thanking the facilitator and SARPAM Director for having the
courage to take this group on an innovative path and the event organisers, for their significant contribution to
the workshop’s success.

Closing comments by SARPAM Director Representatives of the CSO partnership


ANNEX I | WORKSHOP EVALUATION 38
CSO Workshop: 21-22 March 2010
How can we as Civil Society improve Access to Medicines in Southern Africa?

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
SCORE KEY:
1 – POOR; 2 – SATISFACTORY; 3 – GOOD; 4 – EXCELLENT

1 2 3 4
1. Understanding of purpose 2 6
2. Achievement of workshop objective 1 10 6
3. Methodology and approach 1 7 11
4. Facilitation process and support 8 11
5. Level of participation of all delegates 1 5 13
6. Handling of questions and concerns 2 9 8
7. Building of relationships and networks 12 7
WORKSHOP

General reflections and suggestions for future CSO Workshops:


− Good keep it up.
− Ensure that we all have the necessary background info needed to be more resourceful in terms of partici-
pation e.g. info about SARPAM, your expectations and why you need CSO engagement should have been
clear upfront.
− I like the open agenda as a concept but for a group with no real connection before hand I think a bit more
structure would have helped.
− Advance planning.
− Initially I feared the ‘no agenda’ approach but now I appreciate it. Thank you!
− Involve more networks
− The workshop achieved a lot in two days (the achievements exceeded my expectations.
− A new methodology therefore may take time to get fully knowledgeable.
− Perhaps an understanding of the key aims, expected results and the methodology. Also need more clarity
at the beginning

8. Clarity on individual role and accountability 4 11 4


9. Idea of future communication through sms technology 1 2 11 5

General reflections and comments on agreed way forward:


WAY FORWARD

− I liked the idea of participants coming up with the agenda.


− It looks realistic. I hope we shall adhere to it.
− It was a good beginning. Obviously it sets the basis for moving forward. More clarity needed but that is
within sight.
− Not fully satisfied with the action / pact area agreed but will support it.
− Need for better clarity on difference between individual role and fitting into a bigger picture.
− Very good because cell-phones are now available everywhere.
− Better more use of emails for record keeping purposes. Lesser use of SMS.
− Acceptable, can be improved.
− Will become more clear as next steps (report, communications) evolve

9. Workshop venue and resources 6 13


10. Accommodation and meals 8 10
11. Travel logistics and arrangements 3 11 3
General reflections and comments:
− Great organization.
FACILITIES

− Well organized, good approach, results have been achieved from nothing (no agenda).
− Good start. SARPAM must sustain the interest, share info and ensure that the momentum is not lost.
− The methodology and vision for the meeting was quite interesting and opened more opportunities of
ownership.
− Good.
− The methodology and the principles of this workshop need to be tried elsewhere in Africa.
− Great meeting, the approach was completely innovative but idea in allowing participants to see the
agenda. Keep it up Sharon and Shaun. This was a really great.
− Good venture.
− This has proved that an agenda put up by participants enable them. To discuss broadly and in deep the
contents, since they are issues being encountered daily
SARPAM CONTACT DETAILS 39

SARPAM CS MEETING REPORT | Civil Society Partnership for Action on Access to Medicines & Diagnostics in Southern Africa
24 Bolton Road
Parkwood
Johannesburg
South Africa

Tel: +27 11 880 6993


Email: rajeshree@sarpam.net

www.sarpam.net

Twitter: SARPAM2013
Facebook: SARPAM
Skype: SARPAM1

The SARPAM Team appreciates and extends thanks to each and every one who made the workshop possible
and attended and participated in the workshop.