Civil society organizations from 10 countries in Eastern and Southern Africa met to discuss issues related to access to essential medicines in their respective countries and to map out a strategy on how they could go about to advocate and promote access. Organised by HAI Africa and SATAM with support from Open Society Institute (OSI), the seminar brought together a cross-section of professionals - lawyers, health professionals, administrators, communication experts and activists working in civil society and non-governmental organizations. The meeting was held at Silver Springs Hotel, in Nairobi Kenya from 6 – 8 October 2008.
Speaking at the opening session of the seminar, OSI’s representative Roxana Bonnel noted that access to medicines in sub-Saharan Africa was a major concern and said that OSI was supporting the AEM seminar because the issue of stock outs and low availability in East and Southern Africa was one of their priority areas. OSI’s public health program, she said, was working in the area of medicines availability, transparency, enhancing governments’ role to ensure access and innovation. Making a presentation on the supply chain of essential medicines, Patrick Mubangizi, the HAI Africa Coordinator noted that civil society organisations needed to play the crucial role of ensuring that the procurement systems were transparent and provided reliable supplies at the best prices as these are major pre-requisites for a good supply chain. He identified weak public sector management, poor infrastructure, inadequately trained staff, inaccurate quantification and forecasting, and lack of a monitoring system as some of the major challenges causing inefficiency in national medicines supply chains. He suggested that civil society could help alleviate these problems by taking up the responsibility of monitoring medicines availability; getting involved in the tendering, forecasting and quantification process; and advocating for better prices for procurement and financing among other things. Country presentations from Kenya, Malawi, Uganda, Zambia and Zimbabwe revealed some cross cutting issues about the medicines situation. Each country noted that existing problems of stock-outs of essential medicines, a lack of government of accountability, the need for community mobilization to advocate for better public access and availability of medicines, inadequate funding for medicines sector, and a lack of trained human resources. Other challenges identified included the overstocking which leads to expiry of medicines, and rivalry between government agencies involved in procurement. Discussing in country groups, the seminar delegates identified areas in which civil society organisations could improving access to medicines in their respective countries. Participants from Uganda proposed to work on eliminating stock-outs of minimum health package, and strengthening the oversight role of civil society organisations in tracking the supply and distribution of medicines in the minimum health care package. Namibian delegates chose to focus on advocating for affordability of essential medicines, while the Zambian delegates identified raising public awareness (on the existence of the essential medicines package) and lobbying the government to ensure availability of medicines as their starting point. Representatives from Zimbabwe outlined reduction of corruption in the supply chain management and advocacy for civil society representation on the committee to monitor essential medicines as their priority objectives. Madagascar selected working advocating for the elimination of chronic stock-outs as its focus. The Kenyan participants identified three areas in which they could intervene: advocating for greater financial commitment towards health (by the government), strengthening of the medical supply agency which was currently undergoing review, and sensitization of policy makers and raising public awareness though media campaigns. For Malawi, lobbying for CSO representation in the central medical stores (CMS) tendering committee was the first priority and subsequently to monitor and evaluate the efficiency of the CMS in ensuring availability and affordability of medicines. All participants agreed that there was greater need for collaboration with all stakeholders at country and regional level to ensure the success of campaigns to promote access to essential medicines. With the general concession that civil society needed to take action soon, it was agreed that a campaign to eliminate medicine stock-outs should be run at national and regional levels. OSI committed to make some small grants to the countries wishing to implement campaigns and invited participating organisations to submit funding proposals to access the grant. A major outcome of the meeting is the launch of campaigns on elimination of medicines stock outs in 2009 in at least five of the participating countries.