MeTA 19: National Forum 2015, Empowerment of Patients

The two-days annual national forum of the Medicines Transparency Alliance (MeTA) Philippines started today. I attended the afternoon session only because I attended the w FNF event at The Mind Museum, Fort Bonifacio.

Here is the program.

Daty 1, February 17

SESSION 1:  OPENING OF THE 2015 FORUM

ACCESS AND EQUITY: MAKING HEALTHCARE A REALITY FOR ALL

1. Invocation, Ms. Precy Declaro-Deluria,

Executive Director, Philippine Cerebral Palsy, Inc.

2. Overview of the Forum, Ms. Cecilia C. Sison, Country Coordinator, MeTA Philippines

Opening Message, Mr. Roberto M. Pagdanganan, Chairman of MeTA Philippines

3. Remarks from the International MeTA Secretariat

Ms. Deirdre Dimancesco, Technical Officer - Department of Essential Medicines, World Health Organization (WHO)

Dr. Tim Reed, Executive Director, Health Action International (HAI)

4. Message of the Department of Health (DOH)

Atty. Nicolas B. Lutero III, OIC, FDA; Director, Legal Services, DOH

5. Keynote Speech, Dr. Julie Lyn Hall, MBE, WHO Representative to the Philippines

SESSION 2: EMPOWERMENT, ENGAGING PATIENTS IN THE DIALOGUE ON HEALTH

6. Stakeholder Mapping and Development of a Framework for the Engagement and Empowerment of Patient Organizations in the Philippines

Mr. Wadel S. Cabrera III, WHO / MeTA Project Consultant

7. Panel Discussion

Moderator: Dr. Noel R. Juban, Professor, UP College of Medicine

(a) Ms. Deirdre Dimancesco, Technical Officer - Department of Essential Medicines, WHO

(b) Dr. Maria Minerva P. Calimag, President, Philippine Medical Association (PMA)

(c) Mr. Teodoro B. Padilla, Executive Director, Pharmaceutical and Healthcare Association of the Philippines (PHAP)

(d) Engr. Emer Rojas, President, New Vois Association of the Philippines

(e) Dr. Benjamin Bernardino, Secretary General, Life Haven Independent Living Center

(f) Ms. Salvacion Basiano, President, Center for Empowerment and Development of the Elderly and Seniors

(photo below, during the MeTA national forum 2014, held at Bayanihan Center, Unilab Complex, Pasig City)

SESSION 3: MULTISTAKEHOLDER COLLABORATION, HEALTH AND MEDICINES FOR THE FILIPINO PATIENT

8. Panel Discussion – Part 1 (Access to Medicines)

Moderator: Mr. Tomas Marcelo Luke G. Agana III,  Adviser, Philippine Chamber of  the Pharmaceutical Industry (PCPI)

(a) Drug Price Watch / Electronic Drug Price Monitoring System (EDPMS) / Drug Price Reference Index (DPRI)
by Mark Haasis, National Center for Pharmaceutical Access and Management (NCPAM), DOH

(b) Rational Use of Medicines (RUM) Framework / Antimicrobial Resistance (AMR) Policy,

by Dr. Anna Melissa S. Guerrero, Program Manager, NCPAM, DOH

(c) Combating SSFFC (substandard, spurious, falselylabeled, falsified, counterfeit) medical products / Coalition for Safe Medicines, 

by Ms. Maria Lourdes C. Santiago, RPh (invited), Director, Center for Drug Regulation and Research, Food and Drug Administration (FDA)

(d) Pharmaceutical Transparency Through Technology (PTTT) / LUNAS mobile app, 

by Dr. Bryan Albert Lim, Founding Partner, Health Sector Catalyst

(e) Tamang Serbisyo para sa Kalusugan ng Pamilya (TSeKaP) / Z Benefits 

by Dr. Rizza Majella L. Herrera,  Head, PCB/TSeKaP Team, Philippine Health Insurance Corporation (PhilHealth)

(f) Local government initiatives to address medicine needs of its constituents and the community 

by Hon. Gerardo V. Calderon (invited), Mayor, Municipality of Angono, Rizal

(g) Training Modules on Supply Chain Management (SCM) / Philippine Practical Standards for Pharmacists (PhilPSP)

by Mr. Roderick L. Salenga, NPO (EDM), WHO Country Office

Day 2, February 18

SESSION 4:  STAKEHOLDER PERSPECTIVES

10. Stakeholder Workshops

Moderator: Ms. Cecilia C. Sison,  Country Coordinator,  MeTA Philippines

Group Facilitators:

 Mr. Ralph Emerson P. Degollacion

 Dr. Irene F. Farinas

 Mr. Manuel Alexander Haasis

 Dr. Elenita Loida A. Pedrosa

 Ms. Karen A. Villanueva

SESSION 5:  SHARING STAKEHOLDER INSIGHTS

Invocation Ms. Maria Zenaida J. Averilla, Founder / CEO, Scleroderma Society of the Philippines

Reports on the Day 1 Stakeholder Workshops

11. SESSION 6: ACCOUNTABILITY,  FOLLOWING THE MONEY SPENT ON KEY HEALTH PROGRAMS

(a) Medicines Watch, by Dr. Elmer S. Soriano, MeTA / CHAT Project Consultant, Civika Institute

(b) Philhealth Watch, by Mr. Rene R. Raya, MeTA / CHAT Project Consultant, Action for Economic Reform

(c) Sin Tax Monitoring Tool, by Ms. Marian Theresia R. Valera, Consultant, HealthJustice Philippines

12. Lunch / Civil Society Meeting with the IMS

Panel Discussion

Moderator: Mr. Roderick L. Salenga,  NPO (EMD),  WHO Country Office

(a) Asst. Sec. Elmer G. Punzalan, MD (invited), Head, Office for Health Regulation, DOH

(b) Ruben John A. Basa, Senior Vice President, Health Finance Policy Group, PhilHealth

(c) Ms. Teofila E. Remotigue, CEO, National Pharmaceutical Foundation, Inc., Coalition for Health Advocacy and Transparency

SESSION 7:  SUSTAINABILITY, BUILDING ON THE GAINS AND MOVING FORWARD

13. Response of The Filipino Patient 

Mr. Josefino de Guzman, President, Psoriasis Philippines;

Ms. Maria Fatima G. Lorenzo, President, Philippine Alliance of Patient Organizations

Synthesis and Closing Remarks 

Mr. Roberto M. Pagdanganan, Chairman, MeTA Philippines

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See also:
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014 

MeTA 16: Day 1 of Conference 2014, February 11, 2014 

MeTA 17: CHAT General Assembly, March 2014, March 31, 2014 

MeTA 18: More Financial Independence, More Stakeholders Participation, December 11, 2014

ETHIKOS 2: Pharma Companies and Patients, April 01, 2014

ETHIKOS 1: MeTA-PH, PCPI, PHAP and FDA on launching

(Note: This is an expanded version of the paper that I wrote last Friday.)

Last Thursday night, the ETHIKOS (Ethics in Healthcare) Movement was launched at C3 Events Place in Greenhills, San Juan, Metro Manila. Many participants from different groups and sectors. Some quotes from some speakers that night.

All photos I got from the MeTA Philippines facebook page. Thanks Ian Nuevo.

1. Former Gov. Roberto “Obet” Pagdanganan, MeTA Philippines Chairman

Gov. Obet thanked the participants, particularly the organizations that formed movement – the Medicines Transparency Alliance (MeTA) Philippines, the Coalition for Health Advocacy and Transparency (CHAT), and the British Embassy’s Foreign and Commonwealth Office (FCO).

Then he introduced the Convenor Group of the ETHIKOS Movement: (1) Princess Nemenzo of WomanHealth, (2) Celia Carlos of the Drugstores Association of the Philippines (DSAP), (3) Girlie Lorenzo of Kythe Foundation, also of the Philippine alliance for Patient Organizations (PAPO); Tony Leachon of the Philippine College of Physicians (PCP), and himself.

He discussed what ETHIKOS is – a movement to encourage ethics in delivering healthcare to the patients, ethics in dealing with healthcare professionals  and other private players in the sector, ethics in government.

2. Atty. Dave Escalona, Philippine Chamber of Pharmaceutical Industry (PCPI) and United Laboratories

Dave said that the local pharma industry is supporting the Mexico City Principles (MCP) for voluntary codes of business ethics in the biopharmaceutical sector. He introduced a similar term, “Manila Principles” where the basis of such code of ethics are the Generics Act of 1998 and the Cheaper Medicines Law of 2008 (RA 9502), and the object of such ethics is the welfare of the patients.

Thus, the Manila Principles should consider TRIPS flexibilities as contained in RA 9502, avoid whenever possible prolonged data exclusivity, disallow frivolous patents, allow early working of soon-expiring patents of innovator drugs. He lamented that many local pharma companies are small and lesser known compared to big multinational pharma.

3. Teodoro “Ted” Padilla, Pharmaceutical and Healthcare Association of the Philippines (PHAP) Executive Director.

Ted narrated that in 1993, the association introduced and adopted a code of ethics called the PHAP Code of Practice. He quoted the late Doc Alberto “Quasi” Romualdez (a former DOH Secretary, founding chairman of MeTA PH) who said that “The most important achievement of PHAP now is that they have made ethical behaviour an import part of their commitment…”

He emphasized that no amount of health reform will be truly universal if people and players ignore the consequences of unethical behaviour. He also expressed support for the FDA to implement the MCP. Then he mentioned the important role of the innovator companies for endlessly producing new medicines which help save lives and improve the quality of life of Filipinos.

4. Kenneth “Ken” Hartigan Go, Food and Drug Administration (FDA) Director-General.

Doc Ken discussed certain FDA guidelines regarding senior government officials (SGOs) who make follow up calls at FDA. There are four possibilities where SGOs:

(a)     to inquire on behalf of his/her private sector associates, or determine the status of a rival company

(b)     to request earlier facilitationof application (expediting or jumping the queue

(c)     to demand aprovals even if the license or product registration is to be denied, or to demand a denial against a rival company, and

(d)     to reverse a regulatory decision.

My comments to some of these points in my next article about ETHIKOS..

MeTA 16: Day 1 of Conference 2014

The 2014 Medicines Transparency Alliance (MeTA) Philippines forum 2014 started today, here at the Bayanihan Center of Unilab Complex, Pasig City, Metro Manila. Attendance is big, 100+ people attending. I see many new faces here compared to past MeTA PH fora.

Below, they key speakers, from left: Former Bulacan Gov. Roberto "Obet" Pagdanganan, MeTA Philippines Chairman, gave the Opening Remarks. Dr. Tim Reed, Health Action International (HAI, Amsterdam, the International MeTA Secretariat). Dr. Deirdre Dimancesco of WHO in Geneva, and Dr. Francisco Tranquilino of the UP College of Medicine, also Chairman of the Ethics Committee, Philippine College of Physicians (PCP). He gave the Keynote Speech. 

In his brief speech, Dr. Tim Reed noted that "Multistakeholder engagement is clearly achieved in this forum" as the participants come from different sectors and agencies -- government, corporate and industry players, and civil society organization. 

Dr. Art Catli of the Pharmaceutical and Healthcare Association of the Philippines (PHAP) introduced Dr. Tranquilino. Said that the latter is a very popular, well-sought speaker, giving countless speeches here and abroad; that he is a "terror" teacher at UP; a workshorse, a researcher who has published dozens of academic articles, an ambassador of good will. 

Dr. Tranquilino disclosed his past and present engagement in the pharma industry, most of which were with the innovator companies. He started discussing "striking a balance" between innovation and government regulations. 

Medicines save lives, but developing new medicines now take 11-15 years out of 20 years total patent period. Many compounds that were originally discovered and were patented do NOT become medicines, if they do not pass the various clinical trials for safety, efficacy and other criteria. In the last decade, there was dying of pipelines of new revolutionary drugs, resulting in more mergers and consolidation of big pharma companies.  

The Mexico City Principles (MCP) for voluntary codes of ethics of businesses especially in biopharmaceutical sector was adopted by APEC member countries to help reduce corruption, bribery, and at the same time protect public health. 

The next session was on “Multistakeholder advocacy for adherence to the MCP”. The speakers were, from left: Tomas Marcelo "Beau" Agana, Past President of the Philippine Chamber of Pharmaceutical Industry (PCPI), the federation of domestic or national pharma manufacturers and drugstores; Teodoro "Ted" Padilla, Executive Director of PHAP; Atty. Florina Agtarap of the Department of Justice (DOJ) Office of Competition; Dr. C. Diza of the Food and Drugs Administration (FDA); and Dr. Melissa Guerrero of DOH National Center for Pharmaceutical Access and Management (NCPAM). Moderator was Yolanda Ibarle, MeTA Project Director.

Dr. Guerrero said that there are ethical issues in government processes, they have to address those upfront. She hopes that MeTA Philippines and its multi-stakeholder partners can help the DOH urge the local government units (LGUs) abide by DOH rules on the selection of suppliers, truthful procurement of medicines.

Dr. Diza said that FDA will hopefully develop guidelines or an Administrative Order (AO) specifying what needs to be followed from the MCP.

Beau Agana of PCPI talked about their draft Code of Ethics, an APEC workshop for voluntary code of ethics in 2012. Relationship building becomes problematic in pharmaceutical marketing under information asymmetry condition, he said. Code of Ethics will temper maximizing personal interest of doctors and other 3rd party decision makers, and prioritize patients' interests. He added that  patients have started to turn to pharmacists, not their doctors, in their medicines purchase. 

Ted Padilla of PHAP said that they have their Code of Ethics early, that penalties are imposed on  violating member firms and personel. Monetary sanction, a fine, is more effective in tightening behavior. Transparency is essential, there is no substitute to being transparent and honest, and medical decisions must always be made with the best interest of the patients, he added.

During the open forum, some concerns were raised regarding the procurement process and practices of LGUs, not only of medicines but also medical supplies, equipment and facilities.

My main concern in being involved in topics like this is how civil society and voluntary organizations will have greater role in promoting transparency and competition in the economy. Very often, self-regulation by industry players themselves are better than government regulations, restrictions and politics. Manufacturers, wholesalers and retailers who sell only good quality products because they have concern for their customers, or because they are scared that they will be scandalized if their products are discovered to be unsafe and/or ineffective. 

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See also:
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013 
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014

FDA 6: Business and Modernization Plan

The Food and Drugs Administration is technically a very powerful government agency because it can say Yes or No to the introduction of new medicines and vaccines, innovator or generic; new food supplements and drinks; new skin whiteners, boobs enlargers, soap and shampoo, toothpaste and lotions, medicines and vitamins for animals and fishes, medical and dental devices, and many other things.

So a vigilant and technically capable FDA can block the introduction of those “magic” tea/coffee or herbal drinks that can “prevent or cure all types of cancer, all types of cardiovascular diseases…” and penalize violators, those who introduced those “magical, cure all” products without FDA permission and make big money fooling the public and putting the health of some patients in danger .

Yesterday, I attended a presentation by the FDA headed by its Director, Dr. Kenneth Hartigan-Go, held at the Asian Institute of Management (AIM) in Makati. The event was sponsored by the Medicines Transparency Alliance (MeTA) Philippines, in coordination with the Stephen Zuellig Center for Asian Business Transformation.

He presented this paper, but in powerpoint form. This blog post by the way, is 7 pages long including photos and illustrations, so enjoy.

This paper is straightforward and frank. For one, it explicitly admits that the old FDA set was corrupt and fomented corruption. Hats off to the new FDA guys, led by Dr. Ken, for this admission. Undesirable acts can be corrected if the mistake is explicitly recognized in the first place. The paper said,

Why did the old FDA setup foment corruption? The old FDA is a web of misinformation, dead-ends and inconsistency. Companies who seek to be authorized encounter an ill-defined and dated body of regulations. With a bureaucratic process and indefinite deadlines, application turnaround times are known to exceed two years from lodging in of application to release of authorization. This alone translates to losses for companies who cannot operate and are forced to deal with overhead costs without revenues. In their efforts to avoid dealing with the FDA, middlemen (i.e. freelance regulation consultants) have risen to exploit the market of frustrated industry people taking advantage of the lack of transparency, inconsistency with regards to requirements and evaluation process, and the plain distance of the FDA from company offices in central NCR. While not all middlemen are unscrupulous, the agency’s tarnished reputation has been used as an excuse for the middlemen’s own shortcomings. Unfortunately, the old FDA cannot refute the allegations for it is all true – the process is corrupt, the system is sclerotic and the leadership wanting.

These are the four core reforms that the FDA is banking on. And each major heading has many parts or action items.

On (1) Improving the evaluation process, I was very happy to see those “paperless application”, “electronic payment”, “online application guidelines”, “automated renewal of licenses”. Yes, show the paper trails, remove or minimize the face to face interaction between the regulator and those regulated. Transparency alone reduces the itch for corruption and actual commission of corrupt practices.

On (2) Enhancing regulatory inspection, FDA is getting serious on having rule of law, it is one big good news. Make the inspectors more technologically sophisticated and accountable, more bold, prepared and even armed, and have a strong legal team, prosecute violators.

In a brief open forum after Doc Ken’s presentation, I spoke and lauded this new move. FDA is saying to potential violators that “Go ahead, sell and distribute fake or substandard medicines, adulterated foods, etc. and face our lawyers.” The threat of being legally prosecuted when found violating the rules is a stronger deterrence than pre-business inspections.

Health Transparency 14: IMS-CHAT Meeting

The Coalition for Health Advocacy and Transparency (CHAT) is the umbrella organization of health and research NGOs and think tanks that gathered during the Medicines Transparency Alliance (MeTA)-sponsored CSOs Mapping in January 2009. Many of the health NGOs there are coalition themselves of other community and sectoral organizations. CHAT is affiliated with MeTA Philippines and is considered the civil society arm or partner of the latter.

Last week, April 12, 2013, the International MeTA Secretariat (IMS) had a half day meeting with NGO leaders that composed CHAT. About one-half of the organizations within CHAT were represented, good attendance. The IMS were composed of Tim Reed, Executive Director of Health Action International (HAI), Ms. Renee Vasbiner, Administrative Coordinator of MeTA Secretariat, also of HAI, and Ms. Deirdre Dimancesco. Technical Officer of Medicines, Access and Rational Use, Department of Essential Medicines and Health Products, WHO Geneva HQ. 

CHAT was led by former Bulacan Gov. Roberto "Obet" Pagdanganan and Cecile Sison of HealthWatch. Gov. Obet and Cecile are also the Chairman and Secretary General of MeTA Philippines, respectively. The big coalitions within CHAT are the Ayos na Gamot sa Abot-kayang Presyo (AGAP, or good medicines at affordable price), Cut the Cost Cut the Pain Network (3CPNet) and Medical Action Group (MAG), Woman Health, Health Action Information Network (HAIN) and COPAP, the organization of senior citizens. Everyone was given the floor to introduce themselves and the NGOs that they represent, what they do and who are their main constituency.

I introduced Minimal Government Thinkers, Inc. as an independent think tank advocating free market, less government, personal responsibility and rule of law. Our constituency are individuals and groups here and abroad, who read about any free market reforms in the country and in this case, in healthcare policies.

So we have some big NGOs and coalition of NGOs themselves that played very active roles in the enactment of the Cheaper Medicines Law of 2008 or RA 9502, groups and individuals that supported major amendments to the Intellectual Property Code (IPC) of the Philippines like institutionalizing compulsory licensing (CL) of certain patented medicines. And MG Thinkers that advocate respecting IPR as much as possible. So CHAT is a loose coalition and members recognize that.

One advantage, members say, is that there is wide range of discourse and policy options to choose when we discuss certain issues, so they benefit from such diversity of opinions and observations. But one disadvantage is that it is difficult to come up with a consensus stand or statement on some issues, like I advocate less government while many want more government involvement in healthcare. Or possible disagreement in the possible TRIPS Plus provision in the soon to be negotiated EU-Philippines Free Trade Agreement (FTA).

At this point, I spoke. I said that MG Thinkers' involvement in CHAT was a bit interesting. Many if not all of the groups that attended the CSO Mapping workshop were known groups in the IPR debate before RA 9502 was enacted into law. And I was not with them as I was writing many articles defending IPR and my articles were published in many countries like the US, UK, India, Malaysia, Singapore, Philippines, and even in some Arab countries, published in Arabic, courtesy of MG's international free market network.

That when Ms. Klara Tisocki, then of the EU and now with WHO Western Pacific Regional Office (WPRO) invited me to attend the CSO Mapping workshop in January 2009, she has read my name and my articles, and she must have wanted diversity, not monotony, of ideas among CSOs. Klara played a key role in the MeTA formation in the Philippines. And so CHAT was designed to have diversity, to allow some looseness in the umbrella organization. 

On the issue of IPR and medicines, Tim Reed of HAI showed a youtube video produced by HAI Global, about the "EU zoombies" as a result of EU insistence that stronger IPR protection on patented medicines be adopted in various EU negotiations for FTA with different countries.

Then some organization matters were discussed, like key activities for CHAT.

Last April 08, Monday or four days before the meeting with IMS, CHAT also held an internal meeting about issues to discuss. We devise a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis of CHAT. The matrix was shown and discussed by Atty. Paula "Pau" Tanguieng of AGAP. Good presentation, Pau.

It was a good meeting with the IMS, food was nice too.

I keep writing about these meetings and events as many CHAT and MeTA members tell me that although they may not agree with many of my ideas, they still look forward to my analysis, stories and photos. Just one proof that diversity is preferable to monotony. :-)

Cheers guys.
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See also:
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012
Health Transparency 11: MeTA Philippines and Multistakeholder Process, September 19, 2012 
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013

Health Transparency 13: MeTA International Visit to Manila

Last Wednesday, April 10, 2013, the International MeTA Secretariat (IMS) visited Manila to meet up with Medicines Transparency Alliance (MeTA) Philippines Council officers and members, and attend the MeTA Discussion Series on PhilHealth's primary care benefit (PCB) new packages. I am one of the members, that's why I was there.

The three visitors from IMS were Dr. Tim Reed, Executive Director, Health Action International (HAI), Ms. Renee Vasbiner, Administrative Coordinator - MeTA Secretariat, HAI, and Ms. Deirdre Dimancesco. Technical Officer, Medicines, Access and Rational Use, Department of Essential Medicines and Health Products, WHO HQ. 

Tim Reed here speaking during the meeting with MeTA Philippines members, headed by Chairman Roberto "Obet" Pagdanganan (former Bulacan Governor, former PITC President) and Ms. Cecile Sison, MeTA Secretary General. 

The morning meeting was mainly on internal matters, like updates on both the international and Philippines offices of MeTA. There was a brief discussion though on pharmacovigilance, presented by Dr. Mariano Lopez. It is a joint project by the Philippine College of Physicians (PCP), MeTA Philippines, and the Rotary Club of Manila, in coordination with the FDA. Gov. Obet is also the club President this rotary year 2012-13.

The plan is to conduct random drug tests from selected drugstores and hospital pharmacies in terms of drug quality and safety. Any anomaly that will be detected, FDA can quickly act. The results of the FDA laboratory test will be (1) shared among the hospital therapeutics committees to improve drug procurement on the basis of good quality drugs and/or; (2)announced to the general public with considerations for possible litigations and/or; (3)left to FDA’s discretion and regulation.

For me this is a good initiative. Civil society organizations like PCP, MeTA and some Rotary Clubs can and should initiate this kind of projects to further protect patients. One participant narrated that they conducted a similar pharmacovigilance survey in the past, and they encountered difficulty getting the support and cooperation of some government hospitals, especially those run by the LGUs. For instance, they discovered that in a provincial hospital in Bohol, an IV supplied to the hospital was improperly packaged in a mineral water bottle (!).

CSOs and State 16: The Integrity Initiative

Government is force and coercion. It is an institution created by men and women mainly to protect themselves, their families and friends, their properties, from bullies among the population. It was a good "social contract" where people surrender a portion of their individual freedom to the government, like the "freedom to revenge" and physically attack those who committed physical aggression against them and their properties. Government and its courts, justice and police system is supposed to do that job, to penalize those who disrespect other people's right to peaceful living.

But governments since then have been expanding and getting larger to monster institutions. Rule of law was supplanted by rule of men, and some bullies, thieves and other criminals have captured government power so they can become bigger bullies protected by the government itself and its armed forces. Corruption and plunder is among the byproducts of this situation. Another is large-scale human rights violations, imprisonment if not murder of those who protest dictatorial and despotic governments.

In order to minimize or avoid this situation, government itself created certain offices and mechanisms for self-policing and self-regulation. Thus, the separation of power among the Executive, Legislative and Judiciary branches of government, fiscal and oversight function of opposition political parties, and creation of anti-corruption Commissions, Bureaus or Task Forces within the government. But these offices did not do their function in many countries like the Philippines and thus, corruption has become the norm rather than the exception in many countries and governments. 

Non-government mechanisms and initiatives have sprang up recently in many countries like the Philippines, to help fight government corruption. The approach is different than the usual anti-corruption campaigns. Instead of pressuring government to limit corruption from within, the move is to pressure private enterprises and individuals to stop bribery with government offices and even to report corrupt and extortion practices by certain government officials.

This is the thrust of a new group called the Integrity Initiative (II). I have attended a talk by II Chairman, Ramon del Rosario of the Phinma Group of Companies last month. It was held at the Asian Institute of Management (AIM) in Makati and was mainly sponsored by the Pharmaceutical and Healthcare Association of the Philippines (PHAP) and its partner companies, NGOs and government offices like the DOH.. I liked his talk, short (15 minutes or less), extemporaneous and direct. He said that from an initial 100 company-signatories in 2010, II has grown to more than 1,500 signatory companies. They are now piloting two procedures. One is an Integrity Assessment where companies self-declare certain practices to avoid or minimize corruption with government, and two, an Integrity Validation to be done by a third party and check if those self declaration by a signatory company are correct or not.

During the open forum, I spoke and praised this initiative as truly civil society. It's a unilateral action by the private enterprises and groups themselves to start cleaning up their own ranks first, then demand that government should clean its ranks too. This will be a good branding for company-signatories and have obeyed the processes of II. Thus, II-affiliated companies can "brag" or openly declare that they are doing their businesses in transparent manner and comply with certain government regulations. This can be considered as a trademark by which other companies (suppliers and buyers) and ordinary consumers can hold on and expect that what those companies say are indeed true. A pressure from the outside by a united group of companies from different sectors or fields of business can exert substantial change in government.

I also suggested that while there are industry associations in each sector or industry, some of those associations do not have their own code of ethics and self-regulation mechanisms to avoid unethical marketing and advertising of their products and services and hence, cheat on their consumers. So II can possibly create committees to represent the different sectors and industries that can exert if not impose a code of ethics for member companies in each committee. 

I cited a story of an anesthesiologist friend who complained that they caught one local pharma who sold a counterfeit or substandard anesthesia to one hospital. An anesthesia, if in good standard and effective, is supposed to take effect within minutes to a patient. So for a patient to undergo surgery, he is supposed to feel numbed and be asleep within minutes before the knife will slice his/her tummy or other body parts. But the patient was wide awake, did not get numbed, and it is impossible to do the surgery otherwise the patient will be shouting in deep pain. So the surgeons and anesthesiologists have to scamper for a new set of anesthesia before the surgery can proceed. Surgery done. After that, they reported the incident to the FDA through a very confidential letter, and the pharma company later knew of such letter complaint, meaning they have a "mole" within the FDA and threatened to sue the complaining physicians. 

There were other comments from the audience like those from Leonie Ocampo of the Philippine Pharmacists Association (PPhA). Later, Doc Virgie Ala, the director of DOH-NCPAM, came to represent DOH Assistant Secretary Madz Valera who was supposed to give a talk too in that event, but was not able to come due to a sudden Senate Committee meeting that she has to attend. Doc Virgie expressed support for such civil society initiative like the II, as it would be easier for government offices to reduce corruption if there is such initiative from the private sector.

Civil society organizations (CSOs) and State, not just market and state, is a good initiative to limit government power and coercion. CSOs should be independent of government whenever possible, and not just extension of government like what many NGOs, media and academic people are doing. CSOs should be independent of government funding too, in order to ensure such organizational and philosophical independent from the state.

Meanwhile, PHAP Executive Director Reiner Gloor wrote about that event, I just saw it recently, paper elow. Photos here, he's rightmost. Doc Virgie Ala is to my left. Cecile Sison and former Gov. Obet Pagdanganan of MeTA Philippines, Leonie Ocampo to my right. Lower photos, Mon del Rosario of II and Phinma, and Doc Virgie Ala of DOH-NCPAM.

http://www.bworldonline.com/weekender/content.php?id=62191

The Integrity Pledge

Posted on 05:40 PM, November 29, 2012

Medicine Cabinet -- Reiner W. Gloor

IN 2003, world leaders adopted the United Nations Convention Against Corruption and designated Dec. 9 of each year as International Anti-Corruption Day in a bid to promote a culture that values ethical behavior.

Believing that corruption undermines social progress and results in inequality, the Aquino Administration adopted a platform of government that embraces integrity in public leadership. Early this month, President Benigno S. C. Aquino III. issued Proclamation 506 declaring Dec. 9 as National Anti-Corruption Day. In the proclamation he signed, the President said that corruption undermines the institutions and values of democracy and ethical values as well as jeopardizes sustainable development and the rule of law.

The drive to promote integrity has also been undertaken by the private sector recognizing that the government cannot do it alone. In response to the government’s campaign on good governance, the Makati Business Club (MBC), together with several other organizations, launched the Integrity Initiative (II), a multi-sectoral campaign that seeks to ultimately eradicate the corruption that has worsened poverty and stunted “the development of a competitive business environment that operates on a level playing field.”

Health Transparency 12: MeTA Philippines Dynamism

Two weeks ago, I attended the Council meeting of the Medicines Transparency Alliance (MeTA) Philippines, September 19 afternoon, at the Unilab's Bayanihan Center Annex. It was a good meeting, lots of topics discussed from many participants, including new members of the expanded Council. The meeting was presided by MeTA Philippines Chairman Roberto "Obet" Pagdanganan.

I like the expansion in membership of the Council to cover more private and health professional associations. I think some if not all of those professional organizations are also happy to belong to this big alliance with one important goal -- to have more transparency and accountability among various players, public and private, in the medicines manufacturing, distribution, retailing, dispensing and policy making.

There were several items on the agenda, among which are the objectives for Year 1 of MeTA 2, that officially started yesterday, October 01, 2012, up to September 30, 2013. See the five goals below. The quarterly activities including their respective budget starting this 4th quarter of 2012 were clearly discussed by MeTA Phils. Secretary General, Cecile Sison.

Aside from conducting studies on certain health and medicines policies of the Philippine government (DOH, PhilHealth, FDA, etc.), there will be a national forum once a year, a quarterly discussion series, as well as regular quarterly meetings.

MeTA, implemented in the Philippines and six other developing countries,  is actually a unique if not strange NGO. It is a non-government organization but funded by government, the UK Department for International Development (DFID), program and project monitoring is done by the World Health Organization (WHO) in partnership with an international NGO, the Health Action  International (HAI).

Its membership is multisectoral -- from the multilaterals, the national government, health and research NGOs, industry associations, and health professional organizations. From what I observed since I joined the MeTA network through CHAT since 2009, I think the multistakeholder or multi-sectoral approach in dialogue and consensus building is working.

With the huge public debt by the UK and many other European governments and the fiscal bleeding and economic uncertainties that come with it, it is safe to assume that while this project is good, it is highly possible that the UK government will stop funding it in the future. So alternative funding sources have been identified and will be in place next year.

Among these are the incorporation with SEC as a non-stock non-profit organization that has corporate and legal identity to accept grants and donations from various sources, public and private. Another is the collection of annual dues from members: P20,000 for corporate members like industry association and professional organization, P10,000 for associate members like a pharma company or drugstore chain, P5,000 for civil society coalitions like CHAT, P5,000 for individual members, and P2,000 for associate members from civil society. Minimal Government Thinkers will fall under the last category and will pay P2,000 next year.

These rates are actually low considering the various research activities, regular discussion fora, regular meetings and community work each year. Well, there are donations to come, both in cash and in kind, from various sources.

The current officers of the MeTA Philippines Council are:


ROBERTO M. PAGDANGANAN Chairman
JOSE MARIA A. OCHAVE Vice Chairman
CECILIA C. SISON Secretary-General
NORMITA D. LEYESA Treasurer
ALBERTO G. ROMUALDEZ, JR Senior Adviser
REINER W. GLOOR Trustee
KENNETH Y. HARTIGAN-GO Trustee
PAULA MAE B. TANQUIENG Trustee


The corporate members at the moment are:

1. Pharmaceutical and Healthcare Association of the Philippines (PHAP)
2. Philippine Chamber of the Pharmaceutical Industry (PCPI)
3. Drugstores Association of the Philippines (DSAP)
4. Philippine Medical Association (PMA)
5. Philippine College of Physicians (PCP)
6. Philippine Society of Experimental and Clinical Pharmacology (PSECP)
7. Philippine Pharmacists Association (PPhA)
8. Association of Philippine Medical Colleges Foundation, Inc. (APMCFI)
9. Philippine Hospital Association (PHA)
10. Private Hospitals Association of the Philippines (PHAPI)
11. Coalition for Health Advocacy and Transparency (CHAT)

No government agency, national or multilateral, is a corporate member

All of the above have the power to vote and be voted while associate and individual members do not have such rights and power. The latter can attend and participate in the various meetings though. Fair arrangement.

I am excited to see this development and dynamism. Someday MeTA Philippines can evolve into a largely privately-funded and sustained organization. Which is the essence of civil society -- a state of society where the citizens are mature, free and responsible enough to manage their personal, household and community lives via more volunteerism and the least government coercion involved.
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See also:
Health Transparency 7: DOH Advisory Council, CHAT, June 04, 2012
Health Transparency 8: Advisory Council on RA 9502, June 11, 2012
Health Transparency 9: Physician Misdiagnosis, Dispensing Medicines, July 20, 2012
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012
Health Transparency 11: MeTA Philippines and Multistakeholder Process, September 19, 2012

Health Transparency 11: MeTA Philippines and Multistakeholder Process

The Medicines Transparency Alliance (MeTA) Philippines and its multi-stakeholder process and dialogues, along with the DOH Advisory Council on Healthcare (ACH), are the best venues that allowed me to get involved in many policy discussions and even debates on various health issues with various players and stakeholders in this country.

I began writing on health topics in late 2007 after the Symposium on Intellectual Property, Innovations and Health in early September 2007 at Manila Hotel, jointly sponsored by the International Policy Network (IPN) and Minimal Government. I produced lots of blog posts and oped articles in various newspapers, here and other papers in Asia, thanks to IPN media network, on health, especially on intellectual property rights (IPR), drug patents and compulsory licensing, in 2008.

In January 2009, I was invited by the DOH to a first meeting by the Advisory Council. I also invited by Ms. Klara Tisocki, previously with the EU and now with WHO, WPRO, to participate in the MeTA Civil Society Organizations (CSO) mapping two-days workshop. I missed the DOH Advisory Council meeting and the first day of the CSO mapping because I was in Singapore then, in a meeting with fellow free market leaders in Asia.

I was able to attend the 2nd day of the CSO mapping, I was glad to meet the various NGO leaders who were often in the news then because of their involvement in the discussions of the Cheaper Medicines Law or RA 9502, that was enacted in June 2008. I was in the US for the Atlas Liberty Forum when the law was signed that day.

Anyway, I was able to attend the 2nd MeTA National Forum, a 3-days event after the 2-days CSO mapping. I was amazed at the big audience and the wide range of topics that covered not only medicines policy but also other health issues. The officers of MeTA Philippines at that time were former DOH Secretary Alberto "Quasi" Romualdez as Chairman, former Bulacan Governor and former PITC President Roberto "Obet" Pagdangan as Chairman, and Dr. Kenneth Hartigan-Go as Secretary General.

Since then, I got involved in the formation of the Coalition for Health Advocacy and Transparency (CHAT), the civil society partner of MeTA Philippines, as well as other MeTA fora and discussions.

Below, during the MeTA National Forum in January 2010. This is the press conference made while there were on-going panel discussions. Second photo, from left: Nancy Tacandong, acting FDA Director at that time; Gov. Obet, Doc Quasi, Wilbert Bannenberg, the Technical Consultant of MeTA in London, and Reiner Gloor of PHAP.

Group photo also during the 3rd MeTA National Forum. It was a 2-days forum, also held at Diamond Hotel. I attended this forum but I don't think I joined that group photo. I got this from the MeTA website, http://metaphilippines.org.ph/.

Lower photo is another two-days MeTA forum on universal health care (UHC). I was able to attend this too, held at the Ramon Magsaysay Center.

More multi-stakeholder discussion workshops by MeTA sometime in March 2010. I was not there. Lower photo, I like that shot of a friend, respected academic and immediate past Director of FDA, Doc Suzette Lazo, speaking, nice.

We also have several discussions on our own in CHAT, photos below. MeTA Philippines alloted a separate budget for CHAT to conduct various health education and discussion activities.

I am thankful for the nth time, to MeTA Philippines and its multi-stakeholder process in policy discussions. Many members of the MeTA Council are also members of the DOH ACH. They have different agenda topics though as the latter is focused more on policy advice on certain issues to the DOH Secretary while those of MeTA are topics that each member and organization representatives should do in collaboration with each other.

The current officers of MeTA Philippines since about two years ago are Gov. Obet as Chairman, former DOH UnderSec and now PhilHealth VP Alex Padilla Unilab VP Joey Ochave as Vice Chairman, Cecille Sison of HealthWatch as Secretary General, and former PPhA President Normita Leyesa as Treasurer.

Recently, MeTa decided to expand membership of the Council. They will also be charging annual membership fees to members, both as organizational representatives and as individuals. For me this is a good move. A civil society organization like MeTA Philippines, should be able to raise funds internally through annual dues and other activities, and be less dependent on assistance from UK's Department for International Development (DFID) and WHO.

There is an expanded meeting this afternoon, I shall be attending it.
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See also:
Health Transparency 6: Physician Protectionism, May 19, 2012
Health Transparency 7: DOH Advisory Council, CHAT, June 04, 2012
Health Transparency 8: Advisory Council on RA 9502, June 11, 2012
Health Transparency 9: Physician Misdiagnosis, Dispensing Medicines, July 20, 2012
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012

Transitions 3: Lolo Angel Mendoza of AGAP

There are three things in life that are certain: death, taxes and change. Deaths allow us to recall and remember a person in his/her lifetime, if he/she has been kind to us, to other people, or not. It is this prospect of death that may perhaps be the best "regulator" of human behavior. As much as possible, people do not want to remembered as bad when they depart from this planet.

Among those people who have been kind to his friends, family and the rest of humanity, is Angelito "Lolo Angel" Mendoza (1946-2012), the head of the Ayos na Gamot sa Abot Kayang Presyo (AGAP) or Good Medicines at Affordable Prices. AGAP is a big coalition of various NGOs, from labor to community to health NGOs, and some known individuals like former Senator Wigberto "Bobby" Tanada.

Lolo Angel here in a planning workshop by the leaders of member-NGOs of the Coalition for Health Advocacy and Transparency (CHAT), sometime in January 2010. I'm seated in front of him and former Bulacan Governor Obet Pagdanganan.

I have known and met Lolo Angel, as well as many leaders of the biggest health NGOs in the Philippines more than three years ago, when the Medicines Transparency Alliance (MeTA) organized the "CSO Mapping and Workshop for META-Philippines", January 19-20, 2009, at Diamond Hotel, Manila. After that two-days seminar-workshop, the participants agreed to form a huge network or coalition of various NGOs that will advance more transparency in medicine pricing and public policy. So already big coalitions like AGAP, the Cut the Cost Cut the Pain Network (3CPNet) and WomanHealth have become members of that new coalition, which we later called the Coalition for Health Advocacy and Transparency (CHAT). It would be the civil society arm of MeTA Philippines.

These big NGOs were also among the major advocates that pushed for the changes in the country's Intellectual Property Code (IPC) and the enactment of the Cheaper Medicines Law of 2008 or RA 9502. Minimal Government Thinkers was not a major participant in the debates prior to that law. I was just writing in this blog, in the online magazine http://thelobbyist.biz, and some op-ed papers on health issues and my critique of certain provisions of the bill that later became a law. Somehow I got noticed by Ms. Klara Tisocki, the convenor of the CSO Mapping by MeTA and she invited me to that big workshop.

Photos below, during the visit by leaders of MeTA Jordan and MeTA Zambia with MeTA Philippines. The foreign visitors met with member-NGOs of CHAT. Further below, in one of the seminar-meetings by CHAT, May 2011. Gov. Obet beside Lolo Angel.

Lolo Angel had a big lump in his throat, has throat cancer. His voice is coarse and low. I would admit that I could hardly understand him when he speaks, but the man was friendly and hard working. With his disease and frail body, he still managed to attend various meetings and seminars by MeTA Philippines, CHAT, AGAP and other groups.

When we met in some of those meetings and seminars, my favorite greeting to him was "Lo, tagay na tayo!" (Pal, let's have a drink). And he would smile and giggle. Knowing that he cannot drink because of his various medications, I would keep teasing him, "Lolo, mag beer na tayo!"

My position on various public health policy issues is very often contrary to the position of AGAP and other member-NGOs of CHAT. They support compulsory licensing (CL), exhaustion of rights or "parallel importation" and other IPR-tweaking policies in RA 9502, I don't. But in the debate on imposing drug price control in mid-2009, Lolo Angel, AGAP, me and a few other NGOs took the same position of not supporting it. Lolo Angel's alternative to drug price control is more parallel importation and allow those patented but cheaper medicines from India, etc. to be brought in. While the alternative that I advocated was more competition, allow more pharma companies, local and foreign, innovator and generic producers, to come in.

Photos below, various CHAT meetings and seminars, May 2011, held at the PRRM building in Quezon City.

Below, the only photo I have in my computer where Lolo Angel was looking straight to the camera. To his right, were Cecile Sison and former Gov. Obet Pagdanganan. Cecile and Gov. Obet are currently the Secretary and President of MeTA Philippines.

It is sad to see another friend passing away. I knew that he was sick and weak, but I did not realize that he would be departing soon. The last time I saw him was last month, during the AGAP forum with former DOH Secretary Alran Bengzon last February 16, 2012,  Generic Drugs Philippines 3: Dr. Alran Bengzon on Medicines. He looked weak but could still talk and smile.

Lolo Angel, thank you very much for the friendship.
Thank you for the various discussions. We did not share the same position on certain issues, but it was the process of exchange, the civility and respect for different ideas that mattered.

I will miss you.
Rest in peace, my friend.

* See also Transitions 2: Ninang Telly Dakila, February 07, 2011