Experiences and challenges in PSM: Nigeria, a case …...Nigeria: Health care Nigeria: HIV/AIDS, TB, Malaria – 3.6 % HIV/AIDS prevalence (2007) - third largest number of people living

Experiences and challenges in PSM: Nigeria, a case studyBart van der Grinten, Country Manager IDA Foundation Nigeria

AMDS Partners and stakeholders meeting, March 2010

Introduction

February 2010

Agenda• Nigeria

• IDA Foundation Nigeria

• PSM Experiences and challenges

Nigeria: ‘Giant of Africa’

• Total population 154,729,000• ‘Democratically’ elected President• 6th largest producer/exporter of oil in the world• 15 domestic airlines• GDP: 120.8 billion USD• Per capita: 780 USD• 13th poorest country in the world• Population below poverty line: 70%

Nigeria: ‘Giant of Africa’

• Population growth rate 2.8%• Health system performance: 187th out of

191 countries• Infant mortality 71: 1000• Life expectancy: 48 years

Nigeria: Health care

Nigeria: HIV/AIDS, TB, Malaria

– 3.6 % HIV/AIDS prevalence (2007) - third largestnumber of people living with HIV/AIDS

– Fourth largest tuberculosis burden: more than460,000 estimated new cases in 2007

– Largest malaria burden: 225,424 deaths in 2006

Aids Epidemic Update 2009, WHO/UNAIDS

Towards Universal Access – Progress Report 2009,WHO/UNAIDS/UNICEF

Nigeria: PMTCT

SOCIETY FORFAMILY HEALTH

NACA

IDA FOUNDATION NIGERIA

IDA Foundation Nigeria

• Regional office since 2005• Registered with CAC and PCN• Procurement Agent for GF PR’s (NACA, SFH),

PEPFAR IP’s, TB-CAP, WHO/CDC, FMoH,SMoH, CHAN

• Responsible for DDU delivery• Close collaboration with NAFDAC• Link between Nigerian partners and head office

IDA Foundation in Amsterdam

IDA Foundation Nigeria

Case study example: NACA/SFH PSM backbone• Set up by DG Prof. Osotimehin• M&E plus forecasting/quantification: JSI Deliver• Procurement and delivery: Crown Agents and

IDA• Distribution: CHAN• SR’s running programme: FHI (90%) and

Hygeia (10%), no role NASCP

IDA Foundation Nigeria

NACA/SFH PSM backbone challenges• Choice of products (stavudine,

artesunate/amodiaquine)• Planning of ordering• Import of unregistered products (waiver OI’s)• Clearing (form M) and DDU delivery at CMS• Storage

Nigeria: Challenges

• Limited local capacity/collapsed educationalsystem

• Lack of centralised systems(procurement/storage/distribution)

• Lack of transparency• Lack of electricity• Importation/customs• No wholesalers i.e. open market• Cost vs Quality• Registration NAFDAC• Coordination/harmonisation/integration

Nigeria: pharmaceutical system

LEVELS PRIVATE SECTOR PUBLIC SECTOR PARTNERS

International TB GDF GFATM

National Government

Procurement UnitQuality Control Lab

Regulatory Agency

Local WholesalersAcademic Institutions

Regional Regional Store

District

Private

Prescribers

Community

District Store

HIV/AIDS

Prevention &

Care Facilities

Users

Local

Manufacturers

Multinational Suppliers

Distributors

Shops,

Pharmacies

Professional Associations

NGO & Community

Organizations

PEPFAROther Procurement

Agencies

Other Donors

& Lenders

National

HIV/AIDS

Committee

Central Medical Store

Vertical Program

The HIV/AIDS Pharmaceutical System

Example of a centralized distribution system

LEVELS PRIVATE SECTOR PUBLIC SECTOR PARTNERS

International TB GDF GFATM

National Government

Procurement UnitQuality Control Lab

Regulatory Agency

Local WholesalersAcademic Institutions

Regional Regional Store

District

Private

Prescribers

Community

District Store

HIV/AIDS

Prevention &

Care Facilities

Users

Local

Manufacturers

Multinational Suppliers

Distributors

Shops,

Pharmacies

Professional Associations

NGO & Community

Organizations

PEPFAROther Procurement

Agencies

Other Donors

& Lenders

National

HIV/AIDS

Committee

Central Medical Store

Vertical Program

The HIV/AIDS Pharmaceutical System

Example of a centralized distribution system

Nigeria: Opportunities

Nigeria: Objectives

Nigeria: Targets

Nigeria: Challenges

OUR MISSION (not only in Nigeria)