01 November 2011 Helen Tata, WHO/EMP/MAR WHO Technical Briefing seminar Geneva, 31 Oct– 04 November 2011. Access Framework & Challenges in Medicines Supply.

01 November 2011 Helen Tata, WHO/EMP/MAR

WHO Technical Briefing seminarGeneva, 31 Oct– 04 November 2011.

Access Framework & Challenges in Medicines Supply Systems

Mrs Helen Tata (WHO/EMP)

WHO Technical Briefing seminarGeneva, 31 Oct– 04 November 2011.

Access Framework & Challenges in Medicines Supply Systems

Mrs Helen Tata (WHO/EMP)

01 November 2011 Helen Tata, WHO/EMP/MAR

Ensuring access to essential medicines - framework for collective action

1. Rationalselection and use

4. Reliablehealth and supply

systems

2. Affordableprices

3. Sustainablefinancing

ACCESS

01 November 2011 Helen Tata, WHO/EMP/MAR

Architecture

Access

Availability Affordability Adoption

Pharmaceutical Supply system and access to medicines

Adapted from Frost and Reich, 2008

01 November 2011 Helen Tata, WHO/EMP/MAR

Frost and Reich Framework• Components include:• Architecture: systems, structures,

relationships that coordinate the remaining three e.g – human resources, regulation, donor coordination;

• Availability: activities that lead to medicines availability including manufacturing, forecasting, procurement, distribution and delivery;

• Affordability: affordability across the supply system from government to end user; and

• Adoption: processes that influence the demand for medicines, prescribing and use of medicines.

01 November 2011 Helen Tata, WHO/EMP/MAR

Assessment of medicines supply systems

• In 2007 selected countries in AFRO decided to assess the functioning their country architecture

• They had as objectives to:– map financial flows for in-country medicines

procurement and distribution – provide an overview of all stakeholders involved in

in-country medicines procurement and distribution– present a synopsis of in-country medicines

procurement and distribution pathway– review strengths and weaknesses of existing in-

country medicines supply management system

01 November 2011 Helen Tata, WHO/EMP/MAR

Assessment tools• WHO/AFRO and EMP developed

tools to support countries' assessment

• Two sets of questionnaires developed:

1. To map medicines financial flows & distribution

2. To assess medicines supply system around areas of medicines management cycle.

01 November 2011 Helen Tata, WHO/EMP/MAR

• Source: Bergis Schmidt-Ehry, GTZ

Mapping Results

01 November 2011 Helen Tata, WHO/EMP/MAR

Source Of Funds

Procurement Agent/Body

Point of 1st warehousing

Point of 2nd warehousing

MEDICAL STORE

Medicines supply systems in TANZANIA. 2007

PRIMARY HEALTH CARE FACILITYDISTRICT STORE

ZONAL MEDICAL STORE

ESSENTIAL MEDICINES

ARVs MALARIA TB OIARVs Ped

REAGENT Blood safety(+ HIV test)

VACCINES CONDOMS CONTRACEPTIVESMEDICALSUPPLIES

REGIONAL/DISTRICT

VACCINE STORE

HEALTH FACILITY

GOVERNMENT

MULTILATERAL DONOR

BILATERAL DONOR

NGO/PRIVATE

AXIOSTEC &CC

T

CRS IMA CUAMMHOSPITAL COLUMBIA HOSPITAL

TEC &CC

T

HEALTH FACILITY

HEALTH FACILITY HOSPITALTEC &CC

T

ZONAL BLOOD SAFETY CENTRE

Point of Distribution

GOVERNMENT

WBGLOBAL

FUND

SIDA

PEPFAR

USAID

UNICEF

WHO

ABBOTT

CSSC

COLUMBIA

PFIZER

JICA

CLINTON

UNITAID

CIDA

CDC

GAVI

CUAMM

HAVARD

NORAD

HOSPITAL

TEC&

CCT

CLINTON

HAVARD

MEDICALSTORE

CRS

SCMS

EGPAF

MOH& SW

AXIOS

UNICEF

JICA

CDC

COLUMBIA

ABBOTT

GAVI

CUAMM

CROWNAGENTS

USAID

TMAP

AXIOS

United Republic of Tanzania

PATIENT

01 November 2011 Helen Tata, WHO/EMP/MAR

Sources de

Financement

Structure d'appro-

visionnement

1er point de stockage

2ème pointde stockage

Structure dispensatrice

ETAT

BMFONDS

MONDIAL

CAMEBU

DFID

UE

USAID

FNUAP

IPPF

MSF

OMS

GFA

CEPBU

GVC

UNICEF

CLINTON

GTZ

GDF

CTB

CAMEBU

IPA

ACF

CONCERN

CAMEBU PNLOMSFPNLT CICR CEPBU

IMC BPS GVCACF CORDAID

Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007

Site de prise en charge

CDSSNT/CNT CDT/CT COCOLSBPS CPLS CDV Détaillants

CDSSite de prise en charge

PNSR CPLSGrossiste Privé

CNTSCDV

PNSR ACF CORDAIDIMC GVC CONCERNPEV PSI

PDM

CICR SEP/

CNLS

PNLT

PSI

UNICEF

OMS

FNUAP

MSF

ACF

PDM

CICR

CEPBU

CORDAID

GVC

GTZ

CLINTON

UNITAID

GDF

CTB

CONCERN

GAVI

KFW

IPPF

PSI

MEDICAMENTS ESSENTIELS

ARVs PALUDISME TB IOARVs Ped

REACTIFS sécurité du sang

(+ test HIV)VACCINS Préservatifs Contraceptifs

DispositifsMédicaux

CORDAID

SEP/CNLS

ABUBEF

PRISONHÔPITAUX

République du BurundiMinistère de la Santé

Publique

Etat

Bailleurs multilatéraux

Bailleurs bilatéraux

ONG/Privé

PATIENT

Supply system challenges (1)

• Selection:– Supply outside the EML/STG still exists– Procurement of non registered medicines in

countries still exists

• Quantification: – CMS rarely involved in forecasting/procurement– Lack of coordination in planning between MoH/CMS

and all partners results in stock-outs, shortages, overstocking and expired products

– Adequate logistic information system not in place (due to the complexity of the system?)

01 November 2011 Helen Tata, WHO/EMP/MAR

Challenges (2)• Procurement:

– Managed by various partners present in country. – National system hardly in involved in program

procurement

Storage/stock management: – Inadequate storage capacity due to lack of

coordination in procurement planning– Different stock management tools for the same

product originating from different partners• Distribution:

– Inadequate funds for distribution. – Uncoordinated distribution between different

programs leading to high operational costs for all programs.

01 November 2011 Helen Tata, WHO/EMP/MAR

Challenges (3)Financing:

– Funds available mainly for 3 disease programs

– Other areas under funded (e.g. NCD etc)– Financial figures not always available– Logistic support is under- funded

Monitoring-Evaluation:– Each program may have a stand alone

M&E – Different reporting tools– High burden of work for scare human

resources at periphery

01 November 2011 Helen Tata, WHO/EMP/MAR

What can be done?

01 November 2011 Helen Tata, WHO/EMP/MAR

• Source: Bergis Schmidt-Ehry, GTZ

How feasible in the supply system?

01 November 2011 Helen Tata, WHO/EMP/MAR

Benefits of coordinated supply

Platform for dialogue, information Platform for dialogue, information sharing and coordinationsharing and coordination

Joint M & E and reportingJoint M & E and reportingReduced workloadReduced workloadHealth System strengtheningTimely delivery of medicines to target

populationCost savingsCost savings

01 November 2011 Helen Tata, WHO/EMP/MAR

Expectations

• Adequate funding to medicines for priority disease to support distribution of all other categories of medicines

• Stock management tools for medicines from various sources streamlined

• No stock outs in any health facility

• Un-interrupted access to medicines!

01 November 2011 Helen Tata, WHO/EMP/MAR

Questions

• Any questions?

01 November 2011 Helen Tata, WHO/EMP/MAR

• Source: Bergis Schmidt-Ehry, GTZ

Could be feasible in the supply system if..