UNICEF- Update on key activities and plans IPC, 5 th -6 th June. 2014
UNICEF- Update on key activities and plansIPC, 5th-6th June. 2014
Procurement in support of programmes- 2013
Supplies and services for 134 countries and areas
Total procured$2,839
Emergency$127Supplies to 33 countries and areas
Procurement Services$1,363Supplies to 99 countries
Supplier and destination countries
Medicines: 2014 Activities• Procurement strategies to address increasing demand for priority
medicines: ORS/Zinc, amoxicillin DT, gentamicin, CHX, dexamethasone inj, IFA…
• Support work of UNCLSC and Pneumonia and Diarrhoea WG: Amoxi DT ERP, availability of medicines and diagnostics, collaboration to increase sources, country implementation including activities resulting from GF/UNICEF MoU.
• Optimization of kits: iCCM (DRC), Diarrhoea kit, PEP Kit
• Partnerships to ensure availability of pediatric ARVs:IATT Formulary developmentPediatric ARV WGPediatric ARV Procurement Working Group
• Controlled temperature shipments
• Improve internal process and supplier relations to provide optimal service
The market dashboardInspired from UNITAID Market dynamics Dashboard
The Dashboard monitors the market dynamics of more than 50 essential commodities for women and children. It provides a qualitative assessment of the determinants of a healthymarket, including:• Availability• Affordability• Competition• Quality• Acceptability• Delivery• Funding security
http://www.unicef.org/supply/index_70578.html
Published twice a year, aim is to encourage internal and collaborative thinking on ways to address gaps and achieve a more balanced market
2011 2012 20130
2
4
6
8
10
12
250mg DT
Oral Suspension
Trea
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ts o
f 2,5
00 m
g (m
illio
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ORS/Zinc co-pack: 3 LTAs established, first procurement of over 200K packs
Chlohexidine 4% for umbilical cord care: collaboration through UNCLSC to increase number of manufacturers and qualify gel formulations.
Amoxicillin DT: increase in demand and initiation of substitution of suspension
Introduction of optimal products
Kit delivery
2007 2008 2009 2010 2011 2012 2013$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
In PGI value
Ind. Item Stand. Kit CO kit
Majority are health kits
Supply of commodities to manage sexual assault of children and women in the context of emergencies
Challenges• Forecasting the need • Kit design not addressing diversity of situations where it is used (target, skills and care
services)• Repacking of kits at Country Office level to meet needs
• Split up kit contents to distribute to smaller health facilities• Split up blisters/packs to dispense to patients
• Specific needs of children usually not taken care of, e.g. paediatric dosages• Lack of specific Guidance
PEP Children
PEP AdultsWound Care Psychosocial
SupportAssociated Conditions
+ Guidance Documents
Proposed Response (for discussion with partners)
• Easy identification of the necessary items for management of sexual assault• More flexibility in procurement of PEP for children • Holistic response, Clear guidance
Guidelines to be reviewed 2014 (WHO)
Consolidate regimens used
Consolidate formulations
used
• Ensure pediatric ART guidelines are up to date
• Identify regimens and products that can be phased out of formulary (eg. d4T, ddI)
• Review current procurement list for redundancies
• Explore areas for transition to optimal products such as FDC’s and phase out suboptimal or redundant formulations
Partnerships to ensure availability of optimal treatment for HIV in children
Consolidate formulations
used
• Coordinate pediatric ARV procurement amongst partners
• Align both supply and demand to more efficient products.
Interagency Task Team (IATT)/ Pediatric ARV Working Group
Pediatric ARV Procurement Working Group/ Buyer Consortium
Health Technology Centre Essential supplies for Health Programmes
Medical equipment and consumables, diagnostics tests and clinical laboratory equipment
Long Lasting Insecticide treated bed nets ( LLIN’s), Insecticides and Rapid Tests
Malaria Prevention and Diagnostics
Medical Devices and Laboratory
Cold ChainCold chain equipment, refrigerators, waste disposal, injection safety devices
Maternal and New born Health IssuesINNOVATION
FOCUS
Injection safety devices, waste disposal.Immunisation Devices
Health Technology: 2014 Activities
• Optimization strategies defined for Health Technologies Supply Chains,.i.e. Performance indicators, Forecasting, Shipments optimization and Total Landed Cost options
• Quality policies prepared, harmonization with key partners (IVD, High Risk Medical Devices, mapping high-risk products that could be those correspond to class IIB and III of European MDD and develop its risk mitigation protocol).
• Innovation – ARIDA project ( pneumonia diagnostics ), in collaboration with WHO, Malaria Consortium, BMGF
• Partnerships LLIN procurement – GF, UNDP, DfiD, PMI,• Partnerships POC technology – UNITAID, CHAI, 7 countries
• Ensure a cold chain for all TTSPP …. • Scale up of old vaccines …….• Scale up of new vaccines ……• Scale up of new versions such as IPV ….• Healthy market for innovative cold chain equipment• Supply Chain integration – Oxytocin, Insulin• Cold chains for lab samples, blood banks, test kits …
• Immunization devices available for all• Optimizing immunization shipments/cost per device delivered • Untangling the web of quality requirements • Waste management for immunization, diagnostic testing ?• Aligning with WHO PQS for injection safety devices procurement and
providing feedback on evaluation protocols and technical specifications• Contribute to the updating of WHO guideline of injection safety.
2014 Activities
UNICEF-CHAI Project: Accelerate Access to Innovative Point of Care (PoC) HIV Diagnostics: CD4, Early Infant Diagnosis, and Viral Load
Funded by UNITAID
Targets: 7 focus countries Zimbabwe, Tanzania, Kenya, Ethiopia, Uganda, Mozambique, Malawi
Programmatic and Supply coverage:• CD4 testing, which is used for staging and monitoring HIV patients prior to initiation onto antiretroviral
therapy (ART).• Early Infant Diagnosis (EID) testing for infants less than 18 months of age (this technology can be performed
on viral load platforms as well).• Viral Load (VL) testing, which is mainly used for monitoring HIV patients following initiation to ART
UNICEF Quality Policy for procurement of IVDs consulted with WHO, CDC, MSF and fully harmonized with Global Fund.
Phase 1 Nov 2012-December June 2014 US$ 20million
Phase 2a Project proposal approved and MOU currently under negotiations Period July 2014 –Dec 2015 US$ 35million
Phase2b Project ending 2018 funding remains subject to UNITAID board approval
Source: UNIICEF Supply Division
Immunization SuppliesVaccinesBCG , DTP, TT/Td/DT, Measles containing, OPV, HepB, YF, DTP-HepB, DTP-HepB/Hib, DTP/Hib, Hib, MR, Meningitis, MMR, PCV, RV IPV, HPV etc.
Safe Injection equipment
Cold Chain Equipment
Vaccines Supplies: US$ 1, 285 million 2.79 billion doses
2,185 shipments
2013
Countries UNICEF procures on behalf of
Full schedule
Partial schedule
UNICEF has a key role in vaccine procurement, procuring immunization supplies on behalf of around 100 countries annually
Source UNICEF Supply Division
Vaccines: 2014 Activities*
Support to countries / on-going operations: Coordination internally and support to countries for high number of new vaccine introductions (79 new vaccine introductions (13 IPV) in GAVI supported countries in 2014; 123 (59 IPV) in 2015) , and continuing programmes; specific innovative projects follow up: VAR, Visual Vaccines; KPIs
Continued/increased support to MICs and GAVI graduating countries through procurement practitioners forum to support countries moving to self-procurement, review VII and other financing mechanisms, engagement with partners and countries, MIC tender for new vaccines
Polio eradication – IPV tender concluded in Q1 2014 and operationalized during the year; OPV supply and demand planning for vaccines and funding; strategy for type 2 withdrawal
Timely completion of tender activities and additional awards (JE, Mening, penta, HPV, PCV, Rota); develop consolidated strategy for achieving price goals
Provide more useful and accessible information for countries, manufacturers and partners (eg, update website, pricing data, procurement contexts, market updates)
Continue to strengthen supplier relationships, including at least 1 visit to each of the top 10 suppliers and visit to China
Follow-up with DRC and Nigeria on supply chain optimization projects Coordination with partners, including GAVI, BMGF, WHO, GPEI, etc
*Key activities, not all inclusive
Virus detection & interruption
Last wild polio case Certification
RI strengthening & OPV withdrawal
Containment & certification
Introduce IPV
Wild virus interruption
Outbreak response (esp. cVDPVs)
RI strengthening &OPV2 pre-requisites
OPV2withdrawal
Legacy Planning
Finalize long-term containment plans
Complete containment & certification globally
Consultation & strategic plan
Initiate implementation of legacy plan
Last OPV2 useEndgame
Major Objectives 2013 2014 2015 2016 2017 2018
Source: WHO
WHA endorsement in 2013 of Endgame Strategy require IPV introductions in 123 countries globally within 20 months
Sufficient supply secured to meet projected demand through UNICEF at affordable prices, but planning needed
• 20 countries requiring supply in 2014, with 7 planned introductions• A total of 75 countries to introduce in this period, and two continuing
countries• 20 LMIC/MIC countries to continue or introduce sourcing through UNICEF• Flexibility required with regards to product preferences, number of shipments
per year, delivery of buffer stocks, month of introduction, registration requirements
UNICEF support to the tOPV/bOPV switch
• Global synchronized switch from tOPV to bOPV requires careful planning at global and country level
• Engagement with partners, countries, and industry to ensure smooth transition and no shortages of any product
• Protocols and strategies under development for operationalization of a switch
Vaccines stock monitoring and projection tool…
ViVa (Visibility for Vaccines)
…Enabling identification and communication of upcoming potential constraints linked to supply through graphs.
From May to August 2014:Pilot phase with EPI in DRC, Niger and Senegal.Next:Feedback interest survey and decision on continuity and scaling-up.
Supporting Middle Income Countries to Access New Vaccines
For additional information on UNICEF’s MIC New Vaccine Procurement Initiative see http://www.unicef.org/supply/index_67101.html
• UNICEF Vaccine Procurement Practitioners Forum (Q4 2014)
• EURO Inter-country Vaccine Procurement Workshop 2013
• Transition planning for GAVI graduating countries
• Vaccine Procurement System Assessments
•Coordination of MIC support with global/regional partner activities:
• Global MIC Task Force• Vaccine Product, Price and
Procurement (V3P) Project• EMRO Pooled Vaccine
Procurement (PVP) initiative• GAVI support for access to
appropriate pricing for graduates & other LMICs
•Sharing of knowledge of (i) the vaccine market, (ii) Vaccine Security and underlying elements of forecasting, funding and appropriate contracting, (iii) vaccine procurement.
• Issue market analyses.• Publish Reference Prices to
serve as a benchmark for self-procuring MICs.
• Aggregate MIC demand forecasts for new vaccines to provide better visibility to industry.
• Pool MICs’ vaccine procurement to improve demand predictability, reduce transaction costs and improve pricing.
MIC Pooled Procurement
Information Access
Capacity BuildingTechnical
Assistance
Strategic Partnerships
Some countries where we are already working with the govt to strengthen the supply chain and develop capacity
DRCImmunization and
Essential Medicines
NigeriaImmunization
Sierra LeoneAll Health Commodities
KenyaEssential medicines
ZambiaEssential Medicines
AfghanistanImmunization
MadagascarEssential Medicines
MyanmarAll Health Commodities
EritreaEducation
EthiopiaEssential Medicines
NigerEssential Medicines and
Nutrition
TanzaniaEssential Medicines
Cote d’IvoireBednets
MalawiAll Health Commodities
MozambiqueAll Health Commodities
2014 Activities
Support to development and implementation of national supply chain strategies
Global networking and collaboration (GAVI, Global Fund, RBM etc.) Communication strategy and advocacy tools to raise awareness
internally and externally Research to increase understanding of national supply chain models
and promising practices Guidelines for capacity development with a supply chain toolkit for
COs and partners (including a SC health check and performance monitoring tools)
Roster of consultants for technical assistance Support development of the supply community technical skills
framework and professional development plan Develop the Global Learning Centre Strategy including the initial
curriculum (starting with vaccines, bednets and nutrition) South to south exchanges
What does success look like in 2017? Increased use of national supply chains, from determination of need through to
delivery to the last mile, across all programmes and including monitoring
Increased number of countries actively implementing national supply chain strategies, led by government
Strong networks created with increased collaboration, sharing and co-ordination in capacity development and supply chain systems strengthening initiatives at global, regional and country level
At least 20 government supply chains strengthened and optimized for targeted products