Helen Tata: WHO-TBS 4 November 20101 |

WHO Technical Briefing seminarGeneva, 01 – 05 November 2010.

Access Framework & Challenges in Medicines Supply Systems

Mrs Helen Tata (WHO/EMP)

WHO Technical Briefing seminarGeneva, 01 – 05 November 2010.

Access Framework & Challenges in Medicines Supply Systems

Mrs Helen Tata (WHO/EMP)

Ensuring access to essential medicines - framework for collective action

Ensuring access to essential medicines - framework for collective action

ACCESS

1. Rationalselection & use

2. Affordableprices

3. Sustainablefinancing

4. Reliablehealth systems

Helen Tata: WHO-TBS 4 November 20103 |

Helen Tata: WHO-TBS 4 November 20104 |

Assessment of medicines supply systemsAssessment of medicines supply systems

2007 AFRO/EDM and HQ/EMP developed tools to support countries in this activity

1st stage – Map partners supporting medicines procurement and distribution– Financial flows– Warehousing– Distribution

2nd stage

Look at issues around the medicines supply management cycle:– Selection– Procurement– Storage/stock management– Distribution– Financing– M & E

Helen Tata: WHO-TBS 4 November 20105 |

Race to save livesRace to save lives

The rush

Helen Tata: WHO-TBS 4 November 20106 |

Source: Bergis Schmidt-Ehry, GTZ

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

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

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

Partner store within national storePartner store within national store

National Medicines storesNational Medicines stores

Helen Tata: WHO-TBS 4 November 201011 |

Challenges (1)

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

still exists

Quantification: – CMS not always involved in forecasting/procurement– No coordination in quantification between MoH, CMS,

partners resulting in:• stock-outs or• overstocking• expired products

– Inadequate logistic information system

Helen Tata: WHO-TBS 4 November 201012 |

Challenges (2)Challenges (2)

Procurement:

– Managed by various partners present in country.

– National system hardly 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.

Helen Tata: WHO-TBS 4 November 201013 |

Challenges (3)Challenges (3)

Financing: – Funds available mainly for 3 disease programs – Other areas under funded – Financial figures not always available– Logistic support is under- funded

Monitoring-Evaluation:– Each program may have a stand alone M&E – Different reporting tools– Burden of work for scare human resource at

periphery high

Helen Tata: WHO-TBS 4 November 201014 |

What can we do?What can we do?

Helen Tata: WHO-TBS 4 November 201015 |

Source: Bergis Schmidt-Ehry, GTZ

Helen Tata: WHO-TBS 4 November 201016 |

Source: Bergis Schmidt-Ehry, GTZ

Helen Tata: WHO-TBS 4 November 201017 |

BenefitsBenefits

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

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

populationCost savingsCost savings

Helen Tata: WHO-TBS 4 November 201018 |

ExpectationsExpectations

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!

Helen Tata: WHO-TBS 4 November 201019 |

RecapRecap

Coordination, dialogue, information sharingCoordination, dialogue, information sharingJoint M & E and reportingJoint M & E and reportingReduced workloadReduced workloadHealth System strengtheningTimely delivery of medicines to target

populationCost savingsCost savings

Helen Tata: WHO-TBS 4 November 201020 |

Source: Bergis Schmidt-Ehry, GTZ