Multi-country study ondrug supply and distribution activities of faith-based supply organizationsin sub-Saharan African countries, 2003

Sophie Logez / Marthe Everard EDM/PAR

Promoting use of effective medicines supply strategies in Africa

Outline

Objectives Methodology Results Next step

Objectives of the MC Study

Document experiences and practices of FB DSOs

Strengthen EPN’s technical capacity by evaluating drug supply systems existing in the Network

Strengthen collaboration between WHO/EDM and EPN

Outline

Objectives Methodology Results Next step

Methodology

Sample: 16 DSOs in 11 African countries reviewed (Feb-Dec 2003)

Data collection tool: structured questionnaires (4)

Data collection: Paired country assessments by FB DSO staff

Data management: WHO database

Joint analysis of results with all participants (EPN/WHO feedback meeting, June 2004)

Nigeria

Gha

na

Congo DR

Kenya

Tanzania

ZambiaMalawi

South Africa

Rwanda

GhanaNigeriaTanzaniaKenyaUgandaMalawiZambiaS AfricaCameroonRwandaDR Congo

Methodology

Selected countries

Issues Investigated

Role, functions and perspectives of DSOs

Procurement management Founding Bodies's opinion Government’s view Customer's view

Methodology

Outline

Objectives Methodology Results Next step

Governance and Administration

Founding bodies expectations Providing medicines to FB facilities Generating funding to support other projects

Type of boards 44% elected (7DSOs) 38% nominated (6DSOs) 13% committees (2DSOs) 1 DSO with no board

Board meeting: 4times a year (10DSOs) Twice a year (4DSOs) Once a year (1DSO)

Results

Infrastructure

13 DSOs have storage capacity

13 DSOs have cold storage capacity

5 DSOs have regional stores

16 DSOs have necessary utilities

2 DSOs do not have regular email

Results

Services provided by the 16 DSOs

Results

0 2 4 6 8 10 12 14 16

Procurement

Storage

Training

Distribution

Production

Maintenance

IEC materials

Number of DSOs offering the service

Customers Served

Type of customers DSOs (No) DSOs (%)

Any health care provider 5 31Only not-for-profit health facilities 3 19Only faith-based health facilities 2 13Only Christian members 4 25Only same denomination 2 13

Results

Procurement: Drug Selection

By whom? Drug committees: 7 DSOs (44%) DSO's procurement team: 5 DSOs (31%) Individual decision by DSO: 2 DSOs (13%) Customers themselves: 2 DSOs (13%)

Selection principles 14 DSOs select medicines based on EDL 5 DSOs also supply medicines out of EDL 3 DSOs use kit systems

Drug donations 5 DSOs (38%) received donations for free

distribution

Results

Drug Procurement Methods

Procurement (16DSOs)

DSOs(No.)

DSOs(%)

Direct local purchase 7 44

Direct international purchase

6 38

Restricted tender 6 38

Negotiated tender 4 25

International competitive bidding

1 6

3 DSOs buy exclusively locally, 1 DSO exclusively internationally

Results

Price information

Results

0 1 2 3 4 5 6 7 8 9 10

WHO/AFRO drug price indicator

International drug price indicator

Local price indicators

Government price lists

Company price lists

Number of DSOs (13 DSOs)

Criteria for prequalification of suppliers

Results

0 2 4 6 8 10 12

Product quality

Price competitiveness

Delivery time

Registration status

Sole supplier

Suppliers credibility

Number of DSOs (11 DSOs)

Quality Assurance: SOPs for 7 DSOs

Results

0 1 2 3 4 5 6 7

Procurement

Pricing

Storage and distribution

Quantification

Supplier selection

Quality control for procured items

Tender Process

Number of DSOs (7 DSOs)

Human Resources

13 DSOs employed at least one pharmacist (up to 6)

13 DSOs have staff policy

All 16 DSOs use selection committees for recruitment

15 DSOs have staff wages higher than public sector

Wide range of pharmacist annual wages in EPN (from US$2,400 to US$13,450)

Results

Donor Support

12 DSOs reported receiving donor support

Types of donor support DSOs (No) DSOs(%)

Financial support 9 75

Training/fellowship support

9 75

Personnel support 8 67

Material support 7 58

9 DSOs received support from FBOs in Europe and the USAand some from bilateral agencies (USAID, KfW and DfID)

Results

Factors Affecting DSOs Operations

External factors economic situation political situation poverty of population no tax exemption for

imported medicines

Internal factors inadequate financing drug donations lack of qualified staff

for management and activities

reluctance to change mentality

Results

Governments’ view

Acknowledge great contribution of FB DSOs to national drug supply system

Lack of formal reporting/communication

Lack of formal collaboration Perception of governments:

quality of medicines supplied by FB DSOs questioned

distribution of donated medicines not always found appropriate

Results

Customers’ view

Good quality of medicines Medicines supplied

quantities (50 - 75% of needs met) range of items (to be increased)

Need for technical assistance regular supervision training (drug management/RDU)

Better communication/relation

Results

Future Perspectives (1)

Objectives for 15 DSOs: Increase number of customers: 12DSOs

(80%) Improve delivery services for

customers: 7DSOs (47%) Collaborate with other DSOs: 7DSOs

(47%)

Results

Future Perspectives (2)

15 DSOs (94%) planning to scale up of their activities

Activities to increase competitiveness (15DSOs)

DSOs (No.)

DSOs (%)

More competitive prices 11 85

Improved delivery time 9 69

Better customer services 7 54

Provision of extra services 7 54

Improved range of medicines 6 46

Concentration on selected customer needs

5 38

Results

Outline

Objectives Methodology Results Next step

Next step: Feedback meeting June 2004

Recommendations drafted Quality assurance (SOPs) Sustainability of DSOs (financial/organizational) Training (sharing tools) Procurement and storage capacity Collaboration (DSOs/EPN) Distribution service (feasibility study)

Activities identified for DSOs/EPN/wider sector

EPN/WHO Feedback meeting, Nairobi, Kenya, June 2004