WORLD HEALTH ORGANIZATIONTHE WORLD BANK

ARV and related drugs

Supply Chain Management

AIDS Campaign Team for Africa (ACTafrica)

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Africa Region HIV/AIDS ConsultationAddis Ababa, December 14-18 2004

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Presentation Outline

Key steps of Supply Chain Management/Logistics What causes delays at each step What can we do Management weaknesses Financing The way forward

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Revisiting key steps

Steps Emphasis

Product Selection Patents, quality, availability, affordability

Forecasting Full or non-full supply, estimates, absorptive capacity

Procurement Planning, procedures, acquiring

Warehousing Shelf life, storage capacity

Inventory Mgmt. Stock levels, critical monitoring

Transportation Timely distribution, various means

Serving clients Improve health outcomes

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What cause delays?

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What causes delays? Product

SelectionLack of clinical protocols, guidelines or policies.

Forecasting Lack of data on consumption patterns or stock levels or both (M&E: LMIS+Surveillance+…).

Procurement - Poor specifications - Flexibilities

- Incomplete projections - Opportunities

- Unclear procedures Warehousing

or Storing- Storage staff not informed of the procurement in the pipeline.

- Lack of guidelines.

- Sheer volume: new thinking on options

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What causes delays?

Managing Inventory

- Lack of computerized system

- Lack of stock cards Transportation - Unclear transport procedures.

- Transported as ‘secondary’ item as part of other programs.

- Transport mgmt on an ad-hoc basis. Serving clients Lack of availability of commodities;

Lack of procedures for re-supplyLack of sufficient budget allocations (capacity strengthening)

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What can we do?

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What can we do? Product Sel. Use WHO guidelines to develop protocols.

Forecasting - Develop forecast based on the information available, (# of cases, service absorptive capacity).

- Full supply vs non-full supply?

- Install a LMIS as soon as possible

- Test and recommend forecasting software Procure-

ment- Use WHO pre-qualified suppliers (Clinton Foundation) New challenges?!?!

- Outline procurement process.

- Use flexible purchasing options.

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What can we do? Warehousing

or Storing- Need for warehousing (?)

- Outline communication between proc. and storage staff.

- Develop a procedures manual, outlining storage guidelines.

Managing Inventory

Outline the system and inventory management procedures. Daily stock management (Automation is a need)

Transportation Develop a transport management plan Serving clients Monitor stock outs at Service Delivery

Points.

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Management Weaknesses

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Creating an effective and efficient Team Work among Ministry of Health National HIV/AIDS Councils and/or CCMs Drug Regulatory Authority / National Laboratory Ministries of Trade/Commerce and justice/legal National Tender Boards NGOs and Civil Society Organizations Donors and various agencies

Harmonized procedures and coordinated planning

Management Weaknesses

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Management Weaknesses

Lack of: Dedicated fulltime staff. Qualifications to plan and manage logistics. Need for a Logistics champion. Clear job descriptions. Necessary tools. Clearer Procedure Manuals. Encouragement and empowering staff. Performance measures for various functions. Monitoring and strengthening. Supervision (follow-up).

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Financing

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Financing

Estimated US $2.7 billion committed for HIV/AIDS to Sub-Saharan Africa by the World Bank and the Global Fund.

(Commitment = Agreement signed with the governments)

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Financing Coordinate the available financing from all sources

(GFATM, MAP, Bilateral, Others). Establish policies to maintain funding for commodities as

well as for logistics management functions. Adjust program targets if the financing is not available for

the commodities or the supply chain functions. Ensure that the logistic costs are funded as part of the

program. Start establishing a long-term plan for future financing of

the programs. (Advance donor commitment should not be a pre-requisite in estimating future requirements).

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Financing Available financing for PSMP

Faculty, materials, rollout expenses Bank-Netherlands Partnership Program (BNPP) Canadian International Development Agency (CIDA) UNAIDS Budgeted Workplan (UBW) World Bank Training Budget (for Africa region) Nearly $1.0million raisedCountry participants Multi-Country HIV/AIDS Program (MAP) funds at the country

level Global Fund financing Bilateral donors and development partners

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The Way Forward

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The way forwardFacts

~6,000 deaths per day in Sub-Saharan Africa due to AIDS~8,000 new infections every day

ChallengeShall we continue to do the business as usual?

A Bureaucrat or a Warrior mentality against AIDS?

ApproachUse “exceptional” measures

No time for conventional approach

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The way forward Keep the objectives of the Three Ones in focus

One National framework One Institution One M&E system

Use exceptional measures They are expensive, but what is our priority? Contract out routine and mechanical tasks Learn by doing and adapt quickly (flexible MAP

design)

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The way forward Need for a coordinated effort

One national plan agreed by all partners Harmonized procedures and reporting Regional knowledge sharing Resources sharing Joint reviews and follow-ups

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The way forward A comprehensive capacity building program on ARV &

Related Supplies Procurement and Supply Chain Management Program (PSMP) Addis Ababa (Francophone) - Feb 2005 Tanzania (Anglophone), Nigeria - Apr, May 2005 …and so on during 2005

PSMP Phase 1: Training of Trainers (TOT) in all countries

PSMP Phase 2: In-Country rollout by a national institution or a consortium of institutions and local partners (including refresher courses).

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The way forward PSMPs will be Global training events financed by The Bank,

Dutch, Canadians, WHO (TA), UNAIDS (for 2005) Will improve country’s overall planning and management

capacity Country level Core Team Technical Guidelines and Training modules available A coordinated effort by development partners – (less

confusion for country teams)

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The way forward TOT to target:

Ministry of Health Ministry of Trade/Commerce Law/justice/Patent National Pharmacist National HIV/AIDS Council/Commission/Secretariat Principal Recipient