Medicines Supply Systems strengthening : Challenges

1. Medicines Supply Systems strengthening : Challenges Dr Magali Babaley, Dr Helen Tata, Dr Helene Moller Essential Medicines and Pharmaceutical Policies Department (EMP) TBS 16-20 November 2009

2. Medicines supply systems strengtheningActivities of Medicines supply unit: • Mapping of medicines supply systems Support the Ministry of health to map out all partners/actors involved in medicines procurement and distribution and financial flows. "Who do what and how" Use evidence as basis of advocating strategies to strengthen coordination and alignment of partners involved in the supply system. Countries : Cameroon, Senegal, Rwanda, Burundi, Mali, Congo-Brazzaville, DRC, Ghana, Nigeria, Tanzania and Zambia

3. Medicines supply systems in TANZANIA. 2007 United Republic of Tanzania ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINES CONDOMS CONTRACEPTIVES MEDICAL SUPPLIES GOVERNMENT BILATERAL DONOR MULTILATERAL DONOR NGO/PRIVATE C S S C W H O S I D A N O R A D C I D A UN I TA I D H A V A R D P E P F A R GLOBAL FUND CL I NTON A X I O S P F I Z E R J ICA C D C C O L U M B I A G A V I C U A M M U N I C E F U S A I D W B A B B O T T GOVERNMENT Source Of Funds Procurement Agent/Body C L I N T O N H A V A R D E G P A F A X I O S U N I C E F A B B O T T C U A M M C O L U M B I A U S A I D TEC & CCT MEDICAL STORE C R S S C M S MOH & SW J I C A G A V I CROWN AGENTS T M A P C D C Point of 1st warehousing TEC &CCT HOSPITAL CRS IMA MEDICAL STORE AXIOS COLUMBIA CUAMM HEALTH FACILITY HOSPITAL Point of 2nd warehousing TEC &CCT REGIONAL/DISTRICT VACCINE STORE ZONAL MEDICAL STORE HEALTH FACILITY HOSPITAL Point of Distribution TEC &CCT ZONAL BLOOD SAFETY CENTRE DISTRICT STORE HEALTH FACILITY PRIMARY HEALTH CARE FACILITY HOSPITAL PATIENT

4. Medicines supply systems strengtheningActivities of Medicines supply unit: • In depth assessment of medicines supply systems Support the Ministry of health to carry-out an in-depth assessment of the national medicines supply management system (performance indicators for all the components of the medicines supply management cycle are measured) in order to: • determine strengths and weaknesses at each level of the system (central, regional, peripheral), • Identify gaps in the system and proposed strategies to fill in the gaps. Countries : Cameroon, Senegal, Rwanda, Burundi, Mali, Congo-Brazzaville, DRC, Ghana, Nigeria, Tanzania and Zambia

5. Medicines supply systems strengtheningActivities of Medicines supply unit: In collaboration with partners, regional blocks, collaborating centres etc… to ensure effectiveness, accountability and transparency of procurement and supply management system: • Develop and implement strategies to increase the alignment of aid • Support the implementation of a national coordination mechanism in-country (forecasting, financing, disbursement, monitoring-evaluation, training…) • Support the harmonization and the standardization of the technical and financial procedures for procurement among partners

6. Medicines supply systems strengtheningActivities of Medicines supply unit • Support the implementation of the "Model quality assurance system for procurement agencies" at the national procurement agencies level, including prequalification of suppliers. A standardized tender document for medicines pre-selection has been developed by ACAME (Association of 19 procurement agencies from French speaking African countries). A strategy of pooled medicines prequalification is developing by ACAME • Develop norms, standards and good practices, using an harmonized approach, to support and monitor capacity building and increase transparency • Guidelines for drug donation (revised 1999) : revision in process • The Interagency emergency health kit (2006) : revision in process

7. Improving ACCESS to QUALITY Reproductive Health Essential Medicines and Medical Devices COMPREHENSIVE APPROACH – PATH, WHO RHR, UNFPA • Update of treatment guidelines • Harmonise Essential Medicines Lists, globally and nationally • Ensure access to latest information • Harmonise quality standards for priority items • Prequalification of condoms, IUDs, hormonal contraceptives • Strengthen capacity at country level to procure and supply quality medicines and medical devices

8. Improving ACCESS to QUALITY Reproductive Health Essential Medicines and Medical Devices ACHIEVEMENTS • The Interagency List of Essential Medicines in Reproductive Health published and updated in 2006 • Interagency List of Essential Medical Devices published in 2008  • Working with UNFPA, WHO MPS, UNICEF, World Bank to combine the two lists into one procurement list • Essential Medicines for Reproductive Health: Guiding Principles for their Inclusion on National Medicines Lists • PATH in collaboration with WHO/PSM, UNFPA and Partners, developed a “Tool Kit”, field tested in Malawi, Zambia

9. Improving ACCESS to QUALITY Reproductive Health Essential Medicines and Medical Devices ACHIEVEMENTS • Prequalification (WHO QSM ) - 4th Expression of Interest published, 2 implants, combination injectables added • With UNFPA and key stakeholders • specifications for condoms and IUDs • established a system for prequalifying (8 IUD, 55 condom approved) • WHO/RHR and Partners, the IBP Knowledge Gateway: Web-based resource • "Frequently Asked Questions" • Promote sharing and exchange of knowledge in and among countries by supporting virtual on-line Communities of Practice.

10. Medicines supply systems strengtheningActivities of Medicines supply unit Thank you The Medicines supply team: Helen Tata tatah@who.int Helene Moller mollerh@who.int Magali babaley babaleym@who.int