Ensuring access to essential medicines - framework for collective action

1. WHO Technical Briefing seminarGeneva, 31 Oct– 04 November 2011. Access Framework & Challenges in Medicines Supply SystemsMrs Helen Tata (WHO/EMP) Helen Tata, WHO/EMP/MAR

2. 1. Rationalselection and use 3. Sustainablefinancing ACCESS 4. Reliable health and supply systems 2. Affordableprices Ensuring access to essential medicines - framework for collective action Helen Tata, WHO/EMP/MAR

3. Pharmaceutical Supply system and access to medicines Architecture Availability Affordability Adoption Access Adapted from Frost and Reich, 2008 Helen Tata, WHO/EMP/MAR

4. Frost and Reich Framework • Components include: • Architecture: systems, structures, relationships that coordinate the remaining three e.g – human resources, regulation, donor coordination; • Availability: activities that lead to medicines availability including manufacturing, forecasting, procurement, distribution and delivery; • Affordability: affordability across the supply system from government to end user; and • Adoption: processes that influence the demand for medicines, prescribing and use of medicines. Helen Tata, WHO/EMP/MAR

5. Assessment of medicines supply systems • In 2007 selected countries in AFRO decided to assess the functioning their country architecture • They had as objectives to: • map financial flows for in-country medicines procurement and distribution • provide an overview of all stakeholders involved in in-country medicines procurement and distribution • present a synopsis of in-country medicines procurement and distribution pathway • review strengths and weaknesses of existing in-country medicines supply management system Helen Tata, WHO/EMP/MAR

6. Assessment tools • WHO/AFRO and EMP developed tools to support countries' assessment • Two sets of questionnaires developed: • To map medicines financial flows & distribution • To assess medicines supply system around areas of medicines management cycle. Helen Tata, WHO/EMP/MAR

7. Mapping Results • Source: Bergis Schmidt-Ehry, GTZ Helen Tata, WHO/EMP/MAR

8. 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 GLOBAL FUND C O L U M B I A 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 CL I NTON A X I O S P F I Z E R J ICA C D C 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 REGIONAL/DISTRICT VACCINE STORE TEC &CCT ZONAL MEDICAL STORE HEALTH FACILITY HOSPITAL TEC &CCT Point of Distribution ZONAL BLOOD SAFETY CENTRE DISTRICT STORE Helen Tata, WHO/EMP/MAR HEALTH FACILITY PRIMARY HEALTH CARE FACILITY HOSPITAL PATIENT

9. Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007 République du Burundi Ministère de la Santé Publique MEDICAMENTS ESSENTIELS ARVs PALUDISME TB IO ARVs Ped REACTIFS sécurité du sang (+ test HIV) VACCINS Préservatifs Contraceptifs Dispositifs Médicaux Etat Bailleurs bilatéraux Bailleurs multilatéraux ONG/Privé C A M E B U D F I D UE CL I NTON UN I TA I D GDF O M S U N I C E F MS F A C F PDM C I C R B M GTZ C E P B U U S A I D G V C G A V I C T B P S I C O R D A I D I PPF K F W C O N C E R N E T A T F N U A P FONDS MONDIAL Sources de Financement P N L T C A M E B U SEP/ CNLS G D F OM S M S F A C F P DM C I C R SEP/ CNLS G T Z C E P B U G V C C T B P S I C O R D A I D F N U A P IPPF G F A C O N C E R N C L I N T O N I P A U N I C E F Structure d'appro- visionnement 1er point de stockage MSF ACF PNLO CICR GVC CAMEBU PNLT PEV IMC CEPBU PSI ABUBEF PNSR CONCERN CORDAID 2ème point de stockage PNSR HÔPITAUX CNTS IMC ACF PRISON GVC CDS CPLS Site de prise en charge CDV BPS Grossiste Privé CORDAID Structure dispensatrice BPS CPLS Helen Tata, WHO/EMP/MAR CDV Site de prise en charge SNT/CNT CDT/CT CDS Détaillants COCOLS PATIENT

10. Supply system challenges (1) • Selection: • Supply outside the EML/STG still exists • Procurement of non registered medicines in countries still exists • Quantification: • CMS rarely involved in forecasting/procurement • Lack of coordination in planning between MoH/CMS and all partners results in stock-outs, shortages, overstocking and expired products • Adequate logistic information system not in place (due to the complexity of the system?)

11. Challenges(2) • Procurement: • Managed by various partners present in country. • National system hardly in 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/EMP/MAR

12. Challenges(3)‏ Financing: • Funds available mainly for 3 disease programs • Other areas under funded (e.g. NCD etc) • Financial figures not always available • Logistic support is under- funded Monitoring-Evaluation: • Each program may have a stand alone M&E • Different reporting tools • High burden of work for scare human resources at periphery Helen Tata, WHO/EMP/MAR

13. What can be done? Helen Tata, WHO/EMP/MAR

14. How feasible in the supply system? • Source: Bergis Schmidt-Ehry, GTZ Helen Tata, WHO/EMP/MAR

15. Benefits of coordinated supply • Platform for dialogue, information sharing and coordination • Joint M & E and reporting • Reduced workload • Health System strengthening • Timely delivery of medicines to target population • Cost savings Helen Tata, WHO/EMP/MAR

16. Expectations • 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/EMP/MAR

17. Questions • Any questions? Helen Tata, WHO/EMP/MAR

18. Could be feasible in the supply system if.. • Source: Bergis Schmidt-Ehry, GTZ Helen Tata, WHO/EMP/MAR