A system framework for access to medicines – Implications for research and policy
Access Framework & Challenges in Medicines Supply Systems
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Transcript of Access Framework & Challenges in Medicines Supply Systems
Access Framework & Challenges in Medicines Supply Systems
WHO Technical Briefing seminarGeneva, 31 Oct– 04 November 2011.
Richard Laing (WHO/EMP/MPC)With materials developed by Helen Tata
Access Framework & Challenges in Medicines Supply Systems
WHO Technical Briefing seminarGeneva, 31 Oct– 04 November 2011.
Richard Laing (WHO/EMP/MPC)With materials developed by Helen Tata
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Ensuring access to essential medicines - framework for collective action
1. Rationalselection and use
4. Reliablehealth and supply
systems
2. Affordableprices
3. Sustainablefinancing
ACCESS
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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
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Assessment tools• WHO/AFRO and EMP developed tools
to support countries' assessment
• Two sets of questionnaires developed:
1. To map medicines financial flows & distribution
2. To assess medicines supply system around areas of medicines management cycle.
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Mapping Results
Source: Bergis Schmidt-Ehry, GTZ 5
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
UNITAID
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
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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
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?)
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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.
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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 10
What can be done?
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• Source: Bergis Schmidt-Ehry, GTZ
How feasible in the supply system?
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Benefits of coordinated supply
Platform for dialogue, information sharing and Platform for dialogue, information sharing and coordinationcoordination
Joint M & E and reportingJoint M & E and reportingReduced workloadReduced workloadHealth System strengtheningTimely delivery of medicines to target populationCost savingsCost savings
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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!
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• Source: Bergis Schmidt-Ehry, GTZ
Could be feasible in the supply system if..
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