Quantification of Antimalarials

PSM WorkshopNairobi, Kenya

February 21, 2006

Presentation Outline

Introduction/definition

Quantification concepts

Quantification methods

Assumptions and special considerations for quantifying antimalarials

The Procurement CycleReview Medicine

SelectionsDetermine Quantities

Reconcile Needs and Funds

Choose Procurement Method

Locate and Select Suppliers

Specify Contract Terms

Monitor Order Status

Receive and Check Medicines

Make Payment

Distribute Medicines

Collect Consumption Information

Introduction/Definitions

Quantification is the process used “to determine the quantity” or “to express a property that is measurable”

Quantification of antimalarials involves estimating how much of a specific item is needed and what financial means are required to obtain it

Effect of Good Quantification

Consistent availability of supplies (no stockouts)

No over- or understocking

Adequate medicines and supplies available to service providers

Easy management of stock

Rational prescribing and use of supplies

Fulfillment of demand

Fewer expired products and less wastage

Rational adjustment to budgetary constraints

Symptoms of Poor Quantification

Chronic and widespread shortages

Surpluses

Inequity of supply

Inadequate cost-effectiveness

Irrational adjustment to budgetary constraints

Irrational, ineffective prescribing

Suppression or distortion of demand

Inability to respond to increased supply (e.g.epidemics)

Targets for medicines

Disp/CHW

Health Centers

Secondary Hospitals

Reference Hospitals

Private Sector

National Level

Global Level

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Illustration of Concepts of Quantification

Procurement interval

Delivery time

Buffer stock

Quantity of antimalarials required

Starting point

Actual need

Quantification Methods

Consumption

Morbidity

Adjusted consumption

Service-level extrapolation

Consumption Method

The consumption-based method uses historical data on the use or consumption of medicines in the past to calculate the quantities of medicines that will be needed in the future

Morbidity Method

Uses data on diseases and the frequency of their occurrence in the population (incidence or prevalence), or the frequency of their presentation for treatment

Forecasts the quantity of medicines needed for the treatment of specific diseases, based on projections of the incidence of those diseases

Uses standard treatment guidelines (STGs) to project medicine needs

Best approach for justifying a budget request

Adjusted-Consumption Method

The adjusted-consumption method uses data on disease incidence, medicine consumption or use, and/or medicine expenditures from a “standard” supply system and extrapolates the consumption or use rates to the target supply system, based on population coverage or service level to be provided.

The area from which the data are taken must be comparable in terms of morbidity, types of facilities, and prescribing habits.

Service-Level Extrapolation

Service-level projection of budget requirements uses the average medical supply procurement cost per attendance or bed-day in different types of health facilities.

It uses a standard or comparable system from which data can be used to project medicine costs in similar types of facilities in the target system.

Comparison of Methods

Limitations of Methods

Both consumption-based and morbidity-based methods rely on data from the public system and do not take into account potential increases in demand where the public sector is underused (for example, because of ineffective medicines or poor availability of medicines or services).

Assumptions for Quantification

Incidence of fevers that are treated as malaria

Population and age groups vs. age-related doses

Public health facility use

Assumed losses caused by loss, expiration, or diversion

Lead times, safety stock

Percentage of treatment failure requiring second-line treatment

Percentage of case progression to severe malaria

Special Considerations for Quantifying Antimalarial Commodities Preferred methods

Morbidity, particularly for new treatments Consumption (if accurate data are available)

Population or conditions to treat Endemic areas, epidemics, refugee populations Women likely to become pregnant Children < 5 years old Depends on breakdown Children > 5 years old of dosage schedules

Special Considerations for Quantifying Antimalarial Commodities (2) Population or conditions to treat?

Uncomplicated malaria First-line treatment Second-line treatment

Severe malaria IPT RDTs Insecticide-treated nets Other

Population Need to adjust for growth

Peculiarities of ACTs ACTs

Short shelf life (24 months); ordering cycle (usually 12 months) may have to be adjusted to ensure stocks do not expire before used

Flexible delivery schedule may be required Highly effective, may affect the quantity of second-line

treatments required because treatment failures are fewer

First-line treatment failures do not always receive second-line treatment immediately

Little experience with use or quantification

High cost

Peculiarities of ACTs (2) Higher chance of leakage Lack of availability in private sector may affect

use of public sector ACTs are new products; imperfect market

Supply Supply and demand forces have not reached an equilibrium

price

Few manufacturers

Few prequalified suppliers

Capacity of manufacturers to meet demand for ACTs

Peculiarities of ACTs (3) Demand

Financing Major purchasers mainly using donor funding Public and not-for-profit sector demand is increasing relative

to private sector demand Variable user “demand” for, prescribing and use of,

and response to ACTs Inaccurate forecasting leading to insufficient

production? Lack of flexibility to increase production to meet short-

term needs Lack of incentives to manufacture with limited

guaranteed markets

Peculiarities of ACTs (4) Public sector is likely to continue be the main market for

ACTs for most people in the short term

GFATM established to address some of the usual concerns about donor financing; however Delays in approval of Global Fund proposals

Delays in disbursement of funds

Need to ensure supply through continued demand

Accurate forecasting needed

Quantification Tools Available

Quantimed (MSH)

Antimalarial Cost Estimation Tool (WHO)

Other