Procurement of diagnostics: SCMS update on procurement of
standardized laboratory items
WHO AMDS Annual Partners and Stakeholders Meeting
David Jamieson, SCMS Deputy Director, Global Partnerships
May 8, 2013, Geneva.
PEPFAR Implementing Partner
Contents
1. Summary of recent procurement
statistics
2. Recent experience from technical
assistance to harmonize and optimize
diagnostic equipment choices.
2
PEPFAR Implementing Partner
Lab products have become a larger proportion of the total
SCMS procurement since 2009
3
0
50
100
150
200
250
300
350
400
2009 2010 2011 2012
Va
lue
of
De
live
rie
s (U
SD)
Mill
ion
s
Value of SCMS Deliveries by Commodity Type, 2009-2012
ARV - Antiretrovirals - ARV - Antiretrovirals DRUG-Non ARV drugs
HRDT - HIV Rapid Diagnostic Tests LAB - Lab Equipment & Medical Supplies
MC - Male Circumcision Kits Other
PEPFAR Implementing Partner
SCMS sources its commodities worldwide, with the
majority by value sourced from India
4
Asia, 0.9% Canada, 0.1%
Central Africa, 0.4%
Central/South America and Caribbean,
1.3% East Africa,
2.9%
Europe, 16.7%
India, 60.0%
Middle East, 7.5%
Southern Africa, 6.4%
USA, 3.2%
West Africa, 0.6%
Percentage of Total Delivered Value by Region, 2012
PEPFAR Implementing Partner
Over the life of the SCMS project, reagents and analyzers
comprise the majority of the lab commodity value
5
Lab Supplies/Equipment,
$101,378,890
MC Kits, $18,917,559
Test-Other, $5,274,425
Reagents/Analyzers, $183,957,744
HIV Test, $129,841,869
Total Delivered Value by Lab Commodity (USD), SCMS
PEPFAR Implementing Partner
Determine represents by far the majority of HIV Test
kits delivered by SCMS
6
0
5
10
15
20
25
30
35
40
2009 2010 2011 2012
Val
ue
of
Del
iver
ies
(USD
)
Mill
ion
s Delivered Value of HIV RTK by Supplier, 2009-2012
Determine Uni-Gold Bioline Colloidal Gold Stat-pak All other
PEPFAR Implementing Partner
The overall market for reagents and analyzers remains
extremely complex, with FACSCount the largest product
7
FACSCount FACSCount
FACSCount
FACSCount
0
10
20
30
40
50
60
2009 2010 2011 2012
Val
ue
of
Del
iver
ies
(USD
) M
illio
ns
Delivered Value of Reagents/Analyzers by Supplier, 2009-2012
X-Ray
Vitros DT
Vitros 350
UPS
TB
Sysmex
Syphilis
Sharps
Reflotron
QBC
Pregnancy
Pointcare
Pima
Phlebotomy
MGIT
Meningitis
Medonic
MAXM
M2000
Large GloveordersKonelab
Kenza
PEPFAR Implementing Partner
8
Asia, 1.6%
Canada, 0.3% Central Africa, 1.9%
Central/South America and Caribbean,
4.2%
East Africa, 9.1%
Europe, 51.3% India/Pakistan, 1.4%
Middle East, 2.1%
Southern Africa, 17.3%
USA, 8.1%
West Africa, 2.8%
Percentage of Total Delivered Value by Region, 2012
The majority of lab commodity deliveries by value are
sourced from Europe
PEPFAR Implementing Partner
Within lab commodities, reagents and analyzers make up
the largest proportion of SCMS deliveries
9
0
20
40
60
80
100
120
2009 2010 2011 2012
Va
lue
of
Del
ive
ries
(U
SD)
Mill
ion
s Value of Deliveries by Lab commodity, 2009-2012
Lab Supplies/Equipment MC Kits Reagents/Analyzers TEST - HIV Test-Other
PEPFAR Implementing Partner
In 2012, flow cytometry represented nearly 65% of total value
of reagents and analyzers
10
Biochemistry, 12%
Flow Cytometry,
65%
Hematology, 13%
Immuno, 2%
Molecular, 8%
Percentage of value by Reagent/Analyzer Type, 2012
PEPFAR Implementing Partner
Becton Dickinson represents 66% of the total value for flow
cytometry reagents and analyzers
11
Becton Dickinson FACS, 66%
THL, 14%
Partec, 6%
All Other, 15%
Percentage of Value for Flow Cytometry Reagent/Analyzers by Supplier, 2012
PEPFAR Implementing Partner
The number of items purchased more than 20 times per year
has increased since 2009
12
0
1000
2000
3000
4000
5000
6000
2009 2010 2011 2012
Nu
mb
er o
f it
em
s d
eliv
ere
d
Number of Times an Item is Ordered per Year
Number of times individual items were ordered each year, 2009-2012
1 2,9 10,19 20+
PEPFAR Implementing Partner
13
0
10
20
30
40
50
60
70
80
90
100
2009 2010 2011 2012
Val
ue
of
Del
iver
ies
(USD
) M
illio
ns
Number of Times an Item is Ordered per Year
Item value by number of times item ordered each year, 2009-2012
1 2,9 10,19 20+
Value of items purchased more than 20 times purchased per
year has increased significantly since 2009
PEPFAR Implementing Partner
14
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
2009 2010 2011 2012
Nu
mb
er o
f It
ems
Del
iver
ed
Total number of items delivered for items shared by multiple countries, 2009-2012
Unique to One Shared by Two Shared by Three +
The total number of items purchased by three or more
countries each calendar year has also increased
PEPFAR Implementing Partner
The total value for items purchased by three or more countries
during a calendar year has increased since 2009
15
0
20
40
60
80
100
120
2009 2010 2011 2012
Va
lue
of
Del
ive
ries
(U
SD)
Mill
ion
s Total value of Items shared by multiple countries, 2009-2012
Unique to One Country Shared by Two Shared by Three+
PEPFAR Implementing Partner
Recent experience from technical
assistance to harmonize and optimize
diagnostic equipment choices
16
PEPFAR Implementing Partner
Optimization to reduce CD4 costs
• Optimizing laboratory procurement
Selecting and procuring the right product within
the national tiered laboratory system, with an
appropriate throughput and complexity, that is
sustainable within it’s regional and local setting.
• Strategy
• Define the diagnostic coverage
• Compare actual demand to capacity
• Reduce instrument diversity
• Increase utilization to reduce costs
• Evidence based POC integration
17
PEPFAR Implementing Partner
CD4: Finding the best cost/utilization
FACSCount versus FACSCalibur utilization price per test
Instrument Utilization Rate
PEPFAR Implementing Partner
Country A: Service data
Country A Machines % Distribution Lab Level % Utilization Dx Contribution
All Instruments 138 33% 100%
FACSCount 51 37% Level I - Primary outpatient 55% 40%
FACSCount 55 40% Level II - District labs 44% 35%
FACSCount 12 9% Level III - Regional/Provincial Lab 22% 4%
FACSCount 5 4% Level IV - National Reference Lab 53% 4%
FACSCount Total 123 89% 47% 82%
FACSCaliber 0 0% Level I - Primary outpatient 0% 0%
FACSCaliber 3 2% Level II - District labs 7% 2%
FACSCaliber 7 5% Level III - Regional/Provincial Lab 8% 5%
FACSCaliber 5 4% Level IV - National Reference Lab 26% 11%
FACSCaliber Total 15 11% 14% 18%
PEPFAR Implementing Partner
Country B: Service data
Country B Machine #s % Distribution Lab Level % Utilization DXcontribution
All Instruments 105 11% 100%
Guava 30 29% 12% 29%
Cyflow 2 2% 0% 1%
FACSCount Level I - Primary outpatient 0%
FACSCount 11 10% Level II - District labs 7% 7%
FACSCount 51 49% Level III - Regional/Provincial Lab 9% 30%
FACSCount 2 2% Level IV - National Reference Lab 33% 1%
FACSCount Total 64 61% 10% 38%
FACSCaliber Level I - Primary outpatient 0%
FACSCaliber Level II - District labs 0%
FACSCaliber 2 2% Level III - Regional/Provincial Lab 5% 7%
FACSCaliber 7 7% Level IV - National Reference Lab 15% 25%
FACSCaliber Total 9 9% 13% 32%
PEPFAR Implementing Partner
Case study: Ethiopia
• SCMS partnered with USAID and the CDC in a lab
optimization procurement initiative to help the Ethiopian
government maximize donor funding for lab equipment
procurement and distribution
• Analyzed CD4 testing needs by researching the number of
patients served at each site, ART and pre-ART patient targets
and testing trends
• Moved from FACSCalibur machines for lab ART monitoring
sites to less costly FACSCount machines for lower-volume
sites
Saved over $600,000 in the cost of instruments and
reagents within the first year and an additional $100K every
year after
21
PEPFAR Implementing Partner
Eight questions as guide for harmonization
1. Is the diagnostic instrument on the nationally
approved instrument list?
2. Is the request to replace existing old instruments? If
yes, is there an instrument replacement strategy?
3. If these instruments are for new locations, is there an
instrument deployment plan for the proposed
instruments?
4. What is the current estimated diagnostic capacity for
this particular instrument type in country?
22
PEPFAR Implementing Partner
Eight questions as guide for harmonization
5. What is the diagnostic burden at the proposed sites?
Is the instrument selected appropriate, based on
instrument capacity vs. diagnostic demand?
6. Is there suitable infrastructure at the proposed sites -
any additional peripheral needs?
7. Is there expected service delivery expansion at the
proposed sites? (scale up)
8. Have the additional costs of reagents, staff training,
maintenance been considered - what are the funding
sources and estimated costs?
23
PEPFAR Implementing Partner
CD4 opportunities
• Greater efficiency may be established by
maximizing CD4+ instrument utilization rates
• Significant cost savings can be achieved by
maximizing daily testing volumes per
machine.
• Important to develop appropriate instrument
placement strategies before procurement
• Low-throughput point-of-care (POC) CD4+
testing platforms may contribute to lower costs
per test
24
PEPFAR Implementing Partner
Country X: PIMA POC example
• Program expansion driven by PMTCT programs
• No MOH laboratory involvement
• Existing warranties have expired
• Maintenance costs to be negotiated (currently at
$1,200/machine)
25
Overall 2012
Total number of sites 269
Sites with "0" consumption 46
Sites with consumption ≤ 1/day 91
% of sites with 0 or consuming ≤1/day 34%
% of sites with access to referral lab 30%
PEPFAR Implementing Partner
Types of service and maintenance contracts
• Instrument based service and maintenance –
negotiated rate per instrument
• Reagent and service package – negotiated
reagent premium inclusive of service and
maintenance – used with existing machines
or newly purchased instruments
• Reagent Rental/Lease – negotiated reagent
premium inclusive of service and maintenance
and rental costs for instrument
26
PEPFAR Implementing Partner
Existing POC challenges
• Lengthy and unclear introduction/validation
process
• Suboptimal instrument procurements and
long-term planning
• Optimizing existing lab infrastructure
• Evidence based POC integration
• Long-term impact not clearly understood
• Instrument life span
• Maintenance strategy development
• Uptake – lessons learned
27
PEPFAR Implementing Partner
Existing POC challenges
• Limited government, donor, and technical
coordination
• Competing priorities – treatment agenda
(increased access) versus laboratory network
development
• Vendor pressures (misleading)
• Logistics (SDP not lab)
• Procurement, quantification, distribution, and
maintenance
28
PEPFAR Implementing Partner
Takeaways for a national laboratory strategy
• For optimized value and performance central
oversight of all laboratory instruments required
• Effective instrument and vendor management
systems are necessary
• Maintenance and instrument replacement
strategies are needed
• Reductions in instrument diversity
• Leverage data to negotiate contract terms and
establish best fit solutions
• Major opportunities remain for improved value
29
PEPFAR Implementing Partner
30
For more… www.scms.pfscm.org
For www.scms.pfscm.org…
www.scms.pfscm.org
Thank you!
Questions?
Mr. David JAMIESON
Partnership for Supply Chain Management (PFSCM)
1616 N. Ft. Myer Drive, 12th Floor
Arlington, VA 22209 USA
Office: +1.571 227 8669
Cell phone: +1 202 316 4999
Email: [email protected]
2012
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