1. ADDRESSING PHARMACEUTICAL SUPPLY CHAIN NEEDS PRESENTATION TO HEALTH DONOR GROUP MEETING 8 July 2009

2. Pharmaceutical Supply Chain International and national health authorities (regulation, management, policy, HR etc) Pharmaceutical entities (storage, distribution etc) Use (dispensing, patient etc) Pharmaceutical industry (production, R&D etc)

3. Components of supply chain in Malawi MOH, WHO, GFATM, other DPs etc Industry (4x pharmaceutical manufacturers, 2x RUTF manufacturers, distributors etc) NGOs (health facilities, support programs etc) Public health facilities (hospitals, health centers etc) Private sector (pharmacies, medicines vendors, clinics etc) CMS PMPB Users

4. Pharmaceutical Services Professional patient care and availability and management of supplies important as disease management often incomplete without these services Health budgets (low and middle income countries) provide for 20-30% for the services GF RCC 1 Grant $342m (April 2009 – March 2012). Supplies $116m (34%) MK5b for drugs out of total MK32b for health (15%) in this year’s budget

5. Pharmaceutical services delivery Pharmaceutical services (Service delivery) Procurement, storage & distribution (Medical Stores) Pharmaceutical care (clinical) Administration

6. Procurement & Supply Management (PSM) Procurement, storage & distribution (Central Medical Stores) Storage systems and capacity Distribution systems and capacity Supply management systems & capacity (inventory, QA etc)

7. Pharmaceutical care Standards of practice Skills development Training SOPs Guidelines STGs Formularies Supervision National (MOH HQ) Zonal/regional District Facility

8. Administration Planning Quantification Policy development Supplies Human resource Provide qualified personnel Supervision Training M&E Supplies Standards

9. Pharmaceutical supply management To ensure high quality essential drugs and medical supplies are available, affordable and rationally used To ensure that patient has access to right medical supplies in right quantity at right time 4 basic functions form the pharmaceutical supply management cycle

10. Pharmaceutical Supply Management Cycle Procuremen t DistributionUse Selection Management Support

11. At centre of supply management cycle Should consist of capacity for Organization Financing Information management Human resource Should provide policy direction (NDP)) and legal framework (appropriate legislation)

12. Public sector supply chain Central (MOH HQ/CMS) Planning Procurement Warehousing Distribution Management support District Planning Procurement Warehousing Distribution Management support Facility Planning Warehousing Use Data source Interdependent Responsibility for supply management

13. Current situation in Malawi Capacity gaps exist at all levels of the chain in: a) infrastructure (warehousing and distribution capacity) b) systems ( data management, planning, inventory management, Good Warehousing Practices) c) human resource (quantity and skills)

14. Effects of inadequate warehousing capacity Failure to comply with GWP (quality of drugs compromised) Poor inventory management Security cannot be optimized Inadequate stock levels (frequency of ordering) Distribution planning (increased demand and costs)

15. Effects of inadequate distribution capacity Frequency of distribution affected Coverage of distribution Increased warehousing needs

16. MOH and other support levels Inadequate institutional capacity at MOH HQ and other levels (zone, district) to deliver quality pharmaceutical services Inadequate professionally qualified personnel at HQ, zone and district levels for supervision Not all facilities have adequately qualified personnel with dedicated responsibility and accountability for supply management

17. Central Medical Stores Important progress made with Trust Deed being approved. Awaiting appointment of Board (by President) to set CMS Trust in motion Deliver and MSH providing TA with systems development Procurement oversight agent to provide TA to ODPP being recruited (July???)

18. Recommendations Addressing problems at one level of the supply chain will not solve supply management problems in the health sector as supply chain and management cycle components interdependent Attention should be paid to addressing problems at other levels as well

19. Central Medical Stores recommendations Operationalization plan for CMS Trust with detailed and realistic timeframes (additional to CMS Trust Roadmap) should be developed A detailed plan for strengthening entire CMS (including regional stores) developed. Current business plan falls short Re-visit CMS request for TA and address identified needs taking into account developments at CMS

20. MOH institutional capacity recommendations Strengthen administrative and professional capacity of MOH (HQ and support levels) to provide quality pharmaceutical services - review establishment (department or directorate of Pharmaceutical Services?) - effective organizational structure DPs to provide advocacy for establishment of increased institutional capacity (consider size of budget line for pharmaceutical services in health budget)

21. TA to strengthen PSM Collaborative approach by all partners to create synergies necessary to make impact on PSM Support and collaborate with Deliver (CMS and MOH HQ initiatives) and MSH/SPS (facility level initiatives)

22. THANK YOU FOR YOUR ATTENTION