1. Helen Tata: WHO-TBS 4 November 2010 1 |1 | WHO Technical Briefing seminar Geneva, 01 – 05 November 2010. Access Framework & Challenges in Medicines Supply Systems Mrs Helen Tata (WHO/EMP)

2. Ensuring access to essential medicines - framework for collective action ACCESS 1. Rational selection & use 2. Affordable prices 3. Sustainable financing 4. Reliable health systems

3. Helen Tata: WHO-TBS 4 November 2010 3 |3 |

4. 4 |4 | Assessment of medicines supply systems 2007 AFRO/EDM and HQ/EMP developed tools to support countries in this activity 1 st stage –Map partners supporting medicines procurement and distribution –Financial flows –Warehousing –Distribution 2 nd stage Look at issues around the medicines supply management cycle: –Selection –Procurement –Storage/stock management –Distribution –Financing –M & E

5. Helen Tata: WHO-TBS 4 November 2010 5 |5 | Race to save lives The rush

6. Helen Tata: WHO-TBS 4 November 2010 6 |6 | Source: Bergis Schmidt-Ehry, GTZ

7. Source Of Funds Procurement Agent/Body Point of 1 st warehousing Point of 2 nd warehousing MEDICAL STORE Medicines supply systems in TANZANIA. 2007 PRIMARY HEALTH CARE FACILITY DISTRICT STORE ZONAL MEDICAL STORE ESSENTIAL MEDICINES ARVsMALARIATBOI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINESCONDOMSCONTRACEPTIVES MEDICAL SUPPLIES REGIONAL/DISTRICT VACCINE STORE HEALTH FACILITY GOVERNMENT MULTILATERAL DONOR BILATERAL DONOR NGO/PRIVATE AXIOS TEC &CC T CRSIMACUAMMHOSPITALCOLUMBIA HOSPITAL TEC &CC T HEALTH FACILITY HOSPITAL TEC &CC T ZONAL BLOOD SAFETY CENTRE Point of Distribution GOVERNMENT WBWB GLOBAL FUND SIDASIDA PEPFARPEPFAR USAIDUSAID UNICEFUNICEF WHOWHO ABBOTTABBOTT CSSCCSSC COLUMBIACOLUMBIA PFIZERPFIZER JICAJICA CLINTONCLINTON CIDACIDA CDCCDC GAVIGAVI CUAMMCUAMM HAVARDHAVARD NORADNORAD HOSPITAL TEC & CCT CLINTONCLINTON HAVARDHAVARD MEDICAL STORE CRSCRS SCMSSCMS EGPAFEGPAF MOH & SW AXIOSAXIOS UNICEFUNICEF JICAJICA CDCCDC COLUMBIACOLUMBIA ABBOTTABBOTT GAVIGAVI CUAMMCUAMM CROWN AGENTS USAIDUSAID TMAPTMAP AXIOSAXIOS United Republic of Tanzania PATIENT

8. Sources de Financement Structure d'appro- visionnement 1er point de stockage 2ème point de stockage Structure dispensatrice ETATETAT BMBM FONDS MONDIAL CAMEBUCAMEBU DFIDDFID UEUE USAIDUSAID FNUAPFNUAP IPPFIPPF MSFMSF OMSOMS GFA GFA CEPBUCEPBU GVCGVC UNICEFUNICEF CLINTONCLINTON GTZGTZ GDFGDF CTBCTB CAMEBUCAMEBU IPAIPA ACFACF CONCERNCONCERN CAMEBU PNLOMSF PNLT CICR CEPBU IMC BPS GVCACF CORDAID Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007 Site de prise en charge CDS SNT/CNTCDT/CTCOCOLSBPS CPLS CDV Détaillants CDS Site de prise en charge PNSRCPLS Grossiste Privé CNTS CDV PNSR ACF CORDAID IMC GVC CONCERN PEVPSI PDMPDM CICRCICR SEP/ CNLS PNLTPNLT PSIPSI UNICEFUNICEF OMSOMS FNUAPFNUAP MSFMSF ACFACF PDMPDM CICRCICR CEPBUCEPBU CORDAIDCORDAID GVCGVC GTZGTZ CLINTONCLINTON UNITAIDUNITAID GDFGDF CTBCTB CONCERNCONCERN GAVIGAVI KFWKFW IPPFIPPF PSIPSI MEDICAMENTS ESSENTIELS ARVsPALUDISMETBIO ARVs Ped REACTIFS sécurité du sang (+ test HIV) VACCINSPréservatifsContraceptifs Dispositifs Médicaux CORDAIDCORDAID SEP/ CNLS ABUBEF PRISONHÔPITAUX République du Burundi Ministère de la Santé Publique Etat Bailleurs multilatéraux Bailleurs bilatéraux ONG/Privé PATIENT

9. Partner store within national store

10. National Medicines stores

11. Helen Tata: WHO-TBS 4 November 2010 11 | Challenges (1) Selection: –Supply outside the EML/STG still exists –Procurement of non registered medicines in countries still exists Quantification: –CMS not always involved in forecasting/procurement –No coordination in quantification between MoH, CMS, partners resulting in: stock-outs or overstocking expired products –Inadequate logistic information system

12. Helen Tata: WHO-TBS 4 November 2010 12 | Challenges (2) Procurement: –Managed by various partners present in country. –National system hardly 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.

13. Helen Tata: WHO-TBS 4 November 2010 13 | Challenges (3)‏ Financing: –Funds available mainly for 3 disease programs –Other areas under funded –Financial figures not always available –Logistic support is under- funded Monitoring-Evaluation: – Each program may have a stand alone M&E –Different reporting tools –Burden of work for scare human resource at periphery high

14. Helen Tata: WHO-TBS 4 November 2010 14 | What can we do?

15. Helen Tata: WHO-TBS 4 November 2010 15 | Source: Bergis Schmidt-Ehry, GTZ

16. Helen Tata: WHO-TBS 4 November 2010 16 | Source: Bergis Schmidt-Ehry, GTZ

17. Helen Tata: WHO-TBS 4 November 2010 17 | Benefits  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

18. Helen Tata: WHO-TBS 4 November 2010 18 | 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!

19. Helen Tata: WHO-TBS 4 November 2010 19 | Recap  Coordination, dialogue, information sharing  Joint M & E and reporting  Reduced workload  Health System strengthening  Timely delivery of medicines to target population  Cost savings

20. Helen Tata: WHO-TBS 4 November 2010 20 | Source: Bergis Schmidt-Ehry, GTZ