1. Monitoring Drug and Commodity Supply Chains for ARV Programmes Yasmin Chandani John Snow Inc/DELIVER

2. The Supply Chain

3. The Logistics Cycle

4. Background Weak public sector logistics management systems for most essential medicines –Low priority investment area –Historically, few dedicated and consistent human and financial resources Additional stresses include HIV/AIDS related mortality, migration etc.

5. Common Problems Poor storage facilities Weak transportation systems Problematic customs processes Diversion of products Inadequate training Lack of information systems Inaccurate quantification and forecasting

6. Background Vertical inventory management systems stronger than for other health commodities –Challenges with vertical systems Creation of multiple, fragmented MOH logistics systems Duplication of work Integration of services and systems

7. Logistics Systems for ARVs Parallel systems Some integrated logistics functions –Storage, distribution Integrating ARVs with well functioning existing parallel systems –TB/DOTS approach Integrated approach required for HIV/AIDS programs

8. Logistics Management Issues in Scaling up ART Delivery Role of public vs. private sector Supportive policy and legal environment STGs for ARVs and inclusion on NEDL Quality Assurance and Control systems Criteria for quantification and forecasting Harmonized or standardized procurement Max/min inventory control system Secure storage and transportation Monitoring prescribing patterns, dispensing patterns/consumption, stock levels

9. Cross Cutting Issues Procurement of generics Security of storage and distribution Maintaining low, centralized inventory levels, avoiding stockouts –Cost & Control/Fragmentation Agile logistics system dependent on timely data from LMIS to react to –Unexpected consumption patterns –Patient mobility –Accountability

10. Developing a LMIS Purpose To collect, organize and report data that will be used to make decisions Characteristics: –User-friendly, Minimal burden on health workers –Able to provide timely data –Enhance agility of system to respond to changes in consumption due to patient mobility, regime changes, drug substitution, “drug holidays”

11. Essential Data Items in a LMIS Consumption, dispensed-to-user, or sales data Stock on hand Losses and adjustments –Expiries, wastage, breakage, theft Service statistics –Number of clients served –Diagnosis (if applicable)

12. Monitoring logistics functions Tracking commodity availability at sites Monitoring inventory levels Using consumption patterns for quantification and forecasting Prescribing patterns Dispensing patterns Single drug substitution Regimen changes

13. Experience from the field: Uganda Procurement of low-cost, high quality drugs Partnership with JCRC as part of scale up Integrating procurement, storage, distribution under NMS Setting up separate LMIS for ARVs with a view towards long-term integration Linking LMIS with HMIS and M&E Semi-automated system; pilot testing fully automated options Accreditation of private pharmacies contingent on data provision

14. Experience from the field: Kenya Procurement of generic drugs Exploring options for procurement, storage, distribution –Outsourced in the short term? –Development of long term capacity within KEMSA? Fast-tracking development of LMIS based on survey of commercial and other LMIS LMIS to operate under NASCOP (ARV Management Unit), with dedicated long-term advisor to coordinate with partners, including private sector

15. The Way Forward Consistent financing Coordinated procurement of low cost, quality drugs Accurate data capture, timely data transmission –Operations, accountability, linkages with HMIS Secure storage, distribution Balance between rapid/effective parallel systems and long-term system building for HIV/AIDS commodities or all essential medicines