1. Strengthening the Pharmaceutical Sector: Mechanisms to Monitor Performance Douglas L. Keene June 15, 2010

2. HSS Approach for Medical Products Building Block Our implementation strategy is to strengthen the pharmaceutical management system for a wider range of medicines and supplies, not just HIV/AIDS The pharmaceutical system is a large part of the overall health system; by strengthening individual components, the whole system benefits Tools and approaches developed under PEPFAR should be adapted for other health system issues and for other countries

3. LEVELSPRIVATE SECTORPUBLIC/NGO SECTORSPARTNERS International International Procurement Agencies Donors National Government/NGO Supply Services Third-Party Payers Regulatory Agencies Local Wholesalers Academic Institutions Regional Regional Facilities District Private Prescribers Community District Facilities Primary Care Facilities Users Local Manufacturers Multinational Suppliers Distributors Shops, Pharmacies CMS system flow Alternative flow Information flow

4. The Pharmaceutical (Sub) System ©2008 Management Sciences for Health, Inc. All rights reserved.

5. Building Blocks and Intervention Implement RxSolution to strengthen supply chain management Medical Products Develop methodology to estimate medical store service costs Financing Develop and implement coordinated donor procurement mechanism for ARVs Leadership and Governance Facilitate decentralization and patient flow Service Delivery Help MOH identify sources of pharmacy personnel Health Workforce Develop and implement the ART dispensing tool Information

6. Building Blocks and Result Global Fund released funds to procure ARVs in Swaziland based on RxSolution implementation Medical Products Cost allocation methodology for NDSOs established handling fees now reimbursed by Global Fund Financing CPDS governance and monitoring system helped lead to reduction in cost/patient month from $30 to $20 Leadership and Governance ART module for Rx transfer now used for other chronic diseases Service Delivery Hired new staff to fill government vacancies. Staff doubled and 64% absorbed by MoHSS Health Workforce ADT adopted as national ART tool in Namibia and handed over to MoHSS Information

7. Take Home Messages Vertical funding can be used to foster system-wide improvements We all must work across building blocks