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BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT PRESENTED BY MR S MAPIKI CENTRAL MEDICAL STORES BOTSWANA-2006.

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Presentation on theme: "BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT PRESENTED BY MR S MAPIKI CENTRAL MEDICAL STORES BOTSWANA-2006."— Presentation transcript:

1 BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT PRESENTED BY MR S MAPIKI CENTRAL MEDICAL STORES BOTSWANA-2006

2 BACKGROUND Pop. 1,7Million 2002, 110,000 people eligible for Treatment Botswana =1 st African Country to offer free ARVS 2002 Govt. paid over 2/3 and got support from Bill and Mellinda Gates and Pharmaceutical Suppliers Treatment straining limited resources, devt funds diverted to health =25% Nat Budget

3 PSM System had to improve to integrate ARVs i.e Forecasting, quantification, Receiving, Storage, Distribution, Monitoring Forecasting and Quantification Modern PSM Tools e.g formulas based on Historical method and Morbidity/Mortality data. Data from sites also used to forecast

4 PROCUREMENT METHODS Procurement of ARVS i.e budgeting, tendering, ordering all integrated into one CMS System ARVS procured from patent holders thru negotiation for Acces prices and by Direct Contract-Single Sourcing Method Palliatives,Other treatments, detection and prevention supplies thru International Competitive Bidding Prequalification in progress, Voluntary Licence given for CBV to Aspen by GSK

5 STORAGE, INVENTORY MANAGEMENT The ARV Quality Assurance(Testing, inspection,verification from Rcpts- Distr. Integrated with that for other medical supplies Storage Locations in the Warehouse thru a Computerized Warehouse Management System-allocates all receipts randomly. ARVS stored under tighter security

6 DISTRIBUTION A national distribution schedule integrates distribution of ARVS and other Medical Supplies All Transportation is coordinated from the CMS point Distribution based on orders from sites Sites order based on working stock and 3 month buffer stock x no. of patients Frequency of consignments distribution to sites depend on CMS stock on hand

7 PUBLIC PRIVATE PARTNERSHIP A Disease State Management Company engaged to provide Clinical assessment, management, Counselling, ARV Distribution and dispensing PPP meant to assist Govt. in the rollout and to reach segments of the population not yet served

8 MONITORING AND EVALUATION Monthly Site report forms improved based on PSM tools used for monthly monitoring Monitoring tracks the effects of procurement and whether the programme goals on track

9 Monitoring Cont,d Monthly Physical stocktake mandatory Monthly reports from sites mandatory covering: Name of drug Last reported stock Receipts since last report Stock on Hand # of pts on drug since last report # of pts on drug currently # of pts started on drug since last report Projected drug demand for next month

10 PROGRESS SO FAR ,000 HIV+ Needed treatment 4 SITES 7,000 PATIENTS initiated on treatment P50Million (USD 10M) used 2004/05 32 Sites 37,500 patients on Tx by April 05 we estimate 59,000(52,000 Govt. and 7,300 Pvt.) by Dec 05 ( Ref :55,000 required per 3x5 by Dec05) Monthly enrolment rate of ,000 patients P200 Million(USD 45M) spent during 2004/05

11 PROGRESS DEC 2002DEC 2003DEC 2004DEC ,00030,00040,00059,000 AVG ANNUAL COST USD1,000/ PATIENT/Y R

12 DRUG DISTRIBUTION Sites quantify and order from CMS CMS issues and distributes to facilities using CMS transport ARVS transported separately from other drugs Accountability from dispatch to receiving stringent

13 SECURITY-CMS Drugs delivered under security escort Drugs immediately locked up upon receipt Separate storeroom for ARVS Storeroom security guarded for 24 hours Computer Software Record Keeping backed up by manual Bincards Monthly Physical stocktake Accompanying documents signed by CMS Security and sites upon Dispatch

14 SECURITY-SITES All receipts/Issues entered into a record book/computer software ARV stock kept under secure storage with burglar Bars and Alarm Reserve Therapy drugs ordered by special order on named patient basis Patients received monthly supplies /collected monthly refills

15 CHALLENGES Private Sector –Inadequate adherence to guidelines RESISTANCE-beginning to present SECURITY-Pilferages Affordability and sustainability Late presentation for Tx TB/HIV co-infection complicating matters Scale up to districts= capacity constraints Worldwide shortage of Efavirenz,Combivir,Stavudine Patent Rights-TRIPS

16 SCALE UP STRATEGIES Avail ARVS at District Clinics To use district resources(District Pharm. Techs, Nurses and Primary Trainers) Public Private Partnership(PPP) A disease State Management Company to be contracted Will engage Private Physicians for consultation Will engage Retail Pharmacists to dispense and reach more people Will obtain drugs from CMS


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