Presentation on theme: "WHO/UNICEF Technical Briefing Seminar on Essential Medicines Policies Geneva, 8-12 October 2007 Atieno Ojoo, Technical Specialist, HIV/AIDs and malaria."— Presentation transcript:
WHO/UNICEF Technical Briefing Seminar on Essential Medicines Policies Geneva, 8-12 October 2007 Atieno Ojoo, Technical Specialist, HIV/AIDs and malaria
UNICEFs mandate: advocate for childrens rights help meet their basic needs. Equitable ACCESS to essential supplies is fundamental to childrens rights to good health, basic education and protection from harm.
Presentation outline Contextualize the access framework Discuss Current Concerns Outline how to bridge the need/access gap
The access framework Access to essential Medicines is a Human right (Alma Ata 1978, MDG) –Rational Selection –Standards for medicine quality –Affordable prices –Sustainable financing –Reliable supply systems –Geographical access
The story so far…It all started in 1977 Flash back, 22 nd April 2002 "The long-sought inclusion of ARVs in WHOs EML will encourage governments in hard-hit countries to further expand the distribution of these vital drugs to those who need them. Currently, fewer than 5% of those who require treatment in developing countries can access these medicines. Source:E-drug:WHO Press Release on ARVs and the Essential Drugs List Fast forward, 17 th Jan 2007 A shortage of paediatric testing kits (PCR) and specialised medical staff in Zambia is causing delays in rolling out antiretroviral (ARV) drugs for children infected with HIV/AIDS. Despite the National AIDS Council (NAC) having enough ARV medication to treat about 19,000 children, only about 5,000 (~25%)are able to access the drugs. Source: IRIN
UNICEFs priorities in response to the Millennium Development Goals HIV / AIDS Tech. support Antiretrovirals Essential Medicines Test kits GIRLS' EDUCATION School-in-a-box Kit Water & sanitation Education supplies IMMUNIZATION + Vaccines Immunization devices Vitamin A Cold Chain Equip. EARLY CHILDHOOD DEVELOPMENT Mosquito nets Essential medicines Micronutrients Medical Equip. Water & Sanitation Equip. CHILD PROTECTION Emergency kits Water & Sanitation Health & Nutrition Education & Recreation 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria and other diseases 8. Develop a global partnership for development 7. Ensure environmental sustainability
At current rates of progress, the MDG on reducing U5MR goal will be reached 30 years later than planned-WHY?? Source: The Status of the Worlds Children 2006 Current progress on U5MR When goal should be met If trends in the 90s roughly continue, the goal will not be met until 2045
or as elaborate as… SPECIAL STORAGE CONDITIONS WH SPACE AND EQUIPMENT
or as thorny as… No safety, efficacy data, no suitable formulations
Bridging the need/access gap CREATING THE ENABLING ENVIRONMENT NEED ACCESS
QUALITY SPEED EMBODIMENT OF THE WHO ACCESS FRAMEWORK FOR COLLECTIVE ACTION – Millennium Development Goal 8, TARGET 17 – In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries PRICE
Registration, Marketing, patents, pricing Expanded Commodity management cycle Demand Creation Supplier Agreements Financing Receipt, Storage, Distribution Forecasting Quality Assurance Effective Use Product Procurement Product Selection Monitoring Calculating the quantities we should/can buy … Must be done
LOGISTICS Medicines must get to the end user Inventory Mgmt Warehousing Global Shipping Procurement
Importance of inventory management The recent Viracept (Nelfinavir) recall Good points –Ability to track batch records to in country & programme delivery points –Providing options for Rx change Challenges –Not able to track product up to patient level –Re-export for destruction-countries without ability to safely destroy pharmaceuticals –Weak Pharmacovigilance mechanisms
Conclusion Access to medicines is part of an intervention : Always understand the big picture PSM requires systematic/co-ordinated organisation: Define system in detail, assign responsibilities and accountabilities, routinely monitor Financing is critical: Secure & manage funds effectively, efficiently. Remember administrative costs Human resource capacity: Recruit, motivate, train competent and trustworthy personnel Principles: Follow tried and tested good practices
Conclusion contd Legislative, regulatory and commercial context: understand and ensure full compliance in advance. Supplier integrity: pre-qualify suppliers, manage tender process transparently, monitor performance. Product and process quality: monitor and evaluate and take action. Information system: maintain information integrity and flow for action.
SOME USEFUL REFERENCES Managing Drug Supply (Second edition), Management Sciences for Health in collaboration with WHO, 1997, 832 pages ISBN 1-56549-047-9 Operational Principles for Good Pharmaceutical Procurement Interagency guidelines, 2000, 24 pages Ref. no. WHO/EDM/PAR/99.5 Management of Drugs at Health Centre Level, Training Manual (AFRO 2004) http://www.who.int/medicines/library/general/Manage mentDrugsHealthCenterLevel_whoafredp04_3.pdf
SOME USEFUL REFERENCES CONTD. Guidelines for the Storage of Essential Medicines and Other Health Commodities (JSI/DELIVER/WHO/UNICEF 2003) http://www.who.int/medicines/library/theme/theme_su p.shtml#1 Inter-agency Guidelines on Drug Donations (1999) http://www.who.int/medicines/library/par/who-edm- par-1999-4/who-edm-par-99-4.shtml Inter-agency guidelines on safe disposal of unwanted pharmaceuticals in and after emergencies (1999) http://www.who.int/medicines/library/par/who-edm- par-1999-2/who-edm-par-99-2.shtml http://www.who.int/medicines/library/par/who-edm- par-1999-2/who-edm-par-99-2.shtml UNICEF Supply Catalogue - http://www.supply.unicef.dk/catalogue/
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