1. 1 Pharmaceutical System Strengthening: Is There a Need for a New Paradigm? Douglas Keene, PharmD, MHS ICIUM-3 Pre-Conference Session 14 November 2011

2. 2 Dimensions of Drug Supply

3. 3 1983 1997 2001 From Supply Management to Medicines Access

4. 4 A New Paradigm FY 2000: Dimensions of Access

5. 5 Estimated Total Annual Resources Available for AIDS, 1996 – 2005 PEPFAR Source: Lancet, 2006; 368: 526–30 1996199719981999200020012002200320042005 9 000 8 000 7 000 6 000 5 000 4 000 3 000 2 000 1 000 World Bank MAP Launch Signing of Declaration of Commitment on HIV/AIDS Global Fund ( US$ millions ) USAID’s Millennium Challenge Account Global Alliance for Vaccines and Immunization Accelerating Access Initiative

6. 6 Procurement of Drugs Overshadows Human Resources, Capacity, and Systems 48% Drugs Commodities Products etc... 6% Other 11% Infrastructure and Equipment 2% Monitoring and Evaluation 11% Administration 11% Tuberculosis

7. 7 A Few Realities for Saving Lives and Improving Health Funding is never the only constraint and is often not the major constraint “Solving” the financing problem inevitably reveals other weaknesses Lasting impact depends on reliable health systems: – Strengthened systems – Management tools – Human resources – Capacity building

8. 8 Center for Pharmaceutical Management

9. 9 Working Definition of Pharmaceutical Services Pharmaceutical services include all services rendered by pharmaceutical staff to support the provision of patient care and treatment. Beyond the supply of pharmaceutical products, pharmaceutical services include educating and training of staff, providing medicine information and counseling in support of prescribing and dispensing practices, monitoring medicine use to assure patient safety and achieve desired health outcomes, formulating policies and regulation for improved pharmaceutical care, and disseminating information and educational materials to promote public health.

10. 10 USAID Programs Regional Pharmaceutical Management Project [Eastern Caribbean Drug Service] – 1986 – 1990 Rational Pharmaceutical Management Project (RPM) – 1992 – 1999 Rational Pharmaceutical Management Plus Program (RPM Plus) – 2000 – 2007 Supply Chain Management Systems Project (SCMS) - 2005 – 2013 Strengthening Pharmaceutical Systems Program (SPS) – 2007 – 2012 Systems for Improved Access to Pharmaceuticals and Services (SIAPS) – 2011 – 2016

11. 11 Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Pharmaceutical System Strengthening Framework Analysis International health initiatives Local context Health status Health systems Evidence- based strategy Sustainable Health Outcomes and Impact aligned with: Country Strategic Plans and USG/USAID Health-Specific Results Monitor and Evaluate Performance Improved coverage & access of evidence- based interventions Government MOH, other ministries, regulators, policy makers Community patients, consumers, caregivers, civil society Providers public/private, NGO, commercial sector, professional associations Improved health system performance Governance InformationFinancing Service Delivery Human Resources Medical Products

12. 12 SIAPS Core Operating Principles Build on and strengthen existing systems Support integration (of other public health programs and supply systems) Build the capacity of local organizations Support country-led coordination Continually monitor and evaluate Develop improved performance metrics Harmonize tools, approaches, and metrics Share knowledge and information

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