A Call to Action Children – The missing face of AIDS

Procurement and Supply Management: Supporting national capacities Steve Jarrett Deputy Director Supply Division UNICEF

UNICEF has supplied ARVs and test kits to 44 countries so far in the last 2 years, reaching a cumulative total of over $60 million 61 ARV formulations 27 types of test kits

70% of ARVs are destined to East and Southern Africa and 22% to West and Central Africa (2005) ARV Stockpile 4 Countries = 75% Côte dIvoire Ethiopia Malawi Zambia

Supply Division, with UNICEF Country Office support, researches IP and registration status in each country where it supplies ARVs, taking into account WTO/TRIPS safeguards NATIONAL PATENT OFFICES SUPPLIERS Information on developing country pharmaceutical patents in the public domain ACADEMIA, NGOs eg MSF, UN AGENCIES No single 100% reliable source exists, even at supplier or national level.

Procurement and supply management of ARVs has to be seen in the context of the inter-related steps of the complete supply chain cycle Demand Creation Supplier Agreements Financing Receipt, Storage, Distribution Forecasting Quality Assurance Effective Use Product Procurement Product Selection Monitoring

The supply chain comprises three distinct phases: product planning, product acquisition and product delivery Demand Creation Supplier Agreements Financing Receipt, Storage, Distribution Forecasting Quality Assurance Effective Use Product Procurement Product Selection Monitoring Acquisition Planning Delivery

UNICEF combines its field office capacities with HQ Supply Division to cover the full supply chain cycle Demand Creation Supplier Agreements Financing Receipt, Storage, Distribution Forecasting Quality Assurance Effective Use Product Procurement Product Selection Monitoring Acquisition Planning Delivery Field Office HQ SD

UNICEF so far has supported countries in strengthening planning and delivery systems in support of increased ARV access where it provides ARVs Demand Creation Financing Receipt, Storage, Distribution Forecasting Effective Use Product Selection Monitoring Planning Delivery

UNICEF has recently been designated by UNAIDS/GTT as Lead Agency in procurement and supply management Main roles of the Lead Agency: Single entry point for UN Technical Support (broker) Co-ordination and facilitation of technical assistance Establish global and regional support mechanisms Liaison between providers of technical support, UN Theme Groups and global support mechanisms

A set of preliminary interventions have been identified and a tentative budget determined for Intervention Strengthening procurement + supply management planning and implementation Strengthening warehousing management + distribution systems Enhancing national medicines management information systems Increasing regional support capacities

Global level joint problem solving and implementation team (GIST) has been established especially related to implementation of Global Fund grants Formed by UNAIDS, WHO, UNICEF, UNDP, UNFPA, World Bank and Global Fund, with links to bi-lateral agencies Facilitates rapid country driven process for identification of technical support needs with one of UN agencies as country lead 10 countries (Comores, Guinea Bissau, Mozambique, Niger, Nigeria and Senegal in Africa)

UNICEF/HQ /ALEJANDRO BALAGUER Continuous monitoring of demand Comprehensive supply plans Delivery arrangements Stockpiling Key elements to consider in starting capacity building

Over 2.1 million children under 15 are estimated to be living with HIV/AIDS, with 700,000 in need of ARV treatment

UNICEF/HQ /GIACOMI PIROZZI Paediatric ARV dosing schedules are not available for some drugs Most available paediatric ARV formulations require children to take frequent doses of unpalatable syrups Many need cold chain storage, have limited shelf life and stability No FDCs specifically available for paediatric use

Both originator and generic ARV manufacturers have given positive signals for developing appropriate paediatric formulations UNICEF met with 15 manufacturers 12 September to discuss the situation of paediatric formulations Various types of developments underway for both single products and FDCs Soluble tablets, granules, melts, scored tablets are some of the initiatives Target of having WHO pre-qualified products by mid-2006

Due to a better access to treatment, more people are willing to undertake HIV testing Number of patients on ARVs increased to 10,000 by Dec in 24 sites. By end-2005, 40,000 patients to be on treatment in 59 health facilities MALAWI UNICEF/HQ /GIACOMI PIROZZI UNICEF/HQ /AMI VITALE

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