UNICEF involvement in PSM – Case of Ethiopia PSM Consultants Briefing Seminar Copenhagen 30 Jan. – 2 Feb. 2005

Overview 1.History of UNICEF involvement in PSM 2.UNICEF capacity for PSM assistance 3.Challenges faced by partner counties 4.Nature of UNICEF assistance 5.Impact of UNICEF assistance 6.Critical success factors 7.Remaining challenges

UNICEF is the leading agency for childrens supplies

UNICEF Supplies UNICEF procures vaccines for 40 per cent of children in developing countries (2.5 billion doses a year)UNICEF procures vaccines for 40 per cent of children in developing countries (2.5 billion doses a year) UNICEF is the world s largest buyer of mosquito nets (15 million nets in 2005)UNICEF is the world s largest buyer of mosquito nets (15 million nets in 2005) UNICEF procures New ACTs - effective medicines against malaria ($7.6m in 2005)UNICEF procures New ACTs - effective medicines against malaria ($7.6m in 2005)

UNICEF has procured 40 million packets of Oral Rehydration Salts in 2005UNICEF has procured 40 million packets of Oral Rehydration Salts in 2005 UNICEF currently delivers antiretroviral medicines to 44 countries ($33.5 million in 2005)UNICEF currently delivers antiretroviral medicines to 44 countries ($33.5 million in 2005) During 2005, UNICEF reached around $7.7 million worth of test kits.During 2005, UNICEF reached around $7.7 million worth of test kits. UNICEF Supplies

During 2005, UNICEF played key role in emergenciesDuring 2005, UNICEF played key role in emergencies UNICEF has stock of ARVs in Copenhagen for emergencies.UNICEF has stock of ARVs in Copenhagen for emergencies. UNICEF Supplies

Role of UNICEF Supply Division Oversee UNICEF s global procurement and logistics operation. Oversee UNICEF s global procurement and logistics operation. Ensure that high quality, good value supplies reach children and their families quickly. Ensure that high quality, good value supplies reach children and their families quickly. Maintain the highest ethical standards for procurement. Maintain the highest ethical standards for procurement. Provide technical support to UNICEF offices and Procurement Services customers globally. Share procurement know-how with development partners. Innovate to find ever- better supply solutions for children.

Country Office Presence Active Procurement activities in support of Governments and NGOsActive Procurement activities in support of Governments and NGOs In-country logistics, for all commoditiesIn-country logistics, for all commodities Capacity building in programming and supply managementCapacity building in programming and supply management Partnership buildingPartnership building

UNICEF partner constraints in PSM

An Overview of the System

The Supply Management Framework Research

The Supply Management Framework Location of constraints in the Supply Cycle Quantification Distribution Acquisition Selection l e Definition of Responsibilities Identification of Coordination Mechanisms Integration of Existing Institutions & Programs Procurement

Case of Ethiopia Long procurement lead time (average 84 weeks)Long procurement lead time (average 84 weeks) Forex transfer difficultiesForex transfer difficulties Serious constraints in distribution systemSerious constraints in distribution system Preparedness of treatment sitesPreparedness of treatment sites Limited HR capacityLimited HR capacity

General Characteristics –Inaccurate quantification information due to poor LMIS –Non optimum drug availability => waste and expiration –Non-systematic inventory control management systems –Inadequate storage facilities –Limited transport for distribution of drugs –Non-optimum demand for commodities

Ethiopia UNICEF Involvement Procurement servicesProcurement services Forex transfer facilitationForex transfer facilitation Overhaul of in-country logistics system (in process)Overhaul of in-country logistics system (in process) Assistance with commodity distributionAssistance with commodity distribution Technical Assistance to FMOH in logistics managementTechnical Assistance to FMOH in logistics management

Stock Management DistributionOrdering Product Receipt Ethiopia UNICEF Involvement Selection, Quantification Suppliers, Quality Monitoring Delivery Times Customs, Registration, Quality & Order verification Product quality, batch no, Shelf life monitoring, Environ. control, etc Allocation, Transport, Usage Evaluation

UNICEF PSM support making a difference

Performance – Delivery of Products

Results for Ethiopia More than 3 million treatments of Artemether-Lumefantrine to all regions of EthiopiaMore than 3 million treatments of Artemether-Lumefantrine to all regions of Ethiopia Forecasting & procurement – 600,000 P. falciparum malaria cases to be treated in Forecasting & procurement – 600,000 P. falciparum malaria cases to be treated in Largest distribution of ITNs in Ethiopian history (3.5m nets)Largest distribution of ITNs in Ethiopian history (3.5m nets) 1.8m RDTs distributed in m RDTs distributed in 2005 $ 6 m ARV procured and delivered in 6 mths$ 6 m ARV procured and delivered in 6 mths System overhaulSystem overhaul

The Case of ARV supplies MATERIAL No. of Packs Supplie d Current No. of Packs in Stock Expiry Date Reamining shelf life (month s) No. of Treatm ents/m th No. of Treatm ents/m th Monthly consumption 1 Didanosine 100mg tabs/PAC-60 pb 16,000 16,000 7/6/06 101, Efavirenz 200mg caps/PAC-90 pb 1,500 1,5001/8/ Efavirenz 200mg caps/PAC-90 pb 1,334 1,3343/6/ Efavirenz 600mg tabs/PAC-30 pb 4,000 4,000 5,893 5,8932/7/ Lamivudine 150mg tabs/PAC-60 gp 100, ,5011/7/07 166, Lamivudine oral sol.10mg/ml/BOT-240ml pb 3,864 3,8647/6/ Lamivudine oral sol.10mg/ml/BOT-240ml pb 13,164 13,1645/7/ Lamivudine oral sol.10mg/ml/BOT-100ml pb 3,000 3,00011/6/ Nelfinavir 250mg tabs/PAC-270 pb 15,500 15,500 6/7/ Nevirapine 200mg tabs/PAC-60 gp 50,500 50,500 50,490 50,4902/7/07 172, Nevirapine 200mg tabs/PAC-60 gp 5,075 5,0756/6/ Nevirapine oral sol.10mg/ml/BOT 100ml gb 2,163 2,1636/9/ Nevirapine oral sol.10mg/ml/BOT-240ml pb 9,000 9,000 6/7/ Stavudine 30 mg caps/PAC-60 gb 16,200 16,200 10,596 10,5964/7/ ,164 4, Stavudine 40 mg caps/PAC-60 gb 20,000 20,000 4/7/07 191, Stavudine 40 mg caps/PAC-60 gb 13,575 13,5755/6/06 81, ZDV + 3TC mg tabs/PAC-60 pb 11,182 11,18211/7/ ZDV + 3TC mg tabs/PAC-60 pb 7,200 7,2001/7/ ZDV + 3TC mg tabs/PAC-60 pb 12,296 12,2965/8/ Zidovudine 300mg tabs/PAC-60 gp 7,138 7,13811/7/ Zidovudine 300mg tabs/PAC-60 gp 1,000 1,000 1/7/ Zidovudine oral sol.10mg/ml/BOT-100ml pb 3,500 3,500 4/7/ Zidovudine oral sol.10mg/ml/BOT-200ml pb 12,057 12,05712/6/ Zidovudine oral sol.10mg/ml/BOT-200ml pb 9,144 9,1447/6/

Critical success factors Technical expertise within the procurement teamTechnical expertise within the procurement team Country specific interventionCountry specific intervention Stakeholder involvementStakeholder involvement Interpersonal and inter-institutional working relationshipInterpersonal and inter-institutional working relationship Communication and information sharing: SD-CO; CO-MOH; partner-partnerCommunication and information sharing: SD-CO; CO-MOH; partner-partner Clear plan for in-country logisticsClear plan for in-country logistics Periodic review of PSM plansPeriodic review of PSM plans

Remaining challenges Human resource shortagesHuman resource shortages Weak health system and capacity in procurementWeak health system and capacity in procurement Capacity building plan for in country logisticsCapacity building plan for in country logistics Hands on PSM supportHands on PSM support Financing mechanismsFinancing mechanisms

For every child …