1. Essential Drugs and Medicines Policy (EDM) World Health Organization
EDM Country Support to
3x5 strategy
Helen Tata
Essential Drugs and Medicines Policy (EDM)
World Health Organization
18 March 2004

2. Teaching Objectives
At the end participants will understand:
How country support for 3x5 is organised across WHO
EDM contribution to country support for 3X5
Collaboration with other partners involved in 3X5

3. 3x5 Strategy Pillar 4: Effective medicines and diagnostics supply
Element 12: Support country access to , and efficient distribution of high quality, low cost medicines and diagnostics

4. Priority Countries (as agreed with Regions) REGION AFRO
WAVE 1
Burkina Faso
Cote d'Ivoire
Ethiopia
Kenya
Malawi
Mozambique
Nigeria
Republic of South Africa
Swaziland
Uganda
United Republic of Tanzania
Zambia
Zimbabwe
WAVE 2
Angola
Botswana
Burundi
Cameroon
Central African Republic
Democratic Republic of the Congo
Ghana
Guinea
Lesotho
Namibia
Rwanda

5. Priority Countries (as agreed with Regions) REGION AMRO
WAVE 1
Haiti
WAVE 2
Central America Sub-regional Team (possibly located in Honduras)
Guyana

6. Priority Countries (as agreed with Regions) REGION EURO
WAVE 1
Russian Federation
Ukraine
WAVE 2 Central Asian Republics Sub-regional Team (possibly located in Uzbekistan)

7. Priority Countries (as agreed with Regions) REGION EMRO
WAVE 1
Sudan
WAVE 2
Horn of Africa Sub-regional Team (including Djibouti, Somalia and Yemen - possibly located in Djibouti)

8. Priority Countries (as agreed with Regions) REGION SEARO
WAVE 1
India
Myanmar
WAVE 2
Indonesia

9. Priority Countries (as agreed with Regions) REGION WPRO
WAVE 1
Cambodia
People’s Republic of China
WAVE 2
Vietnam

10. Joint Country Scoping Missions 3x5
Of 15 assessment 3x5 missions, EDM participated in the following ten:
Kenya NPO* * NPO participated
India+ +EDM/HQ
Nigeria* **EDM country focal point
Ethiopia*
Tanzania*
China+
Côte d’Ivoire**
Burkina Faso+
Ghana*
Swaziland**
Collaboration with UNAIDS, WB etc.

11. 3 by 5 Country Deployment 27 countries (19 for GFATM proposals)
Approximately 40 HQ staff, also RO and CO staff and consultants
Deployment periods ranging from 1-8 weeks - deadlines (e.g. April GFATM)
Co-ordination with core and critical HQ activities (e.g. finalisation of tools)
Different needs and requests from countries (skills mix, funds, intensity)
Range of roles and products:
GFATM and WB proposals and reprogramming
National operational plan for ART scale-up
Preparation for country team and follow-up
Briefing and mobilising partners

12. Backstopping - Technical
Focal points identified, advice provided and where necessary short-term missions for:
Drug procurement and management;
Diagnostics and laboratory services
Clinical care and guidelines
Testing and counselling
PMTCT
Vulnerable populations
Surveillance; M&E
Capacity building
TB and HIV/AIDS
Budgeting/costing
GFATM proposal development; World Bank reprogramming
Partnerships; Communities

13. Core indicators to monitor national pharmaceutical situations
Level I
Structures &
processes
Level II
Outcomes
Level III
Indicator tools for specific components of the pharmaceutical sector such as
Pricing
HIV/AIDS
TRIPS
Traditional medicine
Etc, etc.

14. Tool for Assessment of Supply Management of ARV
EDM is developing a tool for assessment of ARV supply management
Tool has been field tested in three countries in 2003
Assessment carried out at designated ART centres only
Representative sample of public facilities throughout the countries were surveyed using retrospective and prospective reviews
Preliminary findings only
Evidence based interventions will follow

15. Assessment Findings Country A from designated treatment centres

16. Assessment Findings Country B

17. Findings Country B Reasons for type of findings in country B
Non competent staff handling ARV without training
Fast implementation of ART by designated centres without involvement of competent services of MOH
Running parallel or vertical programmes
System of ARV stock management not harmonised
Absence of national tool to manage ARV supply system
No system to share information between treatment centres
No documentation of activities, absence of collaboration with existing competencies

18. Why Assess?
1. Assess and Monitor
2. Plan
3. Implement
Planned Interventions following assessment to address under performing areas undermining access to ARV

19. Planned Interventions Country A
POA 2004 will support
The development and dissemination of guidelines in management of HIV/AIDS medicines
Capacity building of staff in ARV supply management at treatment centres
Capacity building in use of HIV/AIDS medicines

20. Planned Interventions Country B
POA 2004 will support:
Establishment of collaboration between designated treatment centres and other implementing partners
Capacity building of staff managing medicines at ART centres
Harmonising tools for medicines management, including medicines quantification
Treatment centres in the follow up of patients on ARV
Follow up of ARV quality in use
Development of STG for ART

21. ART Focuses around ARV
ARV are today essential medicines that bring hope to the infected and affected