2. Strategies for Enhancing Access to Medicines Overview of Potential Strategies for Improving Access and Use David Lee

3. Interventions to Improve Access and Use  Procurement and distribution mechanism –El Salvador –Ghana –Tanzania

4. Interventions to Improve Access and Use (2)  Retail medicines outlets –Brazil (Minas Gerais) –Cambodia –Tanzania –India (Rajasthan) –Ghana

5. Contracting Inventory Management/Distribution  El Salvador local partners –Ministry of Health-Suppliers and distributors  Incentives –Volume of sales  Product quality –Product monitoring and enforcement program  Service quality –Supplier and distributor performance monitoring and enforcement program –Rational drug use program

6. Contracting Inventory Management and Distribution  Ghana local partners –Mission sector supply organization (CDC) - suppliers and distributors  Incentives –Volume of sales  Product quality –Product quality monitoring and enforcement program by CDC  Service quality –Supplier and distributor performance monitoring and enforcement by CDC –Consumer education program

7. Contracting Additional Prime Vendor Services  Tanzania local partners –Ministry of Health, Mission/NGO sector - suppliers and distributors  Incentives –Volume of sales  Product quality –Product quality monitoring and enforcement program  Service quality –Supplier and distributor performance monitoring and enforcement

8. Contracting Dispensing Services  Brazil (Minas Gerais) local partners –SUS, State Secretary of Health, Municipalities, microregional health authority - pharmacies  Incentives –Volume of sales  Product quality –Product quality monitoring and enforcement program  Service quality –Pharmacy performance monitoring and enforcement by ANVISA and SUS, including patient counseling

9. Certified Pharmacy and Drug Depot Network  Cambodian local partners –Pharmacists Association of Cambodia - pharmacies and drug depots – prescriber network  Incentives –Access to prescriber network, low cost, quality products, training, certification  Product quality –Product quality monitoring and enforcement program by PAC group purchasing arm  Service quality –Training, monitoring, and supervision by PAC, including consumer education program

10. Network of Accredited Dispensing Drug Outlets  Tanzania local partners –Pharmacy Board, local government - retail drug outlets  Incentives –Marketing advantage, access to: low cost, quality products, expanded product list, information technology, training, accreditation  Product quality and Service quality –Product quality monitoring and enforcement program –Standards compliance program, including consumer education

11. Rural Pharmacy Network  India (Rajasthan) local partners –State PHC network - local NGOs  Incentives –Access to funding, training, fulfillment of mission  Product quality –Product quality monitoring and enforcement program  Service quality –Training, monitoring and supervision by the pharmacy network management, including consumer education program

12. Franchising Essential Medicines  Ghana local partners –Ghana Social Marketing Foundation, chemical sellers  Incentives –Marketing edge, “brand” recognition and promotion, access to low-cost, quality products, training, accreditation  Product quality –Product quality monitoring and enforcement program by GSMF  Service quality –Training, monitoring and supervision by GSMF, including consumer education program

13. Interventions to Improve Access and Use  The devil is in the details …