AMDS Contribution to the Technical Briefing Seminar

October 2007

AMDS Secretariat within the New Organizational Structure - HIV/AIDS DEPARTMENT

Office of the Director

K.M. De CockT. Guerma

Prevention in the Health Sector

Ying Ru LoCoordinator

ART & HIV Care

Charlie GilksCoordinator

Operational & Technical Support

Bradley HershCoordinator

SystemsStrengthening for HIV

Jos Perriëns Coordinator

Strategic Information

Yves SouteyrandCoordinator

CommunicationsResource

Mobilization

• Surveillance• M & E• Operational Research• Country Information

• HR for Health• AMDS• Health Financing

• RCC• IMAI• Partnerships with Civil Society

• ARVs• Paediatrics• O.I• TB/HIV• Drug Resistance

• HIV Testing & Counselling• PMCT• MARP• Emerging Technologies• Prevention with Positives

PMU

Policy and UN coordination

What is AMDS

• AMDS is a network of partner organisations working in procurement and supply management of HIV commodities.

• The secretariat of this network is in WHO/HIV Department.

AMDS Partners

Why do we need partnership

Drug procurement is more than "shopping" drugs

Drug procurement is more than "shopping" Procurement Cycle

DemandCreation

SupplierAgreements

FinancingReceipt, Storage,

Distribution

Forecasting

QualityAssurance

EffectiveUse

ProductProcurement

ProductSelection

Monitoring

How we work

• Open ended partnership, loose network structure• Work on concrete problems as opportunities arise or

needs become acute: GFATM Supply Chain planning; GPRM; regulatory database, IMAI module; forecasting ARV market; Training in drug supply management for HIV programmes.

• Work in under-laboured HIV-specific domains: prices of production, data production for strategy development (ex. API)

• Foster collaboration in and outside WHO based on areas of drug supply chain management.

Results and influence

• Procurement and supply management plans to support Global Fund PR

• Strategic information highly valued : GPRM, Regulatory status

• Strong support from partners for strategic orientation chosen: keep network open, no need for MOUs; focus collaboration on problem solving and practical issues

• Expectations of partners for WHO work increasing: support creation of national level SM coordination groups, organisation of partners in technical communities, broker collaboration between partners, map TA sources, provide normative leadership, increase visibility and commitment to strengthening supply chain management at country level

Why• Collect, consolidate and disseminate strategic information

regarding affordability, accessibility, and availability of HIV drugs:

In-house Products• Global Price Reporting Mechanism - on AMD website• API prices -on AMD website• Regulatory status database - on AMD website

Strategic Information: Global Observatory

Global Price Reporting Mechanism (GPRM) http://www.who.int/hiv/amds/price/hdd/

Why To improve price transparency on ARV market To inform MoHs, state and non state procurement officers and

favour price negotiation To inform WHO management in their strategic decision in

advocacy

How Collection and disseminate transactional data of ARV drugs

prices on the web Produce summary analysis of trend and prices of ARVs

(Summary report) Contributors: CHAI, Crown Agents, GFATM, IDA HIV Group, JSI,

MSH, UNICEF, UNDP, WHO-CPS, WHO NPO, Mission Pharma, SCMS.

Achievements Features and reports improved Number of contributors improved Scope expanded from HIV products to TB, malaria medicines

and substitution therapy

API Price and producer database http://www.who.int/hiv/amds/sourcespricesAPI.pdf

Why Improve price transparency and favour price negotiation Anticipate potential shortage in APIs and inform API

producers Inform WHO management in their strategic decision for

advocacy

How Collect and disseminate lowest and highest prices of each

API on AMD website Analyse API price trends Contributors: all Generic API producers – contact details on

AMD website

Achievement Tool and product Refined Updated information Increased number of companies reporting to AMDS

Regulatory status database http://ftp.who.int/htm/AMDS/drugsdatabase.pdf

WHY Limited access to information on ARV marketing

authorizations by countries Inform WHO management team in making strategic

decision and advocacy Inform state and non state procurement officers, donation

programmes, countries using the GFATM grant on which drug is registered and where

How Collect regulatory information and make it available in the

public domain Contributors: all R&D and generic ARV producers

Achievements Searchable database Cross check information at country level with support from

AMD partners

Forecasting of the ARV market

Why

• To avoid global supply shortages of antiretroviral drugs as it happened during the scaling-up efforts.

How we took it forward

• Production of draft ARV forecasts 2007-2008 for discussion with manufacturers

• Consortium of partners: UNAIDS, UNICEF, PfSCM, USAID, Clinton Foundation, Mexico National Inst of Public Health

• Approaches: normative and consumption models.• Survey 2006: uptake of ARVs in low & middle income

countries. Published in AIDS Journal, July 2006

Country Support in Supply Management

Rationale• PSM constraints are major obstacles in the health system• Access to HIV commodities requires wide partnership• Several partners at country level work in isolation sometimes

in competition• Lack of sharing of information/harmonization of practices

Two major areas of focus• Increase collaboration to strengthen the supply management

in program planning and implementation processes (Unicef, TCM, WB, GF, DELIVER, IDAsolution)

• Support the creation of national PSM coordination groups to achieve integrated national supply chain management systems.

Country support in Supply Management

Capacity building for PSM planning, training and TA

• PSM workshops for national professionals (e.g. IDAsolution, Global Fund)

• Exchange of information and experience sharing among participants

• Consultant database in PSM• TA to urgent request for PSM support when no other

partner is available.

Country support in Supply Management: The Future

Increase visibility and commitment of PSM in planning process

• Collaborate with RCC in RO & CO planning processes to ensure that PSM issues are well addressed

Support creation of national PSM coordination groups

• Map country level presence of partners and their PSM area of work

• Increase WHO capacity to play its convening role of partners at country level: work with TCM, ROs and COs

• Foster collaboration for technical support between WHO and the AMDS Network Organizations: Global Fund, SCMS, WB, UNICEF, etc.

Tool Development Reporting and M&E

Importance• Vertical reporting puts a huge burden on national

programmes• Lack of clarity at implementing levels of the reporting

requirements• Harmonized reporting helps decide where to start improving

supply chain management system

Opportunity• High level of consensus that "verticalization" in reporting

requirements by donors has gone too far: harmonization needed at country level

• The need for AMD network partners (esp. PfSCM) to develop/implement a harmonized and M&E PSM system.

• Partners asked WHO to take this process forward

Tool Development: Reporting and M&E; Handbook of supply management at first-level health care facilities

What we didReporting and M&E of ART-PSM system• Get the facts and move towards consensus

– JSI, MSH, PfSCM, – Programme experts from Rwanda, Tanzania, Uganda, Vietnam– CHMP, CRS, Global Fund, IDA, PEPFAR/OGAC, UNAIDS, UNICEF,

World Bank• Develop outline interagency document• Constitute a working group on content

Next steps• Draft ART-PSM M&E document developed• Field-test and finalise the document

Handbook of supply management at first-level health care facilities

• Manual published and ready for use

Conclusion

• AMDS is part of health system strengthening Unit of HIV Department

• PSM is a wide area requiring strong partnership: AMDS works by fostering partnership among technical institutions working in PSM

• Major areas of AMDS work to increase access to HIV commodities:

• Strategic information: GPRM, regulatory status, API, patent (in progress)

• Forecasting of HIV drug needs• Regional and country support including capacity

building: support in planning (PSM plans) and training of professionals working in national supply chain management systems.

• M&E