Intra- and inter-organizational collaboration in … and inter-organizational collaboration in disaster planning and long term ... Task Force Presentation. 5 ... A B G T E S M O H

Intra- and inter-organizational collaboration in disaster planning and long term humanitarian aid

Perspectives from the architecture for financing global health

Georgia Tech Humanitarian ConferenceFeb 19-20, 2009

Atlanta, GA

Prashant Yadav

2

Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009

Background

Around 10 million children under the age of five die due to lack of access to simple and affordable interventions (WHO 2008).

Over 40,000 people – many of them children – die every day in developing countries from infectious or parasitic diseases

It is estimated (WHO 1998, WHO 2004) that almost one-third of the world’s population does not have access to essential medicines.

In addition to this, each year, personal expenditures on health push more than 100 million people below the poverty line (Xu 2007)

Many could be saved by access to already developed drugs and vaccines

Over $10B is spent annually by international organizations on global health commodities and programs

A large number of organizations and thus a very complex architecture is used to finance drugs, vaccines and health commodities for low income and lead developed countries

3


$10B of annual global health commodities: procurement and financing envelopes

• Product

• ARVs

• Vaccines

• Malaria

• TB drugs

International Procurement structure

• GAVI and UNICEF

• AMFm (under development)

• WHO M2S2• UNICEF

• GDF• GLC

• MoH procurement

Major Financing

• SCMS• CHAI

• US-PEPFAR • Global Fund• UNITAID

• GAVI, UNICEF, BMGF, IFFImOthers

• Global Fund• WB Malaria Booster• UNITAID• US-PMI

N.B: Representative but not necessarily comprehensive

• Essential drugs• National

Governments• Health basket

funding from bilaterals

• Global Fund• UNITAID

4


End patients

Drug Manufacturers

PrivateChannel Buyers

PublicChannel Buyers

NGOChannel Buyers

NGOs

International Financing

Public Sector

Private Sector

How international global health financing flows to low income countries (1)

Slide template borrowed from Dalberg Global Development Advisors- AMFm RBM Task Force Presentation

5


End patients

Drug Manufacturers

PrivateChannel Buyers

PublicChannel Buyers

NGOChannel Buyers

NGOs

International Financing

Public Sector

Private Sector

How international global health financing flows to low income countries (2)

Slide template borrowed from Dalberg Global Development Advisors- AMFm RBM Task Force Presentation

6


Paris declaration and donor coordinationRecommends use of in-country procurement systems instead of

purchasing on behalf of countries

Source: OECD

Example: Financing flow for drugs and health commodities in Zambia

7


Drugs flow supply chain in Zambia

Source Of Funds

Procurement Agent/Body

Point of first warehousing

Point of 2nd

warehousing

Point of 3th warehousing

WORLD

BANK

PEPFAR

DFID

USAID

UNICEF

WHO

CHAZ

ZANARA

CHAI

JICA

WORLDVISION

UNFPA

ZABART

ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs

Ped

REAGENT Blood safety(+ test HIV)

VACCINES CONDOMS Contraceptives MEDICALSupplies

Category of

Products Color

UNICEF

C

H

A

SOC-FH

BOSTON

UNIVERSITY

UNFPA

CIDRZ

ZABART

CARE

Malaria Centre CAREPROVINCIAL STOREDISTRICT STORE

PROV. STORES

DISTRICT STORES

HEALTH FACILITY DISTRICT STORE

HF

GOVERNMENT

BILATERAL DONOR

MULTILATERAL DONOR

NGO/PRIVATE

JICA

BGATES

M

O

H

C

M

S

WORLDVISION WORLD

BANK

USAID

MOH CMSZAMBARTSTORE

CRS

DS

ITN

PATIENT

CHASTORE

CIDRZSTORE

HF

HEALTH FACILITY

AXIOS

HF

UNITAID

GLOBALFUND

CDC

GLASER

M

O

H

CLINTON

HC

HOME BASED CARE

8


Multi-donor coordination in the in-country drug supply chain in Zambia

Donors (CPs)

National Medical Stores

Pharmacy Unit

Finance and Accounts Unit

Drug Supply Budget Line (DSBL)

Procurement and Supply

Unit

MoH

$$ Funds CommittedDisbursement Plan

Purchasing restrictions

Projected RequirementsPlanned vs. Actual Stock Levels

Drug SelectionQuantification

Funds release schedule from MoF/MoHPayment terms etc.

Coordinated Funds to Needs Matching

Procurement Plan and Budget

Source: Fundafunda and Yadav 2008, Matching Demand and Supply for Pharmaceuticals in a Multi-DonorEnvironment: The Drug Supply Budget Line (DSBL) in Zambia

9


A donor coordinated pledge guarantee (PG) mechanism can provide bridge financing and decrease procurement delays (and hence stockouts)

Pledge Guarantee (PG) mechanism

Donor CountryManufacturers1

Donor makes pledge

2Country request

mechanism to cover product cost

3

PG verifies pledge with donor and establishes

MOU

4 Country procures through existing process

5Mechanism pays manufacturer or

procurement agent

6Manufacturer ships product to country

7

Donor pays the mechanism

(1) Could also be accessed by NGO or UNFPASource: Existing McKinsey and JSI Deliver analysis; Dalberg analysis

Source: Work with Dalberg Global Development Advisor for RHSC

Forecast Driven

Drug Substance Manufacturing

Current Push-Pull Boundary in Global Health Supply Chains

Co-formulating and Packaging

Pre-delivery Inspection

Shipping and Transport

Drug SubstanceInventory

Final ProductInventory

Order Driven

Inventory /Order Interface

Source : Yadav, Sekhri and Curtis (2006)

11


Inter-organizational coordination and risk sharing can shift the push-pull boundary

Source: Existing McKinsey and JSI Deliver analysis; Dalberg analysis

Minimum VolumeGuarantee Institution

Country ManufacturersDonor

1

Donors and countries estimate annual purchasing volume for

specified products

2

MVG decides on volume of product and amount of

risk to assume

Establishes master contractswith manufacturer based on

volume / risk tolerance

3Countries and/or donors each place individual orders under

master contract

4

Manufacturer ships products directly to

countries

5

Manufacturer informs MVG of unused volume

Secondary Markets?

6

Sale or storage of unused product; potentially waste

Joint work with Dalberg Global Development Advisors

Forecast Driven

Drug Substance Manufacturing

Shifted Push Pull Boundary in Global Health Supply Chains

Co-formulating and Packaging

Pre-delivery Inspection

Shipping and Transport

Drug SubstanceInventory

Final ProductInventory

Order Driven

Inventory /Order Interface

Source : Yadav, Sekhri and Curtis (2006)

Documents

Intra- and inter-organizational collaboration in … and inter-organizational collaboration in disaster planning and long term ... Task Force Presentation. 5 ... A B G T E S M O H