Overview of Procurement and

Supply Management Processes

for HIV/AIDS and TB Medicines

Francis Aboagye-Nyame Director, SPS Program

Workshop on Procurement and Supply Management for HIV and TB Products September 5-7, 2011

Intercontinental Hotel Nairobi, Kenya

Outline

Stock-outs of HIV/AIDS and TB commodities

Pharmaceutical Management Framework

Procurement Mechanisms for HIV/AIDS and TB Commodities

Supply Chain Management Systems for HIV/AIDS and TB Commodities

Issues in Procurement and Supply Chain Management for HIV/AIDS and TB Commodities

Summary

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Stock-Out of HIV/AIDS Commodities:

What is Known Countries reporting a stock-out

of at least one ARV medicine 1 38% in 2009 (94 countries)

34% in 2008 (90 countries)

38% in 2007 (66 countries)

Islamic Republic of Iran, Tunisia, Yemen, and several Central and South American countries cited medicine supply interruption as a notable barrier to access antiretroviral therapy (ART) 2

Source:

1. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector.

Progress report 2010. World Health Organization, United Nations Children’s Fund and UNAIDS.

2. Global Report: UNAIDS Report on the Global AIDS Epidemic 2010.

18% (32/174) 16% (26/167) 20% (35/176) 22% (34/155)

45% (9/20)

9% (2/22)

41% (9/22)

27% (6/22)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Central Level(2007)

Central Level(2006)

Peripheral Level(2007)

Peripheral Level(2006)

Global HBC (High Burden Countries)

Source:

• Global Tuberculosis Control: Epidemiology, Strategy, Financing. WHO 2009

• Global Tuberculosis Control: Surveillance, Planning, Financing. WHO 2008

Stock-Out of TB Commodities:

What is Known

First-Line Anti-TB Medicines:

Percentage of Countries Reporting Stock Outs

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Procurement Mechanisms for

HIV/AIDS and TB Commodities

National procurement systems International competitive bidding, national competitive

bidding/others National laws

Global Fund Guidelines

World Bank Guidelines

Global mechanisms Voluntary Pooled Procurement and Capacity Building Services

Supply Chain Management System Project

Global TB Drug Facility

Other UN mechanisms

Nonprofit international suppliers working with governments IDA, Mission Pharma, others

Donations and grants from private parties and manufacturers

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Issues in Procurement of HIV/AIDS and TB

Commodities (1)

Absence or inadequate procurement policies, rules, regulations, structures, and formal systems for the procurement of quality-assured pharmaceuticals Compliance with international standards and donor requirements

Transparent and competitive processes

Product specifications

Staff skills and experience in procurement management

Funding Insufficient budgetary allocations

Procurement, clearing, storage, distribution, etc.

Funds released at irregular intervals

TRIPS flexibilities not properly utilized by countries

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Issues in Procurement of HIV/AIDS and TB

Commodities (2)

Global and national markets Limited volumes of pediatric ARVs

Limited sources of quality-assured API

TRIPS limitations

WHO and other prequalification mechanisms limitations

Quantification and supply planning issues Lack of pipeline, enrollment, and consumption data

Complex and fast changing treatment regimens

Push for scale-up

Impact of new diagnostic tools and regimens

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Procurement and Supply Chain

Management System

Efficient Distribution Systems

Maintains a constant supply of drugs

Keep drugs in good condition throughout the chain

Minimizes losses due to spoilage and expiry

Rationalizes storage points

Uses available transport as efficiently as possible

Reduces theft and fraud

Provides information for forecasting drug needs

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ARV Supply Chain – Uganda

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Funders

Procurement Agents

Storage

Distribution

ARV Supply Chain—Ethiopia

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International/Local

Source

PFSA Central

PFSA Hub

Hospitals Health Centers

Health Posts

CLIENTS

National Health

Program

Units

Regional Health

Bureau/Zonal

Health Department

Woreda

Health Office

Key

Flow of pharmaceuticals

Flow of Information

Flujo de Medicamentos de Segunda Linea para el Tratamiento de TB-MDR

Adq

uisi

cion

Dis

trib

ucio

nU

soS

elec

cion

(6) Transporte

Informacion

necesidades

Informacion

necesidades

Transporte

(8.4) Autoriza

entrega almacen

DISA

Expediente

y tratamiento

(6 / 8.5)

Almacen Socios en

Salud

Recibe y almacena.

Entrega Tx para 33

dosis/ paciente (Amx+Cl;

Amk; Cap; Moxi)

(9)

Farmacia Centros de

Atencion a las

Personas

Recibe medicamentos

para 2-3 meses (en

equema completo )

(4)

CARE

(Con recursos de

Fondo Mudial)

Compra directa a

GLC/ IDA

(1.2)

DIGEMID

Elabora fichas tecnicas

de productos

farmaceuticos

(7 / 8.4)

Almacen especializado DISA

Recibe (del MINSA en base a

casos programados; del SeS en

base a aprobados por CER) y

distribuye medicamentos

(3)

OGA/ ORE

Compra por

subasta a la baja

(2)

Estrategia TB

Establecen

requerimientos de

compra

(8.1 / 8.3)

CERI

Recibe expediente

y aprueba

tratamiento

(regulares /

estandarizados

(5)

Almacen Central

Recibe y

almacena

medicamentos

(3.1)

DISA / DIRESA

Consolida casos

atendidos de

establecimientos y

estima necesidad

(3.2)

OGA/ ORE

Establece

requerimientos solicita

presupuesto y compra

(1)

Estrategia TB / DGSP

Elabora protocolos de

tramiento para

pacientes con TB MDR

(1.1)

DIGEMID

Elabora Petitorio

Nacional de

Medicamentos

(4.1)

CARE

Desaduana los

medicamentos

adquiridos por GLC /

IDA

(8)

Centros de Atencion a las

Personas

Identifica caso sospechoso y

consulta al CERI.

Completa expediente para

aprobacion de tratamiento

(8.2)

CER (Nacional) /

Unidad Tecnica

Evalúa expediente y

autoriza medicamentos

(casos especiales /

individualizados)

(10)

Centros de Atencion

a las personas

Enfermera entrega

medicamentos a los

pacientes

Consumo

(10.1)

Paciente completa

TX y cura

(10.2)

Paciente fallece o

abandona

Flujo reverso

de medicamentos

(8.3)

(8.3) Comunica

aprobacion Tx

Informa

existencias y

consumo

(8.3) Comunica

(x Correo-E) la

aprobacion Tx

(8.1)

(8.3)

Informacion

pacientes que

finalizan o

abandonan

Transporte

2nd Line TB Supply Chain – Peru

Issues in Supply Chain Management of

HIV/AIDS and TB Commodities (1) Management information systems

Information to make decisions

Policy and legal framework Product registration

Selection

Treatment protocols

Targets vs. service capacity

Procurement Forecasting and quantification

Procedures and processes

Customs and importation clearance

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Issues in Supply Chain Management of

HIV/AIDS and TB Commodities (2) Storage

Warehousing and storage infrastructure

Scale up

New technologies

Waste management

Security

Inventory management

Inventory parameters

Order processing

Transportation and distribution

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Issues in Supply Chain Management of

HIV/AIDS and TB Commodities (3)

Prescribing, Dispensing, and Use

Patient Safety

Quality Assurance

Post-Marketing Surveillance

Adverse Drug Events Monitoring

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Considerations

Scale up of HIV/AIDS programs

Absorptive capacity

Infrastructure

Funding

New Technologies

Treatment regimens

Cut-off points

Diagnostics

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Summary Pharmaceutical systems are complex

Multiple interrelated components

Decision-making process is complex

Many stakeholders are involved

Systems operate in a dynamic environment

TB and HIV pharmaceutical supply is part of a larger health system

International resources for procurement and technical assistance/capacity building are available

The pharmaceutical management cycle framework guides the systematic analysis and improvement of pharmaceutical systems

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Thank You

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