WHO Technical Briefing Seminar 17 th 20 th November 2008 Use of evidence in strengthening medicine supply systems: The case of Tanzania Mr Joseph Muhume MoH Tanzania 20 th November 2008

Overview of Studies  13 African countries including Tanzania planned in 2006 to carry out studies on medicines supply systems.  The countries conducted two surveys: 1. The Mapping Survey of all partners involved in PSM of medicines and medical supplies; 2. The In-Depth Assessment to identify strengths and weaknesses of the supply management system and to identify opportunities for coordinated, coherent and efficient national medicines supply strategy.

Mapping Medicines Procurement Systems Objective: to establish a map of partners involved in procurement of medicines and medical supplies The results were expected to: To map the financial flows of the existing procurement and distribution system To provide an overview of all stakeholders involved in medicines procurement and distribution To present a synopsis of medicines procurement and distribution pathway in country

1 3 2 Harmonization and Alignment principles by DPs Managing for Results 4 Ownership (Tanzania) Alignment (Donor - Tanzania) Harmonisation (Donor - Donor) Development Results TZ sets the agenda Aligning with TZ agenda Using TZ’s Systems Establishing common arrangements Simplifying procedures Sharing information

Source Of Funds Procurement Agent/Body Point of 1 st warehousing Point of 2 nd warehousing MEDICAL STORE Medicines supply systems in TANZANIA PRIMARY HEALTH CARE FACILITY DISTRICT STORE ZONAL MEDICAL STORE ESSENTIAL MEDICINES ARVsMALARIATBOI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINESCONDOMSCONTRACEPTIVES MEDICAL SUPPLIES REGIONAL/DISTRIC T VACCINE STORE HEALTH FACILITY GOVERNMENT MULTILATERAL DONOR BILATERAL DONOR NGO/PRIVATE AXIOS TEC &CC T CRSIMACUAMMHOSPITALCOLUMBIA HOSPITAL TEC &CC T HEALTH FACILITY HOSPITAL TEC &CC T ZONAL BLOOD SAFETY CENTRE Point of Distribution GOVERNMENT WBWBGLOBAL FUND SIDASIDA PEPFARPEPFAR USAIDUSAID UNICEFUNICEF WHOWHO ABBOTTABBOTT CSSCCSSC COLUMBIACOLUMBIA PFIZERPFIZER JICAJICA CLINTONCLINTON UNITAIDUNITAID CIDACIDA CDCCDC GAVIGAVI CUAMMCUAMM HAVARDHAVARD NORADNORAD HOSPITAL TEC & CCT CLINTONCLINTON HAVARDHAVARD MEDICAL STORE CRSCRS SCMSSCMS EGPAFEGPAF MOH & SW AXIOSAXIOS UNICEFUNICEF JICAJICA CDCCDC COLUMBIACOLUMBIA ABBOTTABBOTT GAVIGAVI CUAMMCUAMM CROWN AGENTS USAIDUSAID TMAPTMAP AXIOSAXIOS United Republic of Tanzania PATIENT

Source Of Funds ESSENTIAL MEDICINES ARVsMALARIATBOI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINESCONDOMSCONTRACEPTIVES MEDICAL SUPPLIES GOVERNMENT MULTILATERAL DONOR BILATERAL DONOR NGO/PRIVATE GOVERNMENT WBWB GLOBAL FUND SIDASIDA PEPFARPEPFAR USAIDUSAID UNICEFUNICEF OMSOMS ABBOTTABBOTT CSSCCSSC COLUMBIACOLUMBIA PFIZERPFIZER JICAJICA CL I N T O N UNITAIDUNITAID CIDACIDA CDCCDC GAVIGAVI CUAMMCUAMM HAVARDHAVARD NORADNORAD AXIOSAXIOS Funding by Supply Type ( Data) 315,17053,85917,7343,90517,30037,0273,722 4, ,20156,85365,869$ ‘ %17.1%5.6%1.2%5.5%11.7%1.2%1.5%17.2%18.0%20.9%

Results: Financial resources Government funding (53%) - USD Million Followed by Global Fund (32%) - USD Million Development partners contributed (15%) - USD 46.2 Million (Actual value of the directly donated goods was not wholly captured; the percentage contribution by partners would have been significantly higher if the actual value of all donated goods are captured.)

Source of Funds: In Kind Donations  About 60% Bilateral donors USAID, PEPFAR, CDC, CHAI, UNITAID, JICA prefer direct in-kind donation.  Donate direct goods through their own or select procuring agents such SCMS, DELIVER, JSI and Crown Agents  or through implementing partners such as CRS, IMA, Columbia University, Harvard University, EGPAF, FHI  GAVI and UNICEF give in kind. This is equivalent to 25% of total multilateral giving.  90% NGO and Private donors CUAMM, CSSC, Pfizer give only in kind.

Partner Alignment: The Global Fund example  GF is inline with GOT system  GF gives fund to the GOT (Paymaster General)  Disbursed to beneficiary programs- NACP/NMCP  Deposited to MSD (NACP/NMCP)  MSD then procure, store, and Distribute  MSD charge 8% for operating costs (the rest 6% covered by MOHSW)

In-Depth Assessment Objectives: To identify strengths and weaknesses at each level of the medicines supply management cycle and analyse the financial flows of the existing procurement and distribution system To identify strengths and weaknesses at each level of the medicines supply management cycle and analyse the financial flows of the existing procurement and distribution system To use the results as evidence for the development of a coordinated, coherent and efficient national medicines supply strategy To use the results as evidence for the development of a coordinated, coherent and efficient national medicines supply strategy

Results-Structure of supply system 1 Central Medical Stores (MSD) semi-autonomous 8 Zonal stores distributed throughout the country Advantages of semi-autonomy of MSD and decentralized management structure to zones is a positive thing. Advantages of semi-autonomy of MSD and decentralized management structure to zones is a positive thing. However not all key areas are decentralized However not all key areas are decentralized Key IssuesResults

Results-Quantification Why only 5% of facilities doing quantification? Why only 5% of facilities doing quantification? Activities at health facilities Key IssuesResults

Results-Storage /Stock Management Expiry at CMS Amount of medicines and supplies that expired in 2006 was 3.7% of sales for the year Amount of medicines and supplies that expired in 2006 was 3.7% of sales for the year The expiry of products at health facilities The expiry of products at health facilities Key Issues Results Is there room for improvement?

Human Resources How do we improve this ratio? How do we improve this ratio? Tanzania Statistical data for Pharmaceutical Human resource NumbersCategory 630 Registered Pharmacists 400 Pharmacy Technicians 330 Pharmacy Assistants 1360 TOTAL Ratio to population: 1 : 105,000 Key IssuesResults

 On 4 th - 5 th May 2008 reports of the two studies were discussed by various stakeholders in the pharmaceutical sector  The CMO (DG-Medical Services) who was the guest of honour recommended that issues identified should be included in the Health Sector Strategic Plan 3 (July 2009 – June 2015) so as to use evidence-based planning in strengthening medicine supply systems Stakeholders consultations

Donors be encouraged to comply with the Tanzanian procurement system Donors be encouraged to comply with the Tanzanian procurement system Standard Operating Procedures be developed for Development Partners and other stakeholders for procurement of medicines and supplies to be utilised in the Tanzanian health system Standard Operating Procedures be developed for Development Partners and other stakeholders for procurement of medicines and supplies to be utilised in the Tanzanian health system  More Pharmaceutical personnel be trained, recruited and retained Issues in HSSP 3

MSD to decentralize key functions to zone office to respond quicker to client needs. MSD to decentralize key functions to zone office to respond quicker to client needs. Health facility and district level strengthened in forecasting, procurement, stocking and rational prescription of medicines Health facility and district level strengthened in forecasting, procurement, stocking and rational prescription of medicines  MSD warehousing, communication and distribution capacities at zonal level be strengthened Issues in HSSP 3

 National medicine policy implementation plan could be another way of implementing remaining recommendations Other opportunities

THANK YOU