Wilbert Bannenberg wilbert@sarpam.net SARPAM Regional procurement policies and access to medicines - lessons from the SADC Pooled Procurement project Wilbert Bannenberg wilbert@sarpam.net SARPAM

Situational Analysis: Key Challenges Limited transparency and poor availability of information Prices, quality, sources of medicines Use of TRIPS flexibilities Reluctance to disclose information Varying availability of selected medicines Lack of standardisation on procurement and pricing information difficult to compare between countries Various levels of development of medicines regulatory systems – no MRAs in some countries Shortages of qualified staff in fields of specialisation No coordination in efforts to strengthen PSM systems Demographic and economic differences among countries

Percentage of NMPA prices below the international MSH benchmark

SADC Pharmaceutical Business Plan: 4.1.5 Promoting joint procurement Evaluate options for pooled procurement for priority medicines and harmonize procurement regulations Identify the priority essential medicines which can bring about the largest savings from pooled procurement or price negotiations Identify and facilitate access to funding sources and finance mechanisms for joint procurement Establish a regional mechanism for pooled procurement of medicines Assess and strengthen national procurement agencies and supply chain management systems

SARPAM Pooled Procurement project Based on SADC Pharmaceutical Business Plan SADC Health Ministers wanted PP since 1997! Efforts did not work due to Drug Regulatory and Procurement system differences SARPAM developed proposal to start with information exchange between Procurement Agencies 13 countries now sharing information At same time, SARPAM started Drug Regulatory harmonisation project Common Technical Document being implemented SADC PP Strategy developed in 2012

SADC Pooled Procurement Strategy Developed by a working group from SADC Member States and partners WHO, UNDP, MSH with technical assistance from SARPAM Discussed and approved by SADC Ministers of Health and HIV/AIDS – Nov 2012 SARPAM facilitating implementation of the strategy Member States choose taking a step-wise approach: Recognition of challenges – 14 sovereign states vs region Prioritise information and work sharing first Group contracting in a later phase

The 4 Pooled Procurement models (Adapted from MSH, 2012) Informed Buying Member States share information about prices and suppliers but undertake individual procurement. Coordinated Informed Buying Member States undertake joint market research, share supplier performance information and monitor prices. Countries undertake individual procurement. Group Contracting Member States jointly negotiate prices and select suppliers. Countries agree to purchase, individually, from selected suppliers. Central Contracting and purchasing Member States jointly conduct tenders and awards contracts through an organisation acting on their behalf. Central buying unit manages the purchase on behalf of countries Member states have chosen to begin with information sharing first until clarity is there on rules and regulations will dictate extent collaboration can go.

PP Strategic Objectives To establish a mechanism for regional procurement of medicines and related commodities. To mobilise resources for the SADC regional procurement for Essential Medicines and Commodities To develop and harmonise policies and guidelines for procurement of Essential medicines and Commodities. To facilitate trade and movement of Essential Medicines and Commodities in the region This includes working on using TRIPS flexibilities!

Intersectoral Cooperation Between the Health sector and Trade (and customs): increased medicines’ trade among MS Finance: ensure resources Procurement: procurement guidelines Legal affairs: legislation and regulations While including development partners, private sector (SAGMA) and Civil Society

Main Responsible Parties SADC Pharmaceutical Procurement Services (SPPS) SADC Secretariat MOH Pharmaceutical Departments Procurement Agencies (e.g., NDSO) Regulators (e.g., LMRA) Partners Suppliers Ministries of Trade, Finance, Justice

Pooled Procurement Benefits Considerable savings by applying information and work sharing among procurement agencies Leading to improved access to essential medicines Development and implementation of regional standards and procedures will lead to increased efficiency Quality assured medicines through regulatory harmonisation Functional regional pharmaceutical procurement agency (SPPS) offering procurement services like information sharing, work sharing , coordination, (e-) procurement services including group contracting

Information & Work Sharing Platform To make available to stakeholders in SADC Member States all key information on medicines that are on the market in the region information on prices, sources and quality of at least 50 essential medicines and other difficult to source products To make available information on ‘good practices’ in SADC Member States on pharmaceutical Procurement and Supply Management (PSM) systems including procedures and tools used a database of expert staff in Member States that apply these practices. Price benchmarking

ACT prices on SADC e-platform http://med-db.medicines.sadc.int/

Price comparison per product

Big differences....

Lesotho data (2012-2013)

SADC can save 18% or $100m

Finally... SADC member states: Pooled Procurement implementation plan approved Options paper for SPPS approved (@ SADC Secretariat) agreed to establish the information sharing e-platform SADC member states meet week 22 September in JNB Acknowledgement - based on a presentation by : Geoffrey Ngwira, SARPAM Pooled Procurement Officer Phone: +265 994 608 005 Email: geoffrey@sarpam.net

Yes, we can!