Medicines Procurement and Supply Management Issues in Nigeria WHO Technical Briefing Seminar 08-12 October 2006 Joel Ewuga Babakandzhi Adagadzu Food and Drugs Services Federal Ministry of Health Abuja - Nigeria

Outline 1 Introduction Present situation Challenges Selection Procurement Warehousing/Distribution Financing issues Challenges Ongoing interventions Future plans

Introduction 1 During the last 2 decades the medicines supply situation in Nigeria has deteriorated considerably Medicines supply is now erratic and unreliable with widespread shortages or stock-outs in spite of the increasing availability of funds

Introduction 2 Increased allocation of health budget to medicines procurement has not improved the supply situation Several development partners have been actively involved in providing support to the government with a view to improving the drug supply situation Such supports are mainly in the form of provision of medicines and health commodities, capacity building, etc.

Selection 1 Presently selection not standardized and coordinated Selection may be by partners, programs or health facilities Selected medicines in most cases do not necessarily conform to the National Essential Medicines List Nobody appears to be in-charge

Procurement (1) Reliable consumption data not available Procurement plan not always available Various partners and facilities procuring independently Certain areas over supplied while others are undersupplied Medicines procured are at an average of 3 times international prices This leads to about 75% loss in savings 30% of medicines procured do not meet the 80% shelf life requirement for rational procurement

Warehousing/Distribution 1 Most procurements are done without prior plan for distribution as only 10% of delivered products have distribution plans No budgets are provided for distribution Consequently, procured medicines are often left for long periods in the stores before distribution resulting at times to expiry Massive wastage of resources through uncoordinated and inappropriate distribution plans of medicines to the same health facilities by various partners and programmes

Financing (1) Health Care Structure in Nigeria comprises of: Primary Health Care (Local govt) Secondary Health Care (State govt) Tertiary Health Care (Federal govt) The Federal Government also provides both financial and technical support to the lower tiers of government in addition to the efforts of these governments Various developmental partners also finance medicines procurement

Challenges 1 Sourcing of funds Development of logistics strategy Training of personnel Centralized procurement or pooled procurement Quality concerns Cost of medicines

Challenges 2 Monitoring and evaluation Development of a sound information system Public/private sector partnership Effective management of the National Health Insurance Scheme, etc.

Key intervention programmes Cost Recovery System or Drug (Medicines) Revolving Funds (DRF) National Health Insurance Scheme Public Private Partnership (PPP) for the financing of public medicines supply Support by partners for various health programmes Inflow of these resources uncoordinated and impact not commensurate

Ongoing Interventions With the support of WHO, the following are ongoing: Establishing a list of key Partners involved in Medicines procurement and distribution with aim of coordination to maximize use of resources To carry our an in-depth assessment of the medicines procurement and distribution in the public sector so as to target interventions in addressing gaps.

Thank you