Finance analysis of pharmaceutical management interventions Edgar Barillas

Premises Finance analysis can be an extension of technical assistance interventions currently implemented by SIAPS Technical information has to be translated in policy briefs and political arguments Technical meetings and political lobbying are still necessary Four cases studies are presented

Case 1: Mobilization of resources for improving storage and transportation SPS 2010 study analyze the structural conditions of regional warehouses and determine the status of their transportation fleets in Dominican Rep. Technical report included a proposal for improving storage practices and conditions, along with estimates of the financial investment required

Case 1: Mobilization of resources for improving storage and transportation (2)

Case 1: Mobilization of recourses for improving storage and transportation (4) USAID investment in studies: USD 10,000 Up to November 2012, these USAID-funded pre-investment studies have made possible the mobilization of USD 461,582 (14% of estimated cost in storage)

Case 1: Mobilization of resources for improving storage and transportation (4) February 2013: SIAPS promoted a meeting for the mobilization of additional recourses Foto que tomo Anadina en e la reunion de almacenes

Case 2: Alternatives for funding ARV in DR 2003— ARV therapy began in public institutions ARV medicines have been funded mainly with resources donated by the Global Fund 2009 – 2012 - the number of cases grew at 33.4 % (2,958 cases) per year, whereas funding decrease of 21.7 % (965,382 US dollars, or USD)

Case 2: Alternatives for funding ARV in DR (2)

Case 2: Alternatives for funding ARV in DR (3) Adult and pediatric ARV medicine stock-outs in central stores and health care facilities, June 2010 to July 2011

Case 2: Alternatives for funding ARV in DR (8) Gap analysis: What is the MoH share?

Official backing by Ministerial Decree on July 2010 Implementation: Case 3: Combined On- and Off-Site Training Contributes to Strengthening Unified Pharmaceutical System in the Dominican Republic With USAID support DR is organizing a unified pharmaceutical system (SUGEMI) Official backing by Ministerial Decree on July 2010 Implementation: Development of operating manuals and SOPs Training for staff

Case 3: Combined On- and Off-Site Training (2) Initial training limited to practical content for the implementation of start-up activities: implementing a national inventory, transferring medicines from two DCP (TB and HIV/AIDS) to integrated regional warehouses, and placing periodic medicine orders and deliveries following standardized procedures. Challenge: Strengthening and maintenance of SUGEMI depends on pharmaceutical management in-depth training.

Case 3: Combined On- and Off-Site Training (3) Learn essential aspects of PSM, while simultaneously acquiring tools and abilities to apply SUGEMI procedures The Certificate Program in Pharmaceutical Supply Management offered by the Autonomous University of Santo Domingo using a hybrid on-site/off-site approach Target audience: Health professionals responsible for PSM functions in the public sector The university assigns a practice site to students who do not have one

Case 3: Combined On- and Off-Site Training (4) The 10-week program uses the following methodologies: Preparatory activities (individual reading): MSH’s book Managing Drug Supply and SUGEMI operating procedures. In addition, students should review national laws and regulations, along with other selected documents.

Case 3: Combined On- and Off-Site Training (5) On-site session: 10 consecutive Saturdays, students meet with the facilitator. Provides an overview of the topic, coordinates games and other group dynamics, discusses the challenges addressed in the previous week’s practice work, and provides instructions to guide students’ on-the-job practice

Case 3: Combined On- and Off-Site Training (6) On-the-job practice: Evaluation of specific components of the supply system in place in his/her institution. Analysis of indicators. During the on-site sessions, findings are shared by students in group discussions. Students propose alternative interventions for addressing the problems

Case 3: Combined On- and Off-Site Training (7)

Case 3: Combined On- and Off-Site Training (8) 30 professionals started the course on November 2012 The firs promotion will complete the course on March 2013 Each student is required to submit a systematic listing of the problems identified in his/her institution, the interventions implemented to correct those problems, and the results achieved

Case 3: Combined On- and Off-Site Training (9) 15 tuition fees were sponsored by USAID/SIAPS at a cost of USD 475/each= USD 7,125 20 additional tuition fees were sponsored by other institutions Institution # TF Total Public teacher insurance (SEMMA) 5 2,375 PROMESE/CAL 4 1,900 Centers of Excellence Abt/ USAID 10 4,750 Private 1 475 20 9,500