Essential Drugs and Medicines Policy (EDM) World Health Organization EDM Country Support to 3x5 strategy Helen Tata Essential Drugs and Medicines Policy (EDM) World Health Organization 18 March 2004

Teaching Objectives At the end participants will understand: How country support for 3x5 is organised across WHO EDM contribution to country support for 3X5 Collaboration with other partners involved in 3X5

3x5 Strategy Pillar 4: Effective medicines and diagnostics supply Element 12: Support country access to , and efficient distribution of high quality, low cost medicines and diagnostics

Priority Countries (as agreed with Regions) REGION AFRO WAVE 1 Burkina Faso Cote d'Ivoire Ethiopia Kenya Malawi Mozambique Nigeria Republic of South Africa Swaziland Uganda United Republic of Tanzania Zambia Zimbabwe WAVE 2 Angola Botswana Burundi Cameroon Central African Republic Democratic Republic of the Congo Ghana Guinea Lesotho Namibia Rwanda

Priority Countries (as agreed with Regions) REGION AMRO WAVE 1 Haiti WAVE 2 Central America Sub-regional Team (possibly located in Honduras) Guyana

Priority Countries (as agreed with Regions) REGION EURO WAVE 1 Russian Federation Ukraine WAVE 2 Central Asian Republics Sub-regional Team (possibly located in Uzbekistan)

Priority Countries (as agreed with Regions) REGION EMRO WAVE 1 Sudan WAVE 2 Horn of Africa Sub-regional Team (including Djibouti, Somalia and Yemen - possibly located in Djibouti)

Priority Countries (as agreed with Regions) REGION SEARO WAVE 1 India Myanmar WAVE 2 Indonesia

Priority Countries (as agreed with Regions) REGION WPRO WAVE 1 Cambodia People’s Republic of China WAVE 2 Vietnam

Joint Country Scoping Missions 3x5 Of 15 assessment 3x5 missions, EDM participated in the following ten: Kenya NPO* * NPO participated India+ +EDM/HQ Nigeria* **EDM country focal point Ethiopia* Tanzania* China+ Côte d’Ivoire** Burkina Faso+ Ghana* Swaziland** Collaboration with UNAIDS, WB etc.

3 by 5 Country Deployment 27 countries (19 for GFATM proposals) Approximately 40 HQ staff, also RO and CO staff and consultants Deployment periods ranging from 1-8 weeks - deadlines (e.g. April GFATM) Co-ordination with core and critical HQ activities (e.g. finalisation of tools) Different needs and requests from countries (skills mix, funds, intensity) Range of roles and products: GFATM and WB proposals and reprogramming National operational plan for ART scale-up Preparation for country team and follow-up Briefing and mobilising partners

Backstopping - Technical Focal points identified, advice provided and where necessary short-term missions for: Drug procurement and management; Diagnostics and laboratory services Clinical care and guidelines Testing and counselling PMTCT Vulnerable populations Surveillance; M&E Capacity building TB and HIV/AIDS Budgeting/costing GFATM proposal development; World Bank reprogramming Partnerships; Communities

Core indicators to monitor national pharmaceutical situations Level I Structures & processes Level II Outcomes Level III Indicator tools for specific components of the pharmaceutical sector such as Pricing HIV/AIDS TRIPS Traditional medicine Etc, etc.

Tool for Assessment of Supply Management of ARV EDM is developing a tool for assessment of ARV supply management Tool has been field tested in three countries in 2003 Assessment carried out at designated ART centres only Representative sample of public facilities throughout the countries were surveyed using retrospective and prospective reviews Preliminary findings only Evidence based interventions will follow

Assessment Findings Country A from designated treatment centres

Assessment Findings Country B

Findings Country B Reasons for type of findings in country B Non competent staff handling ARV without training Fast implementation of ART by designated centres without involvement of competent services of MOH Running parallel or vertical programmes System of ARV stock management not harmonised Absence of national tool to manage ARV supply system No system to share information between treatment centres No documentation of activities, absence of collaboration with existing competencies

Why Assess? 1. Assess and Monitor 2. Plan 3. Implement Planned Interventions following assessment to address under performing areas undermining access to ARV

Planned Interventions Country A POA 2004 will support The development and dissemination of guidelines in management of HIV/AIDS medicines Capacity building of staff in ARV supply management at treatment centres Capacity building in use of HIV/AIDS medicines

Planned Interventions Country B POA 2004 will support: Establishment of collaboration between designated treatment centres and other implementing partners Capacity building of staff managing medicines at ART centres Harmonising tools for medicines management, including medicines quantification Treatment centres in the follow up of patients on ARV Follow up of ARV quality in use Development of STG for ART

ART Focuses around ARV ARV are today essential medicines that bring hope to the infected and affected