UNICEF- Update on key activities and plans IPC, 5 th -6 th June. 2014

Procurement in support of programmes Supplies and services for 134 countries and areas Total procured $2,839 Emergency $127 Supplies to 33 countries and areas Procurement Services $1,363 Supplies to 99 countries

Supplier and destination countries

Medicines: 2014 Activities Procurement strategies to address increasing demand for priority medicines: ORS/Zinc, amoxicillin DT, gentamicin, CHX, dexamethasone inj, IFA… Support work of UNCLSC and Pneumonia and Diarrhoea WG: Amoxi DT ERP, availability of medicines and diagnostics, collaboration to increase sources, country implementation including activities resulting from GF/UNICEF MoU. Optimization of kits: iCCM (DRC), Diarrhoea kit, PEP Kit Partnerships to ensure availability of pediatric ARVs: IATT Formulary development Pediatric ARV WG Pediatric ARV Procurement Working Group Controlled temperature shipments Improve internal process and supplier relations to provide optimal service

The market dashboard Inspired from UNITAID Market dynamics Dashboard The Dashboard monitors the market dynamics of more than 50 essential commodities for women and children. It provides a qualitative assessment of the determinants of a healthy market, including: Availability Affordability Competition Quality Acceptability Delivery Funding security Published twice a year, aim is to encourage internal and collaborative thinking on ways to address gaps and achieve a more balanced market

ORS/Zinc co-pack: 3 LTAs established, first procurement of over 200K packs Chlohexidine 4% for umbilical cord care: collaboration through UNCLSC to increase number of manufacturers and qualify gel formulations. Amoxicillin DT: increase in demand and initiation of substitution of suspension Introduction of optimal products

Kit delivery Majority are health kits

Supply of commodities to manage sexual assault of children and women in the context of emergencies Challenges Forecasting the need Kit design not addressing diversity of situations where it is used (target, skills and care services) Repacking of kits at Country Office level to meet needs Split up kit contents to distribute to smaller health facilities Split up blisters/packs to dispense to patients Specific needs of children usually not taken care of, e.g. paediatric dosages Lack of specific Guidance PEP Children PEP Adults Wound Care Psychosocial Support Associated Conditions + Guidance Documents Proposed Response (for discussion with partners) Easy identification of the necessary items for management of sexual assault More flexibility in procurement of PEP for children Holistic response, Clear guidance Guidelines to be reviewed 2014 (WHO)

Consolidate regimens used Consolidate formulations used Ensure pediatric ART guidelines are up to date Identify regimens and products that can be phased out of formulary (eg. d4T, ddI) Review current procurement list for redundancies Explore areas for transition to optimal products such as FDC’s and phase out suboptimal or redundant formulations Partnerships to ensure availability of optimal treatment for HIV in children Consolidate formulations used Coordinate pediatric ARV procurement amongst partners Align both supply and demand to more efficient products. Interagency Task Team (IATT)/ Pediatric ARV Working Group Pediatric ARV Procurement Working Group/ Buyer Consortium

Health Technology Centre Essential supplies for Health Programmes Medical equipment and consumables, diagnostics tests and clinical laboratory equipment Long Lasting Insecticide treated bed nets ( LLIN’s), Insecticides and Rapid Tests Malaria Prevention and Diagnostics Medical Devices and Laboratory Cold Chain Cold chain equipment, refrigerators, waste disposal, injection safety devices Maternal and New born Health Issues INNOVATION FOCUS Injection safety devices, waste disposal. Immunisation Devices

Health Technology: 2014 Activities Optimization strategies defined for Health Technologies Supply Chains,.i.e. Performance indicators, Forecasting, Shipments optimization and Total Landed Cost options Quality policies prepared, harmonization with key partners (IVD, High Risk Medical Devices, mapping high-risk products that could be those correspond to class IIB and III of European MDD and develop its risk mitigation protocol). Innovation – ARIDA project ( pneumonia diagnostics ), in collaboration with WHO, Malaria Consortium, BMGF Partnerships LLIN procurement – GF, UNDP, DfiD, PMI, Partnerships POC technology – UNITAID, CHAI, 7 countries

Ensure a cold chain for all TTSPP …. Scale up of old vaccines ……. Scale up of new vaccines …… Scale up of new versions such as IPV …. Healthy market for innovative cold chain equipment Supply Chain integration – Oxytocin, Insulin Cold chains for lab samples, blood banks, test kits … Immunization devices available for all Optimizing immunization shipments/cost per device delivered Untangling the web of quality requirements Waste management for immunization, diagnostic testing ? Aligning with WHO PQS for injection safety devices procurement and providing feedback on evaluation protocols and technical specifications Contribute to the updating of WHO guideline of injection safety Activities

UNICEF-CHAI Project: Accelerate Access to Innovative Point of Care (PoC) HIV Diagnostics: CD4, Early Infant Diagnosis, and Viral Load Funded by UNITAID Targets: 7 focus countries Zimbabwe, Tanzania, Kenya, Ethiopia, Uganda, Mozambique, Malawi Programmatic and Supply coverage: CD4 testing, which is used for staging and monitoring HIV patients prior to initiation onto antiretroviral therapy (ART). Early Infant Diagnosis (EID) testing for infants less than 18 months of age (this technology can be performed on viral load platforms as well). Viral Load (VL) testing, which is mainly used for monitoring HIV patients following initiation to ART UNICEF Quality Policy for procurement of IVDs consulted with WHO, CDC, MSF and fully harmonized with Global Fund. Phase 1 Nov 2012-December June 2014 US$ 20million Phase 2a Project proposal approved and MOU currently under negotiations Period July 2014 –Dec 2015 US$ 35million Phase2b Project ending 2018 funding remains subject to UNITAID board approval

Source: UNIICEF Supply Division Immunization Supplies Vaccines BCG, DTP, TT/Td/DT, Measles containing, OPV, HepB, YF, DTP-HepB, DTP-HepB/Hib, DTP/Hib, Hib, MR, Meningitis, MMR, PCV, RV IPV, HPV etc. Safe Injection equipment Cold Chain Equipment Vaccines BCG, DTP, TT/Td/DT, Measles containing, OPV, HepB, YF, DTP-HepB, DTP-HepB/Hib, DTP/Hib, Hib, MR, Meningitis, MMR, PCV, RV IPV, HPV etc. Safe Injection equipment Cold Chain Equipment Vaccines Supplies: US$ 1, 285 million 2.79 billion doses 2,185 shipments 2013 Countries UNICEF procures on behalf of Full schedule Partial schedule UNICEF has a key role in vaccine procurement, procuring immunization supplies on behalf of around 100 countries annually Source UNICEF Supply Division

Vaccines: 2014 Activities*  Support to countries / on-going operations: Coordination internally and support to countries for high number of new vaccine introductions (79 new vaccine introductions (13 IPV) in GAVI supported countries in 2014; 123 (59 IPV) in 2015), and continuing programmes; specific innovative projects follow up: VAR, Visual Vaccines; KPIs  Continued/increased support to MICs and GAVI graduating countries through procurement practitioners forum to support countries moving to self-procurement, review VII and other financing mechanisms, engagement with partners and countries, MIC tender for new vaccines  Polio eradication – IPV tender concluded in Q and operationalized during the year; OPV supply and demand planning for vaccines and funding; strategy for type 2 withdrawal  Timely completion of tender activities and additional awards (JE, Mening, penta, HPV, PCV, Rota); develop consolidated strategy for achieving price goals  Provide more useful and accessible information for countries, manufacturers and partners (eg, update website, pricing data, procurement contexts, market updates)  Continue to strengthen supplier relationships, including at least 1 visit to each of the top 10 suppliers and visit to China  Follow-up with DRC and Nigeria on supply chain optimization projects  Coordination with partners, including GAVI, BMGF, WHO, GPEI, etc *Key activities, not all inclusive

Virus detection & interruption Last wild polio caseCertification RI strengthening & OPV withdrawal Containment & certification Introduce IPV Wild virus interruption Outbreak response (esp. cVDPVs) RI strengthening & OPV2 pre-requisites OPV2 withdrawal Legacy Planning Finalize long-term containment plans Complete containment & certification globally Consultation & strategic plan Initiate implementation of legacy plan Last OPV2 use Endgame Major Objectives Source: WHO

WHA endorsement in 2013 of Endgame Strategy require IPV introductions in 123 countries globally within 20 months

Sufficient supply secured to meet projected demand through UNICEF at affordable prices, but planning needed 20 countries requiring supply in 2014, with 7 planned introductions A total of 75 countries to introduce in this period, and two continuing countries 20 LMIC/MIC countries to continue or introduce sourcing through UNICEF Flexibility required with regards to product preferences, number of shipments per year, delivery of buffer stocks, month of introduction, registration requirements

UNICEF support to the tOPV/bOPV switch Global synchronized switch from tOPV to bOPV requires careful planning at global and country level Engagement with partners, countries, and industry to ensure smooth transition and no shortages of any product Protocols and strategies under development for operationalization of a switch

Vaccines stock monitoring and projection tool… ViVa (Visibility for Vaccines) …Enabling identification and communication of upcoming potential constraints linked to supply through graphs. From May to August 2014: Pilot phase with EPI in DRC, Niger and Senegal. Next: Feedback interest survey and decision on continuity and scaling-up.

Supporting Middle Income Countries to Access New Vaccines For additional information on UNICEF’s MIC New Vaccine Procurement Initiative see UNICEF Vaccine Procurement Practitioners Forum (Q4 2014) EURO Inter-country Vaccine Procurement Workshop 2013 Transition planning for GAVI graduating countries Vaccine Procurement System Assessments Coordination of MIC support with global/regional partner activities: Global MIC Task Force Vaccine Product, Price and Procurement (V3P) Project EMRO Pooled Vaccine Procurement (PVP) initiative GAVI support for access to appropriate pricing for graduates & other LMICs Sharing of knowledge of (i) the vaccine market, (ii) Vaccine Security and underlying elements of forecasting, funding and appropriate contracting, (iii) vaccine procurement. Issue market analyses. Publish Reference Prices to serve as a benchmark for self- procuring MICs. Aggregate MIC demand forecasts for new vaccines to provide better visibility to industry. Pool MICs’ vaccine procurement to improve demand predictability, reduce transaction costs and improve pricing. MIC Pooled Procurement Information Access Capacity Building Technical Assistance Strategic Partnerships

Some countries where we are already working with the govt to strengthen the supply chain and develop capacity DRC Immunization and Essential Medicines Nigeria Immunization Sierra Leone All Health Commodities Kenya Essential medicines Zambia Essential Medicines Afghanistan Immunization Madagascar Essential Medicines Myanmar All Health Commodities Eritrea Education Ethiopia Essential Medicines Niger Essential Medicines and Nutrition Tanzania Essential Medicines Cote d’Ivoire Bednets Malawi All Health Commodities Mozambique All Health Commodities

2014 Activities  Support to development and implementation of national supply chain strategies  Global networking and collaboration (GAVI, Global Fund, RBM etc.)  Communication strategy and advocacy tools to raise awareness internally and externally  Research to increase understanding of national supply chain models and promising practices  Guidelines for capacity development with a supply chain toolkit for COs and partners (including a SC health check and performance monitoring tools)  Roster of consultants for technical assistance  Support development of the supply community technical skills framework and professional development plan  Develop the Global Learning Centre Strategy including the initial curriculum (starting with vaccines, bednets and nutrition)  South to south exchanges

What does success look like in 2017?  Increased use of national supply chains, from determination of need through to delivery to the last mile, across all programmes and including monitoring  Increased number of countries actively implementing national supply chain strategies, led by government  Strong networks created with increased collaboration, sharing and co-ordination in capacity development and supply chain systems strengthening initiatives at global, regional and country level  At least 20 government supply chains strengthened and optimized for targeted products