From 3by5 to Universal Access to HIV/AIDS Treatment: AMDS Technical Briefing Seminar for Consultants on Procurement and Supply Management for HIV, TB and Malaria 30 January 2006 Copenhagen Peter Graaff, AMDS, HIV

2 AMDS Content  Procurement and Supply Management Issues Tools  Aids Medicines and Diagnostics Service Partners Activity Areas  From 3by5 to Universal Access Investment Coordination

3 AMDS Drug procurement is more then "shopping" Procurement Cycle Demand Creation Supplier Agreements Financing Receipt, Storage, Distribution Forecasting Quality Assurance Effective Use Product Procurement Product Selection Monitoring

4 AMDS A moving goalpost From procurement to supply management to…… Price

5 AMDS A moving goalpost From procurement to supply management to…… Price

6 AMDS A moving goalpost From procurement to supply management to…… Procurement What? Where? How much (quantification)? IP barriers Patents Bilateral trade agreements Registration (fast track) Quality (PQ)?

7 AMDS A moving goalpost From procurement to supply management to…… Procurement What? Where? How much (quantification)? IP barriers Patents Bilateral trade agreements Registration (fast track) Quality (PQ)?

8 AMDS A moving goalpost From procurement to supply management to…… Supply management Customs clearance Volume Expiry & stock-outs Information flow Task shifting ……..

9 AMDS A moving goalpost From procurement to supply management to…… Supply management Customs clearance Volume Expiry & stock-outs Information flow Task shifting ……..

10 AMDS A moving goalpost From procurement to supply management to…… Adherence Rational use Patient tracking Side effects Community involvement ………….

11 AMDS A moving goalpost From procurement to supply management to…… price and procurement Increasing lead times with increasing chances of wastage Global capacity IP barriers Patents Bilateral trade agreements …………..

12 AMDS Content  Procurement and Supply Management Issues Tools  Aids Medicines and Diagnostics Service Partners Activity Areas  From 3by5 to Universal Access Investment Coordination

13 AMDS Too much work and too little time  Build on existing capacity  Develop the AMDS as a network with WHO taking on secretariat functions

14 AMDS Initiatives by the AMDS and its partners

15 AMDS Partners  UN Agencies WHO, UNICEF, World Bank, UNAIDS, UNFPA, UNDP  Technical organizations and donor agencies Centrale Humanitaire Medico-Pharmaceutique, Clinton HIV/AIDS Initiative, Commonwealth Pharmaceutical Association, Crown Agents, Ecumenical Pharmaceutical Network, GFATM, IDA, JSI, MSH, ESTHER, USAID  Observers MSF, US State Department (OGAC/PEPFAR),Bill and Melinda Gates Foundation Secretariat AMDS unit of HIV Department of WHO National Regional Global PSM / TCM / HIV

16 AMDS AMDS partners take responsibility for:  Procurement UNICEF, IDA, CHMP and WHO/CPS Stockpile development  "Normative" activities Prequalification Monograph development Forecasting and quantification tool development Supply chain management system development  Operational work Country level staffing Capacity building Technical support

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18 AMDS Global price reporting mechanism

19 AMDS Technical support for PSM Tools Harmonized monitoring system for reporting to donors IMAAI training manual for facility level PSM Planning national levels PSM coordination bodies Country level assessments (including local production) Capacity building PSM workshops GFATM and WB recipients Consultant briefing national capacity building plans inventory of training activities TA for identified "bottlenecks"

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21 AMDS Content  Procurement and Supply Management Issues Tools  Aids Medicines and Diagnostics Service Partners Activity Areas  From 3by5 to Universal Access Investment Coordination

22 AMDS Too much work and too little time  Build on existing capacity  Develop the AMDS as a network with WHO taking on secretariat functions Moving from 3by5 to universal access  Too much work and tool little time…….. and now more then ever at country level

23 AMDS What next? PSM in the context of universal access  National coordination  Integration Universal access requires investment in the health (care delivery) system  Opportunity HIV/AIDS as the engine to develop the pharmaceutical sector  Investment Spending, say 15%, of the value of the product on its delivery to the client is normal but systematically ignored

24 AMDS Coordination versus Fragmentation What next? PSM in the context of universal access The Global Task Team (GTT) UN coordination and cooperation at country level

25 AMDS National PSM Coordination Body Possible activities  Regular information sharing on PSM Current activities Strategic info (e.g. prices, patent status, local production potential)  Harmonization of country-level PSM planning/budgeting, reporting, implementation for ARV supply One system for drug management for multiple donor streams  Training & Implementation Tools Harmonise Supply Chain Management and Monitoring systems Facility-level guidelines on stock management and reporting Common country-level forecasting tool  Common agenda to address HR gap in pharmaceutical sector  A code of conduct for the sales and distribution of ARVs

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27 AMDS For further information please visit the AMDS website or send an to (unit) or