Securing the Supply of Condoms and Other Essential Products for HIV/AIDS Programs Tony Hudgins Yasmin Chandani John Snow Research & Training Institute

The Importance of a strong supply chain to an HIV/AIDS Program Supply chain improvements: Increase program impact - by providing a consistent, reliable supply of essential products; Enhance quality of care - by delivering high- quality products; Improve cost-effectiveness and accountability - by reducing loss and wastage; Increase support of stakeholders - by ensuring the integrity of the supply chain.

The Supply Chain

The RIGHT goods In the RIGHT quantities In the RIGHT condition Delivered to the RIGHT place At the RIGHT time For the RIGHT cost

NO PRODUCT? NO PROGRAM.

The Logistics Cycle

Illustrative Supply Chain Issues Rapid assessment and quantification of product, including: –An indicator-based description of the current logistics system and laboratory capacities; –Quantification of drug and medical supply needs.

Illustrative Supply Chain Issues Product Selection : –Large number of products needed –Ensure consistency with National Essential Drugs Lists. Procurement: Two options –Purchase of product by donor or its agent. –Purchase of product by host country.

Illustrative Supply Chain Issues Issues that affect procurement: –High cost of ART relative to per capita GNP. –Need to procure specific drug combinations from different manufacturers –The inefficiencies and wastage associated with brand proliferation –The potential for diversion given the immense value of the commodities.

Illustrative Supply Chain Issues In-Country Distribution: Public sector problems –Insufficient data for estimating needs; –Mismatches between donated products and local licensing; –Delays in port clearance; –Not enough central storage space;

Illustrative Supply Chain Issues In-Country Distribution: Public sector problems –Aging cold chains with limited capacities; –Insufficient number of trucks or fuel for distribution; –Inadequate laboratory capacities; –Poor security at central, district and SDP levels; –Frequent stock outs, even for inexpensive products

Illustrative Supply Chain Issues In Africa, a number of countries have begun to improve MOH logistics capacities. However, most are ill-prepared to provide adequate service to wide-spread HIV/AIDS care and treatment programs.

Illustrative Supply Chain Issues Alternative Distribution Systems:  NGO, Employer and Commercial Systems A combination of distribution systems is likely to be needed in order to rapidly mobilize for scaled-up HIV/AIDS commodity programming.

Illustrative Supply Chain Issues Logistics Management Information System (LMIS) provides data to: –Track product distribution –Monitor wastage and diversion, and ensure accountability. Effective LMIS in Kenya stretched drugs for STI treatment to last 29 months for over 500 sites compared to predicted 163 sites for 12 months

Illustrative Supply Chain Issues Service Delivery –The reliable and consistent delivery of products to the SDP is essential. –Other components must be in place to ensure the effective delivery of services, including staff training and supervision, information systems to monitor case management and ART resistance, patient education materials, facilities improvement and community sensitization and mobilization.

Budgetary Implications of an Effective Supply Chain The cost of developing and operating an effective supply chain varies widely. Difference between the cost of operating a system for full supply commodities and those that are not in full supply. Both recurrent and development costs must be considered. Use of plural systems may be most cost-effective.

Recommendations Conduct assessment of national logistics capacity and laboratory resources for HIV/AIDS diagnosis and treatment; Conduct national quantification of condoms, drugs, reagents and consumable supplies; Develop procurement and distribution plan based on outcome of assessment ; Develop or strengthen the LMIS; Implement program based on the best use of available resources.