Multi-country study on drug supply and distribution activities of faith-based supply organizations in sub-Saharan African countries, 2003 Sophie Logez / Marthe Everard EDM/PAR Promoting use of effective medicines supply strategies in Africa

Outline  Objectives  Methodology  Results  Next step

Objectives of the MC Study  Document experiences and practices of FB DSOs  Strengthen EPN’s technical capacity by evaluating drug supply systems existing in the Network  Strengthen collaboration between WHO/EDM and EPN

Outline  Objectives  Methodology  Results  Next step

Methodology  Sample: 16 DSOs in 11 African countries reviewed (Feb-Dec 2003)  Data collection tool: structured questionnaires (4)  Data collection: Paired country assessments by FB DSO staff  Data management: WHO database  Joint analysis of results with all participants (EPN/WHO feedback meeting, June 2004)

Ghana Nigeria Tanzania Kenya Uganda Malawi Zambia S Africa Cameroon Rwanda DR Congo Methodology Selected countries

Issues Investigated  Role, functions and perspectives of DSOs  Procurement management  Founding Bodies's opinion  Government’s view  Customer's view Methodology

Outline  Objectives  Methodology  Results  Next step

Governance and Administration Founding bodies expectations  Providing medicines to FB facilities  Generating funding to support other projects Type of boards  44% elected (7DSOs)  38% nominated (6DSOs)  13% committees (2DSOs)  1 DSO with no board Board meeting:  4times a year (10DSOs)  Twice a year (4DSOs)  Once a year (1DSO) Results

Infrastructure  13 DSOs have storage capacity  13 DSOs have cold storage capacity  5 DSOs have regional stores  16 DSOs have necessary utilities  2 DSOs do not have regular Results

Services provided by the 16 DSOs Results

Customers Served Type of customers DSOs (No)DSOs (%) Any health care provider 531 Only not-for-profit health facilities 319 Only faith-based health facilities 213 Only Christian members 425 Only same denomination 213 Results

Procurement: Drug Selection By whom?  Drug committees: 7 DSOs (44%)  DSO's procurement team: 5 DSOs (31%)  Individual decision by DSO: 2 DSOs (13%)  Customers themselves: 2 DSOs (13%) Selection principles  14 DSOs select medicines based on EDL  5 DSOs also supply medicines out of EDL  3 DSOs use kit systems Drug donations  5 DSOs (38%) received donations for free distribution Results

Drug Procurement Methods Procurement (16DSOs) DSOs (No.) DSOs (%) Direct local purchase744 Direct international purchase 638 Restricted tender638 Negotiated tender425 International competitive bidding 16 3 DSOs buy exclusively locally, 1 DSO exclusively internationally Results

Price information Results

Criteria for prequalification of suppliers Results

Quality Assurance: SOPs for 7 DSOs Results

Human Resources  13 DSOs employed at least one pharmacist (up to 6)  13 DSOs have staff policy  All 16 DSOs use selection committees for recruitment  15 DSOs have staff wages higher than public sector  Wide range of pharmacist annual wages in EPN (from US$2,400 to US$13,450) Results

Donor Support 12 DSOs reported receiving donor support Types of donor support DSOs (No)DSOs(%) Financial support975 Training/fellowship support 975 Personnel support867 Material support758 9 DSOs received support from FBOs in Europe and the USA and some from bilateral agencies (USAID, KfW and DfID) Results

Factors Affecting DSOs Operations External factors  economic situation  political situation  poverty of population  no tax exemption for imported medicines Internal factors  inadequate financing  drug donations  lack of qualified staff for management and activities  reluctance to change mentality Results

Governments’ view  Acknowledge great contribution of FB DSOs to national drug supply system  Lack of formal reporting/communication  Lack of formal collaboration  Perception of governments: quality of medicines supplied by FB DSOs questioned distribution of donated medicines not always found appropriate Results

Customers’ view  Good quality of medicines  Medicines supplied quantities ( % of needs met) range of items (to be increased)  Need for technical assistance regular supervision training (drug management/RDU)  Better communication/relation Results

Future Perspectives (1) Objectives for 15 DSOs: Increase number of customers: 12DSOs (80%) Improve delivery services for customers: 7DSOs (47%) Collaborate with other DSOs: 7DSOs (47%) Results

Future Perspectives (2) 15 DSOs (94%) planning to scale up of their activities Activities to increase competitiveness (15DSOs) DSOs (No.) DSOs (%) More competitive prices1185 Improved delivery time969 Better customer services754 Provision of extra services754 Improved range of medicines646 Concentration on selected customer needs 538 Results

Outline  Objectives  Methodology  Results  Next step

Next step: Feedback meeting June 2004 Recommendations drafted  Quality assurance (SOPs)  Sustainability of DSOs (financial/organizational)  Training (sharing tools)  Procurement and storage capacity  Collaboration (DSOs/EPN)  Distribution service (feasibility study) Activities identified for DSOs/EPN/wider sector

EPN/WHO Feedback meeting, Nairobi, Kenya, June 2004