1. WHO Technical Briefing seminar Geneva, 16 – 20 November 2009
WHO Technical Briefing seminar Geneva, 16 – 20 November Challenges in Medicines Supply Systems: Country case studies Helen Tata & Magali Babaley EMP/MAR

2. World Health Organization
Context
16 November 2018
11 African countries planned in 2007 to evaluate their medicines supply systems (Cameroon, Senegal, Rwanda, Burundi, Mali, Congo-Brazzaville, Ghana, Nigeria, Tanzania and Zambia)
The countries carried out either 1 or 2 of these surveys:
Mapping of all partners involved in procurement and distribution of essential medicines and medical supplies;
In-Depth Assessment of medicines supply management system in countries.

3. Mapping/in-depth assessment of medicines supply systems
World Health Organization
Mapping/in-depth assessment of medicines supply systems
16 November 2018
Objectives
Support the Ministry of Health to :
Map out all partners involved in medicines procurement and distribution
Use evidence as basis of advocating strategies to strengthen coordination of partners involved in the supply system.
Carry-out an in-depth assessment of the national medicines supply management system in order to:
determine strengths and weaknesses of the system
Identify gaps in the system and proposed strategies to fill in the gaps.

4. Relevance to MOH To identify information gaps
To have an advocacy tool, an information link and feedback to support planning for a coordinated, coherent and efficient national medicines supply system.
To mobilize resources for under served programme areas within the macro frame of the sector needs
To re-schedule procurement priorities, facilitate forecasting and maintain an interrupted supply chain
To ensure full supply and security for essential medicines

5. World Health Organization
Relevance to Partners
16 November 2018
Factual evidence for:
Providing a plate form for information exchange between partners working in medicines supply system
Providing information on under-financed product categories
Targeting gaps and redefining strategies for strengthening medicines supply systems
Providing information for program monitoring and future projects

6. Tools for Mapping/in-depth assessment
World Health Organization
Tools for Mapping/in-depth assessment
16 November 2018
WHO/AFRO in collaboration with WHO/HQ developed the methodology and questionnaires to support countries in this activity
Tools: 6 questionnaires
1) Partners
2)Ministry of Health,
3)Programmes, )Central Medical Stores, 5)Regional/District Stores and 5)Health Facilities.
Assessment team:
National coordinator
External consultant or expert from WHO/AFRO or HQ‏
WHO Medicines Adviser in country office‏

7. Questionnaire with Partners
Mapping Methodology
Gather Essential Data
Category of products supported
Financial value of support
Procurement agents for partners
Distribution channel of products
Final recipients/beneficiaries of each product supported
through…
Interviews/
Questionnaire with Partners
Multilateral, e.g. World Bank, Global Fund
Bilateral, e.g. USAID, GTZ, JICA etc
Foundations, e.g. Clinton
UN Nations, e.g. UNFPA, UNICEF, WHO
Faith Based Organizations, e.g. CHA, CRS etc
CSOs, e.g. MSF

8. Tool: Level III Indicators
Medicines management cycle
Selection
Quantification/Forecasting
Procurement
Ordering
Storage/Stock management
Distribution
Quality assurance system
Rational use
Financing
Information management
Monitoring and evaluation
Human resources
Policy framework

9. Mapping results Burundi Congo Republic Ghana Mali Nigeria Rwanda
Senegal
Tanzania
Zambia
ALL MAPS

10. Ghana: Funding by supply type (2006)

11. Tanzania: Funding by Supply Type (2006-2007 Data)
315,170
53,859
17,734
3,905
17,300
37,027
3,722
4,700
54,201
56,853
65,869
$ ‘000
100%
17.1%
5.6%
1.2%
5.5%
11.7%
1.5%
17.2%
18.0%
20.9% %
ESSENTIAL
MEDICINES
ARVs
MALARIA TB OI
ARVs
Ped
REAGENT
Blood safety
(+ HIV test)
VACCINES
CONDOMS
CONTRACEPTIVES
MEDICAL
SUPPLIES
GOVERNMENT
BILATERAL DONOR
MULTILATERAL DONOR
NGO/PRIVATE C S O M S S I D A N O R A D C I D A UN I TA D H A V R D P E F A R
GLOBAL
FUND CL I
NTON A X I O S P F I Z E R
GOVERNMENT J
ICA C D C O L U M B I A A B O T G A V I C U A M U N I C E F U S A I D W B
Source
Of Funds

12. Zambia: Funding by Supply type
82,156
1,862
0.6
1,305
10,889
1,495
2,984
0.3
11,718
45,335
5,666
$ ‘000
100% 2% 1% 0%
13% 4%
0.5%
14%
55% 7% %
Category of
Products
Color
ESSENTIAL
MEDICINES
ARVs
MALARIA TB OI
ARVs
Ped
REAGENT
Blood safety
(+ test HIV)
VACCINES
CONDOMS
Contraceptives
MEDICAL
Supplies
ITN
GOVERNMENT
BILATERAL DONOR
MULTILATERAL DONOR
NGO/PRIVATE D F I W H O
WORLD
VISION Z A B R T C D
GLOBAL
FUND C H A I C H A Z UN I TA D
WORLD B A N K P E F A R U S A I D B G A T E S U N I C E F U N F P A A
XIOS M O H J
ICA G L A S E R
Source
Of Funds

13. Study results: Strengths
Increased funding for procurement of specific categories of essential medicines from donors such as:
Global Fund to fight HIV/AIDS, TB, malaria
UNITAID
PEPHAR
Clinton Initiative
World Bank etc
Several partners offering technical support, though not coordinated, to strengthen national capacities in medicines procurement and supply management
Some categories of products receive Logistic support to improve distribution and physical availability
Medicines supply systems (public and private) exist in all the countries
Motivated human resource team in a difficult work environment

14. Study results: Challenges (1)
World Health Organization
Study results: Challenges (1)
16 November 2018
Structure Supply system:
Complex and magnitude not known to the actors
Responsibilities and tasks of each of the actors not clearly defined
Transparency not always assured
CMS is rarely involved in forecasting/procurement
Selection:
Supply outside the EML/STG still exists
Procurement of non registered medicines in countries still exists
Quantification:
Lack of coordination in planning between MoH/CMS and all partners results in stock-outs, shortages, overstocking and expired products
Adequate logistic information system not in place (due to the complexity of the system?)

15. Study results: Challenges (2)
Procurement: Difficult to manage the various procurement and financial procedures specific to each of the multitude of partners.
Stock management:
Specific stock management tools available for products of some partners, leading to increased work load for personnel and adding to the complexity of stock management.
CMS may not have adequate storage capacity due to lack of coordination in procurement planning
Distribution:
Inadequate funds for distribution.
Where funds are available, no coordination between different programs leading to high operational costs for all programs.

16. Study results: Challenges (3)‏
Financing:
Most of today's donor funding target vertical disease programs such as HIV/AIDS, tuberculosis, malaria and EPI
The above may lead to some programs being under-supported while others are over-supported
Financial figures not always available
Logistic support is under- funded
Monitoring-Evaluation:
Each unit/project having its stand alone M&E project for its products (e.g. condoms, ARVs, PMTCT, ITN, Coartem, Test Kits etc
Not easy to manage due to the number of different reporting tools which increase the burden of work for personnel
Human resources:
Allocation of scarce human and financial resources distorted.
Single staff at lower level of care not well equipped for multipurpose tasks
Incentive systems distorted leading to internal brain drain

17. Next steps Providing further support to these countries in:
Coordination strategies/mechanisms at country and global levels
Strengthening systems and tools on needs assessment/quantification
Promoting compliance for Drug Donation Guidelines
Information sharing across national programs/partners for all categories of products studied

18. Drug donation guidelines
Article no. 12 states:
"Costs of international and local transport, warehousing, port clearance and appropriate storage and handling should be paid by the donor agency, unless specifically agreed otherwise with the recipient in advance."
Additional guidelines for drug donations as part of development aid:
"It should be recognized that drugs do not arrive in an administrative vacuum. Drug donations should not create an abnormal situation which may obstruct or delay national capacity building in selection, procurement, storage, distribution and rational use of drugs."
"Administratively, the drugs should be treated as if they were procured. This means that they should be registered or authorized for use in the country through the same procedure that is used for government tenders. They should be entered into the inventory, distributed through the existing distribution channels and be subject to the same quality assurance procedures. If cost-sharing procedures are operational in the recipient country, the donated drugs should not automatically be distributed free of charge."

19. Paris Declaration
Ownership: country sets the agenda
Alignment: donor country
Aligning with country agenda
Using country's systems
Harmonization: donor-donor
Ensure that actions are harmonized, transparent, and collectively effective;
Establishing common arrangements
Simplifying procedures
Complementarities: more effective division of labor
Sharing information to avoid duplication
Managing for results:
Countries and donors to shift focus to development results and get results measured.
Mutual Accountability
Donors and partners are accountable for development results.

20. Partner Alignment: The Global Fund example in Tanzania
GF is inline with GOT system
GF gives fund to the GOT (Paymaster General)
Disbursed to beneficiary programs- NACP/NMCP
Deposited to MSD (NACP/NMCP)
MSD then procure, store, and Distribute
MSD charge 8% for operating costs (the rest 6% covered by MOHSW)

21. World Health Organization
16 November 2018
Thank You