1. Access Framework & Challenges in Medicines Supply Systems
WHO Technical Briefing seminar Geneva, 31 Oct– 04 November Richard Laing (WHO/EMP/MPC)
With materials developed by Helen Tata

2. Ensuring access to essential medicines - framework for collective action
1. Rational selection and use
4. Reliable
health and supply systems
2. Affordable prices
3. Sustainable financing
ACCESS

3. Assessment of medicines supply systems
In 2007 selected countries in AFRO decided to assess the functioning their country architecture
They had as objectives to:
map financial flows for in-country medicines procurement and distribution
provide an overview of all stakeholders involved in in-country medicines procurement and distribution
present a synopsis of in-country medicines procurement and distribution pathway
review strengths and weaknesses of existing in-country medicines supply management system

4. Assessment tools
WHO/AFRO and EMP developed tools to support countries' assessment
Two sets of questionnaires developed:
To map medicines financial flows & distribution
To assess medicines supply system around areas of medicines management cycle.

5. Mapping Results
Source: Bergis Schmidt-Ehry, GTZ

6. Medicines supply systems in TANZANIA. 2007 United Republic of Tanzania
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 W H O 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
Procurement
Agent/Body C L I N T O H A V R D E G P A F A X I O S U N I C E F A B O T C U A M
TEC
&
CCT
MEDICAL
STORE C R S S C M
MOH
& SW J I C A C O U L M B I A C D G A V I
CROWN
AGENTS U S A I D T M A P
Point of 1st
warehousing
TEC &CCT
HOSPITAL
CRS
IMA
MEDICAL STORE
AXIOS
HEALTH FACILITY
COLUMBIA
HOSPITAL
CUAMM
Point of 2nd
warehousing
TEC &CCT
REGIONAL/DISTRICT
VACCINE STORE
ZONAL MEDICAL STORE
HEALTH FACILITY
HOSPITAL
Point of
Distribution
TEC &CCT
ZONAL BLOOD
SAFETY CENTRE
DISTRICT STORE
HEALTH FACILITY
PRIMARY HEALTH CARE FACILITY
HOSPITAL
PATIENT

7. Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI
Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007
République du Burundi
Ministère de la Santé Publique
MEDICAMENTS
ESSENTIELS
ARVs
PALUDISME TB IO
ARVs
Ped
REACTIFS
sécurité du sang
(+ test HIV)
VACCINS
Préservatifs
Contraceptifs
Dispositifs
Médicaux
Etat
Bailleurs bilatéraux
Bailleurs multilatéraux
ONG/Privé E T A C A M E B U D F I UE
FONDS
MONDIAL CL I
NTON UN I TA D
GDF O M S U N I C E F MS F A C F
PDM C I R B M
GTZ C E P B U U S A I D G V C G A V I C T B P S I C O R D A I F N U A P I
PPF K F W C O N E R
Sources de
Financement P N L T C A M E B U I P A
SEP/
CNLS C L I N T O G D F OM S M S F A C F P DM C I R
SEP/
CNLS G T Z C E P B U G V C C T B P S I C O R D A I F N U A P
IPPF G F A C O N E R U N I C E F
Structure
d'appro-
visionnement
1er point
de stockage
PNLT
CAMEBU
PEV
IMC
MSF
ACF
PNLO
CICR
CEPBU
GVC
PSI
CORDAID
ABUBEF
PNSR
CONCERN
2ème point
de stockage
PNSR
Site de prise
en charge
HÔPITAUX
CDV
CNTS
IMC
ACF
PRISON
BPS
GVC
Grossiste
Privé
CORDAID
CDS
CPLS
Structure
dispensatrice
BPS
CPLS
CDV
Site de prise
en charge
SNT/CNT
CDT/CT
CDS
Détaillants
COCOLS
PATIENT

8. Supply system challenges (1)
Selection:
Supply outside the EML/STG still exists
Procurement of non registered medicines in countries still exists
Quantification:
CMS rarely involved in forecasting/procurement
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?)

9. Challenges (2) Procurement:
Managed by various partners present in country.
National system hardly in involved in program procurement
Storage/stock management:
Inadequate storage capacity due to lack of coordination in procurement planning
Different stock management tools for the same product originating from different partners
Distribution:
Inadequate funds for distribution.
Uncoordinated distribution between different programs leading to high operational costs for all programs.

10. Challenges (3)‏ Financing:
Funds available mainly for 3 disease programs
Other areas under funded (e.g. NCD etc)
Financial figures not always available
Logistic support is under- funded
Monitoring-Evaluation:
Each program may have a stand alone M&E
Different reporting tools
High burden of work for scare human resources at periphery

11. What can be done?

12. How feasible in the supply system?
Source: Bergis Schmidt-Ehry, GTZ

13. Benefits of coordinated supply
Platform for dialogue, information sharing and coordination
Joint M & E and reporting
Reduced workload
Health System strengthening
Timely delivery of medicines to target population
Cost savings

14. Expectations
Adequate funding to medicines for priority disease to support distribution of all other categories of medicines
Stock management tools for medicines from various sources streamlined
No stock outs in any health facility
Un-interrupted access to medicines!

15. Could be feasible in the supply system if..
Source: Bergis Schmidt-Ehry, GTZ