1. Access to HIV/AIDS, Tuberculosis and Malaria Medicines. WHO/UNICEF Technical Briefing Seminar on Essential Medicines Policies. Geneva, 18 – 22 September 2006 Elisabetta Molari Procurement, Supply Policy & Management Team Leader

2. 2 Presentation Outline: 1.Overview of The Global Fund Procurement and Supply Management (PSM) process 2.Status of Global Fund Grants and Access to Medicines (Health Products) 3.Global Fund contribution to improving Access and goals of procurement initiatives.

3. 3 The Global Fund’s approach to PSM Principles and minimum standards, not detailed procedures Build upon existing systems Distinction between health and non-health products Expanded definition of Procurement: How products arrive in a country and what happens to them subsequently PR responsible for all PSM activities (whether directly implemented or sub-contracted).

4. 4 PSM Plan Approval Process Proposal recommended for funding Global Fund approval & disbursement GF & LFA assessment process PR submits PSM Plan to Global Fund Revise Plan Implementation of program in line with Grant In case PR lacks capacity: To develop PSM Plan – may seek TA from Partners To conduct procurement – may use a Procurement Agent while building internal capacity.

5. 5 Key documents: Guide to The GF’s Policies on PSM Outlines all Global Fund’s PSM Policies –Procure quality assured products at the lowest price –Adhere to National and International Laws –Conduct procurement in a transparent and competitive manner Based on Global Fund Board decisions Outlines what PR’s need to do.

6. 6 Key documents: (2) Writing the PSM Plan – Version 1, 2 and 3 Guides PR’s in writing the PSM Plan Three Versions: –PRs/SRs that conduct some or all the Procurement in-house –PRs/SRs that completely outsource procurement to a Procurement Agent –PRs that coordinate procurement conducted by SRs

7. 7 Status of Global Fund Grants Financial StatusGrants signed US$ Money disbursed US$ Mean time elapsed in grants Mean funds disbursed Disbursed/ time Global Fund financing (US$), 15 th May 2006 4 billion2.26 billion69%64%93% Financing 333 grants in 127 countries Approved Grants total – US$ 5.3 billion (Rounds 1-5) 77% of funds disbursed expended by the end user (at Phase 2)

8. 8 Distribution of funding after 5 Rounds

9. 9 Regional Distribution of GF Mid-Year Results, June 2006: Results showing No. of People on ART, ITNs distributed and TB Treatment under DOTS

10. 10 Rapid scaling up of results: doubling every year Intervention June 2006Increase since June 2005 HIV: People on ARV treatment 544,0002.5 times TB: People treated under DOTS 1,430,0002.4 times Malaria: Insecticide-treated nets distributed 11,300,0003.6 times Source: http://theglobalfund.org/en/files/about/replenishment/progress_report_midyear_2006.pdfhttp://theglobalfund.org/en/files/about/replenishment/progress_report_midyear_2006.pdf

11. 11 Improving Access: Rational Selection: PRs required to Procure only medicines on National, Institutional or WHO Model List of Essential Medicines and Treatment Guidelines Indicate strategies in place to ensure appropriate use of procured medicines Affordable Prices: PRs required to List medicines by Generic Names and to procure quality assured products at the lowest price Encouraged to apply TRIPS flexibilities in a manner consistent with National & International laws Conduct procurement in a transparent and competitive process Use the Price Reporting Mechanism

12. 12 Improving Access: (2) Sustainable financing: Increased funding made available (sustainability for impact?) Coordination with other donors Reliable Health and Supply Systems: Provide funds through Grants for strengthening health systems Grants funding accessible by all sectors involved in the health system: Public, Private and NGO organizations Guidance on Quality Assurance for pharmaceuticals.

13. 13 Some challenges/bottlenecks across the supply chain which slow Grant Implementation Plan demand Select and purchase product Manage delivery Distribute in country  Lack of or Inadequate information and planning systems.  Lack of supply.  Limited procurement capacity.  High product prices.  Delays in shipping and clearance.  Poor infrastructure and systems.

14. 14 Conclusion: Goals of the Global Fund procurement initiatives Significantly increase speed of grant implementation Reduce the burden on recipient countries by easing procurement bottlenecks in country Develop/review policy procedures and/or requirements for countries Coordination with Partners.

15. 15 Thank you. References: http://www.theglobalfund.org/ http://www.theglobalfund.org/en/about/procurement/