1. WORLD HEALTH ORGANIZATION THE WORLD BANK ARV and related drugs Supply Chain Management AIDS Campaign Team for Africa (ACTafrica) The World Bank Africa Region HIV/AIDS Consultation Addis Ababa, December 14-18 2004

2. The World Bank Presentation Outline Key steps of Supply Chain Management/Logistics What causes delays at each step What can we do Management weaknesses Financing The way forward

3. The World Bank Revisiting key steps StepsEmphasis Product SelectionPatents, quality, availability, affordability ForecastingFull or non-full supply, estimates, absorptive capacity ProcurementPlanning, procedures, acquiring WarehousingShelf life, storage capacity Inventory Mgmt.Stock levels, critical monitoring TransportationTimely distribution, various means Serving clientsImprove health outcomes

4. The World Bank What cause delays?

5. The World Bank What causes delays? Product Selection Lack of clinical protocols, guidelines or policies. ForecastingLack of data on consumption patterns or stock levels or both ( M&E: LMIS+Surveillance+… ). Procurement- Poor specifications- Flexibilities - Incomplete projections - Opportunities - Unclear procedures Warehousing or Storing - Storage staff not informed of the procurement in the pipeline. - Lack of guidelines. - Sheer volume: new thinking on options

6. The World Bank What causes delays? Managing Inventory - Lack of computerized system - Lack of stock cards Transportation- Unclear transport procedures. - Transported as ‘secondary’ item as part of other programs. - Transport mgmt on an ad-hoc basis. Serving clientsLack of availability of commodities; Lack of procedures for re-supply Lack of sufficient budget allocations (capacity strengthening)

7. The World Bank What can we do?

8. The World Bank What can we do? Product Sel.Use WHO guidelines to develop protocols. Forecasting- Develop forecast based on the information available, (# of cases, service absorptive capacity). - Full supply vs non-full supply? - Install a LMIS as soon as possible - Test and recommend forecasting software Procure- ment - Use WHO pre-qualified suppliers (Clinton Foundation) New challenges?!?! - Outline procurement process. - Use flexible purchasing options.

9. The World Bank What can we do? Warehousing or Storing - Need for warehousing (?) - Outline communication between proc. and storage staff. - Develop a procedures manual, outlining storage guidelines. Managing Inventory Outline the system and inventory management procedures. Daily stock management (Automation is a need) TransportationDevelop a transport management plan Serving clientsMonitor stock outs at Service Delivery Points.

10. The World Bank Management Weaknesses

11. The World Bank Creating an effective and efficient Team Work among Ministry of Health National HIV/AIDS Councils and/or CCMs Drug Regulatory Authority / National Laboratory Ministries of Trade/Commerce and justice/legal National Tender Boards NGOs and Civil Society Organizations Donors and various agencies Harmonized procedures and coordinated planning Management Weaknesses

12. The World Bank Management Weaknesses Lack of: Dedicated fulltime staff. Qualifications to plan and manage logistics. Need for a Logistics champion. Clear job descriptions. Necessary tools. Clearer Procedure Manuals. Encouragement and empowering staff. Performance measures for various functions. Monitoring and strengthening. Supervision (follow-up).

13. The World Bank Financing

14. The World Bank Financing Estimated US $2.7 billion committed for HIV/AIDS to Sub-Saharan Africa by the World Bank and the Global Fund. (Commitment = Agreement signed with the governments)

15. The World Bank Financing Coordinate the available financing from all sources (GFATM, MAP, Bilateral, Others). Establish policies to maintain funding for commodities as well as for logistics management functions. Adjust program targets if the financing is not available for the commodities or the supply chain functions. Ensure that the logistic costs are funded as part of the program. Start establishing a long-term plan for future financing of the programs. (Advance donor commitment should not be a pre-requisite in estimating future requirements).

16. The World Bank Financing Available financing for PSMP Faculty, materials, rollout expenses  Bank-Netherlands Partnership Program (BNPP)  Canadian International Development Agency (CIDA)  UNAIDS Budgeted Workplan (UBW)  World Bank Training Budget (for Africa region)  Nearly $1.0million raised Country participants  Multi-Country HIV/AIDS Program (MAP) funds at the country level  Global Fund financing  Bilateral donors and development partners

17. The World Bank The Way Forward

18. The World Bank The way forward Facts ~6,000 deaths per day in Sub-Saharan Africa due to AIDS ~8,000 new infections every day Challenge Shall we continue to do the business as usual? A Bureaucrat or a Warrior mentality against AIDS? Approach Use “exceptional” measures No time for conventional approach

19. The World Bank The way forward Keep the objectives of the Three Ones in focus  One National framework  One Institution  One M&E system Use exceptional measures  They are expensive, but what is our priority?  Contract out routine and mechanical tasks  Learn by doing and adapt quickly (flexible MAP design)

20. The World Bank The way forward Need for a coordinated effort  One national plan agreed by all partners  Harmonized procedures and reporting  Regional knowledge sharing  Resources sharing  Joint reviews and follow-ups

21. The World Bank The way forward A comprehensive capacity building program on ARV & Related Supplies Procurement and Supply Chain Management Program (PSMP)  Addis Ababa (Francophone) - Feb 2005  Tanzania (Anglophone), Nigeria- Apr, May 2005  …and so on during 2005 PSMP Phase 1: Training of Trainers (TOT) in all countries PSMP Phase 2: In-Country rollout by a national institution or a consortium of institutions and local partners (including refresher courses).

22. The World Bank The way forward PSMPs will be Global training events financed by The Bank, Dutch, Canadians, WHO (TA), UNAIDS (for 2005) Will improve country’s overall planning and management capacity Country level Core Team Technical Guidelines and Training modules available A coordinated effort by development partners – (less confusion for country teams)

23. The World Bank The way forward TOT to target:  Ministry of Health  Ministry of Trade/Commerce  Law/justice/Patent  National Pharmacist  National HIV/AIDS Council/Commission/Secretariat  Principal Recipient