1. Experience with common basket for ARV procurement Tanzania Emma Lekashingo Msuya.

2. Background Tanzania has population of 35mill people(2004 census) HIV Prevalence of 7%; About 2million people are living with HIV/AIDS Most of the people are living in rural areas(85%) Has 22 regions,121 districts Ratio doctor: patient is 1:23,000 Ratio nurse: patient 1:6000 Ratio pharmacist: patient 1:50,000

3. Introduction Tanzania adopted Care and Treatment for People Living with HIV/AIDS as one of its key strategies in the Health Sector response to HIV/AIDS pandemic and developed Care and Treatment Plan, which was approved by the Government in October 2003.

4. Sources of funding for the program. Government budget Global Fund USG (PEPFAR). Canadian government SIDA Sweden Norwegian government Clinton Foundation (pediatric drugs)

5. Procurement of ARVs Done in the principle of ensuring economy, efficiency and transparency. Also consideration made on the standards of quality and reputability as well the consideration of the lowest prices being paid for drugs of good quality.

6. Procurement of ARV in Tanzania Done by the Medical Stores Department except for PEPFAR supported drugs. MSD is an autonomous board of the Ministry of Health. Tenders processes done by the Medical Tender Board of the Ministry of Health. Procurement procedures follow the Public Procurement Act of 2001

7. Procurement Planning Done by the National AIDS Control Program with logistic advisers of JSI/Deliver with the MSD. Involves determining the number of patients to be enrolled together with the funds and stocks available in country. There is MOU between GOT and USG on support of the drugs from US as partners.

8. Procurement Methods for ARVs Mainly International competitive bidding. Invitation to pre-qualified suppliers. Tenders advertised through MSD website and local magazines. Tenders closed after 45 days. Tender opening, evaluation and awards are done by Medical Tender Board.

9. Product selection and Quantification Done by National AIDS Control Program. Forecasting and ensuring the rational use Also done by NACP. The rational use is ensured by the development of the guidelines for the healthcare workers for management of patients with HIV/AIDS.

10. Quality Assurance Drugs must be safe, effective and of consistent quality. WHO prequalification system for ARVs. Products must also be registered with Tanzania Food and Drug Authority. MSD: Quality assurance section for quality checks of all ARVs Important: drugs must adhere to GMP and quality specifications.

11. Storage and distribution All ARVs irrespective of their sources (PEPFAR,GOT,CIDA etc) are stored and distributed by the MSD. MSD has eight zones in the country for the purpose of distribution of supplies to the nearest customers.

12. What has been done ……….. The government of Tanzania allocated in its budget a total of 2 million US Dollars in the financial year 2003/04 for the procurement of the first batch of ARVs. The funds procured drugs to cover 4,200 patients on treatment for one year. The government then allocated 3.5 million US Dollars for the financial year 2004/05. The government of Canada supported the program by providing 3.5 million US Dollars for ARV Procurement. All these funds were deposited at the MSD and procurement of Antiretroviral were done through this agency only.

13. Cont……… The Medical stores department also procured ARVs using funds from Norwegian support. This occurred beginning of the year 2005,drugs were delivered and already distributed to the facilities. In September 2005 The Global Fund Tender for ARVs was opened, evaluation done; drugs are expected to arrive early this year. MSD recently floated tender from SIDA Sweden support, the tender is yet to be opened.

14. Cont… For the financial year 2005/06 the government has allocated about 17million US Dollars for procurement of ARVs. The Global fund R4 budget for ARV drugs amounted to 9.8million US Dollars. SIDA Sweden support for ARV amounted to 5mill US Dollars. The total number of patients who are now on treatment is about 24,000

15. Way Forward The government is planning to scale up the provision of ARVs across the country. The plan is to enroll and maintain up to 100,000 patients on treatment by the end of the year 2006. There are lots of challenges with ART program as its with any program, but the government is trying to tackle them whenever possible.

16. thank you for your attention……………………………………..