1. Presentation to JAHSR – November 2015 Health Promotion and System Strengthening Medicines Management Dodoma Innovations Karin Wiedenmayer November 2015

2. Prime Vendor System Rationale  Gap in supply from MSD 40% (fill rate)  Need for supply channel complementary to MSD  Complementary funds available from CHF, NHIF, CS  In case of o/s districts purchase from private suppliers  enormously bureaucratic, lengthy and intransparent procedure  Regional approach with regional pooling of orders allowing economies of scale  Public private partnerships (PPP) promoted by GoT 2/5/2016 HPSS medicines management innovations2 Supply gap 40% gap 40% gap MSD 60% delivered

3. Complementary supplies Previously, overall purchases from private sector was uneconomic (high product prices, per diems, travel costs, etc.) without assurance of quality of what is being purchased Before After 2/5/2016 HPSS medicines management innovations3 Supply gap VF  17  13  6  3  1 Transparent PV Selection Process

4. Concept of the fully functioning PV System Prime Vendor 2/5/2016 HPSS medicines management innovations4 Supply gap

5. Prime Vendor System Features PV concept is a pilot system as described under the bilateral governmental agreement between the GoT and the Swiss government, signed by MoHSW and PMO-RALG The new system serves as a safety net to the region in case of major stock rupture at MSD and/or an unexpected spike in demand due to natural or other disasters…. PV system does not replace MSD but will serve as a supplementary source for medicines and supplies out of stock or short supplied by MSD Districts pool their demand for supplementary medicines at the regional level allowing and benefiting from competitive prices (economies of scale) – throughout the year Public financial management (PFM) guidelines implemented 2/5/2016 HPSS medicines management innovations5 Supply gap

6. Prime Vendor System Features The system does not utilize conventional source of funding e.g. funds deposited by the government at MSD for health facilities; but utilizes supplementary sources of funds such as user fees, CHF, NHIF and basket funds Health facility governing committees (HFGC) are empowered to manage their own funds following stringent SOPs hence enhancing fiscal decentralization. PV system supplies essential medicines and supplies of assured quality, safety and efficacy in accordance to MoHSW National Essential Medicines List and national oversight by the TFDA PV maintains sufficient stock to meet supply shortfalls experienced from MSD 2/5/2016 HPSS medicines management innovations6 Supply gap

7. Prime Vendor System Features The system is closely managed and supported by mandated administrative structures such as a Technical Committee and a Tender Board appointed by regional authorities Strong ownership by region: RMO, RAS The new system appears to motivate MSD to improve services….. The supply system is available to all districts in the region, with option of expanding coverage to other regions in in the country…. The system initially delivers to district headquarters; with option in the future to deliver directly to health facilities The region operates a PV office represented by a PV coordinator, a dedicated pharmacist and support staff 2/5/2016 HPSS medicines management innovations7 Supply gap

8. Prime Vendor 2/5/2016 HPSS medicines management innovations8 Results Supply gap Medicines availability in the region, though not yet at acceptable level, is steadily on the increase from 54% at baseline in 2011 to 76% in July 2015. The target is 100% availability at all the times.

9. Prime Vendor 2/5/2016 HPSS medicines management innovations9 Conclusion Supply gap  The PV system in Dodoma Region is anchored in the regional health structure and in the decentralisation policy of the country  New option for public health facilities to improve medicine availability without compromising quality or price  The new system does not replace MSD but serves as supplementary source of medicines and supplies out of stock or short supplied by MSD  PV system does not utilize conventional source of funding e.g. funds deposited by the government at MSD for health facilities; but utilizes supplementary sources of funds (UF, CHF, NHIF and basket funds) thus strengthening health financial systems  When quality of care is improved the population will be motivated to join CHF and renew their membership, which in turn generates funds to ensure supply of medicines and maintaining of quality of care

10. Prime Vendor 2/5/2016 HPSS medicines management innovations10 Conclusion Supply gap  The system empowers health facilities to purchase supplementary medicines and supplies with their own sources through a shortened and simplified procedure  The PV system is intended to test and establish new best practices in strengthening the health system and quality of care and meeting the needs of the community  The PV system has the objective to ensure that health facilities have medicines and medical supplies to meet the need of the people, by supplementing the regular government supplies with additional supplies  The decentralized PV mechanism therefore works in synergy with a functioning CHF, which both are an integral part of the districts’ ability to fill the gaps left by the central government procurement system

11. Prime Vendor 2/5/2016 HPSS medicines management innovations11 Accompanying measures  Capacity building in ILS and peer coaching  Regular financial and medicine audits for accountability  Interventions to improve use of medicines  Coordination office in Dodoma with PV coordinator and 2 pharmacists  for coordination, M&E and oversight  Two senior Tanzanian consultants involved Supply gap

12. 2/5/2016 HPSS medicines management innovations12 Conclusion  Due to innovative PV system and accompanying measures, mean medicine availability increased by 40% However, it is important to note that the PV system is not a panacea (cure all)! A combination of interventions may be needed to improve medicines availabiity in the country.