Mapping and in-depth Assessment of
Medicines Procurement and Supply Systems
Dr Magali BABALEY
Essential Medicines and Pharmaceutical Policies Department (EMP)
TBS
17-21 November 2008
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TBS 17-21 November 2008
National Medicines Policy (1)
 Objectives:
Ensure equitable availability and affordability of essential medicines,
the quality, safety and efficacy of all medicines and the promotion of
therapeutically sound and cost-effective use of medicines by health
professionals and consumers.
 National supply system:
based on a pyramid approach:
– Central Medical Stores (CMS)
– distribution to Health Facilities :
• Directly from the CMS or
• Through Regional/District Medical Stores
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National Medicines Policy (2)
 Donors support: within the past decade, increased funds to
countries for medicines especially for HIV/AIDS, Malaria and TB
– Multilateral : EU, WB, ADB, IDB, Global Fund, UNITAID,...
– Bilateral : USAID, PEPFAR, French cooperation, DFID, CTB,
JICA, SIDA...
– Foundation : Clinton, Bill & Melinda Gates, Damien...
– UN Family : UNICEF, UNFPA, UNDP, UNAIDS...
– Faith based
– NGOs : MSF, MSH, FHI...
In some cases with their own procurement and supply system.
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Mapping/in-depth assessment of medicines
procurement and supply systems (1)
 Objectives:
Support the Ministry of Health to :
- Map out all partners involved in medicines procurement and
distribution
- Carry-out an in-depth assessment of the national procurement
and supply management system, including all components of the
medicines supply management cycle
- Determine the strengths and weaknesses
- Develop strategies to strengthen the coordination and the
national capacity.
10 countries : Cameroon, Senegal, Rwanda, Burundi, Mali, Congo-Brazzaville,
Ghana, Nigeria, Tanzania and Zambia
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Mapping/in-depth assessment of medicines
procurement and supply systems (2)
 Methodology: 2 steps
– Step 1: Mapping:
• Identify all partners and structures involved (category of products
supported, financial value of support…)
• Describe the procurement (procurement agents) and distribution
channel
• Describe financial flows
Category of products : Essential Medicines with a focus on: adult and pediatric ARVs, Malaria,
TB, OI, HIV/AIDS Reagent, Vaccines, Condoms, Contraceptives and Medical devices
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Step 2: In-depth assessment:
• Procurement and supply systems (calculate performance
indicators for all the components of the medicines supply
management cycle)
TBS 17-21 November 2008
Mapping/in-depth assessment of medicines
procurement and supply systems (3)
 Medicines management cycle
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Selection
Quantification/Forecasting
Procurement
Ordering
Storage/Stock management
Distribution
Quality assurance system
Rational use
Financing
Information management
Monitoring and evaluation
Human resources
Policy framework
TBS 17-21 November 2008
Mapping/in-depth assessment of medicines
procurement and supply systems (4)
 Tools:
For each step, the methodology and questionnaires used to collect
the data have been developed by WHO/AFRO and HQ.
6 questionnaires : Partners, Ministry of Health, Programmes,
Central Medical Stores, Regional/District Stores and Health
Facilities.
 Assessment team:
– National coordinator (to manage the exercise and provide direction in the
process of data collection, entry, analysis, report writing and presenting the findings)
– Trained data collectors
– EDM National Professional Officer (NPO)
– External consultant (WHO/Geneva or AFRO)
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Mapping results (1)
 Burundi
 Congo-Brazzaville
 Mali
 Rwanda
 Senegal
 Tanzania
 Zambia
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Mapping results (2)
Strengths
 Additional funds available to strengthen the medicines
financial system
 Technical support available to strengthen national
capacities in medicines procurement and supply
management
 Logistic support to improve distribution and geographical
availability of medicines
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Mapping results (2)
Weaknesses (1)
 Supply system organigram:
– Complex and unknown by the actors
– Responsibilities and tasks of each of the actors are not clearly
defined
– Lack of transparency from partners
– CMS is rarely involved in forecasting/procurement
 Selection:
– Supply outside the EML/STG still exists
– Procurement of non registered medicines in countries still exists
 Quantification:
– The lack of coordination between MoH and partners results in
stock-outs, shortages, overstocking and expired products
– An adequate logistic information system is currently not in place
(due to the complexity of the system?)
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Mapping results (3)
Weaknesses (2)
 Procurement: Difficult to manage due to the number of different
procurement and financial procedures they have to deal with
(specific for each partner).
 Stock management: Most of the time separate for each partner
therefore increasing the burden of work for personnel and adding to
the complexity of stock management. Storage capacity exceeded
due to lack of coordination.
 Distribution: Lack of coordination between the different programmes
leads to high operational costs for all programmes.
 Financing: Financial figures not always available. Some programmes
may be under-supported while others are over-supported due to
insufficient information and/or coordination. Logistic support is underfunded.
 Monitoring-Evaluation: Difficult to manage due to the number of
different reporting tools therefore increasing the burden of work for
personnel.
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Relevance to MoH
Evidence-based to:
 Develop transparency
 Create with partners a coordination mechanism for a coordinated,
harmonized, coherent and efficient national medicines supply system
 Mobilize resources for under-served programme areas within the
macro frame of sector needs
 Organize and plan capacity building at each level
 Monitor the performance of the system
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Relevance to partners
Evidence-based to:
 Prioritize investments in medicines procurement
 Target support to address gaps identified in the
procurement and supply management system
 Provide information to monitor progress and plan for future
support
 Have a platform to share information and coordinate
procurement and distribution of medicines among partners
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Guidelines for drugs donations
 Guideline no. 12:
– "Costs of international and local transport, warehousing, port clearance and
appropriate storage and handling should be paid by the donor agency, unless
specifically agreed otherwise with the recipient in advance."
 Additional guidelines for drug donations as part of development aid:
– "It should be recognized that drugs do not arrive in an administrative vacuum.
Drug donations should not create an abnormal situation which may obstruct or
delay national capacity building in selection, procurement, storage, distribution
and rational use of drugs."
– "Administratively, the drugs should be treated as if they were procured. This
means that they should be registered or authorized for use in the country
through the same procedure that is used for government tenders. They should
be entered into the inventory, distributed through the existing distribution
channels and be subject to the same quality assurance procedures. If costsharing procedures are operational in the recipient country, the donated drugs
should not automatically be distributed free of charge."
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Paris Declaration
 Ownership
 Alignment:
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Donors align with partners’ strategies
Donors use strengthened country systems
Partner countries strengthen development capacity with support from donors
Strengthen public financial management capacity
Strengthen national procurement systems
 Harmonization:
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Donors implement common arrangements and simplify procedures
Complementarity: more effective division of labour
Incentives for collaborative behaviour
Delivering effective aid in fragile states
Promoting a harmonized approach to environmental assessments
 Managing for results
 Mutual accountability:
– Donors and partners are accountable for development results
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DAKAR Declaration 8 December 2006
ACAME (African Central Medical Stores Association)
www.acame.org
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Article 1: ACAME recommends that the implementation of any essential drugs supply program in
Africa, including programs related to the provision of drugs used for the treatment of the priority
diseases mentioned in the preamble, be part of the concerted approach leading to the strengthening
and sustainability of national supply systems.
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Article 2 : The decision to substitute national Purchasing Centres by United Nations Agencies or
Western Non Governmental Organizations, regarding priority programs' essential drugs management
and/or supply, is considered to be contrary to:
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the basic principles relating to national capacity building of developing countries
the rationalization of existing supply systems
the pharmaceutical requirements
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Article 3 : This decision shall be only provisional and shall be replaced as soon as possible by a
strategy for use and national Purchasing Centres capacity building.
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Article 4 : ACAME recommends that national Purchasing Centres assessment be made within a
concerted framework, which further comprehensively mainstreams drug and environment context within
which the Purchasing Centres evolve, and be documented in a detailed report, providing accompanying
measures in case possible failures have been recorded.
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Article 5 : In the light of the outcomes of the Purchasing Centres assessments made by health
development partners, ACAME has decided to develop a strategic plan for Purchasing Centres
development.
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Mapping model
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The role of WHO (1)
In collaboration with partners, regional blocks, collaborating centres
etc… to ensure effectiveness, accountability and transparency of
procurement and supply management system
 Develop and implement strategies to increase the alignment of aid
 Support the implementation of a national coordination mechanism incountry (planning, financing, disbursement, monitoring-evaluation, training…)
 Support the harmonization and the improvement of the technical and
financial procedures for procurement (ACAME)
 Develop norms, standards and good practices, using a harmonized
approach, to support and monitor capacity building and increase
transparency
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The role of WHO (2)
 Support the implementation of efficient and sustainable medicines
financing systems
 Reinforce collaboration and joint initiatives with our partners
Thank you
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