Getting Medicines to People who
Need Them: Donor Programs &
Coordination
University of Iowa
April 11, 2007
Agenda
• Overview of the Issues
• Some of the Donors
– Multi-lateral
– Bi-lateral
– Foundations & FBOs
• How to Get Drugs to People
• Donor Collaboration
Issues
rth
No
Eu
rop
e
Am
eri
ca
Ja
pa
n
me
ric
As
ia
Mi
dd
le E
ast
Af
ric
a
tin
A
La
a
Global pharmaceutical market
Estimated 2007 Financing Gap
Intervention
Predicted
Financing
Financing
GAP
HIV/AIDS
$10 Billion
$8.1 Billion
TB
$2.5 Billion
$3.1 Billion
Malaria
$0.7 Billion
$2.5 Billion
Total
$13.2 Billion
$13.7 Billion
UNITAID Initiative Slides, Michel D. Kazatchkine
Ministère des Affaires Etrangères, France
The Tanzania pharmaceutical market
‘new money’ could overwhelm current supply chain systems
Millions
(USD)
50
45
40
35
30
25
20
15
10
5
0
PEPFAR HIV/AIDS Drug
Procurement for TZ (2005)
GFATM HIV/AIDS Drug
Funding for TZ (per year)
Total Government Drug
Budget for TZ (2000)
38
15
10
Private
Market
9
Government Additional
Budget
from Donors
Estimated Private Market
(2000)
Access to essential medicines in the developing world
PROCESS
•
•
•
•
•
•
•
•
•
•
•
•
•
R&D
Clinical Trials
Manufacturing
Intellectual Property
Registration
Forecasting
Security
Shipping
Customs
Inventory
In-country distribution
Financing
Market Competition
ISSUES
•
•
•
•
Fakes
Quality
Corruption
Compliance
Complicated supply chain
• Forecasting
• Security
• Quality
Bioavailability compromised for malaria drug
Bioavailability
80%
60%
40%
20%
qu
e
M
al
i
K
en
ya
m
bi
na
oz
a
M
da
n
Su
G
ha
Zi
m
ba
bw
on
e
0%
G
ab
Failure Rate
100%
Sulphadoxine/Pyrimethamine
The Spiral of Abuse
•
•
•
•
•
•
Supplanting of Goods
Quality Damage
Theft
Obsolescence
Inappropriate Stock
Noncompliance
CHCF Delivery
Fine Pick
Warehouse
Patient
Facility Store
Local
Customs
Shipping Agent
Transport
Clearing
Agent
Bulk Transport
The Manufacturer
Bulk Pick
Warehouse
Fake Drugs
Malaria (Chloroquine Tablets)
Fake
80%
60%
40%
20%
oz
da
n
Su
qu
e
am
bi
a
en
y
M
ab
G
K
on
i
al
M
bw
ba
Zi
m
ha
na
e
0%
G
Failure Rate
100%
Convoluted framework for essential drugs in Kenya
Commodity
Type
Family
Planning
(colour coded)
STI
Drugs
(including some
condoms for STI/
HIV)
Vaccines
and
Vitamin A
Essential
Drugs
HIV/AIDS
test kits
(&
hepatitis
B tests)
TB/
Leprosy
Malaria
Condoms
for STI/HIV/
AIDS
prevention
MOH
Equipment
(including
laboratory
supplies)
Organization Key
Gove rnm e nt
World Bank Loan
Bilate r al Donor
M ultilate ral Donor
NGO/Private
Source of
funds for
commodities
U
S
A
I
D
K
f
W
U
N
F
P
A
DFID
(UK)
European
Union
W
H
O
G
A
V
I
GOK
C
I
D
A
UNICEF
JICA
D
u
t
c
h
De -ce ntr alization pr oje cts
US
Gov
GOK,
WB/IDA
World Bank DARE (8 dis tr icts )
SIDA (6 dis tr icts )
Be lgian Gov (BTC) (2 dis tr icts )
EUROPA
Procurement
Agent/Body
Point of first
warehousing
Organization
responsible
for delivery
to district
levels
U
S
A
I
D
K
f
W
KEMSA
Regional
Depots
U
N
F
P
A
DANIDA (11 dis tricts )
Europe an Union (20 dis tricts )
WHO (3 dis tr icts )
Crown
Agents
Government
of Kenya
Dutch
Gov
Agent
KEMSA Central Warehouse
KEMSA, District Hospitals, District Stores
(e s s e ntial drugs k its , TB/le pros y drugs , m alaria
drugs , lab s upplie s , re age nts , HIV/AIDS te s t k its )
Japanese
Private
Company
UNICEF
NPHLS store
GTZ
KEPI Cold
Store
DELIVER (FPLM) and Division of
RH (MOH) (contrace ptive s , condom s ,
STI k its , HIV/AIDS te s t k its )
JICA (5 dis tr icts )
C
D
C
ADB (5 dis tr icts )
Schenker
Warehouse
KEPI
(vaccine s
and vitam in
A)
Express
Kenya
(e quipm e nt)
District level
decisions of
quantity, type and
procurement of
health
commodities
MEDS
Private
Drug
Sources
Donors
At the beginning of 2000 there was NO:
•
•
•
•
•
•
•
GFATM - Global Fund to Fight AIDS, TB & Malaria
PEPFAR - President’s Emergency Program for AIDS Relief
GDF - Global Drug Facility for TB
PMI - President’s Malaria Initiative
UNITAID - International Drug Purchase Facility
Clinton Foundation – Clinton HIV/AIDS Initiative
Bill & Melinda Gates Foundation
Today: multiple mechanisms for medicines
Bilateral Donors
GDF and GLC
UNITAID
Drugs/Dx
$ or
Drugs/Dx
Private Sector
$ or
Drugs/Dx
WHO (ACTs)
$ or Drugs/Dx
US PMI
Drugs/Dx
$ or Drugs/Dx
GFATM
NGOs
$
$ or Drugs/Dx
PEPFAR
FBO networks
$ or Drugs/Dx
$ or Drugs/Dx.
World Bank
Country direct
purchase
$
$
Countries
Multiple Mechanisms of Countries Receiving Support for
Drugs/Diagnostics For HIV, TB and Malaria
Global Fund created January 2002
• Innovative approach to international health financing.
–
–
–
–
–
–
Swiss non-profit foundation, not part of WHO
Double majority board decisions
Financial instrument, not an implementing entity
Support programs that reflect national ownership.
Leverage additional financial resources.
Country Coordinating Mechanism & Principal Recipients
• $6.7 billion grants awarded through January 2007
– 6 proposal rounds
– 450 grants
– 136 countries
• $3.3 billion disbursements
Significant capital from donors
As of January 2007 (billions)
Contributions to Date
Europe
$3.562
USA
$1.897
Japan & Others
$0.995
Private Sector & Others
$0.268
Total
$6.722
What does $3.3 billion achieve?
Intervention
Dec 2006
Funding
HIV: People on ARV treatment
770,000
58%
TB: Cases treated under DOTS
2 million
24%
Malaria: Insecticide-treated nets distributed
18 million
17%
Funding % is for Rounds 1 through 5
Supply chain implications of scale-up
Type of Expenditure
Distribution
Commodities, products & drugs
58%
Human resources
22%
Administration
11%
Infrastructure & equipment
11%
Monitoring & evaluation
2%
Other
6%
Implementation gap
Mechanisms promoting national sovereignty
Mozambique donor basket coordination
Global Fund
GRZ/MOH
CHAZ
UNICEF
Procurement
Pharmacy Team
Hospitals
MOH
Procurement
MSL Central
Warehouse
Direct
Procurement
(Crown Agents)
Districts
CIDRZ
CHAZ Warehouse
Government and NGO ART,
TB, Malaria Facilities
Product
Funds
Information / Data
Stop TB Partnership & Global Drug Facility
GDF established to ensure availability of TB drugs
Problem
Lack of resources
GDF Response
Grant Service: 1st line TB drugs
Inefficient procurement
Direct Procurement Service:
1st & 2nd line TB drugs
Technical Support Service
Inadequate quality assurance
Non-specific international
recommendations
Non adherence to international
recommendations
Diversity of products
Inadequate in-country
management and monitoring
Limited list of standardised
products and packaging
(FDCs and patient kits)
Technical Support Service
(drug management)
GDF performance over 5 years
•
•
•
•
55 grants in 65 countries
9 million patient treatment
$50 million annual procurement
Products
–
–
–
–
First-line adult anti-TB drugs
Second-line adult anti-TB drugs
First-line pediatric anti-TB drugs
Diagnostic kits
• >200 monitoring and technical support missions
UNITAID – the airline ticket levy
• Innovative funding mechanisms for development
• $300 million projected for 2007
• Scale up access to treatment for HIV/AIDS, malaria and TB by:
•
– Lowering the price of quality drugs and diagnostics
– Accelerating the pace at which they are made available
Brazil, Chile, France, Norway and UK
– Based on sustainable and predictable funding
– Operate through existing partner institutions
• Priority:
–
–
–
–
–
Pediatric ARVs
2nd line ARVs
ACT
MDR TB drugs
Diagnostics
45 countries currently engaged in financing
UNITAID strategy through collaboration
• $34.8 M with Clinton Foundation
– Paediatric ARVs against HIV/AIDS
– Goal is 600,000 children
• $5.7 M with Stop TB Partnership and GDF
– Paediatric formulations against tuberculosis
– Goal is 900,000 children
• $79 M with UNICEF and the Global Fund
– ACT (artemisinin-based combination therapy) against malaria
– Goal is 12 million drugs in 19 countries
Faith-based Organizations
WHO: 30% to 70% of Africa health infrastructure
owned by FBOs
5 provinces studied in Zambia by Emory & Cape
Town Universities
87 religious entities providing HIV/AIDS care
MEDS in Kenya
• Serves 40% of population
– 13 million people
– 1,000 customers
• 110 employees
• PEPFAR Participation
– All ARVs; $30 million COP07
CHAN Medipharm in Nigeria
• Serves 25% of population
– 30 million people
– 1,920 customers
• 90 employees
• PEPFAR Participation
– 61 of 83 PEPFAR sites (26 Christian; 5 Muslim)
– 70% of ARVs
JMS in Uganda
• Serves 40% of population
– 10 million people
– 1,171 customers
• 54 employees
• 55% of supplies are local
source
FBOs and the global programs
• FBOs provide much of the healthcare
• FBOs often are not at the table
• FBOs must be engaged to meet scale up
requirements
• FBOs are a key to sustainability
• Faith-based Drug Supply Organizations are
scared
EPN
• Ecumenical Pharmaceutical Network is a thought leader and
advocate in pharmaceutical distribution to developing world
• 76 member organizations in 31 countries
– Christian Health Associations (CHAs)
– Drug Supply Organizations (DSOs)
• WHO/EPN 2003 Survey of Sub-Saharan Africa
–
–
–
–
16 Faith-based DSOs in 11 countries serving …
8,269 hospitals and clinics
112 million population
43% of population on average in country
EPN/SCMS Taskforce
• Provide a platform for continuous dialogue
• Provide a formal mechanism for information sharing and
feedback for all levels
• Contribute to the SCMS supply chain strategy at a global level
• Provide information on interventions in the EPN and PEPFAR
countries
• Identify specific issues of mutual concern and agree upon
mechanisms to ensure they are addressed
• Be a rapid response mechanism for concerns raised in country
• Disseminate examples of best practice, lessons learned and
success stories across countries
• Introductions and access to other stakeholders of mutual
interest
President’s Emergency Plan for AIDS Relief
• 5 years
• 15 focus countries
• $15 billion in funding
• ART for 2 million
• Prevent 7 million infections
• Care for 10 million affected
PEPFAR a new way of doing business
•
•
•
•
•
•
•
Department of State
U.S. Agency for International Development
Department of Defense
Department of Commerce
Department of Labor
Department of Health and Human Services (HHS)
Peace Corps
PEPFAR results through September 2006
• Prevention
– 61.5 million people - reached through community outreach
– 6 million pregnancies - supported prevention of mother-tochild transmission
• Care
– 2 million orphans and vulnerable children
– 2.4 million people living with HIV/AIDS
– 18.6 million counseling and testing sessions
• Treatment
– 822,000 people including 61% women and 9% children
What makes HIV medicines different?
• Medical implications
– Stock-out
– Substandard or counterfeit product
• High-value product
• Size of scale-up effort
• Need for sustainability beyond current funding
situation
Track 1 & 1.5 partners launched ART scale up
Very Dynamic Demand & Scale Up Challenges
Treatment estimates
at the end of 2005
1.3 million
patients
90,000
pallets
Scaling up treatment
by a multiple of 4
5.2 million patients
360,000 pallets
= 1.3 million patients
Source: SCMS
Scaling up treatment
by a multiple of 6
7.8 million patients
540,000 pallets
= Approximately 30,000 pallets of ARV, OI, and STI drugs
Current supply chain challenges can
impede program performance
• Inadequate data for quantification/forecasting of
needed commodities
• Large, infrequent orders place burdens on local
infrastructure leading to stockouts or product
expiration
• Overstretched country storage and delivery routes
increase risk of theft, counterfeiting and spoilage
resulting in health risks and product loss
• Supply of HIV/AIDS commodities is determined by
forecasts rather than demand
How to Get Drugs to People
AMFA South Africa
An African Solution to an African Problem
High Quality Drugs
Distribution
Manufacturing
Quality Control
GAMMA PHARMACEUTICALS LTD
SCMS team operates seamlessly
•
•
•
•
•
•
•
•
Affordable Medicines for Africa
Johannesburg, South Africa
AMFA Foundation
St. Charles, Illinois, USA
Booz Allen Hamilton
McLean, Virginia USA
Crown Agents Consultancy, Inc.
Washington, DC, USA
The Fuel Logistics Group (Pty) Ltd.
Sandton, South Africa
IDA Solutions
Amsterdam, Netherlands
JSI Research & Training Institute, Inc.
Boston, Massachusetts, USA
Management Sciences for Health, Inc.
Boston, Massachusetts, USA
•
•
•
•
•
•
•
•
The Manoff Group, Inc.
Washington, DC, USA
MAP International
Brunswick, Georgia, USA
The North-West University
Potchefstroom, South Africa
Northrop Grumman
McLean, Virginia, USA
Program for Appropriate
Technology in Health
Seattle, Washington, USA
UPS Supply Chain SolutionsSM
Atlanta, Georgia, USA
Voxiva, Inc.
Washington, DC, USA
3i Infotech, Inc.
Edison, New Jersey, USA
SCMS vision is transforming health care delivery
• Transforming health care delivery by ensuring that
quality medicines reach people living with or affected
by HIV and AIDS
Key SCMS strategies support efforts to serve more
people
• Strengthen existing systems
• Aggregate procurement across many clients; longer-term
supplier contracts
• Use world-class freight forwarding and inventory
management; regional distribution centers
• Improve decision making through availability and use of
logistics and supply chain data
• Coordinate efforts and global quantification with multiple
partners
• Ensure sustainable solutions that will last beyond SCMS
Supply chain management
Forecasting – unappreciated critical step
Procurement – local & global implications
• Antiretrovirals
• Rapid HIV test kits
• Essential drugs to treat opportunistic and sexually
transmitted infections
• Laboratory supplies and equipment
• Medical supplies
Increasing stock items at MEDS in scale up
Inventory – extraordinary demand,
unprecedented response
• Smaller, regular shipments to
protect local systems
• Timely, accurate and safe
transport including cold chain
• Delivery of drugs and supplies
door-to-door
• Security
• Shipment tracking from
supplier to recipient
• Rapid response to emergency
orders
Combating counterfeiting - Russian dolls strategy
Nested
Visibility
(Russian Dolls)
Passive RFID
&/or Barcode
Active
RFID
Tag
Passive, SemiPassive, or
Active RFID Tag
Monitoring product quality - Smart Container
• A “Smart Container”
constantly monitors
valuable goods
•
•
•
•
Humidity
Shock
Tamper & Intrusion
Temperature
Savi Sentinel
Inside of Doors
Typically African drug supply chain
GSK
BMS
CIPLA
Merck
Hospitals
Clinics
Pharmacies
Wholesalers
PHD brings a South African business model
that is transformational
PHD
GSK
Merck
Hospitals
GSK
Clinics
Merck
CIPLA
CIPLA
BMS
Pharmacies
BMS
Wholesalers
Regional distribution centers are sustainable
Ethiopia
Nigeria
Côte d’Ivoire
Uganda
Accra, Ghana
Nairobi, Kenya
Rwanda
Tanzania
Zambia
Zimbabwe
Botswana
Mozambique
Namibia
Johannesburg, South Africa
Delivery – the last mile
SCMS strengthens existing supply chain systems
through technical assistance
• Quantification and forecasting
• Assistance to manufacturers and suppliers
• Quality assurance/control
• Freight forwarding and inventory management
• Procurement
• Distribution
• Logistics MIS
Improving Availability and Use of Information
• Global supply chain
visibility
• Product pedigree
• National/local supply
chain visibility
Before and after - simple interventions
Selected highlights from year one
• Strengthening existing systems
– Building capacity of Rwandan public sector procurement agency
– Conducting facility level training in Haiti
– Supporting procurement efforts of FBO in Uganda
• Ensuring an uninterrupted supply
– Prevented stockouts in Botswana, Côte d’Ivoire, Haiti
– Conducted national quantifications to improve forecasts (Côte
d’Ivoire Guyana, Haiti, Zambia)
• Providing affordable, quality commodities
– Declined $2.3M order for ARVs due to overstock
– Saved $1.2M on $4.5M order through quantification, generic
purchase, and price negotiations
– 30% cost savings in Vietnam for ARVs
SCMS collaboration highlights
• OGAC: procurement summary for COP05
• WHO, UNAIDS: global ARV forecasting
• World Bank, Global Fund, USG: procurement
working group
• FDA: harmonizing product registration requirements
• MEDS: East Africa Regional Distribution Center?
• Pfizer: Diflucan donation pilot project
• World Vision: leveraging logistics infrastructure
• CAMERWA (Rwanda): USG direct grantee status
Global Collaboration for Local
Results
Pooled Procurement
Essential principals of collaboration
• Monterey Accord
–
–
–
–
Country ownership
Good governance
Results focused
Utilize all resources - private, public, faith-based, & governments
• UNAIDS three ones is an embodiment for HIV/AIDS
– One country strategy
– One country coordinating mechanism
– One monitoring and evaluating procedure
Pooled procurement a hot topic in collaboration
• Informed buying
– Global Fund Price Reporting Mechanism
• Coordinated procurement
– WB/GF/USG Coordinated Procurement initiative
• Centralized tendering and procurement
– Rwanda/COMERWA joint tendering for Global Fund and USG
• Supply chain management
– SCMS
Global Price Reporting
Mechanism
Global Price Reporting Mechanism an example
of informed buying
• Utilizing Global Fund electronic data to monitor & improve ARV
medicine prices
– Tool to improve efficiency, transparency, accountability of prices
• Potential for utility at many levels
–
–
–
–
–
–
–
donors
implementers
country programs
forecasters
pharmaceutical companies
academics
activist organizations
• Additional electronic data exists in mega funds for HIV/AIDS,
TB, malaria, maybe more
PRM is a limited data set
Data Set Contents
GF
GPRM
Final*
(June 2006)
(June 2006)
(Dec 2006)
1,632
5,501
5,418
#Countries
41
93
90
Time period
Jun 2003Apr 2006
Nov 2002Jun 2006
Nov 2002Jun 2006
#Procurements
#ARVs
15
#Dosage forms
65
#Manufacturers
29
Total Value
$236,167,728
HIV/AIDS 65% spend on 11 products
3 times difference in lead times
Lead Time by Volume for NVP, 200mg
Reported PRM Data
250
200
Lead Time (days)
Cipla Average = 158 Days
150
Potential
Lead Time
Reduction
109 Days
(69%)
100
Heterp Average = 49 Days
50
0
0
50
100
150
200
Cipla
250
Hetero
Order Volume (000’s)
300
350
Huge variance in pricing
Recorded Avg. Price for EFZ, 600mg
Unit Price ($)
$0.75
$2.00
Recorded UNICEF Data
$0.75
$1.94
Potential
Unit
Savings of
$0.06
$0.70
$0.65
$0.66
$0.63
$0.60
$0.57
$0.55
$0.50
Max
Ave
Min
CHAI
00
07
0,
14
0,
21
0,
28
0,
35
0,
42
0,
49
0,
56
0,
63
0,
70
0,
77
0,
85
0,
92
0,
99
1,
06
1,
13
1,
20
1,
28
1,
35
1,
42
1,
63
1,
78
1,
87
2,
05
2,
20
2,
43
2,
70
2,
91
3,
30
3,
61
4,
32
4,
99
6,
8
11 4
,2
5
24
,0
3
0,
0,
volume
price per tablet
70
60
50
40
30
20
10
61
32
91
30
70
20
43
87
05
63
78
42
28
35
13
20
06
92
99
77
85
99
6,
8
11 4
,2
5
24
,0
3
4,
4,
3,
3,
2,
2,
2,
2,
2,
1,
1,
1,
1,
1,
1,
1,
1,
1,
0,
0,
0,
6
63
70
8
0,
10
0,
volume
12
56
42
49
28
35
21
07
14
00
14
0,
0,
0,
0,
0,
0,
0,
0,
0,
0,
High price outliers
stavudine 15mg
20
18
16
stavudine 15mg
Guyana high outlier
prices verified
4
2
0
nevirapine 200mg
100
90
80
nevirapine 200mg
Russia 20x times more
expensive
than median price
0
price per tablet
Rwanda paying 88% more than global median
prices for oral solids
Country
Total #
Procurements
% prices
> global
median
Total
Volume
(tabs)
Total spent compared to
global median price in
$US*
7/05-6/06
7/04-6/05
Macedonia
36
62.1%
25,254,796
5,877,671
4,320,702
Zambia
85
43.5%
45,413740
3,010,395
1,484,232
Rwanda
25
88%
3,725,178
2,896,996
Ethiopia
83
49.4%
64,997,696
1,869,376
3,397,352
Ukraine
27
25.9%
6,963,140
922,093
52,105
Viet Nam
29
51.7%
3,689,160
501,950
262
Sudan
178
51.1%
31,550,248
354,817
191,339
Guyana
19
78.9%
328,510
347,861
110,061
Kenya paying 54% less than global median
prices for oral solids
Country
Total #
Procurements
% prices >
global
median
Total
Volume
(tabs, ml)
Total spent compared to
global median price in
$US*
7/05-6/06
7/04-6/05
Maldives
36
41.7%
35,061,090
-1,681,933
-520,151
Ghana
8
0%
13,486,200
-492,727
-30,962
Haiti
81
9.9%
16,048,110
-273,736
530,636
Kenya
13
53.8%
3,498,900
-227,824
807,153
Mauritania
12
25%
3,831,432
-144,599
Togo
25
4%
4,020,000
-97,610
Cambodia
84
44%
7,272,057
-72,009
Brundi
31
38.7%
2,523,040
-64,978
WB/GF/USG Coordinated
Procurement
Rwanda stimulated the initiative
•
•
•
•
Leadership by the Rwandan Government
Coordination between the government and donors
Joint procurement of ARVs
Building a system for monitoring, tracking, reporting
and auditing ARV consumption and supply
• More patients on treatment
• Lower prices
With effective alignment/coordination,
results will be seen at all levels
Working group
• Accelerated grant
implementation
• Elimination of
duplication of effort
• Coordination of
technical support
In-country
• Reduced stock-outs
• Improved product quality
• Cost savings
• More patients served
• Enhanced local capacity
(human resources and
systems)
Challenges of global partnerships
Challenge
Solution
Resistance to a “new” initiative
Acknowledge the work already
being done
Highlight the working group’s
role to provide resources to
enhance existing efforts
Concern about lack of
participation by other key
stakeholders
Explain phased approach in
incorporating others
Difficulty connecting all the
players (time zones, email
response, weak phone
connections)
Over communicate, over
coordinate, follow through, use
alternative avenues of
communication
Process established by working group to
overcome challenges
• Utilization of a technical secretariat
• Small number of target countries spanning the easy
to the difficult
– Ethiopia, Guyana, Haiti, Mozambique, Rwanda, Vietnam
• Timeline (realistic expectations)
• Scale up from successful base
• Define success (agree on example of the ultimate
objective)
The role of the technical secretariat
Collect data
• HQ teleconference calls
and discussion
• Meeting administration
• Reference documents
• Interview key
stakeholders
Analyze data
• Document status quo
• Identify impediments to
coordination
Propose solutions
• Develop alternatives
• Action/implementation
plan
Overcoming challenges: Guyana
Challenge
Results
Donor disbursement cycles do
not align and often hinder
efforts to coordinate
effectively
Completed national test kit
quantification. Strengthened
and expanded quantification
coordination committee
Limited sharing of supply chain
information among the donors
MOH/WB/GF/USG agreed on
specifications for warehouse
management system
Fragmented procurement
Approved SOW for joint
initiative, including agreement
to share work plans and
develop mechanism for
coordinated procurement
Foundation for success
• Clearly defined mission
• Coordination of global institutions with local
implementation
• Concrete, tangible issues
• Strong leadership
• Resources are committed
• Strong, varied forms of communications
• Country-driven initiatives
• Flexibility
Overcoming challenges: Ethiopia
Challenge
Results
Limited formalized
communication among donors
GFPR/MOH/USG signed MOU
including coordinated
quantification and
procurement
Separate procurement
lifecycles
National ARV quantification to
be completed in February
Limited capacity at PHARMID
to manage expanded
procurement under the
National Logistics Master Plan
Strategic plan completed, and
partners coordinating
implementation
Overcoming challenges: Mozambique
Challenge
Results
Limited sharing of logistics
information among the donors
MOH agreed on specifications
for integrated logistics system
for central medical stores
Partners use different funding
mechanisms (GF/SWAP,
WB/MAP, and USG/PEPFAR)
National quantification of
ARVs completed
Human resources challenges
at Ministry of Health
Technical secretariat currently
providing training on supply
planning, and other trainings
planned
Sustainability is About The Quality of Life
Before treatment for HIV/AIDS /TB
co-infection; March 2003
After treatment for HIV/AIDS /TB
co-infection; September 2003
Questions
Thanks!
For more information:
Website: scms.pfscm.org
E-mail: scmsinfo@pfscm.org
Main phone: +1.571.227.8600
Main fax: +1.703.310.5270