Transcript No Product? No Program. - World Health Organization

Monitoring Drug and
Commodity Supply Chains for
ARV Programmes
Yasmin Chandani
John Snow Inc/DELIVER
The Supply Chain
The Logistics Cycle
Background
• Weak public sector logistics management
systems for most essential medicines
– Low priority investment area
– Historically, few dedicated and consistent
human and financial resources
• Additional stresses include HIV/AIDS related
mortality, migration etc.
Common Problems
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Poor storage facilities
Weak transportation systems
Problematic customs processes
Diversion of products
Inadequate training
Lack of information systems
Inaccurate quantification and forecasting
Background
• Vertical inventory management systems
stronger than for other health commodities
– Challenges with vertical systems
• Creation of multiple, fragmented MOH logistics
systems
• Duplication of work
• Integration of services and systems
Logistics Systems for ARVs
• Parallel systems
• Some integrated logistics functions
– Storage, distribution
• Integrating ARVs with well functioning
existing parallel systems
– TB/DOTS approach
• Integrated approach required for HIV/AIDS
programs
Logistics Management Issues in
Scaling up ART Delivery
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Role of public vs. private sector
Supportive policy and legal environment
STGs for ARVs and inclusion on NEDL
Quality Assurance and Control systems
Criteria for quantification and forecasting
Harmonized or standardized procurement
Max/min inventory control system
Secure storage and transportation
Monitoring prescribing patterns, dispensing
patterns/consumption, stock levels
Cross Cutting Issues
• Procurement of generics
• Security of storage and distribution
• Maintaining low, centralized inventory
levels, avoiding stockouts
– Cost & Control/Fragmentation
• Agile logistics system dependent on timely
data from LMIS to react to
– Unexpected consumption patterns
– Patient mobility
– Accountability
Developing a LMIS
• Purpose
To collect, organize and report data that will be
used to make decisions
• Characteristics:
– User-friendly, Minimal burden on health
workers
– Able to provide timely data
– Enhance agility of system to respond to
changes in consumption due to patient
mobility, regime changes, drug substitution,
“drug holidays”
Essential Data Items in a
LMIS
• Consumption, dispensed-to-user, or sales
data
• Stock on hand
• Losses and adjustments
– Expiries, wastage, breakage, theft
• Service statistics
– Number of clients served
– Diagnosis (if applicable)
Monitoring logistics functions
• Tracking commodity availability at sites
• Monitoring inventory levels
• Using consumption patterns for
quantification and forecasting
• Prescribing patterns
• Dispensing patterns
• Single drug substitution
• Regimen changes
Experience from the field:
Uganda
• Procurement of low-cost, high quality drugs
• Partnership with JCRC as part of scale up
• Integrating procurement, storage, distribution under
NMS
• Setting up separate LMIS for ARVs with a view
towards long-term integration
• Linking LMIS with HMIS and M&E
• Semi-automated system; pilot testing fully
automated options
• Accreditation of private pharmacies contingent on
data provision
Experience from the field: Kenya
• Procurement of generic drugs
• Exploring options for procurement, storage,
distribution
– Outsourced in the short term?
– Development of long term capacity within KEMSA?
• Fast-tracking development of LMIS based on survey
of commercial and other LMIS
• LMIS to operate under NASCOP (ARV Management
Unit), with dedicated long-term advisor to
coordinate with partners, including private sector
The Way Forward
• Consistent financing
• Coordinated procurement of low cost, quality drugs
• Accurate data capture, timely data transmission
– Operations, accountability, linkages with HMIS
• Secure storage, distribution
• Balance between rapid/effective parallel systems
and long-term system building for HIV/AIDS
commodities or all essential medicines