Transcript DRUG STORE SECURITY

BOTSWANA ARV PROCUREMENT
AND SUPPLY CHAIN
MANAGEMENT
PRESENTED BY MR S MAPIKI
CENTRAL MEDICAL STORES
BOTSWANA-2006
BACKGROUND
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Pop. 1,7Million
2002, 110,000 people eligible for
Treatment
Botswana =1st African Country to offer
free ARV’S 2002
Govt. paid over 2/3 and got support from
Bill and Mellinda Gates and
Pharmaceutical Suppliers
Treatment straining limited resources,
devt funds diverted to health =25% Nat
Budget
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PSM System had to improve to
integrate ARV’s i.e Forecasting,
quantification, Receiving, Storage,
Distribution, Monitoring
Forecasting and Quantification
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Modern PSM Tools e.g formulas based
on Historical method and
Morbidity/Mortality data. Data from sites
also used to forecast
PROCUREMENT METHODS
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Procurement of ARV’S i.e budgeting,
tendering, ordering all integrated into one
CMS System
ARV’S procured from patent holders thru
negotiation for Acces prices and by Direct
Contract-Single Sourcing Method
Palliatives,Other treatments, detection and
prevention supplies thru International
Competitive Bidding
Prequalification in progress, Voluntary
Licence given for CBV to Aspen by GSK
STORAGE, INVENTORY
MANAGEMENT
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The ARV Quality Assurance(Testing,
inspection,verification from Rcpts-Distr.
Integrated with that for other medical
supplies
Storage Locations in the Warehouse
thru a Computerized Warehouse
Management System-allocates all
receipts randomly.
ARV’S stored under tighter security
DISTRIBUTION
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A national distribution schedule integrates
distribution of ARV’S and other Medical
Supplies
All Transportation is coordinated from the
CMS point
Distribution based on orders from sites
Sites order based on working stock and 3
month buffer stock x no. of patients
Frequency of consignments distribution to
sites depend on CMS stock on hand
PUBLIC PRIVATE PARTNERSHIP
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A Disease State Management
Company engaged to provide Clinical
assessment, management,
Counselling, ARV Distribution and
dispensing
PPP meant to assist Govt. in the
rollout and to reach segments of the
population not yet served
MONITORING AND EVALUATION
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Monthly Site report forms improved
based on PSM tools used for monthly
monitoring
Monitoring tracks the effects of
procurement and whether the
programme goals on track
Monitoring Cont,d
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Monthly Physical stocktake mandatory
Monthly reports from sites mandatory
covering:
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Name of drug
Last reported stock
Receipts since last report
Stock on Hand
# of pts on drug since last report
# of pts on drug currently
# of pts started on drug since last report
Projected drug demand for next month
PROGRESS SO FAR
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2002
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110,000 HIV+ Needed treatment
4 SITES
7,000 PATIENTS initiated on treatment
P50Million (USD 10M) used
2004/05
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32 Sites
37,500 patients on Tx by April 05 we estimate
59,000(52,000 Govt. and 7,300 Pvt.) by Dec 05
( Ref :55,000 required per 3x5 by Dec05)
Monthly enrolment rate of 1000-2,000 patients
P200 Million(USD 45M) spent during 2004/05
PROGRESS
DEC 2002 DEC 2003 DEC 2004 DEC 2005
20,000
AVG
ANNUAL
COST
30,000
40,000
59,000
USD1,000/
PATIENT/Y
R
DRUG DISTRIBUTION
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Sites quantify and order from CMS
CMS issues and distributes to facilities
using CMS transport
ARV’S transported separately from
other drugs
Accountability from dispatch to
receiving stringent
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SECURITY-CMS
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Drugs delivered under security escort
Drugs immediately locked up upon
receipt
Separate storeroom for ARV’S
Storeroom security guarded for 24 hours
Computer Software Record Keeping
backed up by manual Bincards
Monthly Physical stocktake
Accompanying documents signed by
CMS Security and sites upon Dispatch
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SECURITY-SITES
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All receipts/Issues entered into a record
book/computer software
ARV stock kept under secure storage
with burglar Bars and Alarm
Reserve Therapy drugs ordered by
special order on named patient basis
Patients received monthly supplies
/collected monthly refills
CHALLENGES
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Private Sector –Inadequate adherence to
guidelines
RESISTANCE-beginning to present
SECURITY-Pilferages
Affordability and sustainability
Late presentation for Tx
TB/HIV co-infection complicating matters
Scale up to districts= capacity constraints
Worldwide shortage of
Efavirenz,Combivir,Stavudine
Patent Rights-TRIPS
SCALE UP STRATEGIES
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Avail ARV’S at District Clinics
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To use district resources(District Pharm.
Techs, Nurses and Primary Trainers)
Public Private Partnership(PPP)
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A disease State Management Company
to be contracted
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Will engage Private Physicians for
consultation
Will engage Retail Pharmacists to dispense
and reach more people
Will obtain drugs from CMS