ADDRESSING PHARMACEUTICAL SUPPLY CHAIN NEEDS

ADDRESSINGPHARMACEUTICALSUPPLY CHAIN NEEDS

PRESENTATION TO HEALTHDONOR GROUP MEETING

8 July 2009

Pharmaceutical Supply Chain

International and

national healthauthorities

(regulation,management,

policy, HR etc)

Pharmaceuticalentities

(storage, distributionetc)

Use

(dispensing, patientetc)

Pharmaceuticalindustry

(production, R&Detc)

Components of supply chain inMalawi

MOH, WHO, GFATM, other DPs etc

Industry (4x pharmaceutical manufacturers, 2x RUTFmanufacturers, distributors etc)

NGOs (health facilities, support programs etc)

Public health facilities (hospitals, health centers etc)

Private sector (pharmacies, medicines vendors, clinicsetc)

CMS

PMPB

Users

Pharmaceutical Services

Professional patient care and availability andmanagement of supplies important as diseasemanagement often incomplete without theseservices

Health budgets (low and middle income countries)provide for 20-30% for the services

GF RCC 1 Grant $342m (April 2009 – March 2012).Supplies $116m (34%)

MK5b for drugs out of total MK32b for health (15%)in this year’s budget

Pharmaceutical servicesdelivery

Pharmaceutical

services

(Service delivery)

Procurement,

storage

distribution

(Medical Stores)

Pharmaceutical care

(clinical)

Administration

Procurement & Supply Management(PSM)

Procurement,

storage

distribution

(Central Medical Stores)

Storage systems

and capacity

Distribution systems

and capacity

Supply management

systems & capacity

(inventory, QA etc)

Pharmaceutical care

Standards of practice

•Skills development

•Training

•SOPs

Guidelines

• STGs

• Formularies

Supervision

•National (MOH HQ)

•Zonal/regional

•District

•Facility

Administration

Planning

•Quantification

•Policy development

•Supplies

Human resource

•Provide qualified

personnel

•Supervision

•Training

M&E

•Supplies

•Standards

Pharmaceutical supplymanagement

To ensure high quality essential drugs andmedical supplies are available, affordable andrationally used

To ensure that patient has access to rightmedical supplies in right quantity at right time

4 basic functions form the pharmaceuticalsupply management cycle

Pharmaceutical SupplyManagement Cycle

Procurement

Distribution

Use

Selection

Management Support

Management Support

At centre of supply management cycle

Should consist of capacity for

Organization

Financing

Information management

Human resource

Should provide policy direction (NDP)) and legal

framework (appropriate legislation)

Public sector supply chain

Central (MOHHQ/CMS)

•Planning

•Procurement

•Warehousing

•Distribution

•Management support

District

•Planning

•Procurement

•Warehousing

•Distribution

•Management support

Facility

•Planning

•Warehousing

•Use

•Data source

Interdependent

Responsibility for supply management

Current situation in Malawi

Capacity gaps exist at all levels of thechain in:

a) infrastructure (warehousing anddistribution capacity)

b) systems ( data management,planning, inventory management, GoodWarehousing Practices)

c) human resource (quantity and skills)

Effects of inadequate warehousing capacity

Failure to comply with GWP (quality of drugscompromised)

Poor inventory management

Security cannot be optimized

Inadequate stock levels (frequency of ordering)

Distribution planning (increased demand andcosts)

Effects of inadequate distribution capacity

Frequency of distribution affected

Coverage of distribution

Increased warehousing needs

MOH and other support levels

Inadequate institutional capacity at MOH HQand other levels (zone, district) to deliverquality pharmaceutical services

Inadequate professionally qualified personnelat HQ, zone and district levels for supervision

Not all facilities have adequately qualifiedpersonnel with dedicated responsibility andaccountability for supply management

Central Medical Stores

Important progress made with TrustDeed being approved.

Awaiting appointment of Board (byPresident) to set CMS Trust in motion

Deliver and MSH providing TA withsystems development

Procurement oversight agent to provideTA to ODPP being recruited (July???)

Recommendations

Addressing problems at one level of thesupply chain will not solve supplymanagement problems in the healthsector as supply chain and managementcycle components interdependent

Attention should be paid to addressingproblems at other levels as well

Central Medical Storesrecommendations

Operationalization plan for CMS Trust withdetailed and realistic timeframes (additional toCMS Trust Roadmap) should be developed

A detailed plan for strengthening entire CMS(including regional stores) developed. Currentbusiness plan falls short

Re-visit CMS request for TA and addressidentified needs taking into accountdevelopments at CMS

MOH institutional capacityrecommendations

Strengthen administrative and professionalcapacity of MOH (HQ and support levels) toprovide quality pharmaceutical services

- review establishment (department ordirectorate of Pharmaceutical Services?)

- effective organizational structure

DPs to provide advocacy for establishment ofincreased institutional capacity (consider sizeof budget line for pharmaceutical services inhealth budget)

TA to strengthen PSM

Collaborative approach by all partners tocreate synergies necessary to makeimpact on PSM

Support and collaborate with Deliver(CMS and MOH HQ initiatives) andMSH/SPS (facility level initiatives)

THANK YOUFOR YOURATTENTION