ACCESS TO MEDICINES IN EMERGENCY WHO Technical Briefing

ACCESS TO MEDICINES IN EMERGENCY WHO Technical Briefing Seminar on Access to Essential Medicines 17 -21 November 2009 Stéphanie Arsac ICRC Head Pharmacist

ICRC : Who are we ? 4 The International Committee of the Red Cross (ICRC) is a Swiss-based humanitarian organization and founding member of the International Red Cross and Red Crescent Movement (1863). This Movement is composed of the ICRC, National Red Cross and Red Crescent Societies and the International Federation of Red Cross and Red Crescent Societies. 4 The ICRC is mandated by the international community to be the guardian and promoter of international humanitarian law. 4 We work around the world providing assistance to people affected by armed conflict and other situations of violence. 4 The organization has delegations and missions in some 80 countries around the world and employs a staff of over 12, 000 people, most of them nationals of the countries in which it works. About 800 people work at the ICRC’s headquarters in Geneva, Switzerland,

Access to medicines in Emergency : Key success factors 4 Quality control of medicines via centralized purchase 4 Availability of stocks 4 Strong logistic set-up 4 Trained and experienced people in health & logistics

Key Success Factors on a Global Scale Geneva Peshawar Amman Panama under process Abidjan Kuala Lumpur Nairobi under process Corporate coverage Emergency stock Regional coverage Logistic Hub Sub-regional coverage Flying support

Pre-positioning of Stock 4 The logistic set-up is defined by the positioning and the sizing of 8 Emergency stocks to serve the first phases of large emergency operations 8 Logistic hubs to store and regulate the flows 8 Flying supports, who are human resources mobilised for training, support to intense activities or background actions of anticipation 4 Set-up and infrastructures have different coverage depending on their situation. International set-up covers all the operation theatres, regional covers 4 to 6 bordering countries, sub-regional covers 1 to 3 bordering countries. It is to be noticed than most of flying support and emergency stock can be mobilised all over the world in case of large emergency operation

Pre-positioning of Stock 492 000 sqm of warehouses worldwide 4 Use of kits during the first stage of emergency 4 Re-order in bulk after health assessment

Kits pre-positioned (1) A BASIC/PRIMARY/PUBLIC HEALTH KMEDKIAE 01 B IAEHK, BASIC, 1. 000 pers. /3 m, no malaria KMEDKIAE 01 BM (iaehk, basic, 1. 000 pers. /3 m) MALARIA module KMEDKIAE 01 S (iaehk, suppl. , 10. 000 pers. /3 m) NO NARCO/PSYCHO/MALARIA/PEP KMEDKIAE 01 SM (iaehk, suppl. , 10. 000 pers. /3 m) MALARIA module DINJINSH 10 VI INSULIN, INTERMEDIATE ACTION, 100 IU/ml, human, 10 ml, vial DINJINSH 10 VR INSULIN, RAPID, 100 IU/ml, human, 10 ml, vial KMEDKCHO 01 KIT, CHOLERA (001), 625 treatments with infusions KSANKHEF 01 KIT, HAEMMORRHAGIC FEVER, material for 100 patients KMEDZGVA 081 (kit reproductive health)CLEAN DELIVERY Ref 2 A/UNFPA KMEDZGVA 082 (kit reproductive health)CLEAN DELIVERY Ref 2 B/UNFPA KMEDZGVA 091 (kit reproductive health)POST-RAPE MANAGEMT. Ref 3/UNFPA KMEDZGVA 083 (kit reproductive health)CONTRACEPTION SET Ref: 4/UNFPA KMEDZGVA 084 (kit reproductive health)SIT KIT Ref: 5 / UNFPA KMEDZGVA 093 (kit reproductive health)PROF. MIDWIFERY Ref: 6/UNFPA KMEDZGVA 094 (kit reproductive health)UNSAFE ABORT. MANAGEMT. Ref: 8/UNFPA KMEDZGVA 095 (kit reproductive health) SUTURE Ref: 9/UNFPA KMEDZGVA 096 (kit reproductive health)VACUUM EXTRACTION Ref: 10/UNFPA KMEDZGVA 097 (kit reproductive health) Referral Surgical equip. Ref: 11 a KMEDZGVA 098 (kit reproductive health)Referral Surg. drugs/disp. Ref 11 b KMEDZGVA 099 (kit reproductive health)TRANSFUSION Ref: 12/UNFPA

Kits pre-positioned (2) B TRAUMA / WEAPON-WOUNDED KMEDMDRE 01 MODULE, DRESSING KMEDKWWF 05 KIT, 50 WAR WOUNDED, FIRST AID & TRIAGE, MEDICAL- single use KMEDMFAT 50 BE (module, f. aid-tri. B) SET, EQUIPMENT+misc. mat. , 50 w. w. /cas. Field Surgical Team material + equipment (see separate worksheet) KMEDKFAT 50 KIT, FIRST AID-TRIAGE, 50 war wou. /casualties, modules A/B/C KMEDKWWH 05 KIT, 50 WAR WOUNDED, HOSPITALIZED, RENEWABLES KMEDSLINSR 50 S SET, LINEN, SURGICAL, single use, for 50 wounded hospitalised KMEDSANE 05 B SET, ANAESTHESIA, BASIC MATERIAL, for 50 hosp. single use KMEDSDRU 05 SS SET, DRUGS FOR SURG. AND ANAEST. , SUPLEMENTARY, 50 patients KMEDSTEA 01 SET, TETANUS VACCINE AND IMMUNOGLOBULINS XSEQSTRE 1 X STRETCHER, foldable in width XSTEAUTO 90 AUTOCLAVE, COMBINED, 90 l, elec. /kero. , incl. kero. burner

Kits pre-positioned (3) C SURGICAL INSTRUMENT SETS KMSISAMP 01 SET, AMPUTATION, instruments KMSISBON 01 C set, basic bone surg, comple. , CURETTES KMSISBON 01 SET, BASIC BONE SURGERY, complementary, instruments KMSISBAS 01 SET, BASIC SURGERY, instruments KMSISBOR 01 SET, BONE WIRING & KIRSHNER, 8 sizes + instruments KMSISCRA 01 SET, CRANIOTOMY, complementary, instruments KMSISDEN 01 SET, DENTAL EXTRACTION, instruments KMSISDRE 01 SET, DRESSING, instruments KMSISFIX 02 LF SET, EXTERNAL FIXATION, LARGE, FIXATORS, Hoffmann II KMSISFIX 01 LF SET, EXTERNAL FIXATION, LARGE, FIXATORS, Synthes KMSISFIX 02 LI SET, EXTERNAL FIXATION, LARGE, INSTRUMENTS, Hoffmann II KMSISFIX 01 LI SET, EXTERNAL FIXATION, LARGE, INSTRUMENTS, Synthes KMSISGYN 01 SET, GYNAECOLOGY (dilat. & curettage), instruments KMSISLAP 01 SET, LAPAROTOMY, (+ caesarian), instruments KMSISPLA 01 SET, PLASTER CASTS REMOVAL, instruments KMSISSKI 01 SET, SKIN GRAFT, instruments KMSISSUT 01 SET, SUTURE, instruments KMSISTHR 01 SET, THORACOTOMY, complementary, instruments KMSISSKE 01 SET, TRACTION, instruments + 10 bows KMSISURE 01 SET, URETHRAL SOUNDS, instruments KMSISVAS 01 SET, VASCULAR, complementary, instruments KMSISWOU 01 SET, WOUND EXCISION, instruments XSEQSPLIBA 2 P SPLINT, BOHLER-BRAUN, 70 cm, size 2, 3 pulley, foldable XSINMEDI 507308 SPECULUM, SIMS, 23 cm, open blade 23 x 80 mm, rectal

Logistic Key Figures 4 2740 vehicles / trucks 4 11 aircrafts

Logistic Key Figures 4 65 Log people in HQ 4 132 Log expatriates 4 2800 Log delegation employees 4 Different expertise

Red Cross & Red Crescent Movement 4 ICRC can rely on, or support a network of 186 National Societies and 97 Millions of volunteers

Quality Assurance and central purchase of medicines 4 To avoid counterfeits & Sub-standards 8 Products registered in highly regulated countries 8 If not, products assessed trough the Interagency Product Questionnaire 8 Good Manufacturing Practices audits of pharmaceutical manufacturers by expert auditors = limited number of manufacturers to follow up

Local purchase of medicines 4 local purchase of medicines sometimes needed to fill specific or urgent needs or to supply specific treatments for chronic disease 4 Medical logisticians (pharmacists), are trained to identify reliable sources of medicines and avoid counterfeits and substandards 43 pharmacists in HQ dedicated to Quality Assurance and supporting the field

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