UNICEF involvement in PSM Case of Ethiopia

UNICEF involvement in PSM – Case of Ethiopia PSM Consultants Briefing Seminar Copenhagen 30 Jan. – 2 Feb. 2005

Overview 1. 2. 3. 4. 5. 6. 7. History of UNICEF involvement in PSM UNICEF capacity for PSM assistance Challenges faced by partner counties Nature of UNICEF assistance Impact of UNICEF assistance Critical success factors Remaining challenges

UNICEF is the leading agency for children’s supplies

UNICEF Supplies • UNICEF procures vaccines for 40 per cent of children in developing countries (2. 5 billion doses a year) • UNICEF is the world’s largest buyer of mosquito nets (15 million nets in 2005) • UNICEF procures New ACTs - effective medicines against malaria ($7. 6 m in 2005)

UNICEF Supplies • UNICEF has procured 40 million packets of Oral Rehydration Salts in 2005 • UNICEF currently delivers antiretroviral medicines to 44 countries ($33. 5 million in 2005) • During 2005, UNICEF reached around $7. 7 million worth of test kits.

UNICEF Supplies • During 2005, UNICEF played key role in emergencies • UNICEF has stock of ARVs in Copenhagen for emergencies.

Role of UNICEF Supply Division • • Provide technical support Oversee UNICEF’s global procurement and to UNICEF offices and logistics operation. Procurement Services customers globally. Ensure that high quality, good value • Share procurement know supplies reach children -how with development and their families partners. quickly. Maintain the highest ethical standards for procurement. • Innovate to find everbetter supply solutions for children.

Country Office Presence • Active Procurement activities in support of Governments and NGOs • In-country logistics, for all commodities • Capacity building in programming and supply management • Partnership building

UNICEF partner constraints in PSM

An Overview of the System

The Supply Management Framework Principles Rational Use Formulation HR Access Supply System Legal Framework Financing Research Cost Containment

The Supply Management Framework Location of constraints in the Supply Cycle Selection l e Quantification Distribution üDefinition of Responsibilities ü Identification of Coordination üMechanisms Procurement Acquisition üIntegration of Existing üInstitutions & Programs

Case of Ethiopia • Long procurement lead time (average 84 weeks) • Forex transfer difficulties • Serious constraints in distribution system • Preparedness of treatment sites • Limited HR capacity

General Characteristics – Inaccurate quantification information due to poor LMIS – Non optimum drug availability => waste and expiration – Non-systematic inventory control management systems – Inadequate storage facilities – Limited transport for distribution of drugs – Non-optimum demand for commodities

Ethiopia UNICEF Involvement • Procurement services • Forex “transfer facilitation” • Overhaul of in-country logistics system (in process) • Assistance with commodity distribution • Technical Assistance to FMOH in logistics management

Ethiopia UNICEF Involvement Customs, Registration, Quality & Order verification Selection, Quantification Suppliers, Quality Monitoring Delivery Times Product Receipt Stock Management Ordering Product quality, batch no, Shelf life monitoring, Environ. control, etc Distribution Allocation, Transport, Usage Evaluation

UNICEF PSM support making a difference

Performance – Delivery of Products

Results for Ethiopia • More than 3 million treatments of Artemether. Lumefantrine to all regions of Ethiopia • Forecasting & procurement– 600, 000 P. falciparum malaria cases to be treated in 2005 -6 • Largest distribution of ITNs in Ethiopian history (3. 5 m nets) • 1. 8 m RDTs distributed in 2005 • $ 6 m ARV procured and delivered in 6 mths • System overhaul

The Case of ARV supplies No. of Packs Supplie d MATERIAL Current No. of Packs in Stock Expiry Date Reamining shelf life (month s) No. of Treatm ents/m th Monthly consumption 1 Didanosine 100 mg tabs/PAC-60 pb 16, 000 7/6/06 10 1, 600 0 2 Efavirenz 200 mg caps/PAC-90 pb 1, 500 1/8/08 28 54 0 3 Efavirenz 200 mg caps/PAC-90 pb 1, 334 3/6/06 6 222 58 4 Efavirenz 600 mg tabs/PAC-30 pb 4, 000 5, 893 2/7/07 17 347 5201 5 Lamivudine 150 mg tabs/PAC-60 gp 100, 501 1/7/07 16 6, 281 6932 6 Lamivudine oral sol. 10 mg/ml/BOT-240 ml pb 3, 864 7/6/06 10 386 0 7 Lamivudine oral sol. 10 mg/ml/BOT-240 ml pb 13, 164 5/7/07 20 658 527 8 Lamivudine oral sol. 10 mg/ml/BOT-100 ml pb 3, 000 11/6/06 14 214 0 9 Nelfinavir 250 mg tabs/PAC-270 pb 15, 500 6/7/07 21 738 0 10 Nevirapine 200 mg tabs/PAC-60 gp 50, 500 50, 490 2/7/07 17 2, 970 11 Nevirapine 200 mg tabs/PAC-60 gp 5, 075 6/6/06 9 564 0 12 Nevirapine oral sol. 10 mg/ml/BOT 100 ml gb 2, 163 6/9/06 9 240 1349 13 Nevirapine oral sol. 10 mg/ml/BOT-240 ml pb 9, 000 6/7/07 21 429 0 14 Stavudine 30 mg caps/PAC-60 gb 16, 200 10, 596 4/7/07 19 558 4, 164 15 Stavudine 40 mg caps/PAC-60 gb 20, 000 4/7/07 19 1, 053 2779 16 Stavudine 40 mg caps/PAC-60 gb 13, 575 5/6/06 8 1, 697 0 17 ZDV + 3 TC 300+150 mg tabs/PAC-60 pb 11, 182 11/7/07 26 430 10397 18 ZDV + 3 TC 300+150 mg tabs/PAC-60 pb 7, 200 1/7/07 16 450 0 19 ZDV + 3 TC 300+150 mg tabs/PAC-60 pb 12, 296 5/8/08 32 384 0 20 Zidovudine 300 mg tabs/PAC-60 gp 7, 138 11/7/07 26 275 32 21 Zidovudine 300 mg tabs/PAC-60 gp 1, 000 1/7/07 16 63 0 22 Zidovudine oral sol. 10 mg/ml/BOT-100 ml pb 3, 500 4/7/07 19 184 0 23 Zidovudine oral sol. 10 mg/ml/BOT-200 ml pb 12, 057 12/6/06 15 804 414 24 Zidovudine oral sol. 10 mg/ml/BOT-200 ml pb 9, 144 7/6/06 10 914 0 12181

Critical success factors • Technical expertise within the procurement team • Country specific intervention • Stakeholder involvement • Interpersonal and inter-institutional working relationship • Communication and information sharing: SD -CO; CO-MOH; partner-partner • Clear plan for in-country logistics • Periodic review of PSM plans

Remaining challenges • Human resource shortages • Weak health system and capacity in procurement • Capacity building plan for in country logistics • Hands on PSM support • Financing mechanisms

For every child…