Download Securing the Supply of Condoms and Other Essential

Securing the Supply of Condoms
and Other Essential Products for
HIV/AIDS Programs
Tony Hudgins
Yasmin Chandani
John Snow Research & Training Institute
www.jsi.com
The Importance of a strong supply
chain to an HIV/AIDS Program
Supply chain improvements:
• Increase program impact - by providing a
consistent, reliable supply of essential products;
• Enhance quality of care - by delivering highquality products;
• Improve cost-effectiveness and accountability - by
reducing loss and wastage;
• Increase support of stakeholders - by ensuring the
integrity of the supply chain.
The Supply Chain
The Supply Chain
•
•
•
•
•
•
The RIGHT goods
In the RIGHT quantities
In the RIGHT condition
Delivered to the RIGHT place
At the RIGHT time
For the RIGHT cost
NO PRODUCT?
NO PROGRAM.
The Logistics Cycle
Illustrative Supply Chain Issues
• Rapid assessment and quantification of
product, including:
– An indicator-based description of the current
logistics system and laboratory capacities;
– Quantification of drug and medical supply
needs.
Illustrative Supply Chain
Issues
• Product Selection:
– Large number of products needed
– Ensure consistency with National Essential
Drugs Lists.
• Procurement: Two options
– Purchase of product by donor or its agent.
– Purchase of product by host country.
Illustrative Supply Chain
Issues
• Issues that affect procurement:
– High cost of ART relative to per capita GNP.
– Need to procure specific drug combinations
from different manufacturers
– The inefficiencies and wastage associated with
brand proliferation
– The potential for diversion given the immense
value of the commodities.
Illustrative Supply Chain Issues
• In-Country Distribution: Public sector problems
– Insufficient data for estimating needs;
– Mismatches between donated products and local
licensing;
– Delays in port clearance;
– Not enough central storage space;
Illustrative Supply Chain Issues
• In-Country Distribution: Public sector problems
– Aging cold chains with limited capacities;
– Insufficient number of trucks or fuel for
distribution;
– Inadequate laboratory capacities;
– Poor security at central, district and SDP levels;
– Frequent stock outs, even for inexpensive
products
Illustrative Supply Chain Issues
• In Africa, a number of countries have begun
to improve MOH logistics capacities.
• However, most are ill-prepared to provide
adequate service to wide-spread HIV/AIDS
care and treatment programs.
Illustrative Supply Chain Issues
• Alternative Distribution Systems:
 NGO, Employer and Commercial Systems
• A combination of distribution systems is
likely to be needed in order to rapidly
mobilize for scaled-up HIV/AIDS
commodity programming.
Illustrative Supply Chain Issues
• Logistics Management Information System
(LMIS) provides data to:
– Track product distribution
– Monitor wastage and diversion, and ensure
accountability.
• Effective LMIS in Kenya stretched drugs for
STI treatment to last 29 months for over 500
sites compared to predicted 163 sites for 12
months
Illustrative Supply Chain Issues
• Service Delivery
– The reliable and consistent delivery of products
to the SDP is essential.
– Other components must be in place to ensure
the effective delivery of services, including
staff training and supervision, information
systems to monitor case management and ART
resistance, patient education materials, facilities
improvement and community sensitization and
mobilization.
Budgetary Implications of an
Effective Supply Chain
• The cost of developing and operating an effective
supply chain varies widely.
• Difference between the cost of operating a system
for full supply commodities and those that are not
in full supply.
• Both recurrent and development costs must be
considered.
• Use of plural systems may be most cost-effective.
Recommendations
• Conduct assessment of national logistics capacity
and laboratory resources for HIV/AIDS diagnosis
and treatment;
• Conduct national quantification of condoms, drugs,
reagents and consumable supplies;
• Develop procurement and distribution plan based on
outcome of assessment;
• Develop or strengthen the LMIS;
• Implement program based on the best use of
available resources.