monitoring drug and commodity supply chains for arv programmes yasmin chandani john snow inc/deliver

Monitoring Drug and Commodity Supply Chains

for ARV Programmes

Yasmin Chandani

John Snow Inc/DELIVER

The Supply Chain

The Logistics Cycle

Background

• Weak public sector logistics management systems for most essential medicines– Low priority investment area

– Historically, few dedicated and consistent human and financial resources

• Additional stresses include HIV/AIDS related mortality, migration etc.

Common Problems

• Poor storage facilities

• Weak transportation systems

• Problematic customs processes

• Diversion of products

• Inadequate training

• Lack of information systems

• Inaccurate quantification and forecasting

Background

• Vertical inventory management systems stronger than for other health commodities– Challenges with vertical systems

• Creation of multiple, fragmented MOH logistics systems

• Duplication of work

• Integration of services and systems

Logistics Systems for ARVs

• Parallel systems

• Some integrated logistics functions– Storage, distribution

• Integrating ARVs with well functioning existing parallel systems– TB/DOTS approach

• Integrated approach required for HIV/AIDS programs

Logistics Management Issues in Scaling up ART Delivery

• Role of public vs. private sector

• Supportive policy and legal environment

• STGs for ARVs and inclusion on NEDL

• Quality Assurance and Control systems

• Criteria for quantification and forecasting

• Harmonized or standardized procurement

• Max/min inventory control system

• Secure storage and transportation

• Monitoring prescribing patterns, dispensing patterns/consumption, stock levels

Cross Cutting Issues

• Procurement of generics• Security of storage and distribution• Maintaining low, centralized inventory

levels, avoiding stockouts– Cost & Control/Fragmentation

• Agile logistics system dependent on timely data from LMIS to react to– Unexpected consumption patterns– Patient mobility– Accountability

Developing a LMIS

• PurposeTo collect, organize and report data that will be

used to make decisions

• Characteristics: – User-friendly, Minimal burden on health

workers– Able to provide timely data– Enhance agility of system to respond to

changes in consumption due to patient mobility, regime changes, drug substitution, “drug holidays”

Essential Data Items in a LMIS

• Consumption, dispensed-to-user, or sales data

• Stock on hand

• Losses and adjustments– Expiries, wastage, breakage, theft

• Service statistics– Number of clients served– Diagnosis (if applicable)

Monitoring logistics functions

• Tracking commodity availability at sites

• Monitoring inventory levels

• Using consumption patterns for quantification and forecasting

• Prescribing patterns

• Dispensing patterns

• Single drug substitution

• Regimen changes

Experience from the field: Uganda

• Procurement of low-cost, high quality drugs• Partnership with JCRC as part of scale up• Integrating procurement, storage, distribution under

NMS• Setting up separate LMIS for ARVs with a view

towards long-term integration• Linking LMIS with HMIS and M&E• Semi-automated system; pilot testing fully

automated options• Accreditation of private pharmacies contingent on

data provision

Experience from the field: Kenya

• Procurement of generic drugs

• Exploring options for procurement, storage, distribution– Outsourced in the short term?– Development of long term capacity within KEMSA?

• Fast-tracking development of LMIS based on survey of commercial and other LMIS

• LMIS to operate under NASCOP (ARV Management Unit), with dedicated long-term advisor to coordinate with partners, including private sector

The Way Forward

• Consistent financing

• Coordinated procurement of low cost, quality drugs

• Accurate data capture, timely data transmission– Operations, accountability, linkages with HMIS

• Secure storage, distribution

• Balance between rapid/effective parallel systems and long-term system building for HIV/AIDS commodities or all essential medicines