Transcript WHO Technical Briefing Seminar 17th 20th November 2008 Use of evidence in strengthening medicine supply systems: The case of Tanzania Mr Joseph Muhume MoH Tanzania 20th.

WHO Technical Briefing Seminar
17th 20th November 2008
Use of evidence in strengthening medicine supply
systems: The case of Tanzania
Mr Joseph Muhume
MoH Tanzania
20th November 2008
Overview of Studies


13 African countries including Tanzania
planned in 2006 to carry out studies on
medicines supply systems.
The countries conducted two surveys:
1.
2.
The Mapping Survey of all partners involved in PSM of
medicines and medical supplies;
The In-Depth Assessment to identify strengths and
weaknesses of the supply management system and to
identify opportunities for coordinated, coherent and
efficient national medicines supply strategy.
Mapping Medicines Procurement
Systems
Objective:
to establish a map of partners involved in procurement of
medicines and medical supplies
The results were expected to:
• To map the financial flows of the existing procurement and
distribution system
• To provide an overview of all stakeholders involved in
medicines procurement and distribution
• To present a synopsis of medicines procurement and
distribution pathway in country
Harmonization and Alignment
principles by DPs
Development Results
4
Ownership
2
Alignment
3
Harmonisation
(Tanzania)
(Donor - Tanzania)
(Donor - Donor)
TZ sets
the agenda
Aligning
with TZ
agenda
Establishing
common
arrangements
Managing for Results
1
Using TZ’s
Systems
Simplifying
procedures
Sharing
information
Medicines supply systems in TANZANIA. 2007
ESSENTIAL
MEDICINES
ARVs
MALARIA
TB
REAGENT
Blood safety
(+ HIV test)
ARVs
Ped
OI
United Republic of Tanzania
VACCINES CONDOMS CONTRACEPTIVES
MEDICAL
SUPPLIES
GOVERNMENT
BILATERAL
DONOR
MULTILATERAL
DONOR
NGO/PRIVATE
Source
Of Funds
Procurement
Agent/Body
C
S
S
C
W
H
O
TEC
&
CCT
Point of 1st
warehousing
TEC
&CC
T
Point of 2nd
warehousing
TEC
&CC
T
Point of
Distribution
TEC
&CC
T
S
I
D
A
N
O
R
A
D
C
L
I
N
T
O
N
HOSPITAL
U
N
I
T
A
I
D
C
I
D
A
H
A
V
A
R
D
CRS
H
A
V
A
R
D
P
E
P
F
A
R
MEDICAL
STORE
IMA
REGIONAL/DISTRIC
T
VACCINE STORE
ZONAL BLOOD
SAFETY CENTRE
GLOBAL
FUND
C
R
S
C
L
I
N
T
O
N
S
C
M
S
A
X
I
O
S
E
G
P
A
F
MEDICAL STORE
ZONAL MEDICAL STORE
DISTRICT STORE
P
F
I
Z
E
R
MOH
&
SW
GOVERNMENT
A
X
I
O
S
AXIOS
U
N
I
C
E
F
J
I
C
A
J
I
C
A
C
D
C
C
D
C
C
O
L
U
M
B
I
A
C
O
L
U
M
B
I
A
HEALTH FACILITY COLUMBIA
HEALTH FACILITY
HEALTH FACILITY
PATIENT
A
B
B
O
T
T
A
B
B
O
T
T
G
A
V
I
G
A
V
I
HOSPITAL
C
U
A
M
M
C
U
A
M
M
U
N
I
C
E
F
CROWN
AGENTS
U
S
A
I
D
W
B
U
S
A
I
D
CUAMM
HOSPITAL
PRIMARY HEALTH CARE FACILITY
HOSPITAL
T
M
A
P
Funding by Supply Type
(2006-2007 Data)
$ ‘000
65,869
56,853
54,201
4,70
0
3,722
37,027
17,300
3,905
17,734
53,859
315,170
%
20.9%
18.0%
17.2%
1.5%
1.2%
11.7%
5.5%
1.2%
5.6%
17.1%
100%
ESSENTIAL
MEDICINES
ARVs
MALARIA
TB
OI
VACCINES
CONDOMS
CONTRACEPTIVES
MEDICAL
SUPPLIES
ARVs
Ped
REAGENT
Blood safety
(+ HIV test)
GOVERNMENT
BILATERAL
DONOR
MULTILATERAL
DONOR
NGO/PRIVATE
Source
Of Funds
C
S
S
C
O
M
S
S
I
D
A
N
O
R
A
D
C
I
D
A
U
N
I
T
A
I
D
H
A
V
A
R
D
P
E
P
F
A
R
GLOBAL
FUND
CL
I
N
T
O
N
A
X
I
O
S
P
F
I
Z
E
R
GOVERNMENT
J
I
C
A
C
D
C
C
O
L
U
M
B
I
A
A
B
B
O
T
T
G
A
V
I
C
U
A
M
M
U
N
I
C
E
F
U
S
A
I
D
W
B
Results: Financial resources
Government funding (53%)
- USD 166.6 Million
Followed by Global Fund (32%) - USD 100.6 Million
Development partners contributed (15%) - USD 46.2
Million
(Actual value of the directly donated goods was not wholly captured; the percentage contribution by
partners would have been significantly higher if the actual value of all donated goods are captured.)
Source of Funds: In Kind
Donations

About 60% Bilateral donors USAID, PEPFAR, CDC, CHAI,
UNITAID, JICA prefer direct in-kind donation.




Donate direct goods through their own or select
procuring agents such SCMS, DELIVER, JSI and Crown
Agents
or through implementing partners such as CRS, IMA,
Columbia University, Harvard University, EGPAF, FHI
GAVI and UNICEF give in kind. This is equivalent to 25% of
total multilateral giving.
90% NGO and Private donors CUAMM, CSSC, Pfizer give
only in kind.
Partner Alignment:
The Global Fund example

GF is inline with GOT system

GF gives fund to the GOT (Paymaster General)

Disbursed to beneficiary programsNACP/NMCP

Deposited to MSD (NACP/NMCP)

MSD then procure, store, and Distribute

MSD charge 8% for operating costs (the rest 6%
covered by MOHSW)
In-Depth Assessment
Objectives:
•
•
To identify strengths and weaknesses at each level of the medicines
supply management cycle and analyse the financial flows of the existing
procurement and distribution system
To use the results as evidence for the development of a coordinated,
coherent and efficient national medicines supply strategy
Results-Structure of supply
system
Results
1 Central Medical Stores
(MSD) semi-autonomous
Key Issues
•
8 Zonal stores distributed
throughout the country
•
Advantages of semi-autonomy
of MSD and decentralized
management structure to
zones is a positive thing.
However not all key areas are
decentralized
Results-Quantification
Results
Key Issues
Activities at health facilities
•
Percentage Activity
Dispensing to out
patients
Dispensing to in patients
5%
3%3%
Warehousing
29%
10%
Ordering
Supplies of health
services and medicines
13%
Quantification
16%
21%
Distribution
Compounding and
preparation of I.V fluids
Why only 5% of facilities
doing quantification?
Results-Storage /Stock Management
Results
Key Issues
Expiry at CMS
•
•
Amount of medicines and supplies that expired in 2006
was 3.7% of sales for the year
• Is there room for
improvement?
The expiry of products at health facilities
Factors influencing expiy of stock
37
22
REL FREQ. (%)
15
11
Error in
Non
forecasting Compliance
to the STG
by
prescribers
7.4
3.7
Modification Unqualified Supplies Short expiry
of STG in
staff
excess of products
the course
order placed received
of the
Financial
year
Human Resources
Results
Key Issues
Tanzania Statistical data for
Pharmaceutical Human resource
Category
Registered
Pharmacists
Pharmacy
Technicians
•
Numbers
630
400
Pharmacy Assistants
330
TOTAL
1360
Ratio to population: 1 : 105,000
How do we
improve this
ratio?
Stakeholders consultations


On 4th - 5th May 2008 reports of the two studies
were discussed by various stakeholders in the
pharmaceutical sector
The CMO (DG-Medical Services) who was the
guest of honour recommended that issues
identified should be included in the Health Sector
Strategic Plan 3 (July 2009 – June 2015) so as to
use evidence-based planning in strengthening
medicine supply systems
•
•

Issues in HSSP 3
Donors be encouraged to comply with the
Tanzanian procurement system
Standard Operating Procedures be developed
for Development Partners and other
stakeholders for procurement of medicines and
supplies to be utilised in the Tanzanian health
system
More Pharmaceutical personnel be trained,
recruited and retained
•
•

Issues in HSSP 3
MSD to decentralize key functions to zone office
to respond quicker to client needs.
Health facility and district level strengthened in
forecasting, procurement, stocking and rational
prescription of medicines
MSD warehousing, communication and
distribution capacities at zonal level be
strengthened
Other opportunities

National medicine policy implementation plan
could be another way of implementing
remaining recommendations
THANK YOU