A Call to Action

Children – The missing face of AIDS

Procurement and Supply Management:

Supporting national capacities Steve Jarrett

Deputy Director Supply Division UNICEF

UNICEF has supplied ARVs and test kits to 44 countries so far in the last 2 years, reaching a cumulative total of over $60 million 61 ARV formulations 27 types of test kits

70% of ARVs are destined to East and Southern Africa and 22% to West and Central Africa (2005)

ARV Stockpile

4 Countries = 75% C ôte d’Ivoire Ethiopia Malawi Zambia

Supply Division, with UNICEF Country Office support, researches IP and registration status in each country where it supplies ARVs, taking into account WTO/TRIPS safeguards

NATIONAL PATENT OFFICES

Information on developing country pharmaceutical patents in the public domain

SUPPLIERS ACADEMIA, NGOs eg MSF, UN AGENCIES No single 100% reliable source exists, even at supplier or national level.

Procurement and supply management of ARVs has to be seen in the context of the inter-related steps of the complete supply chain cycle Demand Creation Monitoring Product Selection Effective Use Forecasting Receipt, Storage, Distribution Product Procurement Supplier Agreements Financing Quality Assurance

The supply chain comprises three distinct phases: product planning, product acquisition and product delivery Delivery Monitoring Demand Creation Planning Product Selection Effective Use Forecasting Receipt, Storage, Distribution Product Procurement Acquisition Supplier Agreements Financing Quality Assurance

UNICEF combines its field office capacities with HQ Supply Division to cover the full supply chain cycle Delivery Monitoring Demand Creation Planning Product Selection Effective Use Forecasting Field Office Receipt, Storage, Distribution Product Procurement Acquisition Supplier Agreements Financing Quality Assurance HQ SD

UNICEF so far has supported countries in strengthening planning and delivery systems in support of increased ARV access where it provides ARVs Delivery Demand Creation Planning Monitoring Product Selection Effective Use Forecasting Receipt, Storage, Distribution Financing

UNICEF has recently been designated by UNAIDS/GTT as Lead Agency in procurement and supply management Main roles of the Lead Agency:

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Single entry point for UN Technical Support (broker)

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Co-ordination and facilitation of technical assistance

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Establish global and regional support mechanisms

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Liaison between providers of technical support, UN Theme Groups and global support mechanisms

A set of preliminary interventions have been identified and a tentative budget determined for 2006-7 Intervention Strengthening procurement + supply management planning and implementation Strengthening warehousing management + distribution systems Enhancing national medicines management information systems Increasing regional support capacities

Global level joint problem solving and implementation team (GIST) has been established especially related to implementation of Global Fund grants

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Formed by UNAIDS, WHO, UNICEF, UNDP, UNFPA, World Bank and Global Fund, with links to bi-lateral agencies

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Facilitates rapid country driven process for identification of technical support needs with one of UN agencies as country lead

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10 countries (Comores, Guinea Bissau, Mozambique, Niger, Nigeria and Senegal in Africa)

Key elements to consider in starting capacity building Continuous monitoring of demand Comprehensive supply plans Delivery arrangements Stockpiling

UNICEF/HQ00-0354/ALEJANDRO BALAGUER

Over 2.1 million children under 15 are estimated to be living with HIV/AIDS, with 700,000 in need of ARV treatment

UNICEF/HQ98-0910/GIACOMI PIROZZI

■ Paediatric ARV dosing schedules are not available for some drugs ■ Most available paediatric ARV formulations require children to take frequent doses of unpalatable syrups ■ Many need cold chain storage, have limited shelf life and stability ■ No FDCs specifically available for paediatric use

Both originator and generic ARV manufacturers have given positive signals for developing appropriate paediatric formulations

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UNICEF met with 15 manufacturers 12 September to discuss the situation of paediatric formulations

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Various types of developments underway for both single products and FDCs

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Soluble tablets, granules, melts, scored tablets are some of the initiatives

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Target of having WHO pre-qualified products by mid-2006

MALAWI Number of patients on ARVs increased to 10,000 by Dec. 2004 in 24 sites. By end-2005, 40,000 patients to be on treatment in 59 health facilities Due to a better access to treatment, more people are willing to undertake HIV testing

UNICEF/HQ02-0519/AMI VITALE UNICEF/HQ02-0566/GIACOMI PIROZZI

Supply