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BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT

BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT. PRESENTED BY MR S MAPIKI CENTRAL MEDICAL STORES BOTSWANA-2006. BACKGROUND. Pop. 1,7Million 2002, 110,000 people eligible for Treatment Botswana =1 st African Country to offer free ARV’S 2002

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BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT

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  1. BOTSWANA ARV PROCUREMENT AND SUPPLY CHAIN MANAGEMENT PRESENTED BY MR S MAPIKI CENTRAL MEDICAL STORES BOTSWANA-2006

  2. BACKGROUND • Pop. 1,7Million • 2002, 110,000 people eligible for Treatment • Botswana =1st African Country to offer free ARV’S 2002 • Govt. paid over 2/3 and got support from Bill and Mellinda Gates and Pharmaceutical Suppliers • Treatment straining limited resources, devt funds diverted to health =25% Nat Budget

  3. PSM System had to improve to integrate ARV’s i.e Forecasting, quantification, Receiving, Storage, Distribution, Monitoring • Forecasting and Quantification • Modern PSM Tools e.g formulas based on Historical method and Morbidity/Mortality data. Data from sites also used to forecast

  4. PROCUREMENT METHODS • Procurement of ARV’S i.e budgeting, tendering, ordering all integrated into one CMS System • ARV’S procured from patent holders thru negotiation for Acces prices and by Direct Contract-Single Sourcing Method • Palliatives,Other treatments, detection and prevention supplies thru International Competitive Bidding • Prequalification in progress, Voluntary Licence given for CBV to Aspen by GSK

  5. STORAGE, INVENTORY MANAGEMENT • The ARV Quality Assurance(Testing, inspection,verification from Rcpts-Distr. Integrated with that for other medical supplies • Storage Locations in the Warehouse thru a Computerized Warehouse Management System-allocates all receipts randomly. • ARV’S stored under tighter security

  6. DISTRIBUTION • A national distribution schedule integrates distribution of ARV’S and other Medical Supplies • All Transportation is coordinated from the CMS point • Distribution based on orders from sites • Sites order based on working stock and 3 month buffer stock x no. of patients • Frequency of consignments distribution to sites depend on CMS stock on hand

  7. PUBLIC PRIVATE PARTNERSHIP • A Disease State Management Company engaged to provide Clinical assessment, management, Counselling, ARV Distribution and dispensing • PPP meant to assist Govt. in the rollout and to reach segments of the population not yet served

  8. MONITORING AND EVALUATION • Monthly Site report forms improved based on PSM tools used for monthly monitoring • Monitoring tracks the effects of procurement and whether the programme goals on track

  9. Monitoring Cont,d • Monthly Physical stocktake mandatory • Monthly reports from sites mandatory covering: • Name of drug • Last reported stock • Receipts since last report • Stock on Hand • # of pts on drug since last report • # of pts on drug currently • # of pts started on drug since last report • Projected drug demand for next month

  10. PROGRESS SO FAR • 2002 • 110,000 HIV+ Needed treatment • 4 SITES • 7,000 PATIENTS initiated on treatment • P50Million (USD 10M) used • 2004/05 • 32 Sites • 37,500 patients on Tx by April 05 we estimate 59,000(52,000 Govt. and 7,300 Pvt.) by Dec 05 ( Ref :55,000 required per 3x5 by Dec05) • Monthly enrolment rate of 1000-2,000 patients • P200 Million(USD 45M) spent during 2004/05

  11. PROGRESS

  12. DRUG DISTRIBUTION • Sites quantify and order from CMS • CMS issues and distributes to facilities using CMS transport • ARV’S transported separately from other drugs • Accountability from dispatch to receiving stringent

  13. SECURITY-CMS • Drugs delivered under security escort • Drugs immediately locked up upon receipt • Separate storeroom for ARV’S • Storeroom security guarded for 24 hours • Computer Software Record Keeping backed up by manual Bincards • Monthly Physical stocktake • Accompanying documents signed by CMS Security and sites upon Dispatch

  14. SECURITY-SITES • All receipts/Issues entered into a record book/computer software • ARV stock kept under secure storage with burglar Bars and Alarm • Reserve Therapy drugs ordered by special order on named patient basis • Patients received monthly supplies /collected monthly refills

  15. CHALLENGES • Private Sector –Inadequate adherence to guidelines • RESISTANCE-beginning to present • SECURITY-Pilferages • Affordability and sustainability • Late presentation for Tx • TB/HIV co-infection complicating matters • Scale up to districts= capacity constraints • Worldwide shortage of Efavirenz,Combivir,Stavudine • Patent Rights-TRIPS

  16. SCALE UP STRATEGIES • Avail ARV’S at District Clinics • To use district resources(District Pharm. Techs, Nurses and Primary Trainers) • Public Private Partnership(PPP) • A disease State Management Company to be contracted • Will engage Private Physicians for consultation • Will engage Retail Pharmacists to dispense and reach more people • Will obtain drugs from CMS

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