UNICEF SUPPLY DIVISION MEDICAL TECHNICAL TEAM “ HIV/AIDS: Where Are The Diagnostics ? “. Ludo Scheerlinck. MSc, MBA, MPH. Planning & procurement of diagnostics in support of HIV/AIDS programmes. Rationale Planning Procurement Yemen/MoH/NAP & GFATM financed HIV/AIDS project. Rationale.
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MSc, MBA, MPH
(i) Allocation should be carefully done based on geography and prevalence/incidence.
(ii) Allocation to appropriate service providers:
- CD4 from district level providers up.
- VL only central level: ! consequences for children.
(iii) Caution with perception “automatic”. Staff skills incl. device, procedures and technical aspects !
(iv) Draft generic specification include: test parameters, throughput, type and number of test per year.
(v) Physical environment:
- Dedicated lab rooms with specific requirements
(sample contamination, safety, waste process, etc).
- Supporting devices present & functioning.
(viii) Investment and recurrent cost indication, USD:
- Rapid/Simple test: 0.5 to ± 1.5
- ELISA device: 12.000
reagents: ±1.0 per test
- CD4 device: 25.000 reagents: ± 7.0 per test
- VL device: 55.000 reagents: ± 30 per test
P.S. To be added: – reruns – shelf life opened reagents – supporting devices – staff cost – admin and logistics of samples and test results.
Only when at least the above is identified, agreed, described and budgeted:
“I have properly planned sustainable diagnostics support”.
Procurement exercise without (too many) surprises can start.
Plenty info available about Dx from numerous of sources.
No standard for “assessing needs” and subsequent “planning”.
Approach case-by-case according country, goals and objectives, stakeholders involved, available budget and so on.
Rapid/Simple Test: WHO specified & prequalified and tendered. List available online SD website.
Analyzers: WHO prices and sources guidelines. If not standardized, public tendered. Generic specs submitted or developed in-house.
We “refuse” to just procure & ship-out any BoQ submitted, when reveals inconsistencies vis-à-vis: needs addressed, completeness, or project goals and objectives.
Able to add: (i) start-up reagents, (ii) training needs (user, technical, GLP), (iii) specificationssupporting devices, (iv) maintenance contract.
With “post-planning” efforts increase risk of deviating from actual needs to be covered on site.
To assist, to a certain extend, with planning and procurement SD develops a short planning brief, informing about:
- Dx services to be provide at different levels.
- Allocation of technology.
- Supporting devices.
- Sources to procure from.
- Generic specifications (ELISA, CD4 and VL)
Request for CE prior to procurement equipment & supplies for (i) blood bank, and (ii) Tx initiation and monitoring.
Different lists were inconsistent, poorly specified and budget indication way of the mark. Grant Agreement, Project Proposal or PSM from GFATM website provided necessary info neither.
Three months of communication, no progress.
UNICEF/CO/Yemen invited technical support from SD “to clarify the matter”.
A “new” final equipment list; items, specifications and their respective quantity.
For budgeting and feasibility appraisal purposes (only) lump sum prices were produced (budget review USD 511.000 to 870.000).
A time line/activities for issuance of cost estimate and subsequent procurement.
Context information about a project is essential.
Capacity for basic planning (BoQ & Specs) of commodities in a project context limited with UNICEF/CO, MoH and Global Fund.
Advanced planning issues s.a. (i) recurrent cost (= sustainability), (ii) training & installation, (iii) physical environment, (iv) in-country logistics (v) waste management unheard of.
Technical expertise should have been involved much earlier. Time waste trying to solve complex issues remotely. Project accumulated 5 months delay, seriously jeopardising Year 1 objectives (ARVs also delayed).
Quality planning of diagnostics is vital for smooth PSM, but also for a successful sustainable project &program.
FOR YOUR ATTENTION !