Access to HIV/AIDS, Tuberculosis and Malaria Medicines.

WHO/UNICEF Technical Briefing Seminar on Essential Medicines Policies.

Geneva, 18 – 22 September 2006

Elisabetta Molari

Procurement, Supply Policy & Management Team Leader

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Presentation Outline:

1. Overview of The Global Fund Procurement and Supply Management (PSM) process

2. Status of Global Fund Grants and Access to Medicines (Health Products)

3. Global Fund contribution to improving Access and goals of procurement initiatives.

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The Global Fund’s approach to PSM

• Principles and minimum standards, not detailed procedures

• Build upon existing systems• Distinction between health and non-health

products• Expanded definition of Procurement: How

products arrive in a country and what happens to them subsequently

• PR responsible for all PSM activities (whether directly implemented or sub-contracted).

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PSM Plan Approval Process

Proposal recommended

for funding

Global Fund approval &

disbursement

GF & LFA assessment

process

PR submits PSM Plan to Global Fund

Revise Plan

Implementationof program in line with Grant

In case PR lacks capacity:

• To develop PSM Plan – may seek TA from Partners

• To conduct procurement – may use a Procurement Agent while building internal capacity.

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Key documents: Guide to The GF’s Policies on PSM

• Outlines all Global Fund’s PSM Policies– Procure quality assured

products at the lowest price– Adhere to National and

International Laws– Conduct procurement in a

transparent and competitive manner

• Based on Global Fund Board decisions

• Outlines what PR’s need to do.

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Key documents: (2)Writing the PSM Plan – Version 1, 2 and 3

• Guides PR’s in writing the PSM Plan

• Three Versions:– PRs/SRs that conduct

some or all the Procurement in-house

– PRs/SRs that completely outsource procurement to a Procurement Agent

– PRs that coordinate procurement conducted by SRs

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Status of Global Fund Grants

Financial Status Grants signed

US$

Money disbursed

US$

Mean time elapsed in grants

Mean funds disbursed

Disbursed/ time

Global Fund financing (US$), 15th May 2006

4 billion 2.26 billion 69% 64% 93%

Financing 333 grants in 127 countriesFinancing 333 grants in 127 countries

Approved Grants total – US$ 5.3 billion (Rounds 1-5)

77% of funds disbursed expended by the end user (at Phase 2)

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Distribution of funding after 5 Rounds

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Regional Distribution of GF Mid-Year Results, June 2006:

Results showing No. of People on ART, ITNs distributed and TB Treatment under DOTS

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Rapid scaling up of results: doubling every year

Intervention June 2006 Increase since June 2005

HIV: People on ARV treatment 544,000 2.5 times

TB: People treated under DOTS 1,430,000 2.4 times

Malaria: Insecticide-treated nets distributed 11,300,000 3.6 times

Source: http://theglobalfund.org/en/files/about/replenishment/progress_report_midyear_2006.pdf

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Improving Access:

• Rational Selection: PRs required to • Procure only medicines on National, Institutional or WHO Model

List of Essential Medicines and Treatment Guidelines• Indicate strategies in place to ensure appropriate use of

procured medicines

• Affordable Prices: PRs required to

• List medicines by Generic Names and to procure quality assured products at the lowest price

• Encouraged to apply TRIPS flexibilities in a manner consistent with National & International laws

• Conduct procurement in a transparent and competitive process• Use the Price Reporting Mechanism

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Improving Access: (2)

• Sustainable financing:• Increased funding made available (sustainability for impact?)• Coordination with other donors

• Reliable Health and Supply Systems:• Provide funds through Grants for strengthening health systems• Grants funding accessible by all sectors involved in the health

system: Public, Private and NGO organizations • Guidance on Quality Assurance for pharmaceuticals.

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Some challenges/bottlenecks across the supply

chain which slow Grant Implementation

Plan demand

Select and purchase product

Manage delivery

Distribute in country

Lack of or Inadequate information and planning systems.

Lack of supply.

Limited procurement capacity.

High product prices.

Delays in shipping and clearance.

Poor infrastructure and systems.

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Conclusion: Goals of the Global Fund procurement initiatives

• Significantly increase speed of grant implementation

• Reduce the burden on recipient countries by easing procurement bottlenecks in country

• Develop/review policy procedures and/or requirements for countries

• Coordination with Partners.

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Thank you.

References:

http://www.theglobalfund.org/http://www.theglobalfund.org/en/about/procurement/