UNICEF- Update on key activities and plansIPC, 5th-6th June. 2014

Procurement in support of programmes- 2013

Supplies and services for 134 countries and areas

Total procured$2,839

Emergency$127Supplies to 33 countries and areas

Procurement Services$1,363Supplies to 99 countries

Supplier and destination countries

Medicines: 2014 Activities• Procurement strategies to address increasing demand for priority

medicines: ORS/Zinc, amoxicillin DT, gentamicin, CHX, dexamethasone inj, IFA…

• Support work of UNCLSC and Pneumonia and Diarrhoea WG: Amoxi DT ERP, availability of medicines and diagnostics, collaboration to increase sources, country implementation including activities resulting from GF/UNICEF MoU.

• Optimization of kits: iCCM (DRC), Diarrhoea kit, PEP Kit

• Partnerships to ensure availability of pediatric ARVs:IATT Formulary developmentPediatric ARV WGPediatric ARV Procurement Working Group

• Controlled temperature shipments

• Improve internal process and supplier relations to provide optimal service

The market dashboardInspired from UNITAID Market dynamics Dashboard

The Dashboard monitors the market dynamics of more than 50 essential commodities for women and children. It provides a qualitative assessment of the determinants of a healthymarket, including:• Availability• Affordability• Competition• Quality• Acceptability• Delivery• Funding security

http://www.unicef.org/supply/index_70578.html

Published twice a year, aim is to encourage internal and collaborative thinking on ways to address gaps and achieve a more balanced market

2011 2012 20130

2

4

6

8

10

12

250mg DT

Oral Suspension

Trea

tmen

ts o

f 2,5

00 m

g (m

illio

ns)

ORS/Zinc co-pack: 3 LTAs established, first procurement of over 200K packs

Chlohexidine 4% for umbilical cord care: collaboration through UNCLSC to increase number of manufacturers and qualify gel formulations.

Amoxicillin DT: increase in demand and initiation of substitution of suspension

Introduction of optimal products

Kit delivery

2007 2008 2009 2010 2011 2012 2013$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

In PGI value

Ind. Item Stand. Kit CO kit

Majority are health kits

Supply of commodities to manage sexual assault of children and women in the context of emergencies

Challenges• Forecasting the need • Kit design not addressing diversity of situations where it is used (target, skills and care

services)• Repacking of kits at Country Office level to meet needs

• Split up kit contents to distribute to smaller health facilities• Split up blisters/packs to dispense to patients

• Specific needs of children usually not taken care of, e.g. paediatric dosages• Lack of specific Guidance

PEP Children

PEP AdultsWound Care Psychosocial

SupportAssociated Conditions

+ Guidance Documents

Proposed Response (for discussion with partners)

• Easy identification of the necessary items for management of sexual assault• More flexibility in procurement of PEP for children • Holistic response, Clear guidance

Guidelines to be reviewed 2014 (WHO)

Consolidate regimens used

Consolidate formulations

used

• Ensure pediatric ART guidelines are up to date

• Identify regimens and products that can be phased out of formulary (eg. d4T, ddI)

• Review current procurement list for redundancies

• Explore areas for transition to optimal products such as FDC’s and phase out suboptimal or redundant formulations

Partnerships to ensure availability of optimal treatment for HIV in children

Consolidate formulations

used

• Coordinate pediatric ARV procurement amongst partners

• Align both supply and demand to more efficient products.

Interagency Task Team (IATT)/ Pediatric ARV Working Group

Pediatric ARV Procurement Working Group/ Buyer Consortium

Health Technology Centre Essential supplies for Health Programmes

Medical equipment and consumables, diagnostics tests and clinical laboratory equipment

Long Lasting Insecticide treated bed nets ( LLIN’s), Insecticides and Rapid Tests

Malaria Prevention and Diagnostics

Medical Devices and Laboratory

Cold ChainCold chain equipment, refrigerators, waste disposal, injection safety devices

Maternal and New born Health IssuesINNOVATION

FOCUS

Injection safety devices, waste disposal.Immunisation Devices

Health Technology: 2014 Activities

• Optimization strategies defined for Health Technologies Supply Chains,.i.e. Performance indicators, Forecasting, Shipments optimization and Total Landed Cost options

• Quality policies prepared, harmonization with key partners (IVD, High Risk Medical Devices, mapping high-risk products that could be those correspond to class IIB and III of European MDD and develop its risk mitigation protocol).

• Innovation – ARIDA project ( pneumonia diagnostics ), in collaboration with WHO, Malaria Consortium, BMGF

• Partnerships LLIN procurement – GF, UNDP, DfiD, PMI,• Partnerships POC technology – UNITAID, CHAI, 7 countries

• Ensure a cold chain for all TTSPP …. • Scale up of old vaccines …….• Scale up of new vaccines ……• Scale up of new versions such as IPV ….• Healthy market for innovative cold chain equipment• Supply Chain integration – Oxytocin, Insulin• Cold chains for lab samples, blood banks, test kits …

• Immunization devices available for all• Optimizing immunization shipments/cost per device delivered • Untangling the web of quality requirements • Waste management for immunization, diagnostic testing ?• Aligning with WHO PQS for injection safety devices procurement and

providing feedback on evaluation protocols and technical specifications• Contribute to the updating of WHO guideline of injection safety.

2014 Activities

UNICEF-CHAI Project: Accelerate Access to Innovative Point of Care (PoC) HIV Diagnostics: CD4, Early Infant Diagnosis, and Viral Load

Funded by UNITAID

Targets: 7 focus countries Zimbabwe, Tanzania, Kenya, Ethiopia, Uganda, Mozambique, Malawi

Programmatic and Supply coverage:• CD4 testing, which is used for staging and monitoring HIV patients prior to initiation onto antiretroviral

therapy (ART).• Early Infant Diagnosis (EID) testing for infants less than 18 months of age (this technology can be performed

on viral load platforms as well).• Viral Load (VL) testing, which is mainly used for monitoring HIV patients following initiation to ART

UNICEF Quality Policy for procurement of IVDs consulted with WHO, CDC, MSF and fully harmonized with Global Fund.

Phase 1 Nov 2012-December June 2014 US$ 20million

Phase 2a Project proposal approved and MOU currently under negotiations Period July 2014 –Dec 2015 US$ 35million

Phase2b Project ending 2018 funding remains subject to UNITAID board approval

Source: UNIICEF Supply Division

Immunization SuppliesVaccinesBCG , DTP, TT/Td/DT, Measles containing, OPV, HepB, YF, DTP-HepB, DTP-HepB/Hib, DTP/Hib, Hib, MR, Meningitis, MMR, PCV, RV IPV, HPV etc.

Safe Injection equipment

Cold Chain Equipment

Vaccines Supplies: US$ 1, 285 million 2.79 billion doses

2,185 shipments

2013

Countries UNICEF procures on behalf of

Full schedule

Partial schedule

UNICEF has a key role in vaccine procurement, procuring immunization supplies on behalf of around 100 countries annually

Source UNICEF Supply Division

Vaccines: 2014 Activities*

Support to countries / on-going operations: Coordination internally and support to countries for high number of new vaccine introductions (79 new vaccine introductions (13 IPV) in GAVI supported countries in 2014; 123 (59 IPV) in 2015) , and continuing programmes; specific innovative projects follow up: VAR, Visual Vaccines; KPIs

Continued/increased support to MICs and GAVI graduating countries through procurement practitioners forum to support countries moving to self-procurement, review VII and other financing mechanisms, engagement with partners and countries, MIC tender for new vaccines

Polio eradication – IPV tender concluded in Q1 2014 and operationalized during the year; OPV supply and demand planning for vaccines and funding; strategy for type 2 withdrawal

Timely completion of tender activities and additional awards (JE, Mening, penta, HPV, PCV, Rota); develop consolidated strategy for achieving price goals

Provide more useful and accessible information for countries, manufacturers and partners (eg, update website, pricing data, procurement contexts, market updates)

Continue to strengthen supplier relationships, including at least 1 visit to each of the top 10 suppliers and visit to China

Follow-up with DRC and Nigeria on supply chain optimization projects Coordination with partners, including GAVI, BMGF, WHO, GPEI, etc

*Key activities, not all inclusive

Virus detection & interruption

Last wild polio case Certification

RI strengthening & OPV withdrawal

Containment & certification

Introduce IPV

Wild virus interruption

Outbreak response (esp. cVDPVs)

RI strengthening &OPV2 pre-requisites

OPV2withdrawal

Legacy Planning

Finalize long-term containment plans

Complete containment & certification globally

Consultation & strategic plan

Initiate implementation of legacy plan

Last OPV2 useEndgame

Major Objectives 2013 2014 2015 2016 2017 2018

Source: WHO

WHA endorsement in 2013 of Endgame Strategy require IPV introductions in 123 countries globally within 20 months

Sufficient supply secured to meet projected demand through UNICEF at affordable prices, but planning needed

• 20 countries requiring supply in 2014, with 7 planned introductions• A total of 75 countries to introduce in this period, and two continuing

countries• 20 LMIC/MIC countries to continue or introduce sourcing through UNICEF• Flexibility required with regards to product preferences, number of shipments

per year, delivery of buffer stocks, month of introduction, registration requirements

UNICEF support to the tOPV/bOPV switch

• Global synchronized switch from tOPV to bOPV requires careful planning at global and country level

• Engagement with partners, countries, and industry to ensure smooth transition and no shortages of any product

• Protocols and strategies under development for operationalization of a switch

Vaccines stock monitoring and projection tool…

ViVa (Visibility for Vaccines)

…Enabling identification and communication of upcoming potential constraints linked to supply through graphs.

From May to August 2014:Pilot phase with EPI in DRC, Niger and Senegal.Next:Feedback interest survey and decision on continuity and scaling-up.

Supporting Middle Income Countries to Access New Vaccines

For additional information on UNICEF’s MIC New Vaccine Procurement Initiative see http://www.unicef.org/supply/index_67101.html

• UNICEF Vaccine Procurement Practitioners Forum (Q4 2014)

• EURO Inter-country Vaccine Procurement Workshop 2013

• Transition planning for GAVI graduating countries

• Vaccine Procurement System Assessments

•Coordination of MIC support with global/regional partner activities:

• Global MIC Task Force• Vaccine Product, Price and

Procurement (V3P) Project• EMRO Pooled Vaccine

Procurement (PVP) initiative• GAVI support for access to

appropriate pricing for graduates & other LMICs

•Sharing of knowledge of (i) the vaccine market, (ii) Vaccine Security and underlying elements of forecasting, funding and appropriate contracting, (iii) vaccine procurement.

• Issue market analyses.• Publish Reference Prices to

serve as a benchmark for self-procuring MICs.

• Aggregate MIC demand forecasts for new vaccines to provide better visibility to industry.

• Pool MICs’ vaccine procurement to improve demand predictability, reduce transaction costs and improve pricing.

MIC Pooled Procurement

Information Access

Capacity BuildingTechnical

Assistance

Strategic Partnerships

Some countries where we are already working with the govt to strengthen the supply chain and develop capacity

DRCImmunization and

Essential Medicines

NigeriaImmunization

Sierra LeoneAll Health Commodities

KenyaEssential medicines

ZambiaEssential Medicines

AfghanistanImmunization

MadagascarEssential Medicines

MyanmarAll Health Commodities

EritreaEducation

EthiopiaEssential Medicines

NigerEssential Medicines and

Nutrition

TanzaniaEssential Medicines

Cote d’IvoireBednets

MalawiAll Health Commodities

MozambiqueAll Health Commodities

2014 Activities

Support to development and implementation of national supply chain strategies

Global networking and collaboration (GAVI, Global Fund, RBM etc.) Communication strategy and advocacy tools to raise awareness

internally and externally Research to increase understanding of national supply chain models

and promising practices Guidelines for capacity development with a supply chain toolkit for

COs and partners (including a SC health check and performance monitoring tools)

Roster of consultants for technical assistance Support development of the supply community technical skills

framework and professional development plan Develop the Global Learning Centre Strategy including the initial

curriculum (starting with vaccines, bednets and nutrition) South to south exchanges

What does success look like in 2017? Increased use of national supply chains, from determination of need through to

delivery to the last mile, across all programmes and including monitoring

Increased number of countries actively implementing national supply chain strategies, led by government

Strong networks created with increased collaboration, sharing and co-ordination in capacity development and supply chain systems strengthening initiatives at global, regional and country level

At least 20 government supply chains strengthened and optimized for targeted products