usaid global health supply chain program procurement … · •summary/conclusions 2. usaid global...

USAID GLOBAL HEALTH SUPPLY CHAIN PROGRAM

Procurement and Supply Management

Modern contraceptive use in South Africa – a focus on the private sector

Peter Stephens and Elna Steyn, IQVIA

USAID GLOBAL HEALTH SUPPLY CHAIN PROGRAM-Procurement and Supply Management

Agenda

• Introduction

• Comparisons between Public and Private Sectors

oMethod mix

oPrices

• Contraceptive security

oChanges to supply associated with the end of the public sector tender for

injectables and oral contraceptives in September 2017

• Summary/Conclusions

2


Abbreviations used

• CYP – Couple Years of Protection

• Methods

oEC – Emergency Contraception

o IUD – Intra-Uterine Device

o IUS – Intra-Uterine System

oOC – Combined Oral Contraceptive

oPOP – Progestogen only Oral Contraceptive

oPatch – Transdermal Patch

oRing –Vaginal Ring


Many ways that modern contraceptives can reach user

Final Point of Dispensing

Courier Pharm Wholesalers/DepotDistributors

• Family planning supply chain is complex within both the tender/government system or the private sector with many pathways users can access the product/method of choice

• Final point of dispensing can include:

o Chain pharmacies,

o Community pharmacies,

o Supermarket pharmacies,

o Hospitals or clinics and

o Dispensing doctors

4


Wide range of granular data assets used

• Estimated~95% coverage of private market with data captured at wholesaler to final level before it reaches the patient

(e.g. pharmacy, hospital or dispensing doctor)

• Single Exit Price (SEP) used

Wholesaler Data – used to provide insight into market trends

• Data represents products dispensed (Rx or OTC) by pharmacies, some dispensing doctors and private clinics

• Captured from dispensing software systems, representing ~ 85% of the private market in South Africa

Dispensed data – used to describe users by age

• Public sector data is only available for both depot and direct wholesale supply in 4 provinces in South Africa

• Pricing is a mixture of tender prices plus wholesaler purchases

o May omit direct sales from manufacturers

Public Sector Data – used to compare with private sector sales

5


• Statistical analysis was carried out using the “R” package

for Changepoint Analysis implemented for a change in

mean values, using a significance level of p<0.05. Analysis

was directed to identify multiple changepoints, should they

exist

• The Changepoint algorithm used to detect a significant

change in mean value was the Pruned Exact Linear Time

(PELT) algorithm.

Statistical analysis

Actual CYP values

Mean values for each changepoint period

Example Changepoint output, showing actual values (grey dotted line), mean values for segmented periods (red line),

1

2

2 Changepoint identified


Public versus Private sector


Public sector dominates modern contraceptive supply, except for EC

Note: Comparison carried out in the 4 provinces only that IQVIA collects public sector data

Note: Condom sales not known for public sector, and only partial coverage of private sector

In comparison to many countries, South Africa has a relatively low usage of implants

Due to impact of the DoH Circular 2014 warning of interactions with drugs like ARVs and rifampicin


Private sector delivers wider method mix, with OC taking majority share of CYP, and EC more prominent

9

EC 12%

Implant

1%

Injection - 2

monthly

5%

Injection -

3 monthly

22%IUD

5%

IUS

12%

OC

36%

Patch

6%POP

1% Ring

0%

Share of CYP, Private Sector, 2018

EC0%

Implant7%

Injection - 2

monthly10%

Injection - 3

monthly60%

IUD11%

IUS0%

OC12%

Share of CYP, Public Sector, 2018

OC more popular in private sector facilities located in more urban areas

Private sector growth in CYP +27% 2013-2018

Note: Public sector shares calculated from 4 provinces, private sector national data

Note: Condom sales not known for public sector, and only partial coverage of private sector


Younger age group dominates EC demand in the private sector

10


Prices paid by public sector lower than Single Exit PriceInjectables and OCs prices in public sector increase following end of public sector contract

Note: Public sector prices calculated from 4 provinces, private sector national data


Impact of end of public sector contract in September

2017 on contraceptive security

• Contract for Injectables and Oral contraceptives ends September 2017

• 3 monthly injectable contract

o No company bids for 3 monthly injectable contract

o Fresenius persuaded to continue supply to April 2018

o Post this period ad hoc arrangements with Pfizer for direct orders

• 2 monthly injectable contract

o No agreement reached with Bayer until May 2018 for supply of 2-monthly

injectable

• OC contract

o Shortages reported for OCs in short-term as Mylan reported to struggle to

meet demand

Source: Media reports, Stop Stockouts Project, Department of Health tender


End of public sector contract coincides with significant drop in both public and private sector of 2 monthly injectable

Public sector, 2 monthly injectable Private Sector, 2 monthly injectable

Note: Public sector volumes derived from 4 provinces, private sector volumes national data


No significant negative impact of contract end on 3 monthly injectables in public sector, but private sector sees significant increase

14

Public sector, 3 monthly injectable Private Sector, 3 monthly injectable



End of contract (and disruptions to supply of injectables) led to increase in OC volumes in public and private sectors

15

Public sector, OC Private Sector, OC

• Most reports of public sector stock outs come from provinces where IQVIA does not collect public sector data



EC volumes show significant increases over time, but private sector increase coincides with end of public sector contract

16

Public sector, EC Private Sector, EC



Concentration of market may explain significant impacts of public sector supply challenges

17

1

18

4

1

1

2

1

1

8

1

1

1

0 2 4 6 8 10 12 14 16 18 20

Condom (female)

Condom (male)

EC

Implant

Injection - 2 monthly

Injection - 3 monthly

IUD

IUS

OC

Patch

POP

Ring

No. of manufacturers, 2018Very similar

manufacturers in

public and private

sector

Even private sector

OC market is

relatively

concentrated with two

manufacturers (Aspen

& Bayer) taking 86% of

volume


Conclusions

• Contraceptive security is largely dependent on injectables

o ~70% of CYP linked to injectables

• End of public sector tender linked to interruptions in supplies of injectables and oral contraceptives

o Limited number of manufacturers prepared to bid

• Analysis suggests that:

o Some users switched methods in public sector;

o Some users procured more modern methods from private sector, including EC;

o 3 monthly injectable volumes increased in 4 provinces where IQVIA collects private sector data, despite

market withdrawal of one manufacturer

• Possible solutions (for discussion)

o Wider method mix – resources also needed for training and to ensure availability at facility level

o Multiple factories to be registered where manufacturing supply is concentrated

o Alternative injectable suppliers could be investigated e.g. Manufacturers of those other injectables on

WHO EML, or manufacturers of the same molecule/formulations used in other parts of the world

usaid global health supply chain program procurement … · •summary/conclusions 2. usaid global...

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