Assessment and Monitoring ARV Drug Supply Chains

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Assessment and Monitoring ARV Drug Supply
Chains

• Skills Building Workshop
• XVI International AIDS Conference
• August 17, 2006

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Agenda

• 1415 1425 Introduction to Workshop
• Peter Graaff, World Health Organization (WHO)
• 1425 1445 Assessment and Monitoring Overview
• Richard Owens, Supply Chain Management System
  (SCMS)/John Snow Inc. (JSI)
• 1445 1455 Introduction to Case Study
• Gary Bettger, SCMS/Booz Allen Hamilton
• 1455 1545 Group Breakouts
• Facilitated by Claudia Allers, DELIVER/JSI
  Yasmin Chandani, DELIVER/JSI Helena Walkowiak,
  RPM Plus/Management Sciences for Health (MSH)
  and Henk den Besten, International Dispensary
  Association (IDA) Solutions
• 1545 1615 Break
• 1615 1715 Group Recaps and Discussion
• Gary Bettger, SCMS/Booz Allen Hamilton with
  audience volunteers
• 1715 1720 Presentation of Supply Chain
  Assessment and Monitoring Tools
• Richard Owens, SCMS/JSI
• 1720 1745 Closing Remarks and QA
• Peter Graaff, WHO

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The need for supply chain assessment and
monitoring

• Monitoring Key Challenges
• Key data not systematically collected
• Collected data not systematically used for
  decision making
• Operational
• Quality improvement (where to start)
• Reporting Key Challenges
• Different donorsdifferent requirements
• Reporting puts huge burden on programmes
• Requirements often do not have operational
  relevance
• Requirements often exceed the centrally defined
  requirements

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(No Transcript)
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Introduction to the Skills Building Workshop

• Problem Statements
• The uninterrupted supply of ARVs is a
  prerequisite and ongoing challenge for ART
  programs
• With the increasing number of people on
  treatment, supply chains need to expand
  operations to sustain quality services
• Assessment and monitoring are key
  activities for maintaining
  and
  improving supply chain performance

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Introduction to the Workshop, cont.

• Goal
• Provide participants with an approach for
  
• assessing and monitoring ARV drug supply
  
• chains and for using indicators to measure
  
• performance.
• Objectives
• Distinguish differences between assessment and
  monitoring
• Understand importance of both in an ART scaling
  up environment
• List key components of supply chains that should
  be assessed and monitored
• Apply a set of indicators that can be used for
  decision-making

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ART scale-up is a challenge for the supply chain
Huge progress has been made in strengthening
supply chains over the past 20 years, but this
level of scale-up will challenge even those
supply systems that are currently working well
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Why are supply chains important?

• The purpose of a supply chain is to ensure the
  Six Rights
• The right goods
• in the right quantities
• in the right condition
• delivered to the right place
• at the right time
• for the right cost.
• For ART, continuous availability of a wide range
  of diagnostic, treatment, and care products is a
  prerequisite for success of prevention and
  treatment interventions
• Supply chain excellence enables service providers
  to achieve health care excellence

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In-country supply chain cycle

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Additional challenges for ARV drug supply chains

• Ensuring continuous drug supply and product
  availability during scale-up
• Serious effects of stockouts
• Responding to changing patient needs over time
• High-value, lifesaving drugs
• Multiple adult and pediatric formulations
  (tablets, capsules, liquids)
• Availability of new formulations and new drugs

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Assessment versus monitoring
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How are assessment and monitoring results used?

• Inform policy decisions that affect product use
  and product selection
• Improve accuracy of forecasting and
  quantification
• Coordinate funding among governments and multiple
  donors
• Rationalize allocation of resources for
  procurement
• Increase efficiency of inventory management and
  distribution procedures
• Maintain product quality in-country
• In order to
• Ensure continuous product availability for
  patients at ART sites
• Avoid stockouts and wastage

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Case Study instructions

• Logistics
• The four corners of the room will be used as
  locations for this exercise
• You will be split into groups based on your
  position in the room
• Team 1
• Team 2
• Team 3
• Team 4
• Facilitators
• Each breakout location will have a facilitator to
  help with questions
• In addition, each team should select one or two
  spokespersons for report back
• Scribes
• Each team should select one or two scribes to
  help capture team discussion and provide the
  appropriate summary for report back

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Case Study
Assessment and Monitoring of the ARV Drug Supply
Chain
An international donor agency has committed US
1.0m for procurement of ARVs to help fill the
funding gap to support expansion of the countrys
national ART program. The governments goal is to
have 50,000 people on treatment by the end of
2007. The donor has requested information on
current ARV drug consumption and stock levels in
the country. In a recent meeting of the
procurement sub-committee to determine the
quantities of ARVs needed and to respond to the
donors request, the information on the handout
was presented.
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Skills Building Questions
1. List three supply chain problems in the case
study. 2. Identify possible causes for these
problems. 3. What aspects of the supply chain
would you want to know more about to be able to
address these problems? TIP Remember the Six
Rights
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Group recaps and discussion

• Reports from team representatives each group
  will provide a five to seven minute recap of
  findings
• Team 1
• Team 2
• Team 3
• Team 4
• General discussion
• Similarities/differences in case needs and
  approaches
• Additional information that might be required to
  assist decision makers
• Additional questions
• Which indicators would you use to see if the
  intervention is effective?

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Lessons learned

• Assessment and monitoring need to take place at
  all levels of the system
• Problems are usually multiple and interrelated
• Baseline results from an assessment can help with
  interpreting future results from monitoring
• Simple tools are needed to assist ART sites to
  monitor their supply chains
• Monitoring a few indicators regularly can provide
  early warning of problems and enable corrective
  action
• Revisiting and fixing are part of the assessment
  and monitoring process
• Assessment and monitoring results can be used at
  all levels
• Providing feedback to sites that are being asked
  to report encourages them to improve performance

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Sample of supply chain assessment and monitoring
tools
WHO AIDS Medicines and Diagnostics Service
(AMDS) http//www.who.int/hiv/amds/en/
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Closing Remarks and QA