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SCALING UP ACCESS TO ARV MEDICINES MAJOR ISSUES FACING THE NATIONAL ARVS PROGRAMMES
AND MAIN LMIS ACTIVITIES TO PREVENT ARV STOCK OUT
SOLTHIS COUNTRY EXAMPLES
Etienne Guillard
Pharm.D. - MSc
HSS Departement Director
Solthis
Paris
AMDS partners meeting
Geneva, September 29th, 2014
Contents
1. Few words on Solthis
2. Solthis main LMIS activities to prevent ARV stock out
3. Major issues facing national ARV’s programmes
Our identity
Medical INGO founded in 2003 by 4 specialists in HIV/AIDS from La Pitié-Salpêtrière Hospital (Paris – FRANCE) :
• Pr. Christine Katlama • Pr. Brigitte Autran • Pr. Gilles Brücker • Pr. Patrice Debré
SOLTHIS
Therapeutic solidarity and initiatives against HIV/aids
Scientific Commitment for universal access to health
Our goal
HIGH QUALITY
Improve quality of care
ACCESSIBLE
Decentralization into isolated areas, increase
patients under treatment and receiving free of
charge care
SUSTAINABLE
Work on local and professionnal capacity
building
Solthis provides capacity building for healthcare systems in order to facilitate high quality, accessible and sustainable treatment for patients in developing countries, especially on HIV/AIDS
Health System Strenghtening
Our principles of intervention
• Intervention “in situ”
– Working directly in the field providing direct technical support to public healthcare professionals
• Non substitution
– Support to local actors without replacing them
– Respond to requests from national authorities
– Shared expertise and concerted actions
• Academic and scientific partners
– A network of university hospitals experts
– Academic partnerships : LASDEL, ISPED, ANRS, Resapsi, Sciences Politiques Paris
“one foot on the ground, one foot in the academic”
Our programs
Mali Launch date: 2003 Intervention areas: Bamako, Segou, Mopti
Guinea Launch date : 2008 Intervention areas : Conakry, Boke area, Labé, Mamou, Faranah, Kankan, N’Zérékoré, Kindia
Niger Launch date : 2004 Intervention areas : Niamey, Dosso, Zinder, Diffa, Maradi, Tillabéry, Tahoua, Agadez
Sierra Leone Launch date : 2011 Intervention areas : Freetown
Technical Assistance : 2 missions in Madagascar and Burkina Faso in 2013
Intervention strategy
5 priority functions in healthcare systems
Advice, train, mentor
• Healthcare providers (medical and paramedical)
• Laboratories and other technical platforms
• Pharmacies (procurement, supply chain management, dispensation)
• Health information systems (management of health data)
• Coordination bodies (MoH, NAS, NACP)
Pharma & PSM block: Systemic approach
Contents
1. Few words on Solthis
2. Solthis main LMIS activities to prevent ARV stock out
3. Major issues facing national ARV’s programmes
LMIS segments
Extract from LMIS RBM workshop – Ouagadougou 2014
Focus on data exploitation at central level
To prevent stockouts…
Time Today
Future needs
Future
1
… a two step process
Upstream work
Downstream work
Monitoring uses vs needs
forecasted
Selection Quantification
2
To prevent stockouts…
Tools
HR competences & expertise
SOPs & Guidelines
Organization
& management
… a multifactorial framework
To prevent stockouts…
Tools
HR competences & expertise
SOPs & Guidelines
Organization
& management
… a multifactorial framework
LMIS tools development
• Tools to quantify ART and health products
• Tools to visualize available stocks and an early warning score to avoid stock-outs
• Tools for the compilation and recovery of pharmaceutical & logistics information data
Stocks availability visualization & quantification
Stocks availability visualization & quantification
Stockouts Early Warning Score A risk assessment tool > decision support
To prevent stockouts…
Tools
HR competences & expertise
SOPs & Guidelines
Organization
& management
… a multifactorial framework
Collective responsability & decision-making
Pharma/PSM tech
Central Institutions
Civil society
Technical partners & donors
Information sharing: for the analysis / on the analysis
Implementation of coordination groups
Analysis summary & memo
Coordinated response to stockouts risk
Example – Supply Group Niger
To prevent stockouts…
… not only a LMIS issue… A strong & essential link with Procurement needs to be done Thorough monitoring of Procurement processes
To prevent stockouts…
Do not wait until there is fire!
ANTICIPATION & PREVENTION
To prevent stockouts: Results
Mali No national ARV stockouts
during PSM technical assistance in 2010/2011
Guinea No national ARV stockouts
since 2011 Early warning & coordinated response with JURTA in 2013
Niger No national ARV stockouts
since 2010
Sierra Leone Early warning :
ARV stockouts limited in number, time and
consequences
Contents
1. Few words on Solthis
2. Solthis main LMIS activities to prevent ARV stock out
3. Major issues facing national ARV’s programmes
Major issues facing national ARV’s programmes
• LMIS
Data are essentials
But we need to simplify the working life of our partners (multilevel)
Tools are only one part of the problem
• Procurement
Complexity of processes: agreement, money transfer
• Therapeutic guidelines implementation
Lack of awareness on the timeline
• Lack of coordination & harmonisation between stakeholders & cultural differences of development
If someone uses well a tool which leads to good outcomes, why do we need to change it?
• Lack of capitalisation: build a system
Moving from individual skills to collective skills
