sourcing of arvs & hiv diagnostics - who agent: ... egypt funders procurers observers paediatric...
TRANSCRIPT
Sourcing of ARVs
& HIV diagnostics
Procurement for
Impact P4i
AMDS ANNUAL STAKEHOLDERS AND PARTNERS MEETING 29 September 2014
Global Fund: Procurement for Impact: P4i
Our objective was straightforward: To Increase Access to Products
By fundamentally changing the way we work across the supply chain
Earlier involvement
& closer collaboration
with manufacturers
Improving our purchasing
capability & changing our contracting
models
Optimising the international
supply chain to reduce cost
Better planning & scheduling to
support continuity of supply
Delivering more products at the
right time & place to more people
Global Fund: procurement & contracting Procurement Agent: operational management Increased volume visibility & financial flows
Longer term contracts with committed volumes for the appropriate period
Focus on value as well as affordability: consider both commercial and technical criteria
• better planning & allocation of funds: country level
• leveraging scale in commodity procurement: global
level
ARVs: demand is increasing year-on-year with
ongoing supply challenges
4
• Volumes of ARVs are increasing year or year: 11.7 million in LMIC (end 2013)
• Current Global Fund treatments reach 6.6m people in LMIC (mid-2014)
• Global Fund target to increase this to > 7.6m by 2016
• Supplier delivery performance has been poor - made worse by current order
chaotic practices and some procurement approaches
Investment needed for manufacturers to allocate more production capacity in a
sustainable way and to ensure sufficient and reliable supply
ARVs: the new procurement approach is broad
based & designed to address a range of objectives
These objectives will result in a
new form of supplier engagement
• Reduced lead times
• Improved Delivery
Performance
• Mitigate force majeure
Continued supply of
products through all
stages of the lifecycle
De-risk API supply
Improved payment and
admin processes
Leveraged volumes
Improved planning and
longer term contracts
Use supplier expertise
Collaboration to protect
reasonale margins
Sustainable supply
Competitive pricing &
affordability
On-Time Delivery
Quality & Regulatory
Extend product shelf life
Broader country
registration footprints
Lifecycle Management and ARVs We have overlaid the key ARV attributes to the lifecycle to determine the
strategic priorities
Time
Pipeline Growing Declining
Attributes
Challenges
for suppliers
GF Strategy
Implication
Emerging Mature
Recover from
investment and
Growth
Lack of
clarity for
investment
Brutal competition Ethical exit plan
Address Long lead-time and poor delivery performance
Early engagement Competitive cost Deliver Sustainabiluty: Mitigate price volatility and secure supply
Few FPP
suppliers More suppliers Reducing FPP suppliers Fewer FPP suppliers
Technical Driven
Licensing Continuous process improvement and investment No more investment
Focus on in-
house API supply
Diversification of API
sources
Concentration of API
sources Few API sources
Less competition Competitive drive Few incentives to manufacture
Key elements
1. Based on lifecycle management to drive
affordability and availability.
2. Initial volume commitments will be made out
to the end of 2016
3. New entrants will be encouraged by capping
volume commitments
2. Suppliers encouraged to supply both high
volume and low volume products
3. Initial competitive tender and longer term
value creating partnerships
4. Long term partnerships based on a series of
goal orientated, joint collaborative projects
5. Future volume commitments dependent on
achieving agreed objectives
Paediatric ARVs: Collaboration to improve supply
and access
Cameroon C.A.R.
D.R.C.
Guinea
Angola
Uganda Kenya
Tanzania
Mali
Mauritania
South Africa
Niger
Egypt
Funders Procurers
Observers
Paediatric ARV Procurement Working Group (PAPWG)
Procurement
Consortium
Collaboration of major funders &
procurers • Coordinated procurement
• Consolidate, review, adjust orders
• Review & act on low volume, sub-
batch orders
• Advise non-members of procurement
timelines to facilitate broader
mutually beneficial timeline alignment
• Advocating for use the optimal
formulations (IATT list)
Nigeria
Guinea
Nigeria Cameroon
Cameroon
CHAI
SCMS
UNICEF
PPM
Multiple
C.A.R.
D.R.C.
Congo
Liberia
Guinea
Guine
a-
Bissa
u
Angola
Burkina Faso
Burundi
Cote d’Ivoire
Ghana
Uganda Kenya
Tanzania
Zambia
Mozambique
Mali
Mauritania
Zimbabwe
Niger
Somalia
Swaziland
Togo
Malawi
Egypt
In 2013, 66 countries ordered paediatric ARVs through
the Procurement Consortium of the PAPWG
Chad
Djibouti
Equatorial
Guinea
Gambia
Sudan
Country CHAI SCMS UNICEF PPM
Afghanistan
Albania
Angola
Armenia
Belarus
Brazil
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Congo
Cote d'Ivoire
Cuba
D R Congo
Djibouti
Dominican Republic
East Timor
Egypt
El Salvador
Equatorial Guinea
Gambia
Georgia
Ghana
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Honduras
Country CHAI SCMS UNICEF PPM
Indonesia
Iran
Kenya
Kyrgyzstan
Laos
Liberia
Madagascar
Malawi
Mali
Mauritania
Mongolia
Mozambique
Myanmar
Nepal
Nicaragua
Niger
Nigeria
Pakistan
Papua New Guinea
Philippines
Somalia
Sri Lanka
Sudan
Swaziland
Tanzania
Thailand
Togo
Uganda
Uzbekistan
Vietnam
Yemen
Zambia
Zimbabwe
HIV Diagnostics: Global Fund spend is increasing
in line with WHO guidelines & international targets
In 2013 and 2014 to date the overall reported spend is $113m broken
Down as shown
CD4 $34m
30%
Viral Load $7.7m
7%
RDT $77m
63%
82 million tests;
15 manufacturers
5 manufacturers
5 manufacturers
Programmatic, Financing & Procurement actions
underway
1. Global Fund Quality Assurance Policy for Diagnostics
2. Expert Review Panel to expedite access to high public health impact
products (ERP) • POC for CD4, Viral Load, Early Infant Diagnosis, molecular technologies using
dried blood spots for viral load – with UNITAID
3. Policies for the procurement of health products • Policies on Procurement and Supply Management
of Health Products
• Guidance for financing: Strategic Investment Notes
for HIV and Health Systems Strengthening
(laboratory systems)
• Guidance for the Procurement & Use of HIV RDTs
4. Leveraging existing entities and initiatives
Clinical algorithm and linkages to care
Funded Demand
Quality Assurance Policy
Effective Supplier Engagement
Optimal Selection and Placement
Laboratory & sample transport Systems
Planning and Forecasting
To Scale-up
effective Viral Load
testing
REQUIRES
1
2
3
4
5
6
7
Addressing the Challenges – example of viral load
Some strategic elements are in place……………
1. Mapping country status readiness/optimisation of existing resources
(with partners including CHAI, MSF, PEFPAR, FEI)
2. Supporting development of funded demand: robust funding requests,
grant design & effective implementation
– “Technical considerations for expansion of viral load
testing”; WHO, PEPFAR, CDC, Global Fund, ASLM http://www.who.int/entity/hiv/pub/arv/viral-load-testing-technical-update
– “Programming of laboratory investments with a focus on
viral load testing”; Global Fund http://www.theglobalfund.org/en/procurement
– Development of National Strategies for HIV Viral Load
Implementation Workshop, Ethiopia; September 2014;
ASLM, CADU, CHAI, Global Fund, PEPFAR, WHO
– Technical support to countries (with partners)
3. Engaging with suppliers
– Better pricing and optimal contracting modalities: minimum packages of
service; framework purchase/lease/rental/performance options
…specifically to support scale-up of effective viral
load services
HIV Dx Strategy: consultation launched: will be broad
based and designed to address a range of objectives
These objectives will result in a
new form of supplier engagement
Reduced lead times
Simplify supply logistic
chains & distribution
models
Improved Delivery
Performance
Mitigate force majeure
Continued supply of
products
Matching the specific
needs of country
programmes
Leveraged volumes
Improved planning &
longer term contracts
Use supplier expertise
Product standardisation
Sustainable Supply
Competitive pricing &
affordability
On-Time Delivery
Quality & regulatory
Procurement of Quality
Assured products
Support uptake of new
proven technologies
improving programme
performance
Thank you.
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