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Quantification of Antimalarials
PSM WorkshopNairobi, Kenya
February 21, 2006
Presentation Outline
Introduction/definition
Quantification concepts
Quantification methods
Assumptions and special considerations for quantifying antimalarials
The Procurement CycleReview Medicine
SelectionsDetermine Quantities
Reconcile Needs and Funds
Choose Procurement Method
Locate and Select Suppliers
Specify Contract Terms
Monitor Order Status
Receive and Check Medicines
Make Payment
Distribute Medicines
Collect Consumption Information
Introduction/Definitions
Quantification is the process used “to determine the quantity” or “to express a property that is measurable”
Quantification of antimalarials involves estimating how much of a specific item is needed and what financial means are required to obtain it
Effect of Good Quantification
Consistent availability of supplies (no stockouts)
No over- or understocking
Adequate medicines and supplies available to service providers
Easy management of stock
Rational prescribing and use of supplies
Fulfillment of demand
Fewer expired products and less wastage
Rational adjustment to budgetary constraints
Symptoms of Poor Quantification
Chronic and widespread shortages
Surpluses
Inequity of supply
Inadequate cost-effectiveness
Irrational adjustment to budgetary constraints
Irrational, ineffective prescribing
Suppression or distortion of demand
Inability to respond to increased supply (e.g.epidemics)
Targets for medicines
Disp/CHW
Health Centers
Secondary Hospitals
Reference Hospitals
Private Sector
National Level
Global Level
Qu
antificatio
n
Su
pp
ly accord
ing
to d
eman
d
Illustration of Concepts of Quantification
Procurement interval
Delivery time
Buffer stock
Quantity of antimalarials required
Starting point
Actual need
Quantification Methods
Consumption
Morbidity
Adjusted consumption
Service-level extrapolation
Consumption Method
The consumption-based method uses historical data on the use or consumption of medicines in the past to calculate the quantities of medicines that will be needed in the future
Morbidity Method
Uses data on diseases and the frequency of their occurrence in the population (incidence or prevalence), or the frequency of their presentation for treatment
Forecasts the quantity of medicines needed for the treatment of specific diseases, based on projections of the incidence of those diseases
Uses standard treatment guidelines (STGs) to project medicine needs
Best approach for justifying a budget request
Adjusted-Consumption Method
The adjusted-consumption method uses data on disease incidence, medicine consumption or use, and/or medicine expenditures from a “standard” supply system and extrapolates the consumption or use rates to the target supply system, based on population coverage or service level to be provided.
The area from which the data are taken must be comparable in terms of morbidity, types of facilities, and prescribing habits.
Service-Level Extrapolation
Service-level projection of budget requirements uses the average medical supply procurement cost per attendance or bed-day in different types of health facilities.
It uses a standard or comparable system from which data can be used to project medicine costs in similar types of facilities in the target system.
Comparison of Methods
Limitations of Methods
Both consumption-based and morbidity-based methods rely on data from the public system and do not take into account potential increases in demand where the public sector is underused (for example, because of ineffective medicines or poor availability of medicines or services).
Assumptions for Quantification
Incidence of fevers that are treated as malaria
Population and age groups vs. age-related doses
Public health facility use
Assumed losses caused by loss, expiration, or diversion
Lead times, safety stock
Percentage of treatment failure requiring second-line treatment
Percentage of case progression to severe malaria
Special Considerations for Quantifying Antimalarial Commodities Preferred methods
Morbidity, particularly for new treatments Consumption (if accurate data are available)
Population or conditions to treat Endemic areas, epidemics, refugee populations Women likely to become pregnant Children < 5 years old Depends on breakdown Children > 5 years old of dosage schedules
Special Considerations for Quantifying Antimalarial Commodities (2) Population or conditions to treat?
Uncomplicated malaria First-line treatment Second-line treatment
Severe malaria IPT RDTs Insecticide-treated nets Other
Population Need to adjust for growth
Peculiarities of ACTs ACTs
Short shelf life (24 months); ordering cycle (usually 12 months) may have to be adjusted to ensure stocks do not expire before used
Flexible delivery schedule may be required Highly effective, may affect the quantity of second-line
treatments required because treatment failures are fewer
First-line treatment failures do not always receive second-line treatment immediately
Little experience with use or quantification
High cost
Peculiarities of ACTs (2) Higher chance of leakage Lack of availability in private sector may affect
use of public sector ACTs are new products; imperfect market
Supply Supply and demand forces have not reached an equilibrium
price
Few manufacturers
Few prequalified suppliers
Capacity of manufacturers to meet demand for ACTs
Peculiarities of ACTs (3) Demand
Financing Major purchasers mainly using donor funding Public and not-for-profit sector demand is increasing relative
to private sector demand Variable user “demand” for, prescribing and use of,
and response to ACTs Inaccurate forecasting leading to insufficient
production? Lack of flexibility to increase production to meet short-
term needs Lack of incentives to manufacture with limited
guaranteed markets
Peculiarities of ACTs (4) Public sector is likely to continue be the main market for
ACTs for most people in the short term
GFATM established to address some of the usual concerns about donor financing; however Delays in approval of Global Fund proposals
Delays in disbursement of funds
Need to ensure supply through continued demand
Accurate forecasting needed
Quantification Tools Available
Quantimed (MSH)
Antimalarial Cost Estimation Tool (WHO)
Other
Recommended