PROCUREMENT AND LOGISTICS FOR THE ACQUISITION OF ANTIRETROVIRALS

(Experience of the Burkina Faso HIV/AIDS Disaster Response Project (PA-PMLS)

BURKINA FASO

SUMMARY

• Policy and regulatory framework • Institutional framework and partnership• Implementation framework• Supply planning• Expression of ARV requirements• Initiating the Government procurement process• Major Activities 2004 with CAMEG• CAMEG : Mission and objectives

Policy and Regulatory Framework

• National Health Policy seeks to assure right of equal access to treatment for all

• Universal access to ARV treatment • National legislation and registration of medicines

accredited by the Directorate of Pharmacy, Laboratory and Medicines (DGPLM)

• Essential medicine list for Burkina includes ARVs• Regulations for quality assurance

Regulatory framework for ARV Acquisition

• Overall public procurement regulations • Amendment of the Credit Agreement:

• Authorization to purchase ARVs

• Possibility to use single source procurement through CAMEG

• « Protocole d ’accord » between PA-PMLS and the national pharmaceutical procurement agency (Centrale d ’Achat des Médicaments Essentiels et Génériques (CAMEG))

Institutional Framework

• National AIDS Council (Secrétariat Permanent du Conseil National de Lutte contre le SIDA et les Infections Sexuellement Transmissibles (SP/CNLS-IST))

• HIV/AIDS Committee of the Ministry of Health (CMLS/Santé)

• General Directorate for Pharmaceuticals, Equipment, and Laboratory (DGPLM)

• MAP Project (Projet d’Appui au Programme National Multisectoriel de Lutte contre le SIDA et les IST (PA-PMLS)

• CAMEG

Technical and Financial Partners

• UNAIDS• WHO• The Global Fund• The Program ESTHER • The World Bank

– MAP– The Treatment Acceleration Program (TAP)

• African Development Bank (AfDB)• Société TAN ALIZ (private company)• French Red Cross• Médecins sans frontière (Doctors Without Borders)

Implementation Framework

•Expression of needs

•Contracting

•Purchase/Provision

•Distribution

•Utilization

• Government (SP/CNLS-

IST; CMLS/Santé)

• MAP (PA-PMLS)

• Central distributor

(CAMEG)

• Public hospitals (national, regional, district); private sector

Supply Planning

The Basis for Planning• Estimate population of HIV+ persons • Requirements of sub-programs (MAP, ESTHER, Global Fun, TAP, HIPC, private initiatives (TAN-ALIZ)• Shelf life of medicines (expiration period)• Evolution of treatment regimes

Expression of Needs

• Evaluating number of AIDS patients undergoing ARV treatment• Distribution of patients according to treatment regime• Estimation of quantities by product• Develop table of technical criteria and quantification of needs by product• Transmission to PA-PMLS

Expression of Needs

• Evaluating number of AIDS patients needing ARVs• Number of patients according to treatment regime• Estimation of quantities by product• Develop table of technical criteria and quantification of needs• Transmission to PA-PMLS and other partners

Initiating the government ARV procurement process

Example of MAP (PA-PMLS)• Request for invoice (proforma) to CAMEG

• Request for No Objection by World Bank for single source procurement through CAMEG (as supplier)

• Contract with CAMEG based on the Bank’s model contract for health sector supplies and products

• Signatures by SP/CNLS-IST, Ministry of Health, Ministry of Economy (host ministry of PA-PMLS through 2004)

• Approval by Ministry of Finance and Budget

Procedures for purchase and quality assurance of ARVs

CAMEG is the accredited supplier of essential drugs for the government; CAMEG’s procedures and capacity were evaluated and

approved by the World Bank (IDA)

• Pre-selection of suppliers for a period of three years

• Annual performance evaluation of pre-qualified suppliers

• Product inventory of suppliers is updated annually

• Selection of shortlisted suppliers is based on annual needs assessment and quality/cost evaluation

Procedures for purchase and quality assurance (cont.)

• Supplier contracts include a clause to permit variation of quantities on an annual basis

• Order by «tranches » according to pre-established plan

• Quality assurance for manufacturing, transport, stockage, and distribution

Procedures for purchase and quality assurance (cont.)

• Distribution to end-users including – National referral hospitals (CHU), – Regional hospitals (CHR), – Eventually to District hospitals (CMA)

• Stock management according to best practices

(management tools, logististics)

MAP Contracts in 2004 with CAMEG

• Contract for purchase of ARVs: 320 million FCFA (US$640,000)

• Contract for purchase of contraceptives: 514 million FCFA (US$1,030,000)

• Management contract for supplies procured through WHO (laboratory supplies, reagents, consumables and laboratory equipment) -- 5 million FCFA (US$10,000)

Product Reception

• Establish reception commission

• Verification and reception of products

• Storage in CAMEG warehouses

• Organize distribution

• Implementation reports

For further information, please visit the web site of the CNLS-IST

Address :

http://www.cnls.bf

Presentation of CAMEG

History

• In 1994, established with status of parastatal (commercial) to mobilize an urgent response to the problems unavailability and inaccessibility of generic medicines, and burdensome regulatory procedures

• Since 1997, CAMEG changed its to become a private, non-profit association

OBJECTIVES

• Provide essential generic medicines to public and private health facilities, with priority for district facilities, generic medicines, medical consumables, and basic equipment.

•Acquire essential generic medicines

• Guarantee availability and respect for quality norms

ORGANIZATION

Board of Directors with eleven members divided among three groups

Government (Ministries of Health, Finance, and Commerce) Health partners (donors) Users of CAMEG (consumers associations, etc)

A Supervisory Committee with three members represents each of the three groups

• General Directorate with three Central Directorates

Directorate of Purchase and Logistics

Directorate of Administration and Finance

Directorate of Sales and Marketing

LOGISTIQUES• Fifty-six (56) distribution depots in health districts

• 1210 local depots for essential medicines

• Regional depots in – Ouagadougou: 20,000 m3

– West (Bobo) : 7,500 m3

– East (Fada): 3,500 m3

– North (Ouahigouya): 7.500 m3

• Every depot storehouse is equipped with at least one air conditioned room, one cold chamber, and one « armoire frigorifique »

• 24 véhicules, including 8 trucks, 8 all-terrain, 4 fourgonnettes, 4 cars « berlines »

LA GAMME DES PRODUITS

• 204 Essentiel Generic medicines

• 93 medical consommables• 60 small medical-technical

materials• 43 Laboratory supplies and

reagents• 22 Antirétrovirals• 8 dental products• 8 Contraceptives

De nos jours la CAMEG dispose de 426 produits répartis comme suit:

Profile of CLIENTELE

The clients of CAMEG are distributed as follows:

• 56 District Distribution Depots

• 3 University Hospitals

• 9 Regional Hospitals

• 49 Projects, NGOs, Associations

• 18 services associated with Ministry of Health

• 128 private pharmacies

Thank you ! For further information please visit:

WWW. CAMEG.COM