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UNICEF- Update on key activities and plans

IPC, 30th May. 2013

2013‐ DEFINING THE MEDIUM TERM STRATEGIC PLAN FOR 2014‐2017 (AND RELATED OMP)

2013‐ DEFINING THE MEDIUM TERM STRATEGIC PLAN FOR 2014‐2017 (AND RELATED OMP)

2013‐ DEFINING THE MEDIUM TERM STRATEGIC PLAN FOR 2014‐2017 (AND RELATED OMP)

http://www.unicef.org/about/execboard/files/2013‐16‐Add1‐Annex‐Strategic_Plan‐ODS‐English.pdf

Coverage of core interventions remains low

Source: UNICEF's State of the World's Children 2013

Interventions do not reach those that need them mostInterventions do not reach those that need them most

Source: UNICEF's State of the World's Children 2013

Family Planning Summit Born too soon A Promise

Renewed

Country leadership & Implementation

Decade of Vaccines

Innovation Working Group

Key advocacy events and catalytic initiatives in support of Every Woman Every Child

Commission on Live-saving Commodities

CoIA independent Expert Review Group

Action Steps: Strengthen Global and National Leadership

HIV/AIDS‐ An AIDS Free Generation

http://www.childrenandaids.com/

Tools for Monitoring Results and Bottlenecks and Programme Design 

E.g. DRC 2012L3M/MoRES/DIVA was renamed by MOH as “Renforcement des systèmes de santé au niveaudecentralisé” and has received support from key partners such as EU, WB, GIZ and MSH 

A total of 15 interventions were prioritized: 9 in Health (ANC, PMTCT, SBA, home‐based New‐born Care, EPI, LLIN, diarrhoea CCM), 2 in Nutrition (EBF, complementary feeding), 2 in WASH (hand‐washing, improved sanitation), 1 in protection (Birth registration) and 1 in Education (Quality primary education). Data from HMIS and health facility surveys for the supply(commodities, human resources, geographical access, quality) and LQAS and qualitative surveys for demand related indicators (utilization, continuity, quality, demand barriers).

Results and development has lead to development of strategy for supporting access in community/HF and launch on 31st May 2013 of pilot programme in 3 districts‐ pre‐packed kits of essential drugs for BEOC, malaria and pneumonia management‐ “voucher” for free delivery, EOC and treatment of malaria and pneumonia‐ rigorous management, supervision and monitoring system

Monitoring Results for Equity System (MORES)/L3MDIVA (PSM module in 2013)

IMCI and iCCM: NEW PROJECTS

Integrated management of fever and appropriate treatment for malaria and pneumonia

Malaria

Pneumonia

Diarrhoea

RDTsACTs

ARI TimerAmoxi DT

Antipyretics

Zambia and Madagascar 2013‐2014

Funding from BMGF

POLICY, DEMAND, TRAINING, SUPERVISION, LOCAL SOURCES, PROCUREMENT,  SUPPLY CHAIN, MONITORING

Increase coverage of ORS/Zinc and treatment of pneumonia (public and private sectors)

Ethiopia, Kenya, Niger, Tanzania, 2013‐2014Funding from CIDA

ORS, ZincCo‐pack

MAIN PRIORITITES RELATED TO MEDICINES

ARVs, ACTs, ORS+ZincIndustry Meetings – Nutrition and MedicinesPolicy for Local Purchase Pharmaceuticals

WHO‐ Essential Medicines Policy, ProcurementGFATM Implementation UN Commission on Life Saving Commodities

Maternal and Child Health Priorities‐ UNCLSCInnovation‐ Amoxicillin DT and ORS‐Zinc

Community Case Management (CCM)IEHK 2011

Participation in Ped. ARV Consortium, ACT Task Force. CPPCatalogue and info updatesTemp. Controlled ShipmentsLocal Kit Packing‐ Guidance

Warehouse ReplenishmentSharing and LearningMQAS

Availability of Medicines and Nutrition Supplies 

Procurement Strategies

Partnerships

Supply Chain Management

Internal Processes and Capacity

PROCUREMENT AND SUPPLY UPDATE

Publications of procurement dataRank Mat. no. Mat. short text (Corrected Latest) USD QTY USD QTY USD QTY USD QTY

1 S1561121 New form. Oral reh.salts,1Ls/CAR-10x100 3,467,830 53,225 3,858,240 60,987 4,496,493 60,420 1,888,066 27,1042 S1537100 Sulf.400mg+Trimet.80mg tabs/PAC-500 1,151,714 250,000 4,929,650 1,156,860 2,030,571 440,565 5,055,488 1,098,1263 S1555360 Mebendazole 500mg chewable tabs/PAC-100 3,290,224 1,294,753 5,843,641 2,277,008 204,600 100,000 2,451,218 1,196,5074 S1546315 Erythromycin 250mg tabs/PAC-100 952,065 363,729 1,569,955 558,991 1,844,100 514,000 4,542,772 1,272,3605 S1555370 Albendazole 400mg chewable tabs/PAC-100 2,442,581 1,246,595 2,695,495 1,434,959 1,651,207 895,192 1,750,070 1,003,0006 S1580100 Micronutrient,film-coated tabs/PAC-1000 2,056,893 144,100 5,587,676 386,040 492,720 36,0007 S1580020 Zinc 20mg tablets/PAC-100 1,658,932 890,060 2,796,871 1,906,692 1,948,797 1,359,234 974,140 772,5008 S1550025 Fe(as fum.)+folic 60+0.4mg tab/PAC-1000 1,064,218 260,000 2,188,563 508,703 1,737,596 344,412 2,125,152 447,7779 S1505046 Amoxici.pdr/oral sus 125mg/5ml/BOT-100ml 781,022 1,698,158 1,564,295 3,365,230 1,715,569 4,014,149 1,630,659 3,767,899

10 S1505040 Amoxicillin 250mg caps/tabs/PAC-1000 1,312,048 93,050 4,342,028 302,84511 S1505060 Amoxicillin 250mg tabs/PAC-1000 1,794,000 120,000 3,675,115 250,60312 S1537150 Sulf.100mg+Trimet.20mg disp.tab/PAC-100 247,491 260,100 2,034,354 2,014,657 1,732,171 1,864,594 1,021,523 1,152,16013 S1555965 Paracetamol 500mg tabs/PAC-1000 603,038 175,200 1,057,375 285,873 1,136,584 271,066 2,175,982 436,57314 S0003235 Sulfameth+trimeth.400+80mg tabs/PAC-60 1,025,122 1,385,300 2,187,926 2,956,657 1,406,056 2,076,00015 S1561120 New formula Oral reh.salts,1L s/BOX-100 511,088 80,640 1,531,139 244,976 1,513,616 212,418 843,763 122,58016 S0003236 Sulfameth+trimeth.400+80mg tabs/PAC-1000 1,784,000 200,000 517,360 58,000 888,031 99,555 907,019 107,85017 S1544400 Doxycycline 100mg tabs/PAC-1000 737,500 60,000 1,614,524 130,377 90,400 10,000 1,302,109 126,67218 S1520011 Benzylpenicillin pdr/inj 5MIUvial/BOX-50 408,771 11,763 1,588,767 45,367 216,820 5,000 675,278 16,00019 S1555990 Paracetamol 125mg/5ml or.sol/BTL-60ml 469,728 1,538,586 842,812 2,269,500 778,424 2,632,000 675,889 1,660,00020 S1583000 Retinol 200,000IU soft gel.caps/PAC-500 425,250 55,000 854,390 103,000 494,361 56,430 916,771 99,64921 S0000200 Iodized oil 200mg caps/PAC-1500 247,671 694 2,340,910 7,008 33,860 9222 S1559005 Benzabenzylpen.pdr/inj 2,4MIUvl/BOX-50 270,681 8,960 1,155,416 35,853 31,537 1,000 1,142,582 57,08823 S1537115 Sulf.100mg+Trimet.20mg tabs/PAC-100 662,020 977,000 895,500 1,175,000 497,800 620,000 323,691 410,00024 S1537120 Sulf.800mg+Trimet.160mg tabs/PAC-100 508,203 260,650 239,589 130,915 1,325,346 670,562 274,296 139,12625 S1560812 Sod.lact.comp.inj 1000ml w/g.set/BOX-10 322,363 20,000 610,908 48,573 1,051,457 85,690 335,608 32,88026 S1564326 Sodium chl.inj 0.9% 500ml w/giv.s/BOX-20 438,992 23,000 402,550 24,000 859,377 53,112 577,552 38,20227 S1560811 Sod.lactat.comp.inj 500ml w/g.set/BOX-20 339,594 19,000 727,376 41,420 449,393 24,464 473,670 31,68028 S1551960 Gentamicin inj 40mg/ml 2ml amp/BOX-50 101,733 27,200 821,037 131,000 331,763 38,745 793,424 94,35029 S1552106 Glucose inj 5% 500ml w/giv.set/BOX-20 243,095 13,160 590,362 34,711 530,694 31,972 668,225 42,59430 S1555650 Metronidazole 250mg tabs/PAC-1000 239,400 60,000 398,150 100,000 557,133 119,592 826,850 175,95931 S1510000 Tetracycline eye ointment 1%/TBE-5g 303,529 1,800,000 397,338 2,020,000 145,600 420,000 1,144,323 3,300,00032 S1552300 Hydrochlorothiazide 25mg tabs/PAC-100 255,091 194,730 478,541 345,560 705,741 443,000 345,582 586,76033 S1537130 Sulf.200mg+Trim.40mg/5ml o.s/BOT-100ml 635,116 1,491,923 738,230 1,663,210 202,200 540,000 125,430 297,00034 S1531030 Chloramphenicol pdr/inj 1g vial/BOX-5 67,595 10,800 182,261 32,400 829,964 139,338 541,509 109,95035 S1504002 Alu.hydrox.oral sus 320mg/5ml/BOT-500ml 59,550 16,000 1,486,229 424,46736 S1559080 Phenoxymethylpenicil.250mg tabs/PAC-1000 314,050 23,000 500,250 36,000 168,300 12,000 474,200 36,00037 S1543805 Water for inj 10ml amp/BOX-50 596,010 138,000 360,070 84,993 156,000 40,000 313,046 75,00038 S1553105 Povidone iodine sol 10%/BOT-500ml 356,880 168,000 429,423 198,000 399,513 166,200 179,316 73,60039 S1505098 Ampicillin pdr/inj 500mg vial/BOX-25 396,713 104,300 508,538 155,696 188,978 61,000 260,232 84,00040 S1531005 Ceftriaxone pdr/inj 1g vial/BOX-10 269,612 50,900 415,382 75,828 158,435 31,000 503,734 87,40041 S1531002 Cefixime 200mg tablets/PAC-56 245,717 15,643 189,916 12,872 246,689 35,500 435,745 33,26342 S1583015 Retinol 100,000IU soft gel.caps/PAC-500 166,563 28,062 141,798 21,815 234,538 35,890 355,889 49,42943 S1550000 Ferrous salt 60mg iron tabs/PAC-1000 212,337 93,931 530,833 251,888 78,326 25,000 69,801 24,00044 S1552115 Glucose hyperton.inj 50% 50mL vl/BOX-20 116,826 10,000 483,862 37,700 120,894 10,000 142,385 11,91645 S1531505 Chlorhexidine conc. sol. 5%/BOT-1000ml 248,065 89,160 119,132 41,090 336,882 97,750 159,717 52,29046 S1555930 Nystatin oral sus 100,000IU/ml/BOT-30ml 100,843 121,100 84,937 105,000 144,637 170,000 483,677 680,00047 S1560685 Procaine benzylpeni.pdr/inj 3g vl/BOX-50 478,885 17,000 144,080 4,000 188,985 6,00048 S1506002 Acetylsalicylic acid 300mg tabs/PAC-1000 205,950 67,000 345,000 100,000 131,535 40,000 126,005 40,00049 S1555710 Ciprofloxacin 500mg tabs/PAC-10 123,164 320,387 293,550 595,000 111,961 252,722 276,200 613,00050 S1521015 Aciclovir 200mg tablets/PAC-25 22,725 17,000 437,706 374,000 59,463 46,000 284,690 246,000

ESSENTIAL MEDICINES TOP-50 2009 2010 2011 2012 (up to 17 Sep)

http://www.unicef.org/supply/files/Procurement_Overview_20092012.pdf

Competition and prices

http://www.unicef.org/supply/files/Procurement_Overview_20092012.pdf

2009

Material USD QTY USD QTY USD QTY USD QTY USD/unit USD/unit%change vs 2009

New form. Oral reh.salts,1Ls/CAR-10x100 3,467,830 53,225 3,858,240 60,987 4,496,493 60,420 1,888,066 27,104 65.15 69.66 7%

Sulf.400mg+Trimet.80mg tabs/PAC-500 1,151,714 250,000 4,929,650 1,156,860 2,030,571 440,565 5,055,488 1,098,126 4.61 4.60 0%

Mebendazole 500mg chewable tabs/PAC-100 3,290,224 1,294,753 5,843,641 2,277,008 204,600 100,000 2,451,218 1,196,507 2.54 2.05 -19%

Erythromycin 250mg tabs/PAC-100 952,065 363,729 1,569,955 558,991 1,844,100 514,000 4,542,772 1,272,360 2.62 3.57 36%

Albendazole 400mg chewable tabs/PAC-100 2,442,581 1,246,595 2,695,495 1,434,959 1,651,207 895,192 1,750,070 1,003,000 1.96 1.74 -11%

Micronutrient,film-coated tabs/PAC-1000 2,056,893 144,100 5,587,676 386,040 492,720 36,000 14.27 13.69 -4%

Zinc 20mg tablets/PAC-100 1,658,932 890,060 2,796,871 1,906,692 1,948,797 1,359,234 974,140 772,500 1.86 1.26 -32%

Fe(as fum.)+folic 60+0.4mg tab/PAC-1000 1,064,218 260,000 2,188,563 508,703 1,737,596 344,412 2,125,152 447,777 4.09 4.75 16%

Amoxici.pdr/oral sus 125mg/5ml/BOT-100ml 781,022 1,698,158 1,564,295 3,365,230 1,715,569 4,014,149 1,630,659 3,767,899 0.46 0.43 -6%

Amoxicillin 250mg caps/tabs/PAC-1000 1,312,048 93,050 4,342,028 302,845 1,794,000 120,000 3,675,115 250,603 14.10 14.67 4%

Sulf.100mg+Trimet.20mg disp.tab/PAC-100 247,491 260,100 2,034,354 2,014,657 1,732,171 1,864,594 1,021,523 1,152,160 0.95 0.89 -7%

Paracetamol 500mg tabs/PAC-1000 603,038 175,200 1,057,375 285,873 1,136,584 271,066 2,175,982 436,573 3.44 4.98 45%

Sulfameth+trimeth.400+80mg tabs/PAC-60 1,025,122 1,385,300 2,187,926 2,956,657 1,406,056 2,076,000 0.74 0.68 -8%

New formula Oral reh.salts,1L s/BOX-100 511,088 80,640 1,531,139 244,976 1,513,616 212,418 843,763 122,580 6.34 6.88 9%Sulfameth+trimeth.400+80mg tabs/PAC-1000 1,784,000 200,000 517,360 58,000 888,031 99,555 907,019 107,850 8.92 8.41 -6%

2009 2010 2011 2012 (up to 17 Sep) 2012 (up to 17 Sep)

Cost of basket for main essential medicines largely stable (cost in 2012 at 2009 prices would have been 3% less)‐ but need to engage new manufacturers and maintain competition.

In comparison, for ARVs the cost of top‐10 products in 2012 at 2009 prices would have been 42% more (but ACTs 9% less)

PROCUREMENT AND SUPPLY UPDATE

Continuation of large procurement and distribution projects

Sierra Leone: continuation until 1Q 2014 (Crown Agents already established in country to support capacity development of MoH)Malawi: phase‐out in 2013 as planned

Zimbabwe: continuation until 2014‐15 with start of phase‐out of kits in 2013 (pilot)

PROCUREMENT AND SUPPLY UPDATE

Increasing collaboration with WB funded projects. Support to 55 WB projects in 23 countries since model agreement established in 2008

Since Projects for medicines for Afghanistan, Mozambique, Sierra Leone, Tajikistan

Supply of medicines for humanitarian programmesIncreasing complexity in requirements for supply of medicines to Governments and for humanitarian response• Pakistan: CoPP + requirement of Free Trade Certificate if medicine

not registered in country of origin• Ethiopia: Registration or production in SRA/WHO PQ facility

Impact• Engagement with MoH/NRA complex- a lot of effort required mainly to

clarify requirements• Need additional resources to access and manage documentation

needed to import pharmaceutical (CoPP for Pakistan etc.), which impedes rapid response and timely delivery

• Increase in cost (reduced sources, % for local agent)• Disengagement of humanitarian organizations in medicine supply

CAN IPC SUPPORT DIALOGUE BETWEEN GOV AND HUMANITARIAN ORGANIZATIONS TO IMPROVE SUPPLY EFFICIENCY IN

HUMANITARIAN PROGRAMMES?

Strides

Aurobindo

MylanHeteroCipla

Ranbaxy

MUMBAI

HARARE

JOHANNESBURG

DURBAN

ZIMBABWE ARV DELIVERIES

Freight savings (sea over air) aprox. USD 4M

Temperature Control in Shipments

Plan for 2013Evaluation of UNICEF’s current practices and availability of interventions to improve our own temperature monitoring and control of our shipments.

Pilot project with UNDP

Development of internal policy

Is this an area of work open for collaboration through IPC?