Many governments have introduced supply reform strategies to increase availability of safe, effective and affordable medicines. But little evidence has been collected that establishes if and to what extent they have succeeded. Experience in a number of countries in Africa, Asia and Latin America suggests, however, that contrary to what is often asserted, some supply systems are working well.
Meanwhile, vastly increased funds for medicines procurement are becoming available at global level. To be used effectively, much clearer understanding is needed of country experiences with alternative approaches to medicines supply management. Moreover, examination of vertical versus comprehensive approaches to increasing access to medicines is long overdue.
In 2002, WHO launched two complementary studies. The first of these is a multi-country study to assess reform strategies introduced by governments to centralized medicines supply systems. A start-up stakeholders meeting produced a situation analysis and status report on innovative supply systems, and developed a study protocol. The study will identify why certain strategies have succeeded - i.e. the criteria and social and political conditions that would need to apply in order for success to be replicated.
The results will help generate guidance for governments and agencies working to improve medicines supply.
A second study will map the supply and distribution activities of faith-based nongovernmental organizations in Sub-Saharan Africa. A questionnaire has been developed and will be field-tested and applied in 2003 by medicines supply staff of faith-based organizations. In addition, a regional network of medicines supply experts working for faith-based organizations will be created, to promote exchange of expertise, and to serve as a source of mutual assistance and support.
Autonomous medicines supply agencies - three examples
The Benin Central Purchasing Office (BCPO) for essential medicines supplies was established in 1991. An autonomous supply agency, with a monopoly position, it is responsible for providing medicines to public health facilities and the private not-for-profit sector. BCPO has a management committee, which monitors financial operations, while a steering committee ensures that the agency’s objectives are met. In 1993, after devaluation of the CFA franc, procurement of essential medicines by generic name was initiated. Management principles were also adopted, such as cash-only sales, no credits, responsibility for medicines collection and distribution assigned to clients, and minimum operations budget and personnel. Staff are selected through competitive application and recruited under contract rather than as permanent civil servants. Government regulations and medicines policies are followed, and BCPO’s performance is monitored regularly by the government.
In 1991, the Central Medical Stores became an autonomous agency under the name of CMS Public Corporation (CMSPC) and was capitalized with a government grant. The number of staff was reduced considerably. It has no direct government involvement but works closely with the government. CMSPC has its own independent bank accounts and operates as a monoploy. Funds are received from cash-and-carry sales. It operates an open tendering procurement system to obtain the required bulk quantities of essential medicines by generic name, in accordance with the national list of essential medicines. Following decentralization policies, each of Sudan’s 28 states -including those ravaged by war - has been obliged to organize its own medicines collection and distribution system, as well as its own cost-recovery system. “People’s pharmacies” (semi-private community pharmacies), nongovernment organizations, and sometimes private pharmacies, purchase medicines from CMSPC, which operates a price policy for the various buyers. Government regulations and medicines policies are adhered to. CMSPC’s performance is monitored by the government. But the prevailing economic situation prevents CMSPC from functioning more effectively.
Commercialization of the Government Central Stores in Harare was approved in July 1997. NatPharm was created in 1998, capitalized with a government grant and operates as a commercial company. It has a Board of Directors that monitors operations. It operates in accordance with a Memorandum of Understanding and within Articles of Association, and has signed a performance agreement with the Ministry of Health. Its main customers are the country’s 1300 public health institutions, but it can also make sales to the private sector. Its tender system is directed at obtaining the required bulk quantities of essential medicines by generic name, in accordance with the national list of medicines.