who medicines strategy - libdoc.who.int - World Health Organization

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WHO MEDICINES STRATEGY 2004-2007 | 72EO 4.1Supply systems assessed andsuccessful strategies promoted toidentify strengths and weaknessesin the supply systems and improvethe performance and functioning ofnational medicines supply systemsRationaleMany countries have to contend with a twintrackmedicines supply system — comprising anoften inefficient public medicine supply systemintended to serve the entire country and a varietyof private supply systems serving mostly urbanareas. Recent experience indicates that medicinesupply systems are most effective when they arebased on an appropriate mix of public, private,and NGO procurement, storage, and distributionservices.Public medicines supplysystems are not meeting eitherthe demands or the needs ofcountriesProblems include:> organizational structure and financialmechanism are rigid and inadequate> capital and budget allocations areinsufficient for a well-functioningsystem> number and/or capacity of supply staffare not sufficient to fulfil the tasks> no career development or incentivestructure> procurement procedures are nottransparent and efficient> government interference.The CMS strategy has been successful only wherepublic funding is substantial and sustainable, andwhere the economy has been stable. This is notthe case in most developing countries. As a resultof health sector reforms, a number of differenttypes of supply strategies have evolved out of thehighly centralized public sector supply system.These vary considerably in relation to the role ofthe government, the role of the private sector, andthe use of incentives to boost efficiency.ProgressInnovative approaches to public and privatesupply systems have been adopted in countriessuch as Benin and other West African countries,Colombia, Guatemala, the Newly IndependentStates (NIS) of East and Central Europe, SouthAfrica, and Thailand. 37 These reflect differentcombinations of public and private, centralized,and decentralized approaches. The potential toimprove access through private sector channelshas also been demonstrated in countries asdiverse as Indonesia, Kenya, and Nepal. WHOhas supported developments in supply systemsin the NIS countries and the Balkan Region andprovided training to improve the effectiveness ofsupply systems in Peru and Colombia.Elsewhere, alternative supply mechanisms suchas regional and sub-regional bulk purchasingschemes have been successfully adopted bythe Gulf Cooperation Council and by theOrganization of Eastern Caribbean StatesPharmaceutical Procurement Service whichoperate pooled procurement systems for six andeight countries respectively.
COMPONENTS OF THE STRATEGY | 73MEDICINE SUPPLYSTRATEGIESCentral medical storesCentralized, fully public management,warehousing, and delivery system(Semi-)autonomous supply agencyCentralized, (semi-)privatemanagement and warehousing systemDirect delivery systemCentralized decision-making butdecentralized, private direct deliverysystemPrime distributorCentralized decision-making butdecentralized, private warehousingand delivery systemFully private supplyDecentralized decision-making, fullyprivate wholesalers and pharmaciessystem.Challenges remainingTo date there has been no systematic evaluationof the advantages and limitations of the differentsupply strategies in different (particularly lowincome)settings. Thus, empirical evidence onwhich to base policy-making is limited. Thechallenge for governments is to establish themost appropriate medicines supply strategy, andto identify the extent to which the private sector,including NGOs, can be a partner in supply anddistribution systems.Meeting the challenges 2004-2007Over the next four years WHO will:> support countries in their efforts to integrateinnovative public-private approaches throughan efficient mix of public, private, and NGOsectors in order to ensure the continuousavailability and delivery of medicines ofassured quality to all levels of the health caresystem.> carry out a multi-country study in Africa toevaluate existing public sector supply systems,including development of a comprehensiveassessment tool to enable Member States toassess their own systems.> explore with stakeholders the options fordrawing on the experiences of the NGOsector, including faith-based organizations(see also EO 4.5) to help countries formulatea feasible national medicines supply systembased on an efficient public-private mix.OUTCOME INDICATORS1999 2003 2007No. of countries with public sector procurement limited tonational essential medicines list#REPORTING % TARGET#REPORTING % TARGET71/133 53% 60% 84/127 66% 74%
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REFERENCES | 1471Annual report 2000
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REFERENCES | 14912 th Model List of
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