[e-drug] Drugs Supply Chain Management Challenges

e-drug
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E-DRUG: Drugs Supply Chain Management Challenges
-------------------------------------------

[We invite you to share your thoughts about solutions to current and future challenges to
drugs supply chain management. BS Moderator]

Equitable healthcare services including access to drugs and medical
supplies are the major function of any healthcare system. Effective
healthcare supply chain systems are reliant on rational drugs
selection, pricing and financing. These are also dependent on other
factors such as health policies, economies as well as political
stability forming a series of interrelated dependencies.

Being a very dynamic area, drugs supply chain management has evolved a
number of challenges that can be categorized regionally depending on
the level of resource availability and technology advancement. While
developed countries have managed to do away with most of these
challenges-including poor health policies, poor logistics
infrastructure and management, political interference poor technology
use, poorly resourced Drugs Regulatory Authorities (DRAs), unqualified
supply chain managers, demand supply imbalances, deficit health budgets
and corruption-most of these are still prevalent in the developing
world.

Some challenges like drug quality issues are general as evidenced by
the number of cases in US, which has a well resourced DRA. For example,
the recent case of Chinese made Heparin blood thinner linked to sixty
two deaths and hundreds of allergic reactions in the U.S. and Germany.

As we globalize supply chains, we will reap the associated benefits
including more pricing competitiveness and economies of scale. However,
it is more likely that more challenges will emerge that require
strategic proactive solutions.

Grass root policies, use of Information Technology, capacity building
and global collaboration including information and experience sharing
through forums like E-drug are currently seen as pragmatic solutions
for mitigating these challenges.

How feasible is Information Technology for drug supply chain management
in politically unstable and under-resourced areas?

What are your thoughts about solutions to current and future challenges to
drugs supply chain management?

What role can global collaboration play in capacity building?

Bakari A. Bakari
Information Systems Manager, Medical Stores Dept.
Ministry of Health and Social Welfare, TANZANIA
Public Health Informatics & Leadership Humphrey Fellow 2007/08
North Carolina University, Chapel Hill, NC AED Satellife Intern May
19-June 13, 2008
Boston, MA 02472-2539
bakari@email.unc.edu

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E-DRUG: Any questions or thoughts for Bakari?
----------------------------------------

Bakari Bakari from Tanzania is spending his professional affiliation with E-drug until June 13. He is the Information Systems Manager at the Medical Stores Dept at the MoH in Dar and currently a Hubert Humphrey fellow at the University of North Carolina. In 2005 he designed and implemented a web site to link the public dispensaries to the MSD to improve essential drugs management. He has a great interest in the use of handheld computers for tracking drug supply.

Given his experience and expertise in Africa, we were hoping to tap into his knowledge about
electronic systems and essential drug management in general. It would be good to take advantage of his last couple of weeks with any of your queries.

I will start by asking his opinion on 2 things.
1. I believe that adherence to standard treatment guidelines and documentation of usage is a much better basis for appropriate procurement than reliance solely on computer held or other consumption records.

2. can you share any information about pooled procurement between countries - how it is planned and how it works fnancially and logistically. What are advantages and disadvantages? We are considering some pooled procurement options in Pacific Island Countries where there are enormous problems associated with very small populations (no economy of scale) and huge distances between and within the island countries.

Beverley Snell - Moderator
bev@burnet.edu.au

Bakari is happy to try to answer any of your queries. He set the scene with the following message and he would like to hear from you - ideas or questions.

Equitable healthcare services including access to drugs and medical
supplies are the major function of any healthcare system. Effective
healthcare supply chain systems are reliant on rational drugs
selection, pricing and financing. These are also dependent on other
factors such as health policies, economies as well as political
stability forming a series of interrelated dependencies.

Being a very dynamic area, drugs supply chain management has evolved a
number of challenges that can be categorized regionally depending on
the level of resource availability and technology advancement. While
developed countries have managed to do away with most of these
challenges-including poor health policies, poor logistics
infrastructure and management, political interference poor technology
use, poorly resourced Drugs Regulatory Authorities (DRAs), unqualified
supply chain managers, demand supply imbalances, deficit health budgets
and corruption-most of these are still prevalent in the developing
world.

Some challenges like drug quality issues are general as evidenced by
the number of cases in US, which has a well resourced DRA. For example,
the recent case of Chinese made Heparin blood thinner linked to sixty
two deaths and hundreds of allergic reactions in the U.S. and Germany.

As we globalize supply chains, we will reap the associated benefits
including more pricing competitiveness and economies of scale. However,
it is more likely that more challenges will emerge that require
strategic proactive solutions.

Grass root policies, use of Information Technology, capacity building
and global collaboration including information and experience sharing
through forums like E-drug are currently seen as pragmatic solutions
for mitigating these challenges.

How feasible is Information Technology for drug supply chain management
in politically unstable and under-resourced areas?

What are your thoughts about solutions to current and future challenges to
drugs supply chain management?

What role can global collaboration play in capacity building?

Bakari A. Bakari
Information Systems Manager, Medical Stores Dept.
Ministry of Health and Social Welfare, TANZANIA
Public Health Informatics & Leadership Humphrey Fellow 2007/08
North Carolina University, Chapel Hill, NC AED Satellife Intern May
19-June 13, 2008
Boston, MA 02472-2539
bakari@email.unc.edu

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E-DRUG: For Bakari: Role of IT in counterfeit drug control?
-----------------------------------------------

I would be very interested in Bakari's views on the role of IT in trying to control
counterfeit drugs, whether raw material problems into industry, 'reimportation' into the
the US, or importation into underdeveloped countries?

It would seem to have a major role to play, but what are the challenges that have to
be overcome?

cheers, Billy

Billy Futter
Associate Professor
Faculty of Pharmacy
Rhodes University, Grahamstown, South Africa
email B.Futter@ru.ac.za
phone 046 603 8494
fax 046 636 1205

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E-DRUG: Bakari: treatment guidelines and pooled procurement
------------------------------------------------

Thanks Bev for your stimulating questions. I would like to share with you and the E-drug team that:

1. Much as adherence to standard treatment guidelines and documentation
of usage can serve as a better basis for appropriate procurement, in
developing countries where quality of the later is sometimes
questionable due to various reasons reliance on the same could be
disastrous as one may end up incorrect forecast that can lead into
inappropriate procurement.A combination of all these plus computer held
or other consumption records gives room for easy updation and a more
reliable procurement forecast.

2. I will briefly share a few stuff on pooled procurement and we can
build up from there.
-Works best on a singular/pooled financing setup (i.e donors based
financing) -It is a ideal logistical setup for geographically close
countries
-Works better if countries have similar requirements
-Saves money and reduces supplies lead time due to economies of scale
(i.e pooled bulk purchase cost lower)
-Give room for sharing procurement resources among participating countries

Based on the above (and ofcourse other factors i.e political etc. )the
setup seems most ideal for the small pacific countries in question.
[Thanks Bakari - the Pacific Island Countries (PICs) are considering a model that takes advantages of your points but they need to address the problem associated with the need for re-shipping across many thousands of kilometres from a central destination. It is suggested that suppliers be asked to pack for the individual PICs and send consignments directly. Bev]

Bakari A. Bakari
Information Systems Manager, Medical Stores Dept.
Ministry of Health and Social Welfare, TANZANIA
Public Health Informatics & Leadership Humphrey Fellow 2007/08
North Carolina University, Chapel Hill, NC AED Satellife Intern May
19-June 13, 2008
Boston, MA 02472-2539
bakari@email.unc.edu

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E-DRUG: Soliciting Bakari's input on drug resistance
-----------------------------------------

Bakari very accurately and eloquently describes several of the current
global drug supply chain management challenges which, alongside many
others, we, at the Center for Global Development's Drug Resistance
Working Group (see http://www.cgdev.org/drug_resistance), are seeking to
tackle.

The DRWG seeks to motivate changes in the policies and practices of
global actors that would reduce the drug resistance affecting
high-burden diseases in developing countries, primarily by:

1. Communicating the evidence that drug resistance is an important
global policy priority and articulating a common solution framework
based on the factors driving resistance across diseases;

2. Bringing together and building momentum around the issue among key
global stakeholders across sectors;

3. Identifying core areas for intervention and discussing the set of
incentives, governance capabilities and actions, and financing
mechanisms that could plausibly move the world forward together in the
right direction; and

4. Supporting the launch of (but not directly implementing) immediate
next steps to correct underlying institutional weaknesses and misaligned
incentives and have long-term impact across all diseases and products.

One key component of our ongoing work program is development of a
background paper examining risks and incentives facing different actors
in the product value chain, and testing the implications of changing
incentives through modeling and qualitative research. This paper will
also attempt to address the impediments to past recommendations, seeking
to highlight challenges to implementation of these recommendations and
determining what incentives at which point might have led to larger
impact. As this work moves forward, it will be shared virtually, both
through our website and through a monthly e-newsletter dedicated to drug
resistance and global health (to subscribe, please visit
https://secure2.convio.net/cgdev/site/SPageServer?pagename=register).

We welcome your thoughts and input!

Rachel Nugent
Senior Program Associate for Global Health
Center for Global Development
rnugent@cgdev.org

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E-DRUG: Role of IT in counterfeit drug control? (2)
---------------------------------------

Hi Billy and the E-drug team,

I see the counterfeit/substandard drugs control as more of a moral and
business ethics issue that needs to be addressed at that level by
bringing awareness on the corporate & sectoral effects and the fact
that business entities needs to act responsibly and accountably as
provided in the international business charters.

Associated stern legal measures against the culprits (individuals &
companies) that include exclusion, forefeight and closure are seen to
be deterrent for the business concerns.

At some point political intervention is required especially where the
practise seem to be 'state' organized.

IT remains as a support tool that can works well together with other
systems- Ref. the Chinese Heparin that filtered through hight tech
US-FDA.

Bakari
c/- e-drug@healthnet.org
bakari@email.unc.edu
[The Rapid Alert system based at WHO WPRO is an IT support for combatting counterfeit drugs
http://www.counterfeitmedalert.info BS}

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E-DRUG: For Bakari & others: Bhutan Drugs Supply Chain Management Challenges
---------------------------------------------------------------

Dear all,

Just sharing some experience from Bhutan.

In Bhutan, drug supply management has alsways posed a
great challenge to the health sector. The country's policy
of free health care services including provision of
essential drugs has, in the recent time, raised concerns
about sustainability with increasing drug costs and
emerging new diseases.

Although procurement is limited to the Essential Drugs
List (EDL) and guided by the National drug Policy, meeting
the health care needs of the entire population within the
given limited resources has been a major challenge. This
is further confounded by the fact that Bhutan does not
have any drug testing facility in the country and the DRA
was only recent established in 2004, thus raising concerns
of quality of drugs procured.

Being a small landlocked country, with difficult terrain
wherein most of the primary health care centres are not
accessible by road, distribution of drugs, which is also
done centrally, has not been an easy task. What Bhutan has
hopes to achieve in the coming years is the use of IT
facilities for effective management of medical supplies. A
computerised inventory system is under development
presently which will link the central procurement agency
with all the health centres for effective monitoring of
medical supplies thus reducing problems of stock-outs and
wastages. How user-friendly and practically feasible this
system will be can only be known once tested and tried.

Manusika Rai
EDP Program Manager

Essential Drugs Program
Ministry of Health
Bhutan
"Essential Drugs Programme" <edp@druknet.bt>