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Intra- and inter-organizational collaboration in disaster planning and long term humanitarian aid
Perspectives from the architecture for financing global health
Georgia Tech Humanitarian ConferenceFeb 19-20, 2009
Atlanta, GA
Prashant Yadav
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
Background
Around 10 million children under the age of five die due to lack of access to simple and affordable interventions (WHO 2008).
Over 40,000 people – many of them children – die every day in developing countries from infectious or parasitic diseases
It is estimated (WHO 1998, WHO 2004) that almost one-third of the world’s population does not have access to essential medicines.
In addition to this, each year, personal expenditures on health push more than 100 million people below the poverty line (Xu 2007)
Many could be saved by access to already developed drugs and vaccines
Over $10B is spent annually by international organizations on global health commodities and programs
A large number of organizations and thus a very complex architecture is used to finance drugs, vaccines and health commodities for low income and lead developed countries
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
$10B of annual global health commodities: procurement and financing envelopes
• Product
• ARVs
• Vaccines
• Malaria
• TB drugs
International Procurement structure
• GAVI and UNICEF
• AMFm (under development)
• WHO M2S2• UNICEF
• GDF• GLC
• MoH procurement
Major Financing
• SCMS• CHAI
• US-PEPFAR • Global Fund• UNITAID
• GAVI, UNICEF, BMGF, IFFImOthers
• Global Fund• WB Malaria Booster• UNITAID• US-PMI
N.B: Representative but not necessarily comprehensive
• Essential drugs• National
Governments• Health basket
funding from bilaterals
• Global Fund• UNITAID
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
End patients
Drug Manufacturers
PrivateChannel Buyers
PublicChannel Buyers
NGOChannel Buyers
NGOs
International Financing
Public Sector
Private Sector
How international global health financing flows to low income countries (1)
Slide template borrowed from Dalberg Global Development Advisors- AMFm RBM Task Force Presentation
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
End patients
Drug Manufacturers
PrivateChannel Buyers
PublicChannel Buyers
NGOChannel Buyers
NGOs
International Financing
Public Sector
Private Sector
How international global health financing flows to low income countries (2)
Slide template borrowed from Dalberg Global Development Advisors- AMFm RBM Task Force Presentation
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
Paris declaration and donor coordinationRecommends use of in-country procurement systems instead of
purchasing on behalf of countries
Source: OECD
Example: Financing flow for drugs and health commodities in Zambia
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
Drugs flow supply chain in Zambia
Source Of Funds
Procurement Agent/Body
Point of first warehousing
Point of 2nd
warehousing
Point of 3th warehousing
WORLD
BANK
PEPFAR
DFID
USAID
UNICEF
WHO
CHAZ
ZANARA
CHAI
JICA
WORLDVISION
UNFPA
ZABART
ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs
Ped
REAGENT Blood safety(+ test HIV)
VACCINES CONDOMS Contraceptives MEDICALSupplies
Category of
Products Color
UNICEF
C
H
A
SOC-FH
BOSTON
UNIVERSITY
UNFPA
CIDRZ
ZABART
CARE
Malaria Centre CAREPROVINCIAL STOREDISTRICT STORE
PROV. STORES
DISTRICT STORES
HEALTH FACILITY DISTRICT STORE
HF
GOVERNMENT
BILATERAL DONOR
MULTILATERAL DONOR
NGO/PRIVATE
JICA
BGATES
M
O
H
C
M
S
WORLDVISION WORLD
BANK
USAID
MOH CMSZAMBARTSTORE
CRS
DS
ITN
PATIENT
CHASTORE
CIDRZSTORE
HF
HEALTH FACILITY
AXIOS
HF
UNITAID
GLOBALFUND
CDC
GLASER
M
O
H
CLINTON
HC
HOME BASED CARE
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
Multi-donor coordination in the in-country drug supply chain in Zambia
Donors (CPs)
National Medical Stores
Pharmacy Unit
Finance and Accounts Unit
Drug Supply Budget Line (DSBL)
Procurement and Supply
Unit
MoH
$$ Funds CommittedDisbursement Plan
Purchasing restrictions
Projected RequirementsPlanned vs. Actual Stock Levels
Drug SelectionQuantification
Funds release schedule from MoF/MoHPayment terms etc.
Coordinated Funds to Needs Matching
Procurement Plan and Budget
Source: Fundafunda and Yadav 2008, Matching Demand and Supply for Pharmaceuticals in a Multi-DonorEnvironment: The Drug Supply Budget Line (DSBL) in Zambia
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
A donor coordinated pledge guarantee (PG) mechanism can provide bridge financing and decrease procurement delays (and hence stockouts)
Pledge Guarantee (PG) mechanism
Donor CountryManufacturers1
Donor makes pledge
2Country request
mechanism to cover product cost
3
PG verifies pledge with donor and establishes
MOU
4 Country procures through existing process
5Mechanism pays manufacturer or
procurement agent
6Manufacturer ships product to country
7
Donor pays the mechanism
(1) Could also be accessed by NGO or UNFPASource: Existing McKinsey and JSI Deliver analysis; Dalberg analysis
Source: Work with Dalberg Global Development Advisor for RHSC
Forecast Driven
Drug Substance Manufacturing
Current Push-Pull Boundary in Global Health Supply Chains
Co-formulating and Packaging
Pre-delivery Inspection
Shipping and Transport
Drug SubstanceInventory
Final ProductInventory
Order Driven
Inventory /Order Interface
Source : Yadav, Sekhri and Curtis (2006)
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Yadav . Georgia Tech Humanitarian Conference, Feb 19,2009
Inter-organizational coordination and risk sharing can shift the push-pull boundary
Source: Existing McKinsey and JSI Deliver analysis; Dalberg analysis
Minimum VolumeGuarantee Institution
Country ManufacturersDonor
1
Donors and countries estimate annual purchasing volume for
specified products
2
MVG decides on volume of product and amount of
risk to assume
Establishes master contractswith manufacturer based on
volume / risk tolerance
3Countries and/or donors each place individual orders under
master contract
4
Manufacturer ships products directly to
countries
5
Manufacturer informs MVG of unused volume
Secondary Markets?
6
Sale or storage of unused product; potentially waste
Joint work with Dalberg Global Development Advisors
Forecast Driven
Drug Substance Manufacturing
Shifted Push Pull Boundary in Global Health Supply Chains
Co-formulating and Packaging
Pre-delivery Inspection
Shipping and Transport
Drug SubstanceInventory
Final ProductInventory
Order Driven
Inventory /Order Interface
Source : Yadav, Sekhri and Curtis (2006)
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