global financing facility (gff) in support of every woman every child workshop – day 4 –...

RMNCHStrategy and Coordination Team

RMNCH

STRENGTHENING INVESTMENT CASES

GFF COMMODITIES CLINIC

NOVEMBER 2015

Country Plans benefit from global and regional efforts

• Many issues require cross-country efforts

• Global Actions:

• Science/guidelines

• Price reductions

• Market shaping

• Innovation

• Regional Actions

• Quality control

• Regulatory Harmonization

• Private sector

Commodities and Innovation – identified as a global public goods in the GFF Business Plan

Commodities as ‘Global Public Goods’ to support RMNCAH Plans

Overview

1. UN Commission on Life Saving Commodities

2. How can a ‘commodity-lens’ inform GFF Investment Cases

Overview

Commodities as ‘tracers’ for health systems

1. Shaping global market2. Shaping local delivery markets3. Innovative Financing4. Quality strengthening5. Regulation efficiency 6. Supply and awareness7. Demand and utilization8. Reaching women and children9. Performance and accountability10. Product innovation

Reproductive health

Female CondomsImplantsEmergency Contraception

Maternal Health Oxytocin Misoprostol Magnesium sulfate

Newborn Health Injectable antibiotics Antenatal CorticosteroidChlorhexidineResuscitation Equip.

Child Health AmoxicillinOral Rehydration SaltsZinc

Accelerate achievement of

MDGs 4 & 5

Activities undertaken to implement the UNCoLSC mandate

• Identify bottlenecks across the commodity continuumRMNCH

Landscape Synthesis

Country engagement

Global and Regional support

• Country-driven efforts to address bottlenecks

• Technical Resource Teams: Coordinated efforts to address cross-cutting challenges


Existing data to identify commodity and system bottlenecks

Summary Report and Dashboard

Document Review

Expert Interviews

(MOH databases)

HMIS / LMIS Health Facility Assessments(e.g. SARA, SPA)

Household Surveys (e.g.

DHS, MICS)

(Routine, Monthly)

(2-3 years)

(3-5 years)

(Ad hoc)

(Ad hoc)

LANDSCAPE SYNTHESIS

(annual)


Commodities as ‘tracers’ for the health system

Manufacture Coverage

Systems bottlenecks

Coordinating syste

ms

National plans

Procurement

Supply c

hain

Regulatory

system

Private se

ctor

Quality co

ntrol

CommodityBottlenecks

EML

Procurement

National st

ockFa

cility

stock

Health w

orker p

erform

ance

Remove ac

cess

barriers

Guidelines

Demand generati

on

Commodity ‘pathway’



Landscape Synthesis

Country engagement




Since end 2013, the RMNCH Fund is supporting 19 countries

DRCNigeria

EthiopiaTanzania

KenyaMalawiUgandaSenegal

MozambiqueCameroon

PakistanAfghanistan

ZambiaNiger

Burkina FasoSierra Leone

BeninMali

Bangladesh0.7

3.5

4.0

4.8

5.1

1.8

7.0

7.7

7.9

8.0

8.1

5.5

3.9

3.9

14.8

4.0

3.5

10.3

3.4

5.044

5

7

7.6

12

20

15

22.8

3 countries in Asia receiving RMNCH Fund grant:• Afghanistan• Bangladesh• Pakistan

16 Countries in sub-Saharan Africa

Geographical distribution of country financing requests (N = 19)

Approved budgets from country financing requests (100%= US$204m)

Global Technical Resource Teams 14.9 8.6

Initial financingFollow-on financing


UNCoLSC Recommendation

# Countries(Total = 18) Selected examples Budget

Mapping of market size and manufacturing capacitySupporting local manufacturers with new product introduction

$0.9 m (0.5%)2. Shaping local delivery markets

3

RBF strategies implemented/planned $3.0 m (1.8%)3. Innovative financing

6

District level quantification, m-Health tools for stock monitoring, integrated LMIS systems, Commodity purchase

$52.7m (30.6%)6. Supply and awareness

18

Update of EMLs, treatment guidelines with LSCs5. Regulatory

efficiency9 $4.5 m (2.6%)

Community mobilization, advocacy efforts, printing and dissemination of media materials

7. Demand and utilization

17 $20.9 m (12.2%)

Maternal health vouchers, Telecommunication-availing toll free numbers for calls to ambulance

8. Reaching women & children

6 $2.6 m (1.5%)

Innovative ways to package products- Zinc & ORS, misoprostol, magnesium sulfate

10.Product innovation

3 $0.3 m (0.2%)

Prequalification of new products by reg. agencies, building post market surveillance capacity, training drug inspectors

4. Quality strengthening

8 $1.3 m (0.8%)

Staffing, training, mentorship and support supervision, Development of job aids, checklists across countries

9. Performance and accountability

18 $86.1 m (49.9%)

Country plans address the UNCoLSC recommendations



Landscape Synthesis

Country engagement




9 Technical Resource Teams: 85 organizations, 450 experts

N

R

C

M

GLOBAL REGULATION, MARKETS AND POLICY

SUPPLY CHAIN

DEMAND, ACCESS AND PERFORMANCE

Scientific and technical guidance Manufacturers identifiedNew product innovation

• Price reductions• Local manufacturing• EMLs and treatment

guidelines• WHO Pre-qualification• Fast-track registration • Post-market survey• Pharmaco-vigilance

• Best-practice materials

• ICT innovations• Forecasting• Commodity security

strategies

• Demand generation tool-kits• Financial access barriers• Procurement support• Health worker job-aids,

check-lists and training materials

RMNCH COMMODITY TRTs

ADVOCACY TRTAdvocacy tool-kit

DIGITAL HEALTH TRTInventory of e-and m-Health tools


Overview


2. How can a ‘commodity-lens’ inform GFF Investment Cases• Implantable Contraceptives• Country Planning

Post 2012 efforts to enhance access to implantable contraceptives

Family Planning 2020 (2012)

UN Commission on Life Saving Commodities (2012)

Implant Access Program (2013)• Price reductions by 50% over six years

• Volume guarantees 7.7 million implants procured in 2014; 3-fold increase from 2011

Global Program to Enhance Reproductive Health Commodity Security (UNFPA)

• Policy efforts, training, commodity procurement and demand generation support to 46 countries

Have global efforts increased utilization of contraceptive implants?

Coverage gains: 4-fold increase since 2012 – where are the bottlenecks?

Kenya (2008-09, 2014)

Malawi (2010, 2014)

Ethiopia (2011, 2014)

Uganda (2011, 2015)

Senegal (2010-11, 2014)

Mali (2006, 2012-13)

Cameroon (2011, 2014)

Nigeria (2008, 2013)

Average

0% 2% 4% 6% 8% 10% 12%

1.9%

1.3%

3.4%

2.7%

1.1%

0.1%

0.7%

0.0%

1.4%

10.8%

9.4%

7.2%

4.9%

4.8%

2.5%

1.3%

0.4%

5.2%

Post-2012 Pre-2012Sources: DHS, MICS surveys

UNCoLSC RECOMMENDATION AREA INDICATOR

RMNCH CoordinationCoordination mechanism exists RMNCH plan costed and budgetedCommodity security strategy robust

Innovative financing Results-based financing includes family planning

Regulatory Efficiency

Implants on National Essential Medicines List National treatment guidelines for implantsImplants Registered in-country Prescription authority for implants clearly defined

Quality StrengtheningProcure from GMP-accredited manufacturers National medicines control laboratory functionalMonitoring quality and safety of medicines

Supply and Awareness

Forecasting Tools utilizedComprehensive national LMIS for all commoditiesSupply chain training extends to districtsImplants tracked in LMIS No national stock-outs of implants% facilities with implants available

Health Worker Performance and accountability

Training curricula exist for implants (national)% facilities with recent staff training on implantsJob aids or check lists for implants (national) % facilities with job aids or check lists for implants

Demand & UtilizationDemand Generation included in national planNo user fees for implants including insertion/removalImplant utilization routinely tracked in HMIS

CommodityPathway


Rating Indicator Performance (Weakest ‘1’ to ‘5’ Strongest)

18

1 Very Weak

2 Weak

3 Moderate

4 Strong

5 Very Strong

Qualitative indicator ex: “RMNCH Plan Costed and Budgeted”

• RMNCH plan exists at national level only

• No RMNCH plan exists; needs to be developed

• RMNCH plan exists at national and sub-national levels and/or includes intervention costs for implementation

• RMNCH plan exists at national and sub-national levels and includes costs for implementation with associated funding sources

• RMNCH plan exists at national and sub-national levels, includes costs for implementation with associated funding sources, and includes high-impact interventions


Rating Indicator Performance (Weakest ‘1’ to ‘5’ Strongest)

19

1 Very Weak

2 Weak

3 Moderate

4 Strong

5 Very Strong

Continuous variable ex: “Stock available to Point-of-Service”

• 60-69% stock availability at point-of-service (e.g. health facility)

• <60% stock availability at point-of-service (e.g. health facility)



• >= 90% stock availability at point-of-service (e.g. health facility)


Single-Country dashboard to identify specific bottlenecks

20


Multi-country dashboard to identify cross-cutting issues

21

Coordination mechanismRMNCH plan costed and budgeted

Commodity security strategyResults-based financing mechanism

National EMLNational treatment guidelines

Registered in-countryPrescription authority

Procure GMP-accredited manufurersNational medicines control lab

Monitoring quality and safety of medicinesForecasting tools

Comprehensive national eLMISSupply chain training to districts

Tracked in eLMISNo national stock-outs% POS stock available

Training curricula (national)% facilities with recent training

Job aids or check lists (national)% facilities with Job aids / check list

Demand generationPolicy against user fees

Service utilization routinely tracked

I.F.

Qua

lity

HR

Perf

orm

ance

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

20%

50%

71%

70%

30%

30%

40%

30%

22%

30%

56%

30%

88%

30%

38%

11%

50%

30%

100%

30%

57%

50%

50%

14%

All countries at least one affected area

if < 80% stock

Commodity and systems-related bottlenecks – 10 countries


Overview


2. How can a ‘commodity-lens’ inform GFF Investment Cases• Implantable Contraceptives• Country Planning


Averag

e Ratin

g

Nationa

l EML

Nationa

l treat

ment gu

idelines

Registe

red in-

country

Prescr

iption

author

ity

Tracke

d in eL

MIS

No nat

ional st

ock- ou

ts

Stock

availab

le at P

oint- of

-Servic

e [B]

Trainin

g curri

cula (na

tional)

Recent

trainin

g at Fa

cilities

[B]

J ob aid

s or ch

eck list

s (natio

nal)

J ob aid

s / ch

eck list

at Fac

ilities [B

]

Policy

against

user f

ees

Service

Utiliza

tion rou

tinely t

racked

Covera

ge rate

[B]

3.5 4.7 4.2 5.0 4.8 1.0 4.2 1.5 3.9 3.0 4.4 3.5 5.0 1.3 1.8

Female Condom 3.6 5 3 n/a 3 1 5 1 3 3 5 4 5 5

Implant 3.4 5 3 5 5 1 5 1 3 3 5 4 5 1 1

Emergency contraceptive 3.6 5 5 5 5 1 5 2 3 3 5 4 5 1 1

Oxytocin 3.8 5 5 5 5 1 5 1 5 3 5 3 5 1

Misoprostol 3.5 5 5 5 5 1 1 1 5 3 5 3 5 1

Magnesium Sulfate 3.8 5 5 5 5 1 5 1 5 3 5 3 5 1

Injectable Antibiotic 3.4 3 5 5 5 1 5 2 3 3 3 5 1

Antenatal Corticosteriod 3.3 5 3 5 5 1 5 1 3 3 3 5 1

Chlorhexidine 3.2 5 1 n/a 5 3 3 3 3 5 1

Neonatal Resuscitation 2.8 n/a 5 n/a 5 1 1 1 3 3 3 5 1

Amoxicillin 3.8 5 5 5 5 1 5 1 5 3 5 5 1 3

ORS 3.8 5 5 5 5 1 3 5 3 5 5 1 3

Zinc 3.4 3 5 5 5 1 2 5 3 5 5 1 1

Child

Average Rating:

Repr

oduc

tive

Mat

erna

lN

ewbo

rn

RMNCH lansdscape results help identify commodity bottlenecks

• National treatment guidelines on select commodities need further development • While there have been few national stock-outs in last year, stock availability is low and eLMIS requires some attention • RMNCH in-service training curricula should be expanded • Lacking data on the availability of newborn and child health job aids at facility level• Data gaps in terms of service utilization, coverage of MNH commodities and female condoms


Systems-related bottlenecks and change over time

Domestic and international procurement from Good Manufacturing Practice (GMP) accredited manufacturers

25

No unified RMNCH commodity security strategy (FP strategy is in use but expired)

National coordination mechanism exists, chaired by MoH

National eLMIS exists for select commodities

Category IndicatorRating (2013)

Rating (2015)

Coordination

Coordination mechanism 4 5

RMNCH plan costed and budgeted 4 3

Commodity security strategy n/a 3

Innovative Finance Results-based financing mechanism 3 3

Quality

Procurement from GMP- accredited manufacturers n/a 5

National medicines control lab 3 4

Monitor quality & safety of medicines 4 4

Supply

Forecasting tools 3 2

Comprehensive national eLMIS n/a 3

Supply chain training to districts 5 4

Demand & Access Demand generation 3 3


Cross country comparisons on key performance indicators26

<<< Below Average Above >>>

National EML

National treatment guidelines

Registered in-country

Prescription authority

Tracked in eLMIS

National stock-outs

% POS with stock available

Training curricula (national)

% facilities with recent training

Job aids or check lists (national)

% facilities with job aids or check lists

Policy against user fees

Service Utilization routinely tracked

Coverage rate

Average

Supp

lyD

eman

d &

Acc

ess

(2.00) (1.50) (1.00) (0.50) - 0.50 1.00 1.50 2.00

Population

Regulatory Efficiency Supply & AwarenessPerformance and Accountability

Reaching Women & Children

Supply & AwarenessPerformance and Accountability

Demand & Utilization

- National EML- National treatment guidel i nes- Registered in-country- Pres cription authori ty

- Tra cked in eLMIS- National l evel s tock-outs

- Trai ni ng Curriculum- Job ai ds or checkl is ts

- Pol icy agai ns t user fees

- Stock out in heal th faci l ities

- Recent tra ining at faci l iti es- Job a ids or checkl ists at fa ci l ities

- Coverage rates

Female Condom 3 / 12 7 / 12 5 / 12 6 / 12 7 / 10 9 / 10 10 / 10Implant 6 / 12 4 / 12 5 / 12 6 / 12 6 / 10 9 / 10 12 / 12Emergency contraceptive 7 / 12 6 / 12 5 / 12 6 / 12 6 / 9 9 / 10 3 / 3

Oxytocin 2 / 12 5 / 12 3 / 12 6 / 12 4 / 11 10 / 10 No dataMisoprostol 7 / 12 6 / 10 3 / 12 6 / 12 9 / 9 10 / 10 No dataMagnesium Sulfate 6 / 12 7 / 12 3 / 12 6 / 12 7 / 11 10 / 10 No data

Injectable antibiotic 6 / 12 6 / 12 7 / 12 6 / 12 5 / 10 7 / 7 No dataAntenatal Steriod 10 / 12 6 / 11 7 / 12 6 / 12 6 / 9 7 / 7 No dataChlorhexidine 9 / 12 5 / 9 7 / 12 6 / 12 3 / 3 7 / 7 No dataNeonatal Resuscitation 2 / 12 7 / 9 7 / 12 6 / 12 1 / 2 7 / 7 No data

Amoxicillin 9 / 12 7 / 10 0 / 12 6 / 12 6 / 9 4 / 5 10 / 10ORS 3 / 12 6 / 11 0 / 12 6 / 12 2 / 6 4 / 5 8 / 12Zinc 7 / 12 7 / 11 0 / 12 6 / 12 4 / 5 4 / 5 9 / 9

RMNCH Coordination Innovative Financing Supply & Awareness Quality Strengthening Demand & Utilization

- Coordination mechanis m- RMNCH plan costed and budgeted- Commodity securi ty strategy

- Resul ts-based fi nanci ng mechanis m

- Forecasting tools- Comprehensi ve na tional eLMIS- Supply chain training to di stricts

- Procure GMP-accredi ted manuf.- National medici nes control lab- Medicine qual ity - Pati ent s afety

- Dema nd generation

10 / 12 8 / 12 11 / 12 11 / 12 4 / 12

Systems-related indicators: National-level Bottlenecks

Commodityby RMNC Service Area

Commodity-related indicators: National-level Bottlenecks Facility-level Bottlenecks

Legend: % of countries with bottlenecks

<= 20%

21-40%

41-60%

61-80%

81-100%

No da ta

12 country assessment of commodity-related bottlenecks

40% of essential commodities out of stock (12 countries)

SERVICE AREA COMMODITY Ca

mer

oon

DRC

Ethi

opia

Keny

a

Mal

i

Mal

awi

Nig

eria

Sene

gal

Sier

ra Le

one

Tanz

ania

Uga

nda

Zam

bia

Female Condom 66% 58% 93% 80% 74% 25% 10% 12% 12% 89% 52%Implant 46% 78% 22% 25% 63% 11% 6% 4% 20% 71% 35%Emergency contraceptives 71% 87% 31% 15% 20% 15% 86% 27% 36% 43%Oxytocin 9% 10% 3% 49% 5% 16% 22% 18% 6% 50% 23% 19%Misoprostol 71% 21% 90% 89% 84% 99% 65% 55% 85% 73%Magnesium Sulfate 49% 78% 11% 74% 15% 49% 65% 14% 11% 67% 68% 46%Injectable antibiotics 8% 3% 47% 9% 18% 47% 15% 28% 31% 73% 28%Antenatal Steroids 7% 11% 8% 84% 84% 42% 96% 42% 76% 50%Chlorhexidine 64% 51% 25% 47%Neonatal Resuscitation 11% 91% 51%Amoxicillin 16% 31% 24% 48% 47% 21% 72% 8% 33%ORS 26% 9% 10% 13% 21% 5% 14%Zinc 37% 24% 19% 46% 31% 31%TOTAL AVERAGE 46% 43% 24% 51% 69% 30% 30% 53% 26% 26% 57% 35% 40%

Average

Reproductive

Maternal

Newborn

Child

Global partnerships to improve regulatory efficiency and quality

Country Activities:

• Update and align Essential Medicines Lists and Treatment Guidelines

GLOBAL REGULATION MARKETS & POLICY TRT• WHO Fast-Track Registration Process• Regional efforts to harmonize guidelines• Joint manufacturer inspections• Support to local manufacturers

• GMP certification• Active Pharmaceutical Ingredient

• Market shaping activities• Negotiate price reductions on products

• Implants, NB Resuscitation devices• Model ‘pharmacovigilance programs’• Post-market surveillance support

Supply Chain remains a critical challenge in most countries

Country Activities: • Quantification workshops held for life saving commodities• Supervision and health worker training on stock

management• Mobile phone tracking systems for stock-outs• Procure transport and IT equipment

SUPPLY CHAIN TRT• Support for integrating Logistics and Health Management

Information Systems• Assistance with developing medium-term commodity

security strategies• Forecasting algorithms for essential commodities• Support for developing supply chain training and quality

improvement programs• Interagency Supply Chain Group

• KPIs• Reduce fragmentation

• Revolving commodity procurement fund

Job-aids/check-lists can strengthen the performance of health workers

Country Activities: • Health worker training

• Facility: Newborn care, misoprostol, implantable contraceptives

• Integrated community case management for CHWs

HEALTH WORKER PERFORMANCE TRT

Integrated demand generation strategies for commodities/services

Country Activities: • Develop messaging materials for pneumonia

recognition, female condoms, emergency contraception

• Community awareness raising activities – child survival days

• KAP surveys

DEMAND GENERATION TRT• Integrated tool kit to

support demand generation activities• Latest best-practice• Step-by-step

implementation guide


Advocacy tool-kit: enhancing civil society involvement in RMNCAH

• Package of materials and guidance for civil society

• Messages to inform relevant audiences about RMNCH commodities and services

• Examples to use with relevant decision makers and stakeholders

• Links to wider global advocacy initiatives• EWEC, PMNCH, FP2020

• Adaptable tools:Policy brief templatePress release templateLetter of support templateAdvocacy strategy development template


www.lifesavingcommodities.org

Knowledge repository available to all

• The commodity-lens can inform and strengthen RMNCAH Plans

• Landscape Synthesis• Use existing data to identify key bottlenecks• Track progress over time• Compare information across countries• Identify cross-cutting areas where additional global and

regional efforts are required

• Technical and programmatic resources are available to support countries

• Require communication and coordination• Country platforms as the entry point

Summary

global financing facility (gff) in support of every woman every child workshop – day 4 –...

Healthcare