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8 Confronting Challenges to the Supply Chain for SecondLine Drugs
8 Confronting Challenges to the Supply Chain for SecondLine Drugs
Pages 99-112
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From page 99... ...
• armonizing quality standards and treatment regimens could at H tract additional suppliers of second-line drugs, create competition, and reduce prices. • t could be beneficial to quantify the risks associated with supplying I second-line drugs through more effective forecasting, aggregated to reduce country-by-country exposure of suppliers to risk and shared among countries to create a transnational market for these drugs.
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From page 100... ...
Less risk is associated with overstocking firstline than second-line drugs because the former are relatively inexpensive, noted Prashant Yadav, Senior Research Fellow, and Director of Healthcare Research, William Davidson Institute, University of Michigan. For secondline drugs, overstocking can waste scarce financial resources that could otherwise be used for expanding MDR TB programs.
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From page 101... ...
If a country anticipates a short-term gap in financing that will lead to a stockout in the national program, it can secure bridge financing until the funds become available. Long Lead Times and Delays in Procurement Most second-line drug manufacturers employ make-to-order production -- they do not start production until final purchase orders are received.
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From page 102... ...
Weak Distribution Infrastructure The distribution infrastructure for second-line drugs often is skeletal, and logistics management information systems (LMIS) beyond the district or state level often are weak.
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From page 103... ...
Yadav cited two examples from the retail industry that could hold potential for improving the efficiency and effectiveness of the second-line drug supply chain. First, consumption data from the point of sale are embedded into the planning process at every level of the retail supply chain.
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From page 104... ...
The need for second-line drugs can be expected to increase accordingly. Funding for second-line drugs in India has come from the Global Fund Rolling Con tinuation Channel (RCC)
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From page 105... ...
To counter delays in the provision of second-line drugs, the RNTCP procures drugs through two independent sources. For states funded by the Global Fund, the drugs are procured through the GDF by the IDA Foundation after approval from the GLC.
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From page 106... ...
For states funded by the Global Fund, drugs are procured only from suppliers prequalified by WHO, so that high quality standards are maintained. For states funded by the World Bank, drugs are procured through international competitive bidding, with procurement restricted to suppliers compliant with WHO-Good Manufacturing Practice (GMP)
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From page 107... ...
Finally, I Singh cited a case in which the Clinton Health Access Initia 3This section is based on the presentation of Inder Singh, Executive Vice President of Access Programs, Clinton Health Access Initiative.
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From page 108... ...
MOVING TOWARD A FUNCTIONAL MARKET FOR SECOND-LINE TB DRUGS4 Owen Robinson, Partnerships Manager, Mirebalais National Teaching Hospital, Partners In Health, discussed the relationship between management of MDR TB drugs and a strong, quality-assured drug marketplace. A strong drug management strategy can manage risk, lower price, and increase availability, but such a strategy must be global in scope, he said.
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From page 109... ...
Key requirements for aggregating risk include a centralized aggregating entity; a credible global forecasting mechanism marked by two-way information flows; and a virtual rotating stockpile, in which one country can shift its supplies to another if it does not meet its projections for drug consumption. This approach relies on coordination among countries rather than centralized control of drug procurement.
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From page 110... ...
Robinson pointed to an analysis of first-line drugs conducted by the Clinton Health Access Initiative that found that countries procured prequalified drugs only when they were forced to work through the GDF mecha
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From page 111... ...
Consolidating demand around a single quality standard would integrate the market, said Saxena, which should improve lead times dramatically. Nigorsulton Muzafarova, GDF, WHO Regional Office for Southeast Asia, cited the general scarcity of APIs for second-line drugs discussed by Yadav in his presentation -- a major issue for producers of second-line drugs.
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From page 112... ...
• Aggregating risk by global ordering, rather than country-by-country ordering, would improve the supply chain as part of a global archi tecture that would innovate drug procurement procedures. • A virtual rotating stockpile may help prevent stockouts.
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