Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis Workshop Summary (2013) / Chapter Skim
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3 Financing of MDR TB SLDs
3 Financing of MDR TB SLDs
Pages 67-92
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From page 67... ...
During the workshop, speakers and participants from organizations that provide funding for SLDs described challenges and barriers that their respective organizations have faced in funding MDR TB and explained some of the funding strategies that they have used to address those issues. USAID's Funding Perspective1 Cheri Vincent, TB Team Leader, USAID, described SLD supply chain challenges from the perspective of USAID.
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From page 68... ...
An analysis of a randomly selected set of countries that compared the number of available Global Fund or UNITAID SLD treatment regimens to the number of MDR TB patients enrolled in 20113 revealed that only 39 percent of the available funds were actually used by countries for MDR TB treatment regimens. In other words, of the selected countries, only 30 percent met their planned MDR TB treatment objectives.
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From page 69... ...
USAID's Approach Vincent described USAID's three-pronged approach for making affordable, quality SLDs available around the world. The first approach is to improve and expand the global SLD supply chain, which mainly involves • coordinating with GDF4 and other partners on SLD SCM at the global level; • improving procurement procedures; • harmonizing treatment regimens; and • improving the data on SLD needs.
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She maintained that because the Global Fund is the major donor for SLD procurement outside of countries' direct procurement, it needs a restructured focus with new procedures and processes put into place. Vincent suggested that there is a need for four interventions that the Global Fund and others should support through GDF, including 1.
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From page 71... ...
, and that countries need intensified support and capacity building to scale up. Perspective from BMGF7 Michael Kimerling, Senior Program Officer, Tuberculosis Global Health Program, BMGF, described two key challenges related to the overfragmentation of the market at multiple levels.
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Currently, there are three key funders in the MDR TB space: Global Fund, UNITAID, and individual governments. He suggested interacting directly with those governments that are developing economically and have their own resources and health budgets that could potentially be combined with funding organizations in an innovative way.
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Presentation at IOM workshop on Developing and Strengthening the Global Supply Chain for SecondLine Drugs for Multidrug-Resistant Tuberculosis.
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and that the organization then spends those funds in an innovative way. Innovative Funding Mechanism The air ticket funding mechanism involves application of progressive levies10 to all flights departing from contributing countries, levies from 9 of which represent 80 percent of UNITAID's funding11 (the other 20 percent comes from various sources12)
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Manufacturers' confidence in the market was bolstered by UNITAID's coming to the table with a large pool of funding and resources, which resulted in successful price negotiations, improved price transparency, and development of new formulations. Procurement was innovative despite institutional constraints similar to those in the MDR TB supply chain.
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Next, Nina 14 Thissubsection is based on the presentations by David Ferreira, Managing Director for Innovative Finance, and Head of the Washington, DC, Office, GAVI; and Nina Schwalbe, Managing Director, Policy and Performance, GAVI. 15 Among the partners are multilateral agencies, BMGF, developing country governments, donor country governments, civil society organizations, research institutes, and the vaccine industry.
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was created to present a feasible, sustainable, and attractive market for producers. The AMC is essentially a long-term secure contract; manufacturers are offered a donor-funded16 price guarantee and purchase commitment as a supply incentive to develop new formulations according to stringent quality standards.
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to balance supply and demand to ensure sufficient uninterrupted market supply; (2) to control vaccine prices to minimize costs to GAVI and beneficiary countries; and (3)
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Factors that influence GAVI's decisions about potential market-shaping interventions include the production complexity of vaccines (which has some similarities with MDR TB injectables) , the market environment, and GAVI's relative market power.
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Supply Chain Management System21 SCMS Objectives PEPFAR/USAID's SCMS was mandated to establish and operate a safe, secure, reliable, and sustainable supply chain and to develop countrylevel self-sustaining supply chain skills and capabilities. Gordon Comstock, Director, Global Supply Chain, Partnership for Supply Chain Management, 21 This subsection is based on the presentation by Gordon Comstock, Director, Global Supply Chain, Partnership for Supply Chain Management.
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SCMS was designed to eliminate supply chain barriers, stockouts, and overstocks by integrating the supply chain's four key levers: 1. Financial structure enables continuous product supply by pooling procurement through a USAID working capital fund.
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Pooled Procurement The in-country SCMS supply chain model aligns with health care services and strengthens national systemic infrastructure. It seeks to balance country ownership and pooled procurement through a national– organizational partnership.
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Presentation at IOM workshop on Developing and Strengthening the Global 3-2 Figure Supply Chain for Second-Line Drugs for Multidrug Mostly bitmapped Resistant Tuberculosis, based on presentation to Global Fund Market Dynamics Committee by Results for Development Institute, March 28, 2011. CHAI's Model for Improved Access to Pediatric HIV Treatment23 David Ripin, CHAI, recounted several procurement challenges faced by CHAI's UNITAID-funded project to scale up and catalyze the market for pediatric HIV treatment.
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From page 84... ...
The result was greater access to low-volume products, lower risk of stock-outs, and more consistent lead times. Feedback from suppliers indicated that they preferred tendering practices that split supply across more than one supplier in a predictable manner to allow higher confidence in allocating production capacity.
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Tender Splitting to Aid Market Entry Ripin explained that minimum batch sizing is a particularly crucial barrier in the pediatric HIV market (as it is for MDR TB) , both for new products and for suppliers seeking to enter the market.
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Presentation at IOM workshop on Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis. Figure 3-3 combination therapies, or ACTs)
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As a possible alternative, he suggested taking advantage of and improving existing drug distribution systems in-country. Other efforts are under way to gather information and initiate improvements in the operation of the SLD supply chain, and workshop participants discussed these related efforts and their goals (Box 3-1)
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. Vision: All people with MDR TB are able to access affordable, quality-assured treatment within a sustainable MDR TB drug market Increased Affordability of Increased Supply of IQA Greater Operational GOALS IQA SLDs SLDs Efficiency • Credible capacity • Regular process for • DocumentaƟon and • AllocaƟon of funds • Formal report with • Proven examples of plan to deliver operaƟonal diagnosis of global for addiƟonal evidence to support public–private OUTCOMES against projected forecasƟng supply chain purchase of PQ local adopƟon of collaboraƟon in demand MDR drugs by key IQA standards MDR TB in India and • Increased • PrioriƟzaƟon of top treatment programs other target • Adequate volume manufacturer issues • Improved local geographies from qualified confidence • Larger, more viable understanding of • Improvement plans suppliers market for IQA IQA public health • Technical assistance developed and drugs benefits plans implemented • Sustainably reduced • Increased • Increased demand prices and improved availability and for IQA SLDs availability for key demand for IQA through new SLDs drugs treatment channels WORKSTREAM 1 1.5 2 3 4 5 Manufacturer OperaƟonal Supply Chain Financing IQA Private-Sector Scale-Up Forecasts Diagnosis Mechanisms RecommendaƟon Engagement FIGURE 3-4 SLDAII vision and goals.
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that would overcome the supply chain barriers that today prevent IQA SLDs from reaching the entire global population of MDR TB patients? The Summit included participants from both within and outside the sphere of MDR TB expertise who were tasked with dissecting the prob lem, analyzing it, and producing actionable outcomes.
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a This box is based on the presentations by Michael Kimerling, Senior Program Officer, Tuberculosis Global Health Program, BMGF, and Tracy Sims, Vice President, Eli Lilly & Co. Foundation.
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SOURCE: Sims, 2012. Presentation at IOM workshop on Developing and Strengthening the Figure 3-5 Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis.
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