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Analyzing Options for Strengthening Pharmaceutical Systems

To promote informed decision making in selecting appropriate interventions to address complex issues faced by health and pharmaceutical systems, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program has prepared this guidance document for technical assistance providers, policymakers, and key stakeholders in pharmaceutical systems to use as they consider system improvements and intervention alternatives. This approach involves active engagement of relevant stakeholders throughout a systematic assessment and comparison of options based on current system considerations, viability of potential interventions in view of their operational characteristics, existing legal and regulatory frameworks, and potential cost implications.

This paper describes an evidence-based approach for the critical and systematic analysis of intervention options in pharmaceutical systems, supported by practical examples and technical annexes that the reader may use to tailor the approach to a variety of technical areas and problems.

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Options Analysis for Integration of Oxytocin in the EPI Cold Chain in Mali

The Maternal Health Technical Resource Team (MHTRT) of the UN Commission on Life-Saving Commodities for Women and Children has been exploring strategies to increase access to quality oxytocin, including advocating for the integration of oxytocin in the existing cold chain for the Expanded Programme on Immunization (EPI).

Some countries, such as Mali and Ghana, have attempted integration in some areas of the country already and have experiences that can help answer that question. PATH and the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program recently prepared case studies on these countries that describe the extent to which integration was achieved. In neither case was integration systematic; it occurred spontaneously and out of necessity at points along the distribution chain.

The purpose of this activity is to work with national stakeholders to identify and analyze feasible and acceptable options for the integration of oxytocin in the EPI cold chain at key points along the distribution chain and to develop guidance on the operationalization of such integration.

A team composed of an international consultant, a national consultant, two representatives from the Directorate of Pharmacy and Medicines (DPM) and the SIAPS-Mali team worked together in the preparation and organization of workshops.

During the preparatory phase of the two working meetings, the team developed the terms of reference, the letter of invitation, and the agenda of the working meetings and presentations and agreed on the profile of the participants for the working meetings.

The methodological approach was the same for both working meetings, namely presentations followed by discussion and group work, summarized in a plenary session.

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Addressing the Unmet Need for ART among HIV+ Women and Newborns in Cameroon through Strengthening the Supply Chain of PMTCT Commodities

The Government of Cameroon and its partners have made major investments in the last decade in prevention, treatment, and care of HIV-infected patients. However, unmet need for antiretroviral therapy (ART) among HIV-positive pregnant women remains high at 66%. Critical to satisfying this need is ensuring adequate availability of prevention of mother-to-child transmission (PMTCT) commodities for rollout of new Option B+ guidelines. The Cameroon supply system consists of a cost recovery system for essential medicines and other health commodities and a free-of-charge system for priority commodities including those for PMTCT and ART. This study examines options for improving the supply and availability of these commodities.

Published in: Immunology and Infectious Diseases, Vol. 3(4), pp. 31 – 40

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Supply Chain Options Analysis: PMTCT Option B+, Family Planning, Maternal, Newborn, and Child Health Commodities

HIV, malaria, and unintended fertility constitute barriers to the achievement of Millennium Development Goals 4, 5, and 6 in Cameroon. The national health sector strategy 2011-2015 describes disease control targets, including the elimination of mother-to-child HIV transmission and reducing child mortality. In this analysis, SIAPS provides evidence for the design of interventions to strengthen the health supply system—a crucial factor in achieving health targets in Cameroon.  Included among these interventions is the national strategy for the prevention of mother-to-child HIV transmission (PMTCT), PMTCT Option B+. This analysis sets out to determine optimal storage space and logistics costs for the rollout of PMTCT Option B+; logistics management information requirements; feasible supply options, labor and equipment requirements, and regulations and policies related to the distribution of  PMTCT Option B+ and antiretroviral treatment (ART) commodities.

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