Despite being one of the most densely populated countries in the world, the overall health in Bangladesh has steadily improved over the last 30 years. While the Government of Bangladesh’s efforts have resulted in impressive gains in public health, weaknesses in pharmaceutical management, including logistics and supplies, infrastructure, and the low performance of health care providers, remain obstacles to obtaining access to efficacious medicines and quality health services, particularly for the poor. SIAPS has been working closely with the Ministry of Health and Family Welfare (MOHFW) since 2011 to implement a series of systems strengthening interventions to support the government’s health objectives. Using a systems-based approach, SIAPS catalyzes effective leadership, good governance, and evidence-based decision making to strengthen procurement and supply chain systems.
Financing for the Procurement of Medicines and Supplies for the Diagnosis and Treatment of HIV/AIDS in the Dominican Republican
In 2012, the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program carried out a study that concluded there was a USD 2.5 million financial gap for providing antiretroviral therapy (ART) to 22,440 patients who were hoped to be covered in 2013. This estimate included an expanded security stock that would avoid scarcities caused by delays in purchases or shipments. The presentation and discussion of this study with authorities and specialists from the Ministry of Public Health (Ministerio de Salud Pública, or MSP), the National Council on HIV/AIDS (Consejo Nacional del VIH/SIDA, or CONAVIHSIDA), and international aid agencies allowed the referenced financial gaps to be closed by means of better price negotiation with international suppliers and the first-time allocation of USD 1.9 million for the purchase of ARVs in the MSP budget. In 2013 only USD 350,000 was required from PEPFAR to cover shortages in supplies.
How Public Funds Were Spent on Procurement of Medicines in Ukraine’s Hospitals: Interim Analysis for the Ministry of Health, Ukraine
Pharmaceuticals may constitute as much as 40% of the health care budget in low and middle-income countries, yet large portions of the population may lack access to even the most essential medicines. The limited public sector funds are frequently spent on ineffective or unnecessary medications. An analysis of past spending patterns on procurement of medicines will help the Ministry of Health policymakers and key government stakeholders in Ukraine for decisions on adopting the national Essential Medicines List (EML) in practice.
The purpose of this technical brief is twofold:
- To demonstrate the need to rationalize limited public funds for maximum health impact.
- To emphasize the need for proper selection of medicines based on WHO recommendations and the rationale for an EML as the sole basis for public sector procurement in Ukraine.
After summarizing high-level data analysis, this technical brief also takes a close look at insulins and analogues that account for the most expenditure.
This [report] is extremely useful. We need to use this information for the purpose of reforming the procurement system as well. The EML has become even more necessary now.”
– Dr. Ihor Perehinets, Deputy Minister of Health of Ukraine
Medicine prices are a contentious issue, with many products arguably unaffordable, even in developed countries, where, on average, approximately 10% of the health budget is spent on medicines. But in low- and middle-income countries, that figure is usually substantially higher, reflecting both limited resources and generally inefficient public health systems. Given that a sizable proportion of the population usually pays for medicines out of pocket, high medicine costs disproportionally affect the economically disadvantaged and are more likely to impair patient access to effective treatments in poorer communities.
The final price for the paying customer—whether the patient, the public health service, or an insurance company— is compounded by all activities involved in the development, production, procurement, and distribution of the medicine. This report will focus on only those activities that are under the control of the Government of Ukraine, that is, procurement and distribution. However, it is worth mentioning that development and production costs—activities that are undertaken by private companies and that are often used to justify high prices—are currently under international scrutiny, with recent studies showing that pharmaceutical companies spend more on marketing than on research and development.
UNITAID is a global health initiative, established to provide sustainable, predictable, and additional funding to significantly impact market dynamics to reduce prices and increase the availability and supply of high-quality commodities for the prevention, diagnosis, and treatment of HIV and AIDS, malaria, and tuberculosis (TB), primarily for people living in low-resource settings.
The SIAPS Program supported the development of this guideline, which informs grantees of the principles, norms, standards, and procedures that apply when UNITAID funds are used for procurement. Recognizing the importance of harmonizing UNITAID’s procurement approach with established international best practices, this guideline is the result of a comprehensive desk review of the procurement practices of other organizations including, but not limited to, the Global Fund, WHO, the World Bank, and UNICEF.
The introduction of framework agreements for the 2015 public health care procurements in the Poltava and Dnipropetrovsk oblasts of Ukraine reduces the risk of stock-out and helps employees more efficiently use their time by creating more flexible, shorter procurement procedures, while decreasing the opportunity for corruption. These framework agreements, the first to be used for […]
With more than 20% of Lesotho’s population living with HIV, the need to scale up preventive measures has been recognized as crucial in the country’s fight against the disease. Although the estimated number of new HIV infections per year decreased from 30,000 in 2005 to 26,000 in 2013, the country has historically experienced low levels of […]
Warehouse Improvement Plan and Draft Operating Procedures for the Central Warehouses of the Directorate General of Health Services and the Directorate General of Family Planning in Bangladesh
This report summarizes technical findings and recommendations to assist two important supply chain management organizations that support the Government of Bangladesh’s (GOB) Ministry of Health and Family Welfare (MOHFW). The first organization— the Ministry’s Central Medical Stores Depot (CMSD)—is headquartered in Dhaka. It serves as the central procurement and distribution arm of the Directorate General of Health Services (DGHS). The second organization—the central warehouse (CWH) of the Directorate General of Family Planning (DGFP)—is also located in Dhaka. It supports the DGFP’s family planning and reproductive health commodity storage and distribution requirements.
Con el propósito de analizar estos problemas, AMI organizó una reunión en la ciudad de Cartagena en abril de 2010 y una segunda en Lima en Agosto de 2011. En estas reuniones los participantes discutieron avances y problemas en la gestión del suministro de antimaláricos y acordaron intervenciones nacionales y regionales para enfrentar los problemas que aún persisten.
The overall goal of the SIAPS/Bangladesh program is to build the capacity of MOHFW and its key directorates—DGFP, DGHS, DGDA, and HED—and other indigenous institutions to efficiently and effectively manage their procurement and supply chain management activities. Special focus will be given to TB commodity management at all levels. Read about their progress toward this goal in their July 2013 newsletter.
To learn more about SIAPS program activities worldwide, please read our annual report for program year 6.
Project dates: January 2012 – September 2017
A presentation by Mohan P. Joshi, Principal Technical Advisor and Lead for Pharmaceutical Services, SIAPS, at USAID in Arlington, VA […]