Pharmaceutical

The prevention and treatment of HIV infection and the opportunistic infections associated with full-blown AIDS are heavily dependent upon pharmaceutical-based interventions, which need the continuous and timely supply of a wide range of drugs. In addition, because the cost of antiretroviral drugs is high relative to other drugs, the supply chain responsible for the procurement, storage, transport, and distribution of these drugs must work efficiently to minimize wastage losses from leakage, damage, and expiration.

All these demands make pharmaceutical management an important component of effective health systems. The Health Systems 20/20 project collaborated with several external partners – such as Rational Pharmaceutical Management, Management Sciences for Health, etc. – to create the Health Systems Assessment Approach: A How-to Manual (HSAA). The HSAA allows a team of assessors to rapidly gauge the strengths, weaknesses and opportunities in six areas of the health system in a country. This includes a module for the assessment of the pharmaceutical sector of a health system. This module has been applied to take stock of the pharmaceutical management systems in several countries: from procurement and warehousing at the central level, to distribution at all levels.

The Health Systems 20/20 project has assisted countries with planning for large-scale immunization programs, which involves a strategy for vaccine sourcing and distribution. In Southern Sudan, Health Systems 20/20 assisted the Ministry of Health set up a proposal development process towards health system strengthening financing from the Global Alliance for Vaccines and Immunization (GAVI). The project also participated in an assessment of the Southern Sudanese health care system using the HSAA. These activities positioned Southern Sudan to submit its GAVI application in 2008. If awarded, Southern Sudan could receive approximately US$7 million for four years, helping the country transition from emergency relief towards the expansion of quality immunization programs in order to increase routine immunization coverage.

Health Systems 20/20 assisted the Ministry of Health of Madagascar develop its application for a health system strengthening grant from GAVI. The application was conditionally accepted and Madagascar is set to receive up to US$11 million. This grant will address health system obstacles and contribute to increasing the country’s DTP3 immunization coverage to 95% by 2010.

In addition, accurate cost estimations are crucial to determining feasibility and financial planning of HIV treatment programs. Through several tools designed by Health Systems 20/20, such as AIDSTreatCost and the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT), policymakers are able to estimate the recurrent costs of scaling up antiretroviral treatment, including the large proportion of these costs that are related to drug procurement.

The Health Systems 20/20 project has looked carefully at the health system-wide effects of HIV/AIDS funding, including on the wider pharmaceuticals and commodities system. The analysis of Global Fund for AIDS, Tuberculosis and Malaria (GFATM or Global Fund) financing in Benin, Malawi, and Ethiopia revealed wider effects of HIV-specific funding for pharmaceuticals and commodities; especially via the fragmentation of prior procurement arrangements, the bypassing of the existing government drug warehouses and systems, etc. These effects can weaken procurement, supply, and distribution for other drugs and commodities. Such analysis is important for planners in national HIV/AIDS programs and the ministries of health to avoid causing any harm while achieving rapid scale-up of priority interventions.