jeudi 12 janvier 2012
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by Juanita Folmsbee, SCMS and Hai Le, PATH While project Optimize seeks innovative supply chain solutions for vaccines, it often finds those solutions already being implemented in other supply chain systems. In this article, we explore a success story from the Supply Chain Management System (SCMS), a project of the US President’s Emergency Plan for AIDS Relief (PEPFAR)—administered by United States Agency for International Development—to scale up HIV/AIDS prevention, care, and treatment programs in selected developing countries. In Vietnam, SCMS works with the government to ensure PEPFAR-supported government-care delivery sites receive continuous supplies of antiretroviral (ARV) medicines. Recognizing an opportunity to save valuable budget dollars and increase efficiency, the Vietnamese Administration for AIDS Control (VAAC)—a department in the Ministry of Health—recently collaborated with SCMS to integrate and streamline three distribution systems for ARV medicines. Current distribution systems Currently in Vietnam, ARVs are distributed through three different supply channels set up by four different funders: the National Program (NP), the Global Fund (GF), PEPFAR, and the Clinton Foundation, in which PEPFAR contributes 60% of the total budget. According to October 2011 data from VAAC, the NP supports around 4,369 patients at 94 sites, the GF program supports around 17,303 patients at 149 sites, and the PEPFAR distribution system established by SCMS supports 36,388 patients receiving antiretroviral treatment. Each system has different policies for distribution frequency, stock management and quantification, calculation and order, and return and reallocation. Without any centralized management, the three parallel systems have no way of knowing stock levels of the others and only contact one another when there is a stock-out or potential product expiry. Making one system Many of these stock-out situations can be averted if the stock status across programs is known and managed centrally. As requested from VAAC, SCMS has developed a “making one system” solution for ARV distribution from the central level to the treatment sites which will require all programs to change some of their current practices. The GF and NP both use the traditional Vietnamese public-sector distribution practice of sending medicines from a central location to a provincial authority. In the PEPFAR system, stock is delivered directly from central warehouses to treatment sites, bypassing the Provincial AIDS Center (PAC) level. Figure 1 shows the fundamental difference between the two systems. There are many advantages to the PEPFAR system, including shorter lead time to sites, lower stock levels, less paperwork, no need for PAC drug stores, transparent stock management, and easier to manage returns and reallocations. The system is not without disadvantages, however, which include a higher workload for central teams and the central pharmacy (known as CPC 1) and a lack of ownership at the PAC level. http://www.technet21.org/components/com_agora/img/members/2939/mini_Summary-of-the-two-main-alternatives-for-a-single-distribution-system.jpg Great success…and remaining challenges The next two years will be focused on centralizing and streamlining the multiple supply chains for ARVs and creating a single, unified supply chain that can efficiently and safely move ARVs from national stores to local health centers. Rather than building its own warehouses or in-house distribution system, VAAC will outsource warehousing and distribution to CPC 1, a quasi-public entity. A challenge for SCMS is to help the government find the appropriate balance between which activities should be centralized and which activities should remain decentralized for drug procurement and distribution of HIV/AIDs commodities. For more than six years, SCMS has made a great impact on the Government of Vietnam: leading the first national five-year forecast of ARVs in March 2010, implementing a central logistics management information system, making training more immediately accessible and cost effective through self-learning modules to dispensers, and perhaps most notably creating a centralized ARV medicine warehousing and distribution system. Those working on supply chain system efficiencies for vaccines can learn much by collaborating and sharing lessons learned with organizations like SCMS who are also applying modern supply chain solutions to improve supply chain performance. Figure source: Couldwell MV, Nhung ATH. A Single National ARV Distribution System for Vietnam. Arlington. VA: SCMS; 2009 To comment, click reply.
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