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Gain a glimpse into PFSCM’s world and keep up to date with developments in the public health supply chain sector. Access our blog for thought leadership articles and scroll down for the latest news.

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Global Health Supply Chain logo

Leveraging a digital network to enhance patient safety through product serialization. Join the PFSCM/IAPHL Listserv email forum discussion now

PFSCM is pleased to announce that starting on 21 May 2018 we are moderating an email discussion on the International Association of Public Health Logisticians‘ knowledge sharing platform Listserv. This is expected to run until June 2018.

The topic up for discussion is “leveraging a digital network to enhance patient safety through product serialization.”

Background

According to 2017 data published by the World health Organization (WHO), 1 in 10 medical products circulating in low- and middle-income countries are either substandard or falsified. WHO estimates that 72,000 to 169,000 children may die each year from pneumonia due to substandard and falsified antibiotics.

The WHO reports show that all disease areas are impacted by falsified medicines, with antimalarials and antibiotics being the most commonly reported.

Individually serializing all health care products at the patient-pack level with unique, traceable identifiers, as many governments are now requiring, is one important response to the issue. These patient-pack identifiers can then be scanned at intermittent points throughout the supply chain, verifying their authenticity.

Objective
This discussion seeks to explore how modern digital networks can be used to link all stakeholders — manufacturers; procurement organizations (international and local, public and private); logistics service providers; national, regional, and district central stores; dispensing points; and, ultimately, patients themselves.

This, too, provides shared transparency and enables authentication of medical products throughout the supply chain.

The discussion will be broken down into three sections:

  1. What it takes to operationalize a digital network
  2. Moving from tracking shipments to tracking patient packs (serialization)
  3. Data visibility — you have all this data, now what?

If you are an IAPHL member, please join our discussion starting on May 21, 2018. If you have a question to post but are not a member, please email your question to PFSCM and we will submit it on your behalf. Or become a member here.

The moderated discussion will be summarized and made available once the discussion is concluded.

 

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Dispelling myths about drug procurement policy

– Published in the Lancet Global Health Volume 6, No. 6, e609–e610, June 2018

Drug prices are controversial in all countries, and nowhere more so than in low-income and middle-income countries, where access to essential drugs is very price sensitive. The higher the price, the fewer the patients who can be treated, so therefore the aim is to maintain drug prices consistently low. However, it is unclear whether the lowest price for a drug will always be the best value, and it is an issue that many purchasers must consider. Will quality be compromised? Will the bidder offering the lowest price be able to deliver on time and in full? Unsatisfactory answers to these key questions will put lives at risk.1

Since 2005, the Partnership for Supply Chain Management (PFSCM) has been providing procurement services to the US Government, the Global Fund to fight AIDS, Tuberculosis and Malaria, and other public-sector clients worldwide, supplying over 5 billion US$ in health commodities. Procurement of health commodities is complex. Some evaluation criteria used for procurement of health commodities by PFSCM are absolute. For instance, the product must be of the right quality, as indicated by pre-qualification by the WHO or approval by a stringent regulatory authority. The product must be suitable for the country in which it will be used, registered for use in that country, and have sufficient shelf life left to be used before expiry.

Two important best practices are used by PFSCM that may seem counterintuitive to non-experts but have resulted in lower drug prices and better outcomes. Purchasing from multiple competitively priced suppliers, rather than purchasing only from the supplier offering the lowest price, incentivises more suppliers to stay in the market. This practice helps drive prices down over time and reduces the likelihood of stockouts. In addition, coordinating procurement and streamlining product selection helps phase out inferior drug formulations and improves the availability of optimal drug formulations.

To procure from multiple suppliers, PFSCM begins by verifying the eligibility of offers received on the basis of donor and country requirements. The next step involves verifying product-specific eligibility criteria. Only then does PFSCM address qualitative and quantitative factors such as delivery time, past performance of vendors, remaining and total shelf life, available production capacity, current orders, and price, to make a judgment on best value. PFSCM closely considers the dynamics of the market to maintain a viable number of vendors to sustain competition. From PFSCM’s own experience procuring health commodities, when a drug loses patent protection or is licensed for generic production, the first-to-market generic supplier sets prices at least 20% below the patent holder. A second entrant will then often set the price around 10% lower. Once the third, fourth, or fifth suppliers enter the market, competition gets fiercer, and prices drop strikingly to a level at which most procurement prices are within a 5% band.

PFSCM has developed an award matrix (see below) to distribute supply over multiple vendors, incentivising a broader supplier base. Each vendor that is considered for an award must set a price that is within the competitive range, which is usually between 2% and 5% below the lowest compliant offer. With this award matrix, PFSCM establishes a minimum order quantity per product per supplier, while ensuring that transport costs are optimised. The actual percentages awarded by PFSCM to each vendor also consider production batch size, container loading, and delivery time.

Table:

Matrix for distributing supply over multiple vendors.

Although price is an important factor to consider when maximising the amount of procured health commodities, it is not the only one involved in granting a procurement award. Considering all other factors besides just the cost of the drug will lead to the timely, reliable delivery of safe, high-quality products, and ultimately result in lower prices from increased competition. This strategy ensures that lifesaving treatments are not withheld unnecessarily from the people who need them most.In addition to engaging multiple vendors to promote competition, the second important strategy that PFSCM considers involves consolidating demand and coordinating procurement in a regularly scheduled manner. This practice demonstrates commercial viability to generic drug manufacturers, reduces lead times, and avoids stockouts.2 The ARV Procurement Working Group (APWG) follows this strategy to ensure coordinated placement of orders to avoid production delays.3 A suitable level of coordination among stakeholders helps steer the market towards optimal drug formulations, by phasing out inferior drug formulations and introducing new and more effective formulations. This ensures that clinically important, low-volume antiretrovirals are maintained in the market.2 Using a coordinated and streamlined product selection process, APWG helped increase the proportion of optimal paediatric antiretrovirals purchased from 88% to 95% between 2013 and 2015, while the mean total lead time decreased from 84 days to 63 days.2

Download the PDF version.

References:

1. Tren, R, Hess, K, and Bate, R. Drug procurement, the Global Fund and misguided competition policies. Malar J. 2009; 8: 305

2. APWG. Case study: sustaining paediatric ARV supply security with the Paediatric ARV Procurement Working Group.
https://www.theglobalfund.org/media/6492/psm_paediatricarvprocurementworkinggroupcasestudy_report_en.pdf

3. The Global Fund. Sourcing and management of health products: antiretrovirals.
https://www.theglobalfund.org/en/sourcing-management/health-products/antiretrovirals/

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Watch Imperial Logistics webinar on Building a Blockchain-Enabled Pharmaceutical Control Tower

On May 3, Clinton de Souza, Director of Public Health at PFSCM partner company Imperial Logistics gave an informative webinar on Building a Blockchain-enabled Pharmaceutical Control Tower.

De Souza was joined by Bernard Goor, Vice-President of Sales and Marketing for Pharma and Healthcare at One Network.

Imperial Logistics explained how they leverage One Network to provide an end-to-end fulfillment backbone spanning their entire distribution process for essential medical supplies, including serialization and authentication of HIV and antimalarial drugs.

Read more about the webinar here or watch it here.

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Four common compliance challenges faced by pharmaceutical wholesalers and distributors in Africa

In 2017, PFSCM embarked on a campaign to pre-qualify pharmaceutical distributors and wholesalers in Africa, ensuring that we and others procure only the best quality, compliant products close to the point of care.

Last year, PFSCM audited more than 58 suppliers in eight African countries. In total, 37 (63%) of the 58 vendors passed the pre-qualification audits.

PFSCM Product Quality Assurance Unit Manager Stephen Kimatu explains that vendors are pre-qualified in accordance with the World Health Organization’s (WHO’s) Model Quality Assurance System (MQAS) for Procurement Agencies.

Audit results show that the majority of vendors scored less than 80% on the WHO MQAS pre-qualification and re-assessment criteria and/or failed on the Quality Control (QC) criteria for testing products in an ISO/IEC 17025-certified or WHO-PQ quality control laboratory.

However, these vendors do comply with the various general requirements specified in the WHO MQAS. These include quality management; organization structure; documentation; self-inspection; product recalls; complaint handling; handling of recalled, rejected, or returned goods; security; and record-keeping processes.

Most vendors also scored sufficiently on purchasing or procurement practices and complied with specifications pertaining to the receipt and storage of purchased products.

Through ongoing engagement with vendors, PFSCM identified four key challenges faced by distributors and wholesalers in Africa:

1. Lack of awareness of WHO MQAS standards and sustained enforcement of cGDP

Many African countries enforce WHO Good Distribution Practices (GDP) standards for the receipt, storage, and distribution of products, but they neglect to legally enforce the complete WHO MQAS standards, which address the pre-qualification and reassessment of the suppliers and manufacturers they buy from.

In some countries, regulators undertake pre-qualification and reassessment of suppliers to some extent, but this alone is not sufficient to ensure utmost product quality and safety is maintained throughout the supply chain.

There also tends to be a greater focus on developing and enforcing regulations such as current Good Manufacturing Practices (cGMP) for pharmaceutical manufacturers than on regulations such as GDP for distributors and wholesalers.

A lack of active regulatory surveillance has resulted in some wholesalers lagging behind on even the country-specific GDP standards.

Common observations include:

  • Failure of routine inspections by regulatory authorities.
  • Absence of registered pharmaceutical personnel on the premises.
  • Lack of compliance with the national drug authority’s storage requirements, especially for narcotics and psychotropics.

2. Lack of specific QA expertise

Many wholesalers and distributors do not have a qualified quality assurance (QA) manager on staff or a quality policy in place.

As a minimum requirement, most companies employ a pharmacist, pharmaceutical technician or technologist to oversee the intake and storage of medicines, but these individuals do not necessarily have the applicable training to also focus on QA matters.

Investing in a dedicated quality manager will enable vendors to develop quality procedures and policies to become more compliant with WHO MQAS and GDP, as well as the use of ISO/IEC 17025 QC labs for testing.

Common observations include:

  • No dedicated QA manager.
  • Quality manuals that require improvement.
  • Lack of laboratory testing and testing plans or strategies.
  • Lack of quarantine areas.

3. Lack of a QMS

Many distributors and wholesalers do not have enough knowledge about a Quality Management System (QMS) and its benefits.

Implementing a QMS can be a challenging task with quite a bit of theory, documentation, and details to be created and checked. Such a task requires a professional in the field to ensure that the QMS is practical for the business, the document management is effective, the level of detail is suitable for the operation, staff and management are involved, and customer satisfaction remains the main focus.

In addition, Kimatu notes that many operations may disregard QMS because they find it hard to justify the initial investment.

“The return on investment for implementing QMS is complex. Rather than trying to explain a monetary return at a specific point in time, one should rather focus on the fact that the implementation of QMS will reveal areas for improvement, streamline business, integrate processes, and guide employees. These almost always result in savings, as costly mistakes are kept to a minimum and profit is driven by increased productivity.”

Some benefits of QMS include:

  • Better process control and integration.
  • Cost savings and reduced wastage.
  • Streamlined operations for business growth.
  • Increased market share.
  • More engaged staff and increased morale.
  • More effective marketing to exploit new sectors.
  • Continuous improvement of products, processes and systems.

Altogether, QMS increases consumer confidence and ensures safer products.

Common observations include:

  • Lack of standard operating procedures (SOPs) for key processes.
  • No review dates for SOPs.
  • Lack of self-inspection reports.
  • Lack of quality manuals.
  • Lack of designated quality managers.

4. Ambiguity in understanding the benefits of investing in infrastructure and other improvements

Even though many operations and infrastructure, such as warehouses, comply with local regulations and pass routine inspections, they still lack in compliance with global standards.

These businesses are sustained by local buyers (buying in compliance with local regulations), and therefore the businesses find the benefits of investing in improved infrastructure to gain international business ambiguous. Without upfront international procurement contracts, many local vendors are not easily persuaded to make the often significant investments required to upgrade systems and facilities.

This quandary continues, as global demand will not be stimulated without the availability of enough globally compliant local sources, while local resources will not invest in becoming compliant without the demand already existing.

Kimatu explains that even though this challenge remains extremely difficult, some industry-wide initiatives could set the ball rolling for improvement.

“A more standardized global approach to harmonizing standards may reduce the level of dissimilarity between regulations, systems, and procedures, thereby reducing the level of repeat effort and investment needed by each vendor to comply with various clients’ quality expectations. This could go a long way in helping vendors realize the benefits of international best practices.”

Further, the continued efforts of pooled procurement to aggregate demand may also aid in breaking down barriers.

Common observations include:

  • Lack of space, causing overstacking and hampering cleaning and inspections.
  • Lack of quarantine areas for received products or products awaiting a QA determination.
  • Lack of adequate warehouse to enable temperature mapping.
  • Lack of professional pest control services.
  • Lack of designated areas for damaged, recalled, returned, or expired goods.
  • Poor storage and distribution of some product categories, particularly cold chain products.
  • The importance of pre-qualifying in Africa

By pre-qualifying vendors in Africa, PFSCM is developing reliable sources of supply closer to the point of care, ensuring affordable, quality medicines are readily available to vulnerable communities. Through world-class audits, we are creating awareness and educating vendors about the benefits of quality compliance, opening their service to a wider network of international buyers.

“By expanding local compliant sources, we are developing local supply chains and local communities, while saving costs, reducing lead times, meeting our clients’ needs, and minimizing the environmental impact of international cargo shipment,” said Kimatu.

Through pre-qualifying vendors in Africa, we are:

  • Strengthening supply chains by expanding the pool of quality compliant and reputable distributors, wholesalers, and manufacturers.
  • Educating vendors about the global standards for procurement and distribution.
  • Helping vendors to identify opportunities for improvement.
  • Inspiring vendors to achieve compliance in order to expand their market share and aid in developing local economies and public health supply chains.
  • Ensuring that PFSCM and its clients have access to more vendors in Africa, minimizing the challenges of global procurement and distribution, which include production delays, shipping lead times, funds spent offshore, and carbon footprint.
  • Ensuring lifesaving commodities are readily available to some of the most vulnerable and hard-to-reach communities in Africa.

PFSCM’s experience in pre-qualifying vendors

PFSCM participated in the working group that collaborated with the committee to review and develop the WHO MQAS.

We gained vast experience in pre-qualifying vendors during the 10 years we managed the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Supply Chain Management System (SCMS) project. During this period, PFSCM pre-qualified 57 manufacturers, 10 of which were based on the African continent.

PFSCM’s Quality Assurance unit operates under our stringent QMS, which is ISO 9001:2015 certified by one of the world’s most reputable certification bodies for management systems, DQS Management Systems Solutions.

Global Health Supply Chain logo

The Eastern Europe and Central Asia AIDS Conference took place in Moscow, Russia, from April 18 to 20, 2018. The concept of the conference was: “Mobilizing resources: experience, investments, innovations.” The objective of the conference was to develop regional guidelines that contain systemic cross-sectoral approaches to solving the problem of HIV/AIDS on national, regional, and global levels. The implementation of these recommendations can facilitate the adaptation of national policies and improve the effectiveness of national HIV prevention programs, while taking into account the regional context and local specific features of the epidemic. Further, other goals of the conference focused on the measures for eliminating HIV infection and other socially significant diseases in Eastern Europe and Central Asia, presenting high-performance programs, and exchanging experience among scientists, experts, policymakers, health care professionals, and public figures in relation to the best HIV response strategies. In line with these objectives and goals, PFSCM Global Supply Chain Director Wesley Kreft presented on international best practices in procurement of HIV commodities.

International best practices in procurement of HIV commodities

Adhering to global best practices for the procurement of HIV commodities is key to ensuring that a cost-effective and reliable supply of readily available, quality medicines is accessible to patients. The World Health Organization’s (WHO’s) guidelines and recommendations provide the backbone for best procurement, distribution, quality testing, and patient regimen practices, ensuring safe, effective, and sustainable treatment. However, the successful execution of these instructions rests with the countries, governments, and agencies managing the supply chains. Presenting at the VI Eastern Europe and Central Asia AIDS Conference, PFSCM’s Wesley Kreft discussed four ways best procurement practices ensure funds go further for uninterrupted HIV commodity availability.

  1. Following the WHO’s latest guidelines and recommendations for HIV treatment.
  2. Using fixed-dose combinations to reduce supply chain, distribution and product cost, while minimizing expired stock.
  3. Pooling the product demand across countries to strengthen the negotiating power for best value HIV commodities.
  4. Implementing a Control Tower to provide the visibility and data needed to optimize stockholding, prevent stock-outs and negotiate better logistics contracts to integrate parallel supply chains.

To learn more, please get in touch with us.

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PFSCM implements One Network’s Control Tower solution to strengthen health supply chains for developing countries

One Network Enterprises, the global provider of multi-party digital network platform and services, today announced that The Partnership for Supply Chain Management (PFSCM) — a nonprofit organization providing global procurement and distribution services for low- and middle-income countries — has implemented One Network’s Supply Chain Control Tower solution to advance its end-to-end supply chain visibility. PFSCM, which has a long history of innovating and driving fundamental improvements in the performance of global health supply chains, is migrating critical requisition, order, and transportation management functions into its existing One Network Real Time Value Network (RTVN) decision-making supply chain suite.

“Our goal is to strengthen, develop, and manage secure, reliable, cost-effective, and sustainable global supply chains to improve the lives of people in underdeveloped countries,” said Richard Owens, PFSCM Director.

“By extending One Network’s Control Tower capabilities on our RTVN, we can provide real-time visibility, digital collaboration, and advanced analytics to move to true data-driven decision-making. Our collaboration with One Network is central to PFSCM’s digital transformation and provides us the foundation we need to drive the next wave of innovation within global supply chains for public health.”

Leveraging the One Network RTVN and new Control Tower solution, PFSCM is now able to:

  • Manage freight costs through digital oversight of complex rates/contracts across multiple freight forwarders, and automate freight quotes via PFSCM’s proprietary freight calculator and load optimization tool.
  • Automate operational processes and reduce manual workload to minimize potential for error and increase efficiency.
  • Streamline communications with vendors, freight forwarders, and clients through One Network’s digital engagement tools.
  • Optimize performance and generate savings through native alerts and proactive management tools.
  • Expand data visibility for partners and clients though scalable, real-time integration.

PFSCM provides global procurement and distribution services, ensuring the reliable availability of essential products — including lifesaving medicines — to programs in low- and middle-income countries. Working with country governments, humanitarian agencies, non‐governmental organizations, and leaders in the pharmaceutical industry, PFSCM develops and manages secure, cost‐effective, and sustainable global supply chains.

“Implementing PFSCM’s Control Tower to optimize supply chain networks and ensure the availability of essential products to programs in developing countries is one of our most important projects,” said Greg Brady, CEO of One Network.

“Working together, we can help link global and in-country supply chains from the factory to the point of care; digitally capture data at the point of delivery; synchronize item master management with global standards; and leverage Blockchain solutions to enable automated and secure execution of critical supply chain functions, with full audit traceability.”

See the original press release produced by One Network Enterprises here.

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LMIS contributed to 21% improvement in pharma supply chain in Myanmar 

A project to assist the  Myanmar Ministry of Health and Sports (MoHS) to improve supply chain management in public sector health systems at the regional and lower levels through system improvements and capacity building has yielded satisfying results in just one year of implementation.

The Regional Supply Chain Strengthening (RSCS) project, funded by the  Three Millenium Development Goal  (3MDG) fund and implemented by the Partnership for Supply Chain Management (PFSCM), showed an overall improvement of 21%, with logistics management information system (LMIS) implementation advancing the most, from a poor rating to a good rating between 2016 and 2017.

The RSCS project was initiated under the 3MDG fund to help the MoHS implement an LMIS and related strengthening initiatives at the lowest health system level in three regions: Ayeyarwady, Bago, and Magway. These three regions, with 79 townships and 3,738 health care facilities, represent nearly 30% of Myanmar’s population.

Baseline assessment determines supply chain needs

To gauge the condition of the health commodity supply chain, a baseline study was conducted at 301 (8%) of the basic health facilities in the three regions between June 2016 to July 2016.

The facilities were scored according to the RSCS performance appraisal scoring system for supply chain management, which uses five performance levels: bad, poor, moderate, adequate, and good. Five supply chain management categories were evaluated, namely human resources, LMIS, supply, storage conditions, and stock status.

Some of the main findings of the baseline study included:

  • A lack of an organized supply chain structure.
  • A lack of structured information flow between different levels of the supply chain.
  • Basic health staff inadequately trained in stock management and using a time-consuming stock record-keeping system.
  • Many incidents of stockout and excess/unused medicines.

Actions taken to improve supply chain management

After identifying the key opportunities for improvement, the RSCS project team collaborated closely with the MoHS, especially at the regional and township levels, to:

  • Implement a harmonized LMIS for essential medicines and health commodities.
  • Train MoHS staff on supply chain management.
  • Help the MoHS introduce logistics management units at the regional and township levels.
  • Strengthen supply chain management by changing from a “push” to “pull” system for re-supply (in a pull-based supply chain, procurement and distribution are demand driven rather than to forecast).

The LMIS consists of a paper-based monthly reporting form that health facilities use to record consumption and stock-level data and then send to the township level for further aggregation into an electronic data system.

Further, a pilot of mSupply, an electronic LMIS data aggregation and reporting system, has been implemented in 15 townships (five townships in each region) since November 2016. After evaluating the pilot, the MoHS agreed to roll out mSupply to 64 more townships by May 2017.

These information streams are expected to make it easier for managers to avoid stockouts or excess medicines with risk of expiry by, for example, reallocating stock from one facility to another or from one township or region to another.

During the LMIS implementation, RSCS trained local staff on key supply chain management topics and provided hardware, software, and tools such as stock books and forms.

Overall results

In 2017, an endline study was conducted at the same 301 health facilities to measure the progress and success of the LMIS and other strategies.

Of the five categories, the biggest impact was made in the LMIS area, which moved from a poor to a good rating. The LMIS focus streamlined record keeping and improved stock management practices, including the performance of regular physical stock checks and the use of first expired first out (FEFO) distribution, which can reduce expiry.

The human resources score also improved significantly from moderate to good, which likely resulted from intensive RSCS training on proper record keeping, used of paper-based reporting forms, and stock management improvements.

The supply conditions area moved from poor to moderate, while the storage conditions and stock status areas improved from moderate to adequate. These improvements resulted from a combination of RSCS training activities, LMIS activities, and the wide distribution of the Guidelines for the Storage of Essential Medicines and other Health Commodities, which the project produced in the local language. In addition, in 2015 during the preparation phase, the RSCS team visited many facilities and gave hands-on product management advice to the basic health facility staff.

Stockouts continued to remain high, owing to procurement practices outside of RSCS’s influence, but with long-term implementation and continued improvement, the LMIS is expected to also help reduce stockouts.

The overall RSCS supply chain system score, which is the average of the five categories, improved from 47% to 68%, which indicates an adequately functioning supply chain per the criteria established by RSCS and 3MDG as part of the project’s monitoring and evaluation

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CHAI’s Vineet Prabhu: “TLD as first-line treatment for adults will change the market in a big way.”

The generic antiretroviral (ARV) market will be in a state of transition in 2018 with the introduction of a new fixed-dose combination (FDC) to serve as an alternative first-line treatment for adults. The product, known as “TLD,” is a single pill comprised of tenofovir disoproxil fumarate (TDF), lamivudine (3TC), and dolutegravir (DTG).

Demand for TLD is expected to be significant

The ARV Procurement Working Group (APWG) – in coordination with various procurement agents, donors, and other partners – has compiled key recommendations for procurement of TLD to help country programs prepare adequately for this transition. Read the full announcement here…

Ultimately, the goal is to ensure all patients, both new and existing, have access to a sustainable supply of ARVs before, during, and after the transition to TLD, while attempting to limit the amount of wasted legacy ARV stock.

Speaking during a webinar arranged by the ARV Procurement Working Group on February 8, 2018, Vineet Prabhu, Associate Director of HIV Market Intelligence at of the Clinton Health Access Initiative (CHAI), noted that with the launch of TLD, it will be the first time that a best-in-class treatment is made available to the market at a lower entry price than the current standard of care.

He added that TLD is creating a lot of movement in the market with orders actively being placed.

Supporting the supply chain

PFSCM Global Supply Chain Director and ARV Procurement Consortium (part of the APWG) chairperson Wesley Kreft also presented on the occasion, recapping the history of the working group and the role it will play in supporting stakeholders during this market transition.

Kreft explains that the APWG has always had a firm grip on the general ARV market even when it was just supporting paediatric programs.

“About seven years ago, ARV stakeholders were trying to navigate a small but complex market that had around 65 different paediatric ARV formulations, which made visibility into volumes and capacity extremely challenging for those involved in the supply chain. The APWG provided insight into these challenges and supported the supply chain through stakeholder engagement and pooled procurement initiatives that helped align the sector, stimulating demand and improving service delivery.

In 2016, the then Paediatric ARV Working Group (PAWG), underwent its own transition, becoming the APWG to support the procurement activities of adult formulations as well. With many years of experience under its belt, the APWG is well positioned to now assist even more stakeholders in adapting to this market transition.

“The APWG will be engaging with donors, recipients, and suppliers to ensure that old products are phased out appropriately, that healthy demand for TLD is stimulated, and that supply remains reliable.”

Kreft concluded that the working group and PFSCM strongly encourage initiatives that make new drugs available to patients at affordable prices.

About the ARV Procurement Working Group (APWG)

In early 2016, the Paediatric ARV Procurement Working Group (PAPWG) broadened its mission to include select adult ARVs, a change reflected in the group’s new name: the ARV Procurement Working Group (APWG). The expansion has allowed the working group to continue its support of at-risk paediatric ARVs while also enabling the same coordination and collaboration to be applied to adult products with challenging market conditions.

Under the Supply Chain Management System (SCMS), PFSCM was a founding member of the PAPWG, an effort to pool the requirements for paediatric ARVs to create and manage sufficient demand to keep the market attractive to suppliers. By coordinating the demand of major purchasers — such as PFSCM and the Global Fund to Fight AIDS, Tuberculosis and Malaria — with demand from smaller countries, supply became more consistent and flexible. PAPWG results are described in a paper published on the Global Fund’s website.

The APWG’s Procurement Consortium is chaired by PFSCM’s Director of Global Supply Chain Wesley Kreft.

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Major donors and health agencies developing Global Accelerator for Paediatric Formulations 

By David Jamieson

As we have discussed in news blogs last year, limited treatment options and sub-optimal formulations have contributed to poor adherence and outcomes for children living with HIV. To improve coordination in tackling the barriers to research and development that remain, major global players are developing an initiative called the Global Accelerator for Paediatric Formulations (GAP-f), working to build consensus and define the working group’s structure. Formal launch is planned for later this year.

In November 2017, at a meeting convened by His Eminence Peter Kodwo Appiah Cardinal Turkson, Prefect of the Dicastery for the Promotion of Integral Human Development, key principles of the GAP-f set the basis for commitments to be known as the Rome Action Plan, which promote three key principles:

  • Focusing on priority paediatric drugs and formulations;
  • Accelerating development, review, and introduction of paediatric formulations; and
  • Collaborating to expedite the development and introduction of paediatric products.

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PFSCM reaffirms commitment to quality and service excellence through new ISO 9001:2015 certification

Partnership for Supply Chain Management (PFSCM), a leading public health supply chain solutions provider and a procurement agent of The Global Fund to Fight AIDS, Tuberculosis and Malaria, is pleased to announce that we received ISO 9001:2015 certification on November 16, 2017.

PFSCM’s Quality Management System received its previous ISO 9001:2008 certification in 2014 and has since upheld the highest quality standards, ensuring successful annual auditing and registration by one of the world’s most reputable certification bodies for management systems, DQS Management Systems Solutions.

DQS Management Systems Solutions — which is a member of the global network of certification bodies, IQNet — audited PFSCM’s US and Netherlands offices and endorsed the recommendation to advance from 9001:2008 to 9001:2015.

PFSCM Director Richard Owens says quality management and quality assurance have always been at the core of everything PFSCM undertakes, and the new certification reaffirms the organization’s commitment to transparency, continuous improvement, and service excellence.

“We are very proud to have earned the certification to ISO 900:2015. We have always been focused on the quality and reliability of our systems, services, and processes, and having an esteemed institution such as DQS find us deserving only drives us further,” adds Owens.

PFSCM Senior Quality Unit Manager Michael Harrigan explains that the ISO 9001:2015 certification provides PFSCM’s current and new clients with the assurance that PFSCM’s business is conducted within a standardized framework, with documented process methodology, competent staff, and defined roles, as well as an understanding of client requirements.

This conduct involves upholding key global principles of quality management systems, some of which are summarized below:

Improving customer satisfaction: A fundamental principle of ISO 9001:2015 is to continuously improve customer satisfaction through planning and striving to meet and exceed customer expectations.

Improving process integration: ISO 9001:2015’s process approach enables an organization to easily identify areas where efficiency and cost savings can be improved. Improved process flow and integration reduces errors and inefficiencies, increasing service levels and cost savings for customers.

Upholding evidence-based decisions: Through ISO 9001:2015, the organization commits to making decisions based on accurately analyzed data and facts. This not only ensures that the organization is able to meet and measure its goals and progress, but also gives customers the assurance that decisions are based on sound judgment.

Continuous improvement: A requirement of ISO 9001:2015 is to continuously improve the suitability, adequacy, and effectiveness of the organization’s quality management system. These improvements are based on the analysis of results and the outcomes of management reviews.

In conclusion, the ISO 9001:2015 certification provides clients with peace of mind in knowing that their expectations will be met in a transparent and compliant manner.

95 SiB installed in Malawi

Innovative storage solutions bring health products closer to communities in Malawi

The public health supply chain in Malawi will benefit from an additional 7,000 m2 of combined pharma-grade storage space that will relieve pressure on central medical stores and health facilities and bring lifesaving medicines closer to rural communities.

In October 2017, the Partnership for Supply Chain Management (PFSCM), a leading public health supply chain solutions provider, and its South African-based supply chain services partner, Resolve Solutions Partners, successfully completed the installation of 95 Storage-in-a-Box (SiB) facilities across Malawi, from Chitipa in the north, to Nsanje in the south.

SiB units are modular, scalable prefabricated storage facilities that can be erected quickly and affordably in remote locations. These units offer simple, secure space for the storage of medicines and can be converted for more specialized purposes, such as clinics.

For this project. ninety 70 m2 and five 140 m2 pharmacy conversions of the SiBs were installed. In its standard configuration, the units include everything needed to store and manage products in a safe and compliant manner. This includes a small office space, security, air-conditioning, shelving, pallets, a fire extinguisher, automatic voltage regulator, insulation, and a generator.

The SiBs have an energy-efficient roof and venting design, while thermoshield paint and motion-activated light emitting diode (LED) lights further increase energy efficiency. Some of the units will also be kitted with solar energy solutions as part of a new project run by PFSCM and Resolve.

This was the second SiB project undertaken by PFSCM and Resolve in Malawi. The success of the first SiB project, which entailed the installation of 115 SiBs under the PEPFAR-funded Supply Chain Management System (SCMS) program in 2016, sparked the interest of the international donor community, and at the end of that year, the Global Fund to Fight AIDS, Tuberculosis and Malaria committed funding for the additional 95 SiBs to help further the Government of Malawi’s goal of increasing pharmaceutical storage capacity.

In February 2017, the second SiB project was kicked off, starting with site assessments and procurement. By May 2017, PFSCM had established an office in Lilongwe to streamline the implementation and management of the project. The PFSCM team in Malawi was mobilized to oversee project implementation and monitor the installation progress, inspection, and handover of the completed units to beneficiary health facilities.

Resolve established eight dedicated teams and two warehouses, one each in Lilongwe and Blantyre. Four teams covered the central and northern region, operating from Lilongwe, and the other four teams worked from Blantyre, covering the southern region.

The first two sites to receive SiBs were demonstration sites. One 70 m2 SiB was installed at the Blantyre South Lunzu Health Center demonstration site in eight days, and one 140 m2 SiB was installed in Mzuzu at the Moyale Barracks Health Center in 15 days. These sites were used to train new installers and standardize the installation process.

The installation of each SiB entails five phases, namely site preparation, flooring work, wall construction, roofing, and electrical work.

The installations were monitored and inspected by qualified engineers and architects with extensive experience in designing, inspecting, and managing building infrastructure projects, including prefabricated units. The monitoring consultants worked closely with Resolve’s installation team to ensure the proper handover of the units to the health facilities.

By October 24, 2017, all 95 SiBs had been installed and handed over to the beneficiary health facilities.

On August 23, 2017, the Minister of Health and Population Services of Malawi, Hon. Atupele Muluzi, visited the Diamphwe Health Center, in the Lilongwe District. The purpose of the visit was to acknowledge the positive impact of the newly built prefabricated pharmacy store, which, along with the Health Center, serves a catchment area of over 21,000 people.

85 Solar Power Solutions project

85 solar power projects to improve healthcare facilities and save lives in Malawi

The Malawi Ministry of Health (MoH), in cooperation with the Project Implementation Unit of international financing giant The Global Fund to Fight AIDS, Tuberculosis and Malaria, have committed more than $3.5 million to improving the energy infrastructure at 85 health care facilities across Malawi.

The facilities will be equipped with combinations of solar power solutions, which will enable health care providers to better serve the thousands of patients who visit the facilities each year and decrease facilities’ dependency on the unstable national power network. Fewer patients will be turned away because of power outages, and overall service quality — as well as safety in and around these facilities — will be improved.

The Partnership for Supply Chain Management (PFSCM), a leading public health supply chain solutions provider, is pleased to announce that we were awarded the contract to supply, deliver, and commission these solar power solutions.

The contract was awarded by the MoH at the start of October 2017, and will be executed in close cooperation with supply chain services provider Resolve Solution Partners. Resolve is a long-time PFSCM partner and a subsidiary of the South African-based logistics giant, Imperial Logistics South Africa.

Resolve is responsible for installation of the solar power units and will support the MoH and health care facilities with a three-year maintenance program.

PFSCM and the Malawi MoH have a well-established relationship going back several years. The new solar contract comes on the back of two recently completed projects to install 210 Storage-in-a-Box (SiBs) units, on which PFSCM and Resolve also collaborated. These units provide health facilities with pharmaceutical-grade storage for medicines and medical supplies, protecting them from spoilage, theft, or mismanagement.

The 85 health care facilities comprise staff housing, small health posts, SiBs, clinics, and hospitals. In total, 17 urban facilities, 23 semi-urban facilities, and 45 rural facilities will be equipped with various energy saving solutions.

Notable hospitals include the Bwaila Hospital in Lilongwe and the Queen Elizabeth Central Hospital in Blantyre, as well as the Mzuzu Central Hospital and the Zomba Central Hospital.

The project entails the installation of various combinations of photovoltaic (PV) systems, solar-powered security lights, solar water pumps, and solar geysers, as well as the application of thermal paint at some facilities.

The system outputs vary from 5 kW to 100 kW to address energy consumption needs based on facility size and function — ranging from small facilities using low-voltage appliances to large facilities, such as clinics and hospitals, where critical appliances, machines, and medical equipment need to be prioritized.

In addition, all-in-one 40 W security lights will be installed in the surrounding areas of some facilities. The security light kit includes the solar panel, battery, light, and radar-based motion sensor to be mounted on the pole.

Further, remote monitoring will be offered to support and maintain the PV systems. This essential service allows for any inefficiencies or errors in the system to be easily identified and resolved, reducing downtime and minimizing unplanned maintenance and repairs.

Read more about our partner Resolve’s coverage on this project.

Malawi, located in southeast Africa, has an estimated electrification rate of only about 10% and remains one of the most severely constrained power sectors in sub-Saharan Africa1.

Even though the country is diversifying its energy portfolio to include a 300 MW coal-fired thermal power plant, cross-border connections for the supply of electricity from Mozambique and Zambia, and Power Purchase Agreements with at least three Independent Power Producers (IPPs), it remains heavily reliant on hydroelectric power produced at three plants on the Shire River that are fed by Lake Malawi.

More than 95% of Malawi’s electricity is produced by hydroelectric power stations, but erratic rainfall, two late rainy seasons, and prolonged droughts in many parts of the country have resulted in a 66% decline in power generated by the Shire River plants.

The ripple effect of these climate changes is far reaching. The country’s forests are under increasing pressure as people to turn to wood for fuel, and the public health and economic impact is extensive, with power-reliant sectors such as health care, farming, and manufacturing taking severe strain.

Continuous government efforts, such as the health care facilities solar project and the Electricity Supply Cooperation’s recent collaboration with IPPs to bring an additional 70 MW onto the grid by October 20182, are promising developments in Malawi’s mission to add 100 MW to the national grid by 2020.

  1. export.gov: https://www.export.gov/article?id=Malawi-Energy
  2. The Times Group: https://www.times.mw/escom-to-add-70-megawatts-of-power-through-solar/

IRS Delivery

Lifesaving IRS commodities delivered to Mozambique in the fight against malaria

In August 2017, the Partnership for Supply Chain Management (PFSCM), a leading public health supply chain solutions provider, orchestrated the delivery of a large consignment of Actellic 300CS IRS commodities to be used in the Mozambique Ministry of Health’s Indoor Residual Spraying (IRS) campaign which took place around October 2017.

The milestone consignment of 33 containers was shipped via three ports of entry, across more than 2,000 kilometers, to seven regional warehouses in Mozambique.

PFSCM procured, quality tested, and managed the IRS delivery on behalf of the Global Fund to Fight AIDS, Tuberculosis and Malaria, who funds the ongoing annual spraying campaign.

A proactive approach: Anticipating challenges, conducting in-country groundwork

PFSCM Global Supply Chain In-Country Logistics Service Manager Jef Imans says it was critical that the shipment was delivered on time, that sufficient compliant storage was available in all seven regions, and that the quality sampling and logistics was done in a cost-effective manner.

“This shipment entailed many complex facets. To save time and money, we conducted the product quality sampling early in the preparation phase and tendered the shipment to ensure cost efficiency. Apart from this, we anticipated that poor infrastructure, language barriers, and bureaucracy would likely attribute to the complexity of distribution.”

Imans explains that PFSCM took a proactive approach to solving the logistics challenges and visited several of the designated warehouses, ports, and in-country stakeholders to ensure all requirements were met before the 33 containers of IRS were delivered.

Further, PFSCM also greatly improved supply chain communication channels by building rapport with in-country stakeholders, such as the logistics service providers, agents, warehouse managers, and other institutions.

“Through the in-country groundwork, we avoided many pitfalls, such as incorrect delivery addresses, availability of labor for offloading at warehouses, and import waiver delays.”

The team not only succeeded in ensuring a successful delivery, but also managed to create awareness about the importance of this malaria prevention project and the shipment of commodities that make it possible.

By sharing their expertise and conveying a genuine sense of responsibility, the PFSCM team motivated the various stakeholders to uphold the same level of ownership.

Price reduction to yield future savings

Meanwhile, earlier in 2017, PFSCM negotiated a 17% price reduction on Actellic 300CS. Prior to these negotiations, the pricing for this IRS commodity had remained the same since 2014. The price reduction is expected to yield significant savings on future procurements and will contribute to saving more lives.

ISO 9001:2015 certification logos

What should you deliver by unmanned aerial systems?

New white paper from JSI (PFSCM partner)

As more low- and middle-income countries explore opportunities to improve their public health supply chains and diagnostics networks, knowing how best to use unmanned aerial systems (UAS) to improve reach in the last mile is critical.

Under the inSupply project, JSI Research & Training Institute, Inc., and its partners LLamasoft, Inc., and the Nichols Group provide objective guidance for countries and public health stakeholders on how to make informed decisions about which health products to prioritize for cost-effective delivery using UAS vs. well-managed traditional modes of last-mile delivery, such as land cruisers and motorcycles.

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Global Health Supply Chain logo

This year the Global Supply Chain Summit will be taking place in Ghana from 15 to 17 November.

The theme of this year’s conference is Linking to the future of Global Health Supply Chain Management: Enhancing the role of the private sector, technology enablement, and workforce development and empowerment.

PFSCM will be presenting on two very relevant and pressing topics:

Reaching the last mile: Improving supply chain performance through private-sector investment

– by PFSCM Head of Logistics, Ishmael Muchemenyi

Underperformance and the impact on last-mile delivery remains the biggest challenge faced by public health supply chains in developing countries. Aging and limited supply chain infrastructures are coming under increasing pressure to meet new demands, such as the need for transparent data, measurable last-mile results, and performance tracking. Leveraging the existing commercial services and capacity of private-sector entities will enable these supply chains to become sustainable, high-performing mechanisms that can adopt new technologies to overcome last-mile challenges. At the GHSC Summit, PFSCM will delve into a proven approach of investing in private-sector entities to advance our quality standards through training, capacity building, and infrastructure development.

Topics to be explored include:

  • Achieving public health drug deliveries by contracting with and managing local logistics service providers.
  • Improving the performance of local private-sector actors to support public health requirements.
  • Achieving private-sector performance levels in public health supply chains.

Increasing access to essential medicines through pre-qualified, quality local sources

– by PFSCM Product Quality Assurance Unit Manager, Stephen Kimatu

In many low-income countries, especially in Africa, the supply of quality-assured essential medicines tends to be inconsistent and unreliable. Poorly resourced public-sector supply chains, pervasive risk of falsified or substandard pharmaceuticals, a lack of World Health Organization (WHO)-prequalified local manufacturing sites, and scarcity of products approved by a stringent regulatory authority (SRA) are all factors that hamper the sustainable development of supply chains.

Recognizing this problem, PFSCM launched an innovative audit and prequalification program to assess a pharmaceutical wholesaler, distributor, or manufacturer’s level of compliance with leading compliance and quality standards, such as those set out by the WHO. Once prequalified, further investments can be made to assist vendors in advancing quality and compliance.

Using this approach, PFSCM has developed a network of prequalified local sources in Africa. This network brings essential medicines closer to patients and aids in developing supply chains and directly supporting donor programs and local governments.

Topics to be explored include:

  • PFSCM’s product QA approach, experience, and coverage.
  • How developing the capacity of local private sector pharmaceutical wholesalers increases drug availability in low- and middle-income countries (LMICs).
  • Specific examples highlighting the health access impacts as a result of private sector development and support.

For more details about the conference, visit the GHSCS website.

Click here to get in touch with PFSCM.

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Clinical microbiology conference logo

PFSCM partner Imperial Logistics has established a new working group on supply chain control towers.

“The working group aims to ensure a shared understanding of supply chain control towers and to explore potential business opportunities, specifically where current client relationships can be enhanced,” says Imperial Logistics chief strategy officer Cobus Rossouw.

In addition, the working group will articulate and document an implementation roadmap for Imperial Logistics’ supply chain control towers.

Click here to read more.

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Clinical microbiology conference logo

David Jamieson, PFSCM Global Partnerships Adviser, presented a keynote to the Scientifictree.com Clinical Microbiology conference in Rome, Italy, this week on the supply chain challenges and achievements in meeting the UNAIDS 90-90-90 targets to contain the HIV epidemic.

Based on the paper David published in 2015 in the Journal of the International AIDS Society (JIAS), he updated the meeting on the achievements so far as demonstrated by recent UNAIDS estimates of numbers infected, on treatment, and achieving viral suppression.

Using the theme of closing in on the targets, he showed how in rural East Africa, UNAIDS estimates that 90% know their status, and most of those are on treatment with encouraging viral suppression results (see image of presentation slide below). David also showed how five African countries are closing in on epidemic control, which is when the number of new infections drops below the number of deaths from AIDS-related illness.

These results demonstrate that, as shown in David’s paper, the supply chain has adapted to the increases demanded to reach the 90-90-90 targets, but more still needs to be done.

Challenges include the number of new infections, for which the rate is not slowing down enough; marginalized populations, which remain at great risk; and the rate of new infection in Eastern Europe and central Asia, which is accelerating alarmingly.

For the supply chain, chain David emphasized the continued need to engage the private sector; the need to be flexible and adaptive for new testing approaches, such as self-testing; and the need to bring exciting new drugs into use faster than ever before.

Questions from the conference were mainly around the continued challenges in getting people, especially men, to come forward for testing. If we do not achieve the first 90, with 90% of people with HIV knowing their status, then the second and third 90s cannot be achieved. Concern was also expressed about the risk of viral resistance as some of the older drugs become less effective over time.

David ended his presentation on a positive note, saying that well-managed supply chains can support 90-90-90, but we have to continue to adapt and respond as needs change and exciting new drugs become available, and be resilient in ensuring high performance, as millions rely on the drugs and diagnostics that we must supply on time and to the best value over the coming years.

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VMMC guide cover

We have known for years that if babies born with HIV do not receive treatment, more than 50 percent will die before their second birthday, but we also know that when treated, they can grow into healthy adults. Until very recently, a big challenge has been reaching mothers and their new babies soon enough, testing baby, and getting the results back to mom. Reliable diagnosis could only be completed in larger laboratories, meaning blood samples had to be transported to the lab, kept fresh for testing, and then the results returned — by which time, mother and baby were probably back in their village and might never get the result.

PFSCM has always been firmly committed to improving the care, detection, and treatment of the youngest patients. Drawing on our expertise in managing global supply chains and optimizing laboratory networks, our contribution will be to ensure that the supply chain doesn’t let these patients down; that smart network design places these new instruments where they will make the most difference; and that results get back to mom and her health caregivers at the earliest opportunity.

Read more at our PFSCM Supply Lines blog.

VMMC guide cover

The Under the auspices and funding of SCMS, has developed a new comprehensive toolkit that provides guidance on health care waste management (HCWM) and environmental hygiene best practices for VMMC services. The toolkit is available for download on USAID’s AIDSFree website.

The toolkit contains two components — program guidance and site guidance — each of which is based on VMMC program experience, WHO guidance, and USAID environmental protection/compliance regulations.

Program guidance

The resources in the toolkit’s program guidance component provide VMMC implementing partners with guiding principles for the design, implementation, and monitoring of VMMC environmental health programs. Resources include:

  • A program management guide on safer HCWM practices in VMMC programs
  • Assessment tools
  • Incident management tools
  • Audit tools
  • Disposal guidance for unusable medical products
  • Disposal guidance for unusable pharmaceutical products

Site guidance

In the site guidance component of the toolkit, the resources provide health service providers with specific guidance and tools to teach and reinforce environmental health management. Resources include:

  • A site management guide on environmental health management in VMMC programs
  • Training materials, including a staff pocket guide with a key ring
  • Posters
  • Assessment tools
  • Incident management tools
  • Monitoring tools
  • Disposal guidance for unusable medical products

PAPWG

Through the support of PEPFAR, the President’s Malaria Initiative (PMI), and USAID, PFSCM and the USAID | DELIVER PROJECT contributed to strengthening Zambia’s public health supply chain for HIV/AIDS medicines, malaria medicines, essential medicines, and family planning products. The projects worked to build the capacity of the Government of Zambia (GRZ) to ensure the availability and security of vital health commodities at service level sites by:

  • Strengthening logistics systems to avail critical data for informed supply chain decision making;
  • Increasing ownership to conduct coordinated, transparent quantification, procurement planning, and supply monitoring;
  • Providing cost effective,reliable procurement services;
  • Reinforcing infrastructure for warehousing, distribution, and testing; and
  • Improving strategic management and planning for increased commodity security.

Check out this video to learn more about the supply chain challenges faced when the two projects began and the achievements brought about through collaboration with the Ministry of Health, Medical Stores Limited (MSL), and other partners. The video also looks ahead at the future of the supply chain in Zambia, with recipient, implementer, and donor testimony.

IATT paediatric updated ARV formulary and limited-use list: 2016 update

The 2016 update to the IATT Paediatric ARV Formulary and Limited-Use List has now been officially endorsed by both WHO and UNICEF and is available online.

The first IATT optimal paediatric ARV formulary was created in 2011 by the Child Survival Working Group and the Supply Chain Management Working Group of the Interagency Task Team (IATT) on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children. Since then, the group has convened in conjunction with the ARV Procurement Working Group (APWG) every six months, and following any updates from the WHO Consolidated ARV Guidelines, to update the existing optimal paediatric ARV formulary. This edition reflects the 2016 WHO Consolidated Guidelines and takes account of changes in the markets.

The list continues to serve as guidance for national programs, procurement agencies, funders, and manufacturers to select products that closely align to the criteria describing optimal paediatric dosage forms.

PAPWG

A new paper from the Global Fund and UNITAID describes how the challenging market for paediatric anti-retroviral medicines has been transformed.

The Paediatric ARV Procurement Working Group (PAPWG) was established in 2011 to address procurement and access challenges in the small and highly fragile paediatric ARV market. The Working Group was established as a global collaboration and coordination, including major financiers and procurers of ARVs, as well as technical bodies, through procurement promoting optimal products and regimens. Bringing these partners together enabled greater visibility into this fragile market than any one partner could achieve alone. The PAPWG’s leadership and successful management of the paediatric ARV market has ensured an uninterrupted supply and treatment for children living with HIV. PFSCM and SCMS were founding members of the PAPWG.

The paper and lessons learned can be found here.

The approach taken by the Working Group is now being applied to other commodities and health interventions with similar market conditions. In early 2016, the PAPWG expanded its mandate to include specialist adult ARVs facing similar market challenges, and to support the scale-up of new optimal regimens and formulations.

warehouse workers

The UNAIDS “90-90-90” strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on ARTs and 90% of whom will achieve sustained virologic suppression. Reaching these targets by 2020 will reduce the HIV epidemic to a low-level endemic disease by 2030. From a supply chain perspective, each of the “90’s” has possible complications and roadblocks towards realizing the promise envisioned by 90-90-90.

Read a “real world analysis” of these proposed strategies and policies in our article “The 90 90 90 strategy to end the HIV Pandemic by 2030: Can the supply chain handle it?” just published in the Journal of the International AIDS Society.

mother and child

The new, scored, fixed-dose combination (FDC) tablet containing 120 mg of Abacavir (ABC) and 60 mg of Lamivudine (3TC) is available for procurement through Mylan.

This formulation can significantly decrease pill burden in children (by at least 50% compared to existing formulations of ABC), particularly when used as a once-daily regimen. The reduced pill burden may improve patient adherence and simplify the supply chain at no additional cost to national HIV programs. Furthermore, this formulation may prevent sub-optimal dosing that occurs when adult formulation tablets are cut for use by children.

For further background and a dosing chart for quantification of ABC/3TC (120/60 mg) requirements by weight band, please see the information briefs available in English, French, and Spanish.

ABC/3TC (120/60 mg) Tablet Informational Brief

Note d’information sur les comprimés d’ABC/3TC (120/60 mg)

Nota informativa sobre la pastilla ABC/3TC (120/60 mg)

Storage facilities are critical in ensuring that people can receive the life-saving medicines they need for survival. Without proper storage, drugs can lose potency, become damaged or even be stolen. Earlier this year, SCMS began the deployment of 115 storage-in-a-box (SiB) units in Malawi, funded by USAID and the Department for International Development (DFID).

To learn more, check out the MBC News video, taken during the launch of the first SiB at the Chitedze Health Centre in Lilongwe. It features interviews with Ministry of Health Principal Secretary Mc Phail Magwira, USAID Mission Director Doug Arbuckle, and DFID head in Malawi, Philip Smith, on this critical effort.

mowafy picture

USAID published a great story about SCMS in its USAID Impact Blog titled, “Delivering Life-Saving HIV/AIDS Drugs Around the World” by Sherif Mowafy. It highlights the importance of supply chains in public health and cites some of SCMS’s many successes and impacts. This story further promotes our SCMS 10 Year Review, “Ten Years of Supporting PEPFAR through Stronger Public Health Supply Chains.”

pepfar hands holding ribbon

SCMS is proud to release its report, “10 Years of Supporting PEPFAR through Stronger Public Health Supply Chains: A Report on SCMS Contributions to PEPFAR Results.” As SCMS marks a decade of operating the largest public health supply chain in the world on behalf of the US government, the project looks back at how it helped to move the global community closer to reaching our collective goal: achieving an AIDS-free generation.

At the International AIDS Conference in July in Durban, South Africa, PFSCM conducted a satellite panel discussion with the theme of “Meeting the Supply Chain Challenge of 90-90-90.” The 90-90-90 targets have a number of ramifications on the various elements of the supply chain.

Five panelists representing UNAIDS, which established the 90-90-90 goals; WHO, which develops related policy and guidance; Mylan, an ARV manufacturer; Alere, a diagnostics manufacturer; and Imperial Health Sciences, a health logistics firm and PFSCM partner, engaged in thought-provoking discussion to unpack the challenges facing each 90.

PFSCM’s David Jamieson introduced the panel discussion and framed the discussion around innovations needed to achieve the 90-90-90 goals. With PFSCM’s Gordon Comstock moderating the panel, Peter Ghys of UNAIDS and Daniel Low-Beer of WHO spoke about the modeling that led to 90-90-90 and the innovations needed to treat all. Arvind Kanda of Mylan, Willem Pretorius of Alere, and Iain Barton of Imperial Health Sciences discussed the specific pharmaceutical, diagnostics, and logistics innovations needed to achieve 90-90-90.

PFSCM Supply Lines Blog

PFSCM Supply Lines is a platform to share our health supply chain knowledge and the latest public health news with our stakeholders and interested parties.

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