Innovative Approaches to Promoting Access to Medicines

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1 Innovative Approaches to Promoting Access to Medicines Nana Boohene; 20 February 2015 Social Forum at The Human Rights Council (On behalf of Christopher Game Chief Procurement Officer, the Global Fund) 1

2 Table of Contents The Global Fund s Work in over 140 Countries The changing Global Health Landscape requires Innovative Approaches to increasing access to essential health commodities GF Human Rights & Procurement Strategies to increase Access Joint Partnership of 9 Development Organisations to promote Sustainable and Equitable Access to Health (including essential medicines)

3 The Global Fund s Work TGF Grants Fight AIDS, TB, and Malaria in 140 Countries The Global Fund is a key mechanism for achieving health related Millennium Development Goals Source: Global Fund Grant Data, end 2013 High Impact Africa 1 High Impact Africa 2 High Impact Asia Africa and the Middle East Asia, Europe and LAC Since its creation in 2002, the Global Fund finances over 1,000 programs in 140 countries with approved funding of US$29.4 billion.

4 The Global Fund s Work TGF Strategy is based on 5 core Principles Invest more strategically in areas with high potential for impact and strong value for money, and fund based on countries national strategies; Evolve the funding model to provide funding in a more proactive, flexible, predictable and effective way; Actively support grant implementation success through more active grant management and better engagement with partners; Promote and protect human rights in the context of the three diseases; and Sustains the gains, mobilize resources by increasing the sustainability of supported programs and attracting additional funding from current and new sources.

5 Issues The Global Health Landscape is changing Over 100 MICs, account for five of the world s seven billion people, where we also find the greatest disease burden - and where over 75 percent of the world s poor now live. Many people in such countries cannot afford to procure essential health commodities and services out-ofpocket, should donor/ governmental institutional frameworks be removed. Key populations who are often marginalized or criminalized also frequently experience challenges in accessing health, even when governmental institutional frameworks exist. These changes require an innovative response

6 Strategies to Increase Access to Health including essential medicines Context The Global Fund disburses over $2 billion per year 40% of the organization s annual budget is spent on health products. Strategies Human Rights Considerations in the Global Fund Strategy Procurement for Impact (P4i) Leveraging Technology to innovate and secure the Supply Chain in order to increase Access to affordable, safe, efficacious health products The E-marketplace taking procurement online

7 Human rights in the Global Fund Strategy Global Fund Strategic Objective 4 commits the Global Fund to protecting and promoting human rights through 3 actions: 7

8 Integrate human rights considerations throughout grant cycle Integrating human rights into the grant-making process means that the principle of country ownership must involve an inclusive country dialogue with space for meaningful involvement of civil society, communities and key populations in designing, monitoring and implementing programs that affect their lives. 8

9 Invest in human rights programs to address barriers to services Legal environmental assessment and law reform Legal aid and legal literacy Human rights training for police, health workers and officials Community-based monitoring Policy advocacy For additional details and guidance, see: Global Fund Information Notes, including: Human Rights for HIV, TB, Malaria and Health Systems Strengthening Grants Addressing Gender Inequalities and Strengthening Responses for Women and Girls Addressing Sex Workers, Men Who have Sex with Men, and Transgender People in the Context of the HIV Epidemic Harm Reduction for People who Use Drugs 9

10 Ensure Global Fund does not support programs that infringe human rights Five minimum human rights standards have been added to the Global Fund s grant agreement, establishing the Fund s bottom line in terms of its expectations for all programs financed by the Fund. The standards were developed based on consultations with human rights experts and key population networks. By signing the grant agreement, implementers commit to these standards and will work with the Global Fund to ensure that programs and interventions do not violate human rights. 10

11 GF Procurement Strategies to Increase Access P4i has changed Procurement Practice to Increase Access Fundamentally changed the way GF work across the supply chain to increase access to products Earlier involvement and closer collaboration with manufacturers Improved our purchasing capability and changed our contracting models Optimising the international supply chain to reduce cost Better planning and scheduling to support continuity of supply Delivering more products at the right time and place to more people

12 GF Procurement Strategies to Increase Access P4i increases access through lower prices and through better managing supply/ availability The GF Procurement Transformation has addressed issues of price, supply and quality of medicines to increase access to GF Financed Medicines. The innovation is embedded in the approach used to gain a better understanding of the products and suppliers we work with. Examples of P4i contribution to improved Access include: Reduced prices Global Fund Procurement has analyzed and now better understands the cost-of-good-sold (COGS) of the medicines the organization procures to support grants. This means the Global Fund is driving better value for money with manufacturers, around a fair margin and can subsequently sustain that margin Supplier engagement - P4i engages suppliers to ensure sustainable supply of health commodities to grants.

13 GF Procurement Strategies to Increase Access Securing the Supply Chain (Availability and Quality) We have developed an algorithm to use technology to guarantee equitable access to safe, efficacious, quality and affordable health products in Sub-Saharan Africa Invetigated 10 Innovative Detection Technologies (TruScan, CD3, PharmaSecure, PharmaCheck, M- Pedigree, Global Pharma Health Fund, MiniLab, Chinese Mobile Laboratory, SICPATRACE, and FIONET) o These offer a compelling and mutually reinforcing set of technologies leading to explicit and specific combinations (a deployment algorithm) of the 10 for different circumstances. Interaction with the USA Institute of Medicine (IOM) led to detection innovations and selection techniques which have being incorporated into the deployment algorithm.

14 INTERNATIONAL DATABASE WORLD HEALTH ORGANISATION (WHO) PORT OF ENTRY/LOCAL FACTORY TRUSCAN, CD3, GHFM CENTRAL MEDICAL STORE, NATIONAL DRUG STORE TRUSCAN, CD3, GHFM, FULL LAB ENQUIRY/RESPONS E AXIS (AUTHENTICATION) PROVINCIAL MEDICAL STORE TRUSCAN, GHFM, M-PEDIGREE, PHARMASECURE, PHARMACHECK REGIONAL DATABASE CENTRAL HOSPITAL TRUSCAN, GHFM, M-PEDIGREE, PHARMASECURE, PHARMACHECK COUNTRY DATABASE PROVINCIAL HOSPITAL M-PEDIGREE, PHARMASECURE TECHNOLOGY PROPRIETORS HEALTH PROVIDERS DISTRICT HOSPITAL M-PEDIGREE, PHARMASECURE LOCAL HOSPITAL M-PEDIGREE, PHARMASECURE CLINIC M-PEDIGREE, PHARMASECURE ADVOCACY + EDUCATION PATIENT M-PEDIGREE, PHARMASECURE REGULATORS, NGOs, INSPECTORS LOCAL DATABASE M-Pedigree/ Pharmasecu re Movement of Authentication Data Movement of Medicine GHFM -- Global Health Fund MINILAB Movement of information

15 GF Procurement Strategies to Increase Access E-marketplace squares the strategic dilemma of affordability, accessibility and country ownership From a limited short term model Despite savings and risk limitation, current Global Fund pooled procurement mechanism* shows limitations due to competing countries interests to a sustainable long term model Future model must provide market transparency while keeping countries owners and accountable for procurement operations Purchasing power and related savings through pooled orders Mitigation of fiduciary and operational risk Better transparency and oversight Increasing countries procurement and supply chain capabilities and capacity Call for country ownership and operational leeway Support for local manufacturing Market transparency for buyers and suppliers, especially small ones Affordable and accessible products thanks to aggregation of volumes and more sustainable supply Independent countries decisionmaking in procurement operations Risk mitigation thanks to direct cash-to-suppliers payments, suppliers screening and reviews 15

16 GF Procurement Strategies to Increase Access E-marketexchange A game-changer for global health procurement with several benefits Short term Long term Buyers E-/marketplace procurement mechanisms Global fund-funded countries Purchase from e-catalogues Issue e-rfps and e-auctions Purchase at pre-agreed prices from Global Fund tender All countries along development continuum and global health key stakeholders Pool with other buyers to issue e-rfps and e-auctions Key benefits More accessible and affordable products Significantly more efficient and cheaper procedures Independent decision making Direct payment to suppliers, with potential benefit for IMF fiscal space and fewer reporting requirements Optimal pricing and equitable access Acceleration of product innovation Acceleration of procurement autonomy Sustainable procurement function after from Global Fund support 16

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