PAHO Technology, Healthcare and Research Project of Essential Medicine and Biologicals

1. The PAHO Strategic Fund Linking Technical Cooperation in PSM with Aquisition of Strategic Public Health Supplies PAHO Technology, Healthcare and Research Project of Essential Medicine and Biologicals Pan American Health Organization

2. What is the PAHO Strategic Fund ? DEMAND SUPPLY Supply System Assessments Regulatory Framework Good Storage, Warehousing Distribution Practices Rational Use Selection, Formularies Demand Estimates, Forecasting Financing Analysis Pricing, Supplier, Market Info. PAHO SF Procurement ACQUISITION Other Monitoring andEvaluation Pan American Health Organization

3. The Strategic Fund: A Country Based Initiative • 2000: established by the Director of PAHO at the request of Brazil during the 42nd Meeting of the Directing Council • 2004: Resolution CD45R7 of the 45th Directing Council on Access to Medicines: • Strengthen capacity in programming and planning of supplies • Facilitate the achievement of economies of scale • Promote continuous availability of Strategic Public Health Supplies • 2004 & 2005: Resolutions of the 45th and 46th Directing Councils in HIV/AIDS: • Critical Line of Action #4 of the Regional Plan in HIV/AIDS for the Health Sector, 2006 – 2015. • 2006, Resolution of the 47th PAHO Directing Council on Public Health, Health Research, Production and Access to Essential Medicines Pan American Health Organization

4. Concepts in Collaborative Procurement Source: MSH / RPM Plus, Rockefeller Foundation 2005 Pan American Health Organization

5. What is a Strategic Public Health Supply? A product is considered to be a Strategic Public Health Supply when it meets the following criteria: • Is included in the WHO list of essential medicines or in the list of insecticides recognised and recommended by an Expert Committee of WHO • Is included in treatment protocols or algorithms recommended by WHO and is considered highly effective in the treatment and prevention of disease • Contributes significantly in reducing disease mortality and morbidity, improving quality of life for patients • Is subject to particular challenges in procurement and supply management • Economies of scale can be achieved as volumes purchased increase Initial list focuses on HIV/AIDS, Malaria, TB and neglected disease Pan American Health Organization

6. Works through Works through Working Group PAHO Supports Collaborating Centers BDS, COHAN, ENSP Other Partners WHO (AMDS, MMSS) CF, MSH, GDF, Global Fund Participating Countries 1. Ministry of Health 2. Social Security System 3. Global Fund Projects Operating Structure Strategic Fund Pan American Health Organization

7. WHO Collaborating Center Strategic Fund Network Sites Regional Office PAHO Tech / Admin Units, Procurement WHO/PAHO CC Supply Subregional post Intl Caribbean Subregional THS/EV CA / Andean SF Consultant HIV/AIDS Sub-regional CAREC/HIV/AIDS WHO/PAHO CC Supply SF Coordination Subregional MERCOSUR THS/EV RAVREDA Malaria Strategic Fund Operational Network WHO CC Policies Rational Use Pan American Health Organization

8. The Process 2005 - 2006 • Revision of the Operational Framework • Sub-Regional Workshops to initiate roll-out (Central America, Andean and Caribbean) • National Workshops (interprogrammatic) to establish country operations • Development of country work-programs based on priorities • Supply System Assessments (NIC, HON, ECU, GUT, DOR) • Procurement Planning (GUT, HAI, ECU, NIC, HON, BEL) • Capacity Building (Caribbean regional, BEL, ECU, TRT) • Negotiations with Partners (COHAN, MSF, GDF) • Linking with Global and Regional Prequalification and the Regional Network of QC Labs Pan American Health Organization

9. Some Key Results • 19 countries participating - 30% increase in 2 years • 2 Social Security Agencies, and 4 PRs participating • Positive Country Experiences: • Guatemala: Consolidation of demand MS, IGSS, PR • Ecuador: Resolution of key bottle-neck, facilitating GFATM disbursement • Haiti: Single Procurement Plan for all GFATM beneficiaries • Venezuela: Elimination of vertical PSM programs • Clinton Foundation joint work in Barbados, Belize, Surinam, Ecuador and Honduras • 2 Publications, Webpage • ARV Price referencing with Regional Negotiations • Consolidated procurement of anti Malarials for Andean countries • Consolidated procurement malarial, PAMAFRO 2006-2007 • Strategic partnerships, COHAN, `Clinton Foundation`, MSH. • Publications, informative bulletins, developed Web page • Capitalization account used for purchases of emergency procurement (Brazil (ARVs), Bolivia (TB)) Pan American Health Organization

10. Ecuador achieves Significant Reductionin Antiretroviral Prices 2007` Source : Agua Buona, February 2007 Pan American Health Organization

11. US$ Procurement Summary Strategic Fund • Forecast Procurement: 2006 (US$ 12 million), 2007 (US$ 20 million) • Breakdown by Disease Area • HIV/AIDS (ARVs) 82% • Malaria 13% • TB 4% • Others 1% • Value Capitalization Account (established 2005) end: US$ 290,000 Pan American Health Organization

12. www.paho.org/StrategicFund • Contacts: • James Fitzgerald, Coordinator, Strategic Fund, PAHO Washington DC • strategicfund@paho.org Pan American Health Organization