Overview of UNICEF engagement in health & supply. Supply Division, 27 September 2010

Transcription

1 Overview of UNICEF engagement in health & supply Supply Division, 27 September 2010

2 Presentation outline Reaching MDGs with equity Priority interventions Introduction to UNICEF Supply Divisions work The way forward at country level

3 Causes of Maternal Deaths Global Sepsis 8% Embolism 2% Abortion 9% Other direct 10% Haemorrhage 32% Hypertension 17% Indirect 22% Source: WHO 2010

4 Maternal deaths per 100,000 live births Trends in the maternal mortality ratio 1990 & , Sub- Saharan Africa South Asia Middle East/ North Africa East Asia/ Pacific Latin America/ Caribbean CEE/CIS Developing countries World

5 Causes of Child Deaths Pneumonia and Diarrhea account for more than 1/3 of child deaths.

6 Child Mortality Still almost 9 million children dying every year, more than 3 million are newborns Almost no decline in early neonatal mortality in decades

7 Reaching the MDGs with EQUITY - Overcoming barriers that prevent poorest from using services task shifting: community outreach - Maternal and newborn care Working where there is the greatest needs gives the greatest returns in real results

8 Overcome Barriers to Access Elimination of user charges; expansion of cash transfers Community case management (CCM): greater use of community health workers to deliver basic health care services outside of facilities CCM utilizes trained, supervised community members, linked to facility based services; many of them are volunteers enhanced community involvement to promote care-seeking practices Pneumonia, diarrhoea, malaria, measles and severe acute malnutrition that afflict and kill poor children in particular, can often be managed successfully at the community level if community health workers are provided with adequate supervision, support and incentives.

9 Maternal and newborn care Upgrade facilities and expand maternity services at the primary level Application of three types of intervention packages proven to have high impact on the main causes of MNC deaths among the poor: curative, preventive and promotive

10 High Impact Child Survival Intervention Packages Curative Services ORS & Zinc for diarrhea Antibiotics for pneumonia ACTs for malaria Ready-to-use therapeutic foods (RUTF) Preventive Services Contraceptive distr. Immunization Vitamin A dist. De-worming Growth Monitoring Health Promotion Breastfeeding Hand washing with soap Sanitation Health care seeking Using bed nets Balanced diet HIV/AIDS awareness Reduce smoke pollution in homes Priority essential medicines for addressing child survival

11 Product and Supply Chain Considerations Products to come in appropriate strengths and pack sizes to meet the needs of CHWs, caregivers, and children in the community Packed for easy dispensing and inventory management (blister strips) Age appropriate strengths to avoid tablet splitting Packaged with information and pictures for caregivers to remember instructions for administration Need to move from liquids to solids-to-liquids formulations (cost, storage, supply chain) Ability to use weight based dosing, with effort to standarise the weigh bands Appropriate strength and formulation for children

12 Product and Supply Chain Considerations contd. Strategies to enhance adherence (packaging & labelling) Regulatory requirements, e.g. quality standards Products should be packaged appropriately for CCM settings Heat and moisture stable Protected from heat, sunlight, moisture, crushing Product formulations to be both pediatric- and supply chain- friendly Dispersible if possible Taste-masked to make appealing to children and caregivers

13 Introduction to UNICEF Supply Divisions work

14 UNICEF HQ Organizational Groupings Executive Director Programme Group Management Ext. Relations & Resource Mobil. Regional Offices Programmes Finance Resource Mobilisation Country Offices Policy & Planning Human Resources Commun ication Supply ITD Emergency Ops Research Audit & Evaluation Executive Board Sec. NatComs & Greeting cards HQ in Copenhagen Oversees UNICEF s supply chain work Approx. 900 supply & logistics staff globally

15 Overarching objectives of Supply Market Shaping Ensure availability of essential commodities at global and national level, eg, Sufficient global production quantities Affordable pricing Healthy & diverse supplier base Paediatric formulations International quality standards Product innovation Service Delivery Help ensure availability of essential commodities at point of service-delivery, eg, use different supply chain models to support distribution at population-level, health post, school level, and community distribution bridge expertise for national capacity attained externally or though continued internal development performing operations research and pilots to support scale-up including by national systems Tech innovation

16 UNICEF engagement in supply & logistics varies depending on country context and programme For example, 3.3 billion doses of vaccine Zinc 18 million bed nets RUTF, therapeutic foods 17 million ACT treatments Vitamin A 5 million ARTs Cotrimoxazole De-worming Essential Medicines Clean Water products Hygiene products Countries UNICEF procures on behalf of Major ACSD supplies Part of ACSD supplies

17 UNICEF procurement throughput by programme (RR/OR/ORE) and procurement services

18 Procurement Services provided to a wide range of countries; thoughput is concentrated to a few 101 countries assisted Top 10 countries represent 66% 57% procured for LDC countries Country 2009 % of Total PS Ethiopia 131,672,884 13% India 123,954,870 12% Nigeria 87,907,832 8% Pakistan 81,271,595 8% Congo, Dem. Rep 68,882,676 7% Bangladesh 62,147,345 6% Malawi 41,853,164 4% Sudan 40,585,188 4% Kenya 22,054,184 2% Uganda 20,658,079 2% Source: Based on FLS report ZPOX2 and ZDELX showing PO s and WH orders placed from 2000 to 2009

19 Procurement throughput by ten largest commodity groups, 2009

20 Millions of USD Largest 10 supplier countries by value (determined by country of invoice), Largest supplier countries in

21 Service delivery

22 Definition of Need (spec, timing, qty) Budgeting and Planning Procurement Delivery & Clearance Inspection Warehousing & Distribution & Reorder national, provincial, district, community Utilization by Beneficiary Monitoring & Evaluation Improving the end-to-end service delivery of essential products Planning Procurement Logistics & Delivery M&E Traditional Focus. Current Improvements Next Challenge

23 2005 Supply Function evolution 70% direct delivery Direct Delivery Procurement Services % programme direct delivery, 50% PS Capacity building activities limited ad hoc Innovation approach conceived Direct Delivery Procurement Services To be: Capacity building structured as Supply Enabling Innovation approach established PS growth, direct delivery via UNICEF programme diminishes Direct Delivery Procurement Services CB/ES IV To be: Growth in Enabling Supply and Innovation activities PS stabilises, direct delivery diminishes Some activities transition/merge between direct delivery and PS Some activities transition/merge between PS and Enabling Supply Innovation & Learning Lab in SD Direct Delivery Procurement Services Enabling Supply IV To be: 2020 Innovation as prime driver of all other sectors Direct delivery is more focused and provides innovation and business experience for Enabling Supply Excellence in Direct Delivery focused on fragile states and emergency response Enabling Supply activity emphasis greater than UNICEF programme emphasis Direct Delivery Procurement Services Enabling Supply Innovation

24 Innovation

25 MDG 1 Innovationd to combat malnutrition RUTF, RUSF, Micronuts, Fortification (eg, Ultra rice) MDG 2 Harness Tech to improve access to education Improved shelter solutions emergency schools Innovative flooring for dirt floors Remote learning- (eg, Libraries) School hygiene MDG 3 Develop solutions to feminine hygiene products Develop markets to ensure community availability MDG 4 & 5 Innovation Focus Areas Diagnostic tools for predicting complications (eg, fetal heart monitor) Improving clean-safe delivery kits & umbilical cord care Solar-chill cold-chain for vaccines & meds Paediatric Meds for low birth weight/premature birth (eg, gentamicin) Low-cost neonatal resuscitators Pre-packaged oxytocin to treat haemorrhaging Support new vaccine market & scale-up MDG 6 Mother-Baby- Pack Prevention of malaria transmission in children MDG 7 Water solutions for emergency (eg, new jerry cans) Solar power sources Greening our buildings Adjust the view: Prioritise innovations that help address inequities MDG 8 Support innovative financing mechanisms Inform CSR approaches to innovation for children Partnering for in-country delivery of services, incl. with academia+ private sector Agile contracting Recycled goods4 school furn. Respiratory timer Harness the potential of information technology for faster and more accurate data capture and analysis to improve assessment, diagnostics, operations management, mapping, monitoring and communicating with others

26 Prevention of malaria in children School furniture from recycled materials Retaining soap in schools Menstrual hygiene and management Agile contracting Temperature monitoring device for vaccines Respiration rate timer to diagnose ARIs Collapsable jerry can Tent Solar refrigeration for vaccines and medicines Rapid SMS for data collection RUTF Mother and Baby Pack Auto-disable syringes

27 The way forward

28 Some of UNICEF partnership landscape Measles Initiative ECHUI WHO UNHCR GAIN WFP UNDP UNFPA Roll Back Malaria Human. Clusters IFRC MSF UN Agencies + NGOs + Natcoms Industry (10,000/yr) Polio Eradication Micro- Nut. Init. Programme Partnerships GAVI Immunization Bill&Melind Gates Found. GFATM The Global Fund HIV/AIDS, TB, Malaria Advance Market Commitment (8 donors/$1.5b) Governments Fritz Inst. Humanit.. Logs Academia + Policy UNITAID Air travel tax IUPHAR Meds4 Children SAGE immunization IFFIm Federal Bonds for development Assistance ($3B) WorldBank Sole-sourced for health procurement Funding alliances IPC Pharma Policy Design Inst.

29 Ways forward: Integration and Complementarity Integrated packages of interventions Complementary service delivery modes Integrated planning, costing and budgeting Downstream/upstream integration Integrated data collection (MICS) Mainstreaming cross-cutting areas

30 Ways forward: Integrating spatially At the household/community level: Promotion of positive care practices e.g exclusive breast-feeding, care for pregnant women Promotion of hand washing, use of toilets, treatment of home drinking water, reducing smoke polution Sleeping under bed-nets Community case management of diarrhea, pneumonia and severe acute malnutrition Home based new born care Post-natal visit

31 Integrating high impact interventions in outreach health services / national health days Immunization Distribution of insecticide treated nets Vitamin A supplementation De-worming Messages on key behaviors such as hand washing and breast feeding

32 Highest Priority Childrens Medicines Amoxicillin - dispersible, scored 250 mg and 500 mg in packs of 10 ORS in smaller sachets (200ml) and child-friendly flavour Zinc - 20mg scored dispersible tablet ACT(s) - dispersible/fsod and dose optimized in appropriate dosage forms Artesunate - rectal & injection (needs improvement); NOT SINGLE ORAL COMPONENT Oxygen TB FDCs HIV FDCs Analgesics - Paracetamol (dispersible) and Morphine Vitamin A

33 Continued support to community health improvements Focus on availability and appropriate use for medicines to address common causes of child morbidity and mortality Pneumonia, Malaria, Diarrhoeal diseases, Neonatal causes, Measles, AIDS..: Amoxicillin - dispersible, scored 250 mg and 500 mg in packs of 10 ORS in smaller sachets (200ml) and child-friendly flavour Zinc - 20mg scored dispersible tablet ACT(s) - dispersible/fsod and dose optimized in appropriate dosage forms Artesunate - rectal & injection (needs improvement); NOT SINGLE ORAL COMPONENT Oxygen TB FDCs HIV FDCs Analgesics - Paracetamol (dispersible) and Morphine Vitamin A vaccines Ensure products are fit-for-purpose

34 Systems Strengthening Increased focus on procurement and supply management systems and in-country logistics bottlenecks in general.