Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop – Day 4 – Strengthening Investment Cases: GFF Comodities
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This document discusses using a commodity lens to inform investment cases for the Global Financing Facility (GFF). It summarizes efforts to increase access to reproductive health commodities and identifies bottlenecks. Global initiatives like the UN Commission on Life Saving Commodities and the Implant Access Program have increased availability but country data shows gaps remain. Dashboards are presented to rate countries on commodity indicators and identify weak areas like guidelines, stockouts, training and data collection. Analyzing commodity pathways can help strengthen health systems and inform priority actions in national plans to further expand access and coverage of maternal, newborn and child health commodities.
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Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop – Day 4 – Strengthening Investment Cases: GFF Comodities
- 1. RMNCH Strategy and Coordination Team RMNCH STRENGTHENING INVESTMENT CASES GFF COMMODITIES CLINIC NOVEMBER 2015
- 2. Country Plans benefit from global and regional efforts • Many issues require cross-country efforts • Global Actions: • Science/guidelines • Price reductions • Market shaping • Innovation • Regional Actions • Quality control • Regulatory Harmonization • Private sector Commodities and Innovation – identified as a global public goods in the GFF Business Plan Commodities as ‘Global Public Goods’ to support RMNCAH Plans
- 3. Overview 1. UN Commission on Life Saving Commodities 2. How can a ‘commodity-lens’ inform GFF Investment Cases Overview
- 4. Commodities as ‘tracers’ for health systems 1. Shaping global market 2. Shaping local delivery markets 3. Innovative Financing 4. Quality strengthening 5. Regulation efficiency 6. Supply and awareness 7. Demand and utilization 8. Reaching women and children 9. Performance and accountability 10. Product innovation Reproductive health Female Condoms Implants Emergency Contraception Maternal Health Oxytocin Misoprostol Magnesium sulfate Newborn Health Injectable antibiotics Antenatal Corticosteroid Chlorhexidine Resuscitation Equip. Child Health Amoxicillin Oral Rehydration Salts Zinc Accelerate achievement of MDGs 4 & 5
- 5. Activities undertaken to implement the UNCoLSC mandate • Identify bottlenecks across the commodity continuumRMNCH Landscape Synthesis Country engagement Global and Regional support • Country-driven efforts to address bottlenecks • Technical Resource Teams: Coordinated efforts to address cross-cutting challenges
- 6. Activities undertaken to implement the UNCoLSC mandate • Identify bottlenecks across the commodity continuumRMNCH Landscape Synthesis Country engagement Global and Regional support • Country-driven efforts to address bottlenecks • Technical Resource Teams: Coordinated efforts to address cross-cutting challenges
- 7. RMNCH Strategy and Coordination Team Existing data to identify commodity and system bottlenecks Summary Report and Dashboard Document Review Expert Interviews (MOH databases) HMIS / LMIS Health Facility Assessments (e.g. SARA, SPA) Household Surveys (e.g. DHS, MICS) (Routine, Monthly) (2-3 years) (3-5 years) (Ad hoc) (Ad hoc) LANDSCAPE SYNTHESIS (annual)
- 8. RMNCH Strategy and Coordination Team Commodities as ‘tracers’ for the health system Manufacture Coverage Systems bottlenecks Commodity Bottlenecks Commodity ‘pathway’
- 9. Activities undertaken to implement the UNCoLSC mandate • Identify bottlenecks across the commodity continuumRMNCH Landscape Synthesis Country engagement Global and Regional support • Country-driven efforts to address bottlenecks • Technical Resource Teams: Coordinated efforts to address cross-cutting challenges
- 10. Since end 2013, the RMNCH Fund is supporting 19 countries DRC Nigeria Ethiopia Tanzania Kenya Malawi Uganda Senegal Mozambique Cameroon Pakistan Afghanistan Zambia Niger Burkina Faso Sierra Leone Benin Mali Bangladesh 0.7 3.5 4.0 4.8 5.1 1.8 7.0 7.7 7.9 8.0 8.1 5.5 3.9 3.9 14.8 4.0 3.5 10.3 3.4 5.0 5.0 7.0 7.6 12.0 20.0 15.0 22.8 3 countries in Asia receiving RMNCH Fund grant: • Afghanistan • Bangladesh • Pakistan 16 Countries in sub- Saharan Africa Geographical distribution of country financing requests (N = 19) Approved budgets from country financing requests (100%= US$204m) Global Technical Resource Teams 14.9 8.6 Initial financing Follow-on financing
- 11. RMNCH Strategy and Coordination Team UNCoLSC Recommendation # Countries (Total = 18) Selected examples Budget Mapping of market size and manufacturing capacity Supporting local manufacturers with new product introduction $0.9 m (0.5%) 2. Shaping local delivery markets 3 RBF strategies implemented/planned $3.0 m (1.8%) 3. Innovative financing 6 District level quantification, m-Health tools for stock monitoring, integrated LMIS systems, Commodity purchase $52.7m (30.6%) 6. Supply and awareness 18 Update of EMLs, treatment guidelines with LSCs 5. Regulatory efficiency 9 $4.5 m (2.6%) Community mobilization, advocacy efforts, printing and dissemination of media materials 7. Demand and utilization 17 $20.9 m (12.2%) Maternal health vouchers, Telecommunication-availing toll free numbers for calls to ambulance 8. Reaching women & children 6 $2.6 m (1.5%) Innovative ways to package products- Zinc & ORS, misoprostol, magnesium sulfate 10.Product innovation 3 $0.3 m (0.2%) Prequalification of new products by reg. agencies, building post market surveillance capacity, training drug inspectors 4. Quality strengthening 8 $1.3 m (0.8%) Staffing, training, mentorship and support supervision, Development of job aids, checklists across countries 9. Performance and accountability 18 $86.1 m (49.9%) Country plans address the UNCoLSC recommendations
- 12. Activities undertaken to implement the UNCoLSC mandate • Identify bottlenecks across the commodity continuumRMNCH Landscape Synthesis Country engagement Global and Regional support • Country-driven efforts to address bottlenecks • Technical Resource Teams: Coordinated efforts to address cross-cutting challenges
- 13. 9 Technical Resource Teams: 85 organizations, 450 experts N R C M GLOBAL REGULATION, MARKETS AND POLICY SUPPLY CHAIN DEMAND, ACCESS AND PERFORMANCE Scientific and technical guidance Manufacturers identified New product innovation • Price reductions • Local manufacturing • EMLs and treatment guidelines • WHO Pre-qualification • Fast-track registration • Post-market survey • Pharmaco-vigilance • Best-practice materials • ICT innovations • Forecasting • Commodity security strategies • Demand generation tool-kits • Financial access barriers • Procurement support • Health worker job-aids, check-lists and training materials RMNCH COMMODITY TRTs ADVOCACY TRT Advocacy tool-kit DIGITAL HEALTH TRT Inventory of e-and m-Health tools
- 14. RMNCH Strategy and Coordination Team Overview 1. UN Commission on Life Saving Commodities 2. How can a ‘commodity-lens’ inform GFF Investment Cases • Implantable Contraceptives • Country Planning
- 15. Post 2012 efforts to enhance access to implantable contraceptives Family Planning 2020 (2012) UN Commission on Life Saving Commodities (2012) Implant Access Program (2013) • Price reductions by 50% over six years • Volume guarantees 7.7 million implants procured in 2014; 3-fold increase from 2011 Global Program to Enhance Reproductive Health Commodity Security (UNFPA) • Policy efforts, training, commodity procurement and demand generation support to 46 countries Have global efforts increased utilization of contraceptive implants?
- 16. Coverage gains: 4-fold increase since 2012 – where are the bottlenecks? 1.9% 1.3% 3.4% 2.7% 1.1% 0.1% 0.7% 0.0% 1.4% 10.8% 9.4% 7.2% 4.9% 4.8% 2.5% 1.3% 0.4% 5.2% 0% 2% 4% 6% 8% 10% 12% Kenya (2008-09, 2014) Malawi (2010, 2014) Ethiopia (2011, 2014) Uganda (2011, 2015) Senegal (2010-11, 2014) Mali (2006, 2012-13) Cameroon (2011, 2014) Nigeria (2008, 2013) Average Pre-2012 Post-2012 Sources: DHS, MICS surveys
- 17. UNCoLSC RECOMMENDATION AREA INDICATOR RMNCH Coordination Coordination mechanism exists RMNCH plan costed and budgeted Commodity security strategy robust Innovative financing Results-based financing includes family planning Regulatory Efficiency Implants on National Essential Medicines List National treatment guidelines for implants Implants Registered in-country Prescription authority for implants clearly defined Quality Strengthening Procure from GMP-accredited manufacturers National medicines control laboratory functional Monitoring quality and safety of medicines Supply and Awareness Forecasting Tools utilized Comprehensive national LMIS for all commodities Supply chain training extends to districts Implants tracked in LMIS No national stock-outs of implants % facilities with implants available Health Worker Performance and accountability Training curricula exist for implants (national) % facilities with recent staff training on implants Job aids or check lists for implants (national) % facilities with job aids or check lists for implants Demand & Utilization Demand Generation included in national plan No user fees for implants including insertion/removal Implant utilization routinely tracked in HMIS Commodity Pathway
- 18. RMNCH Strategy and Coordination Team Rating Indicator Performance (Weakest ‘1’ to ‘5’ Strongest) 18 1 Very Weak 2 Weak 3 Moderate 4 Strong 5 Very Strong Qualitative indicator ex: “RMNCH Plan Costed and Budgeted” • RMNCH plan exists at national level only • No RMNCH plan exists; needs to be developed • RMNCH plan exists at national and sub-national levels and/or includes intervention costs for implementation • RMNCH plan exists at national and sub-national levels and includes costs for implementation with associated funding sources • RMNCH plan exists at national and sub-national levels, includes costs for implementation with associated funding sources, and includes high-impact interventions
- 19. RMNCH Strategy and Coordination Team Rating Indicator Performance (Weakest ‘1’ to ‘5’ Strongest) 19 1 Very Weak 2 Weak 3 Moderate 4 Strong 5 Very Strong Continuous variable ex: “Stock available to Point-of-Service” • 60-69% stock availability at point-of-service (e.g. health facility) • <60% stock availability at point-of-service (e.g. health facility) • 70-79% stock availability at point-of-service (e.g. health facility) • 80-89% stock availability at point-of-service (e.g. health facility) • >= 90% stock availability at point-of-service (e.g. health facility)
- 20. RMNCH Strategy and Coordination Team Single-Country dashboard to identify specific bottlenecks 20
- 21. RMNCH Strategy and Coordination Team Multi-country dashboard to identify cross-cutting issues 21
- 22. 2 / 10 5 / 10 5 / 7 7 / 10 3 / 10 3 / 10 4 / 10 3 / 10 2 / 9 3 / 10 5 / 9 3 / 10 7 / 8 3 / 10 3 / 8 1 / 9 4 / 8 3 / 10 7 / 7 3 / 10 4 / 7 5 / 10 5 / 10 1 / 7 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Coordination mechanism RMNCH plan costed and budgeted Commodity security strategy Results-based financing mechanism National EML National treatment guidelines Registered in-country Prescription authority Procure GMP-accredited manufurers National medicines control lab Monitoring quality and safety of medicines Forecasting tools Comprehensive national eLMIS Supply chain training to districts Tracked in eLMIS No national stock-outs % POS stock available Training curricula (national) % facilities with recent training Job aids or check lists (national) % facilities with Job aids / check list Demand generation Policy against user fees Service utilization routinely tracked Coordina tionI.F.RegulatoryQualitySupply HR Performance Demand &Access All countries at least one affected area if < 80% stock Commodity and systems-related bottlenecks – 10 countries
- 23. RMNCH Strategy and Coordination Team Overview 1. UN Commission on Life Saving Commodities 2. How can a ‘commodity-lens’ inform GFF Investment Cases • Implantable Contraceptives • Country Planning
- 24. RMNCH Strategy and Coordination Team Average Rating National EM L National treatm ent guidelines Registered in-country Prescription authority Tracked in eLM IS No national stock-outs Stock available at Point-of-Service [B] Training curricula (national) Recent training at Facilities [B] Job aids or check lists (national) Job aids / check list at Facilities [B] Policy against user fees Service Utilization routinely tracked Coverage rate [B] 3.5 4.7 4.2 5.0 4.8 1.0 4.2 1.5 3.9 3.0 4.4 3.5 5.0 1.3 1.8 Female Condom 3.6 5 3 n/a 3 1 5 1 3 3 5 4 5 5 Implant 3.4 5 3 5 5 1 5 1 3 3 5 4 5 1 1 Emergency contraceptive 3.6 5 5 5 5 1 5 2 3 3 5 4 5 1 1 Oxytocin 3.8 5 5 5 5 1 5 1 5 3 5 3 5 1 Misoprostol 3.5 5 5 5 5 1 1 1 5 3 5 3 5 1 Magnesium Sulfate 3.8 5 5 5 5 1 5 1 5 3 5 3 5 1 Injectable Antibiotic 3.4 3 5 5 5 1 5 2 3 3 3 5 1 Antenatal Corticosteriod 3.3 5 3 5 5 1 5 1 3 3 3 5 1 Chlorhexidine 3.2 5 1 n/a 5 3 3 3 3 5 1 Neonatal Resuscitation 2.8 n/a 5 n/a 5 1 1 1 3 3 3 5 1 Amoxicillin 3.8 5 5 5 5 1 5 1 5 3 5 5 1 3 ORS 3.8 5 5 5 5 1 3 5 3 5 5 1 3 Zinc 3.4 3 5 5 5 1 2 5 3 5 5 1 1 Child Average Rating: ReproductiveMaternalNewborn RMNCH lansdscape results help identify commodity bottlenecks • National treatment guidelines on select commodities need further development • While there have been few national stock-outs in last year, stock availability is low and eLMIS requires some attention • RMNCH in-service training curricula should be expanded • Lacking data on the availability of newborn and child health job aids at facility level • Data gaps in terms of service utilization, coverage of MNH commodities and female condoms
- 25. RMNCH Strategy and Coordination Team Systems-related bottlenecks and change over time Domestic and international procurement from Good Manufacturing Practice (GMP) accredited manufacturers 25 No unified RMNCH commodity security strategy (FP strategy is in use but expired) National coordination mechanism exists, chaired by MoH National eLMIS exists for select commodities Category Indicator Rating (2013) Rating (2015) Coordination Coordination mechanism 4 5 RMNCH plan costed and budgeted 4 3 Commodity security strategy n/a 3 Innovative Finance Results-based financing mechanism 3 3 Quality Procurement from GMP- accredited manufacturers n/a 5 National medicines control lab 3 4 Monitor quality & safety of medicines 4 4 Supply Forecasting tools 3 2 Comprehensive national eLMIS n/a 3 Supply chain training to districts 5 4 Demand & Access Demand generation 3 3
- 26. RMNCH Strategy and Coordination Team Cross country comparisons on key performance indicators 26 <<< Below Average Above >>> (2.00) (1.50) (1.00) (0.50) - 0.50 1.00 1.50 2.00 National EML National treatment guidelines Registered in-country Prescription authority Tracked in eLMIS National stock-outs % POS with stock available Training curricula (national) % facilities with recent training Job aids or check lists (national) % facilities with job aids or check lists Policy against user fees Service Utilization routinely tracked Coverage rate Average RegulatorySupplyPerformance Demand& Access
- 27. Population Regulatory Efficiency Supply & Awareness Performance and Accountability Reaching Women & Children Supply & Awareness Performance and Accountability Demand & Utilization - National EML - National treatment guidelines - Registered in-country - Prescription authority - Tracked in eLMIS - National level stock- outs - Training Curriculum - Job aids or checklists - Policy against user fees - Stock out in health facilities - Recent training at facilities - Job aids or checklists at facilities - Coverage rates Female Condom 3 / 12 7 / 12 5 / 12 6 / 12 7 / 10 9 / 10 10 / 10 Implant 6 / 12 4 / 12 5 / 12 6 / 12 6 / 10 9 / 10 12 / 12 Emergency contraceptive 7 / 12 6 / 12 5 / 12 6 / 12 6 / 9 9 / 10 3 / 3 Oxytocin 2 / 12 5 / 12 3 / 12 6 / 12 4 / 11 10 / 10 No data Misoprostol 7 / 12 6 / 10 3 / 12 6 / 12 9 / 9 10 / 10 No data Magnesium Sulfate 6 / 12 7 / 12 3 / 12 6 / 12 7 / 11 10 / 10 No data Injectable antibiotic 6 / 12 6 / 12 7 / 12 6 / 12 5 / 10 7 / 7 No data Antenatal Steriod 10 / 12 6 / 11 7 / 12 6 / 12 6 / 9 7 / 7 No data Chlorhexidine 9 / 12 5 / 9 7 / 12 6 / 12 3 / 3 7 / 7 No data Neonatal Resuscitation 2 / 12 7 / 9 7 / 12 6 / 12 1 / 2 7 / 7 No data Amoxicillin 9 / 12 7 / 10 0 / 12 6 / 12 6 / 9 4 / 5 10 / 10 ORS 3 / 12 6 / 11 0 / 12 6 / 12 2 / 6 4 / 5 8 / 12 Zinc 7 / 12 7 / 11 0 / 12 6 / 12 4 / 5 4 / 5 9 / 9 RMNCH Coordination Innovative Financing Supply & Awareness Quality Strengthening Demand & Utilization - Coordination mechanism - RMNCH plan costed and budgeted - Commodity security strategy - Results-based financing mechanism - Forecasting tools - Comprehensive national eLMIS - Supply chain training to districts - Procure GMP- accredited manuf. - National medicines control lab - Medicine quality - Patient safety - Demand generation 10 / 12 8 / 12 11 / 12 11 / 12 4 / 12 Systems-related indicators: National-level Bottlenecks Commodity by RMNC Service Area Commodity-related indicators: National-level Bottlenecks Facility-level Bottlenecks Legend: % of countries with bottlenecks <= 20% 21-40% 41-60% 61-80% 81-100% No data 12 country assessment of commodity-related bottlenecks
- 28. 40% of essential commodities out of stock (12 countries) SERVICE AREA COMMODITY Cameroon DRC Ethiopia Kenya Mali Malawi Nigeria Senegal SierraLeone Tanzania Uganda Zambia Female Condom 66% 58% 93% 80% 74% 25% 10% 12% 12% 89% 52% Implant 46% 78% 22% 25% 63% 11% 6% 4% 20% 71% 35% Emergency contraceptives 71% 87% 31% 15% 20% 15% 86% 27% 36% 43% Oxytocin 9% 10% 3% 49% 5% 16% 22% 18% 6% 50% 23% 19% Misoprostol 71% 21% 90% 89% 84% 99% 65% 55% 85% 73% Magnesium Sulfate 49% 78% 11% 74% 15% 49% 65% 14% 11% 67% 68% 46% Injectable antibiotics 8% 3% 47% 9% 18% 47% 15% 28% 31% 73% 28% Antenatal Steroids 7% 11% 8% 84% 84% 42% 96% 42% 76% 50% Chlorhexidine 64% 51% 25% 47% Neonatal Resuscitation 11% 91% 51% Amoxicillin 16% 31% 24% 48% 47% 21% 72% 8% 33% ORS 26% 9% 10% 13% 21% 5% 14% Zinc 37% 24% 19% 46% 31% 31% TOTALAVERAGE 46% 43% 24% 51% 69% 30% 30% 53% 26% 26% 57% 35% 40% Average Reproductive Maternal Newborn Child
- 29. Global partnerships to improve regulatory efficiency and quality Country Activities: • Update and align Essential Medicines Lists and Treatment Guidelines GLOBAL REGULATION MARKETS & POLICY TRT • WHO Fast-Track Registration Process • Regional efforts to harmonize guidelines • Joint manufacturer inspections • Support to local manufacturers • GMP certification • Active Pharmaceutical Ingredient • Market shaping activities • Negotiate price reductions on products • Implants, NB Resuscitation devices • Model ‘pharmacovigilance programs’ • Post-market surveillance support
- 30. Supply Chain remains a critical challenge in most countries Country Activities: • Quantification workshops held for life saving commodities • Supervision and health worker training on stock management • Mobile phone tracking systems for stock-outs • Procure transport and IT equipment SUPPLY CHAIN TRT • Support for integrating Logistics and Health Management Information Systems • Assistance with developing medium-term commodity security strategies • Forecasting algorithms for essential commodities • Support for developing supply chain training and quality improvement programs • Interagency Supply Chain Group • KPIs • Reduce fragmentation • Revolving commodity procurement fund
- 31. Job-aids/check-lists can strengthen the performance of health workers Country Activities: • Health worker training • Facility: Newborn care, misoprostol, implantable contraceptives • Integrated community case management for CHWs HEALTH WORKER PERFORMANCE TRT
- 32. Integrated demand generation strategies for commodities/services Country Activities: • Develop messaging materials for pneumonia recognition, female condoms, emergency contraception • Community awareness raising activities – child survival days • KAP surveys DEMAND GENERATION TRT • Integrated tool kit to support demand generation activities • Latest best-practice • Step-by-step implementation guide
- 33. RMNCH Strategy and Coordination Team Advocacy tool-kit: enhancing civil society involvement in RMNCAH • Package of materials and guidance for civil society • Messages to inform relevant audiences about RMNCH commodities and services • Examples to use with relevant decision makers and stakeholders • Links to wider global advocacy initiatives • EWEC, PMNCH, FP2020 • Adaptable tools: Policy brief template Press release template Letter of support template Advocacy strategy development template
- 34. RMNCH Strategy and Coordination Team www.lifesavingcommodities.org Knowledge repository available to all
- 35. • The commodity-lens can inform and strengthen RMNCAH Plans • Landscape Synthesis • Use existing data to identify key bottlenecks • Track progress over time • Compare information across countries • Identify cross-cutting areas where additional global and regional efforts are required • Technical and programmatic resources are available to support countries • Require communication and coordination • Country platforms as the entry point Summary