Prashant Yadav Georgia Tech Humanitarian Conference Feb 19-20, 2009 Atlanta, GA

Transcription

1 ntra- and inter-organizational collaboration in disaster planning and long term humanitarian aid Perspectives from the architecture for financing global health Prashant Yadav Georgia Tech umanitarian onference eb 19-20, 2009 tlanta, G

2 Background round 10 million children under the age of five die due to lack of access to simple and affordable interventions (WO 2008). Over 40,000 people many of them children die every day in developing countries from infectious or parasitic diseases t is estimated (WO 1998, WO 2004) that almost one-third of the world s population does not have access to essential medicines. n addition to this, each year, personal expenditures on health push more than 100 million people below the poverty line (Xu 2007) Many could be saved by access to already developed drugs and vaccines Over $10B is spent annually by international organizations on global health commodities and programs large number of organizations and thus a very complex architecture is used to finance drugs, vaccines and health commodities for low income and lead developed countries Yadav. Georgia Tech umanitarian onference, eb 19,2009 2

3 $10B of annual global health commodities: procurement and financing envelopes Product Vs nternational Procurement structure M Major inancing -PP Global und T Vaccines Malaria GV and Mm (under development) WO M22 GV,, BMG, m Others Global und WB Malaria Booster T -PM TB drugs G GL Global und T ssential drugs Mo procurement.b: epresentative but not necessarily comprehensive ational Governments ealth basket funding from bilaterals Yadav. Georgia Tech umanitarian onference, eb 19,2009 3

4 ow international global health financing flows to low income countries (1) rug Manufacturers nternational inancing Private hannel Buyers Public hannel Buyers GO hannel Buyers Private ector Public ector GOs nd patients lide template borrowed from alberg Global evelopment dvisors- Mm BM Task orce Presentation Yadav. Georgia Tech umanitarian onference, eb 19,2009 4

5 ow international global health financing flows to low income countries (2) rug Manufacturers nternational inancing Private hannel Buyers Public hannel Buyers GO hannel Buyers Private ector Public ector GOs nd patients lide template borrowed from alberg Global evelopment dvisors- Mm BM Task orce Presentation Yadav. Georgia Tech umanitarian onference, eb 19,2009 5

6 Paris declaration and donor coordination ecommends use of in-country procurement systems instead of purchasing on behalf of countries xample: inancing flow for drugs and health commodities in Zambia ource: O Yadav. Georgia Tech umanitarian onference, eb 19,2009 6

7 rugs flow supply chain in Zambia ategor y of Products olor TL M Vs ML TB O Vs Ped GT Blood safety (+ test V) V OOM ontraceptives ML upplies T GOVM T BLTL OO MLTLTL OO GO/PVT ource Of unds W O WOL VO Z B T GLOBL Z T WOL B K P P B G T P X O M O J G L Procurement gent/body WOL VO Z B T Z M O L T O Z WOL B K BOTO V TY O - M P J Point of first warehousing ZMBT TO TO Z TO MO TT TO M POVL TO Malaria entre Point of 2 nd warehousing TT TO POV. TO LT LTY Point of 3th warehousing LT LTY PTT TT TO OM B Yadav. Georgia Tech umanitarian onference, eb 19,2009 7

8 Multi-donor coordination in the in-country drug supply chain in Zambia oordinated unds to eeds Matching Procurement Plan and Budget unds release schedule from Mo/Mo Payment terms etc. Mo inance and ccounts nit onors (Ps) $$ unds ommitted isbursement Plan Purchasing restrictions rug upply Budget Line (BL) rug election Quantification Pharmacy nit Projected equirements Planned vs. ctual tock Levels Procurement and upply nit ational Medical tores ource: undafunda and Yadav 2008, Matching emand and upply for Pharmaceuticals in a Multi-onor nvironment: The rug upply Budget Line (BL) in Zambia Yadav. Georgia Tech umanitarian onference, eb 19,2009 8

9 donor coordinated pledge guarantee (PG) mechanism can provide bridge financing and decrease procurement delays (and hence stockouts) onor pays the mechanism 7 Pledge Guarantee (PG) mechanism PG verifies pledge with donor and establishes MO 3 2 ountry request mechanism to cover product cost 5 Mechanism pays manufacturer or procurement agent onor 1 ountry Manufacturers ource: Work with alberg Global evelopment dvisor for onor makes pledge 4 ountry procures through existing process 6 Manufacturer ships product to country Yadav. Georgia Tech umanitarian onference, eb 19,2009 (1) ould also be accessed by GO or P ource: xisting McKinsey and J eliver analysis; alberg analysis 9

10 urrent Push-Pull Boundary in Global ealth upply hains nventory /Order nterface rug ubstance nventory inal Product nventory rug ubstance Manufacturing o-formulating and Packaging Pre-delivery nspection hipping and Transport orecast riven Order riven ource : Yadav, ekhri and urtis (2006)

11 nter-organizational coordination and risk sharing can shift the push-pull boundary econdary Markets? ale or storage of unused product; potentially waste 6 onors and countries estimate annual purchasing volume for specified products 1 Minimum Volume Guarantee nstitution 2 MVG decides on volume of product and amount of risk to assume stablishes master contracts with manufacturer based on volume / risk tolerance Manufacturer ships products directly to countries 5 Manufacturer informs MVG of unused volume onor ountry 4 Manufacturers Joint work with alberg Global evelopment dvisors 3 ountries and/or donors each place individual orders under master contract Yadav. Georgia Tech umanitarian onference, eb 19,2009 ource: xisting McKinsey and J eliver analysis; alberg analysis 11

12 hifted Push Pull Boundary in Global ealth upply hains nventory /Order nterface rug ubstance nventory inal Product nventory rug ubstance Manufacturing o-formulating and Packaging Pre-delivery nspection hipping and Transport orecast riven Order riven ource : Yadav, ekhri and urtis (2006)