Faith-based Drug Supply Organizations

Welcome to the faith-based Drug Supply Organizations (DSOs) portal. This portal aims to be an online meeting room, library and information exchange to increase networking between DSOs and support capacity development.

This work is part of EPN's Access programme. The project document is available on the DSO project document page. The content of this document was created by a meeting of 16 DSOs in a participative workshop setting, in June 2004, in Nairobi, Kenya. This same event also identified a set of characteristics of a functional DSO, as well as indicators for these characteristics.

The DSO project is mainly funded by SIDA (Swedish Agency for International Development Cooperation).

The DSO project builds on the WHO/EPN Multi-country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations.

New to the DSO Portal

Also on this site:

News from DSOs - a single point of access for newsletters from DSOs around the world
Resources for building your own website
Details of EPN DSO activities
A noticeboard for DSO jobs and announcements
A list of EPN DSO members and links to more information on them
A library of materials and web links to support DSOs

Should you wish to sign up for e-pharmalink, the EPN newsletter for pharmacists working in resource-poor environments, please use this link - subscribe to e-Pharmalink.

Document du projet ODM

The DSO project was developed by representatives of 16 DSOs in a participative workshop setting, in June 2004, in Nairobi, Kenya.

View or download the DSO project document [.pdf 150Kb] [.doc 441Kb]

The participants of the WHO/EPN Multi-country Study met for a feedback meeting to review the study findings and identify ways forward. Working together, they identified priority steps to increase their sustainability and capacities.

The priority areas identified by the group were as follows.

Quality assurance
Sustainability
Access to medicines
Staff and organisational training
DSO storage and management capacities
Collaboration
Distribution services.

This project particularly focuses on those interventions that benefit from economies of scale by being achieved centrally, while benefiting organisations across the region and, indeed, in other resource-poor regions, with advice and information.

DSO Project Summary

Following the successful WHO/EPN Multi-country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations in Sub-Saharan African Countries, and a subsequent feedback meeting, a number of priority steps were identified. These steps aim to develop the sustainability and capacity of faith-based drug supply organisations (DSOs) that work in resource-poor environments and are key to widespread access to HIV/AIDS, malaria, and TB treatments. This project aims to carry out activities towards achieving these steps. The initial study and the feedback meeting were multi-country activities, and it is believed that the priority beneficiaries of this project will also be in multiple countries. Project title: Enhancing the capacity and sustainability of faith-based drug supply organisations

Goal: Increasing access to medicines and positive health outcomes.

Purpose: Enhance the capacity and sustainability of faith-based DSOs.

Objectives:

Increased capacity of DSOs to monitor and evaluate themselves for better feedback and management information.
Increased capacity of DSOs in key organisational, service, and staffing areas.
Increased networking between DSOs that supports information sharing and capacity development.

Activities:

[Objective 1]

1. Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO.

[Objective 2]

2. Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas.
3. The facilitation of processes that develop DSO staff and institutional capacities.
4. Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.
5. Identify appropriate stock management computer software options and make the information available to the DSOs.

[Objective 3]

6. Support DSOs’ access to information through the provision of information portal services through the EPN website.

Period: This project is expected to be carried out over two years.

Document du projet ODM (1)

Introduction

The Ecumenical Pharmaceutical Network

Mission

Facilitating the development of compassionate, just, and sustainable health care in and through the church health care system.

Goal

The support of healthcare providers to improve patient care through proper drug policies, management, and use, especially but not exclusively through church-related health institutions or programmes.

Network objectives

Improve the capacity of healthcare staff and managers of institutions and programmes to rationally manage, prescribe, and dispense drugs, based on the Essential Drug Concept (EDC).
Increase awareness of pharmaceutical issues and promote policy development in church health programmes.
Expand and strengthen national and international networking.
Increase the selection and dissemination of key information on the Essential Drug Concept and Rational Drug Use.

Network details

The Ecumenical Pharmaceutical Network, formerly known as the Pharmaceutical Programme of the World Council of Churches (WCC), and Community Initiatives Support Services (CISS), was started as a programme in the then Christian Medical Commission (CMC) in the early 1980s. It now has a diverse range of members from North and South, comprising of Catholic and Protestant church-related donor agencies, low-cost essential drug suppliers, Joint Procurement Units and Christian Health Associations and health departments in Christian Councils and individual denominations. It works closely with other organisations, such as Health Action International (HAI), the World Health Organization (WHO), and Management Sciences for Health (MSH), as well as the International Network for Rational Use of Drugs (INRUD).

Currently, EPN has members in over 30 countries. Each year, members meet to discuss emerging drug, health, and policy development issues, and also to network. At country level, EPN has started to develop Country Focal Points (CFPs) who serve to facilitate information exchange and communication between country members and the rest of the network. CFPs also assist in organising country specific activities, and in mobilising churches in advocacy issues.

The Network currently employs three staff in the Secretariat and carries out its activities mainly through its members in the individual countries.

Funding

The Network is mainly funded by church-related agencies such as Misereor (Germany), ICCO (Netherlands), Bread for the World (Germany), and other such supporters. Over the years, it has also been funded by EED, Service Overseas, EZE, Christian Aid, Cordaid (formerly Bilance), and Caritas Italiana. A small income is generated from partial fees paid to courses organised by EPN and through fundraising, e.g. from WHO for specific training activities. Co-funding is also provided indirectly (in-kind) through members’ input of time, travel costs, out of pocket expenses, and other such overheads.

International Board

The International Board comprises of representatives from the donor community, main sub-regions (Francophone, Anglophone, and Newly Independent States), Christian Health Associations, and Joint Procurement Units. It also has a member from the WCC. It is responsible for strategic planning, leadership, and management of the Network. The Board meets three times a year.

Introducing faith-based drug supply organisations

The ‘private not-for-profit sector’, plays an important role in pharmaceutical supply services in many countries. Faith-based organizations (FBOs) are one of the major actors in this sector. Their share in health service and essential medicine supply provision varies considerably among countries, but in low-income countries they can provide up to 50% of curative services.

The results of the WHO/EPN study indicate that, among the 16 DSOs in Sub-Sahara African countries, five (31%) started their activities in the early 1970s, four DSOs (25%) were founded during the 1980s, another four (25%) during the 1990s, and more recently two DSOs (13%) have started their activities after 2000.

The main reasons given by church organisations for initiating DSO activities are to:

Meet medicines needs of the population they are serving through faith-based health facilities
Respond adequately to increasing stock-outs of the government medical stores
Manage effectively pooled procurement for various church denominations within the same country
Extend the work of churches to reach the poor and to provide them with health care services.

In general, DSOs have become more active in medicine procurement and distribution when the public drug supply system has increasingly failed to meet the medicines needs of faith-based health facilities. See Appendix 2 for a fuller description of the DSOs and the key results from the WHO/EPN study.

Document du projet ODM (2)

Project overview

The participants of the WHO/EPN study met for a feedback meeting in Nairobi, Kenya in June 2004, to review the study findings and identify a way forward. Working together, they identified priority steps to increase their sustainability and capacities.

The priority areas identified by the group were as follows.

Quality assurance
Sustainability
Access to medicines
Staff and organisational training
DSO storage and management capacities
Collaboration
Distribution services.

This project draws together the recommendations into a plan of action and seeks support for this work in the area of increasing the impact and sustainability of DSOs. The project has the following outline.

Goal:Increasing access to medicines and positive health outcomes.
Purpose:Enhance the capacity and sustainability of faith-based DSOs.
Objectives:

Increased capacity of DSOs to monitor and evaluate themselves for better feedback and management information

Impact indicator
- Re-use of the tool, comparability of data over time, usefulness of results to intervention planning.
- Commitment of DSOs to using the tool.
Increased capacity of DSOs in key organisational, service, and staffing areas

Impact indicator

Increased capacity of staff and DSO institutions involved in using the capacity building tool in Key areas, verified through self-assessment and post process feed back
DSOs re-examine their distribution approaches and are able to make well informed decisions about the most appropriate model for their environment. Verified through self-assessment and examination of case studies indicating DSO follow-up.
DSOs re-examine their stock management computer software and are able to make well informed decisions about the most appropriate model fro their environment. Verified through self-assessment and examination of case studies indicating DSO follow-up.

Increased networking between DSOs that supports information sharing and capacity development

Impact indicator
- DSOs updated and responsive to new information, verified through a self-assessment survey and examples of use of information.

Activities:
[Objective 1]

Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO.

Output indicator
- Completion and testing of tool

[Objective 2]

Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas.

Output indicator
- Completion and testing of tool and manuals
The facilitation of processes that develop DSO staff and institutional capacities.

Output indicator

Number of such activities facilitated

Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.

Output indicator

Document available

Identify appropriate stock management computer software options and make the information available to the DSOs.

Output indicator
- Document available

[Objective 3]

Support DSOs’ access to information through the provision of information portal services through the EPN website.

Output indicators
- EPN website constructed, regularly updated, and carrying relevant information
- Levels of usage of the website and satisfaction of DSOs with the website.

Rationale

The project is designed to address those areas where the potential of DSOs to provide services is limited in some way. The needs assessment undertaken by the DSO group, and informed by the WHO/EPN study, is detailed fully in Appendix 1.

From this needs assessment, the group produced a list of recommended activities for the individual DSOs, the EPN Secretariat, and for WHO. The recommendations are detailed below and those specific to EPN are highlighted. The highlighted recommendations have provided the core activity areas of the project’s objectives.

Quality assurance

SOPs for quality assurance

Recommendations	Commitment/Action by:
Provide background and reference materials	WHO
Develop training on development of SOPs	EPN Secretariat
Development of SOPs at DSO level	CHAZ, CHAM, Ghana
Implementation of SOPs at DSO level	DRC, CHAM, CHAN, JMS, CHAZ, Ghana
Development of monitoring (self-audit) of use of SOPs	TZ, MEDS
Development of non-testing quality assurance SOPs	JMS, Ghana

Addressing qualified staff needs

Recommendations	Commitment/Action by
Short-term technical assistance to develop staff capacities is required from the wider sector
DSOs should employ and retain qualified staff	TZ, CHAN
DSOs to take steps to be an 'attractive' employer e.g.: Provide good working environment Institute good system of benefits Training Staff development Supporting allocating budgets for training Provide attractive uniform for staff Investigate and learn about other employer’s “attractiveness”	TZ

Quality control laboratories

Recommendations	Commitment/Action by:
Strengthen existing DSO QC labs	MEDS
Set standards for QC labs	WHO, AMFA
Map existing QC labs for collaboration	AMFA
EPN to provide updated information on issues related to QC, e.g. counterfeit drugs	EPN Secretariat
DSOs to contract QC laboratory services	TZ, DRC, CHAN
DSOs to collaborate with existing laboratories for QC, e.g. government and private	CHAM, TZ

Sustainability

Recommendation	Commitment/Action by:
EPN to solicit for funds from the wider sector for capacity building in planning and financial management	EPN Secretariat
EPN to facilitate the exchange of existing tools and best practice in financial management and planning.	EPN Secretariat
Equip the DSO management with planning and financial management skills	TZ, CHAN
Equip the DSO with knowledge of the revolving fund concept for sustainability	TZ, CSSC, CHAN
DSOs to involve the founding body in planning	TZ, CSSC, CHAN
DSOs and the wider sector should organise regular meetings with stakeholders	TZ, CSSC, CHAM, Ghana
EPN to develop training on collaboration techniques	EPN Secretariat

Access

Recommendations	Commitment/Action by:
Need to verify use of inventory consumption data for placing orders.	TZ, DRC, Ghana
Development of training in drug procurement management	WHO, TZ
The network supports exchanges between DSOs	EPN Secretariat
DSOs need to advocate for the reinforcement of the skills of the management committees governing them, with the goal of increasing sustainability
Advocate for DTCs and the use of EDL for placing orders	CHAM, TZ, Ghana
DSOs need to have clear understanding of various methods of financing (including Revolving Drug Funds) and the implementation of such solutions	TZ
Build-up FBO capacities to receive international funding
Study successful fundraising organisations for lesson learning
DSO negotiate with quality local suppliers for reduced prices	Ghana
Organise pooled procurements	Ghana, TZ, CHAM
Encourage local production by first carrying out a feasibility study	Ghana, CHAZ, TZ

Training

Recommendations	Commitment/Action by:
DSOs and EPN should develop in-service training tools for Rational use of drugs Drug management Management and leadership	EPN Secretariat, Ghana TZ, CHAZ, CHAM (rational use of drugs) TZ, CHAZ (drug management).
Regional/sub-regional rational drug management courses should be facilitated and coordinated.	WHO
Funds for training of DSOs and customers should be advocated for and EPN should facilitate lesson learning	CHAM, EPN Secretariat

Storage capacities and management

Recommendation	Commitment/Action by:
EPN should provide information on good drug management storage practice to DSOs	WHO, to support EPN in the dissemination of the recent booklet on the subject.
DSOs should improve physical infrastructure and storage conditions	CHAM, Ghana
EPN should provide guidance on best practice so that DSOs can efficiently develop written SOPs for storage, inventory control, etc., in a participatory manner including all staff	CHAZ, TZ, Ghana, CHAN, CHAM EPN Secretariat
DSOs should develop DMIS, defining data collection requirements, analysis, use, and reporting.	Ghana, CHAZ, DRC, CHAM, CHAN, TZ
EPN, WHO, and DSOs should identify appropriate stock management computer software and mobilise funding and technical assistance.	EPN Secretariat
DSOs should improve communications to customers on stock position and other complementary information	DRC, Ghana, TZ, MEDS
EPN should design or identify and organise training and technical assistance on procurement.	EPN Secretariat.

Collaboration

Recommendations	Commitment/Action by:
Representatives of DSOs should increase awareness on the importance of collaboration among managers and owners of DSOs, moving their organisations from competition to cooperation	TZ, Ghana
EPN should organise networking and regular exchange visits among DSO managers	EPN Secretariat
EPN should turn EPN website into an information portal	EPN Secretariat

Distribution

Recommendations	Commitment/Action by:
A feasibility study should be undertaken by EPN that details the most common distribution models, and compares the strengths and weaknesses behind DSO distribution services and contracting out options.	EPN Secretariat, JMS

Document du projet ODM (3)

Activities for each objective

Each recommendation from the group was examined and three key objectives have been developed that address the areas in the recommendations in a cost-effective manner. For indicators, please see Section 2. The activities associated with these objectives are detailed below.

[Objective 1]

Activity 1: Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO. Such a tool would use a simplified version of the WHO/EPN study survey and use the baseline established by the original study (see Section 1.6).

Steps

Draw up draft tool.
Distribute to all DSO members for comment and hold a small consultation meeting to finalise draft.
Draw up second draft
Two-country test.
Finalise document.
Dissemination of tool in print and web forms.

[Objective 2]

Activity 1: Design and draw together more detailed DSO-specific capacity building tools, such as “how to” manuals, on key areas:

Financial issues
- Planning and financial management skills
- Revolving drug fund concept for sustainability
- Fundraising.
Standard operational procedures (SOPs)
- How to develop SOPs
- Setting SOPs for DSO quality assurance, including control laboratories.
Management and leadership for DSOs
- Collaboration techniques
- Negotiation skills.
Drug management
- Drug procurement management
- Organising pooled, bulk, and joint procurements.

Steps

Development of expert team for informing the process and peer review.
Desk review of existing material.
Survey of perceived ‘gaps and usability’ in material contents.
Survey of experiences and lessons learnt by individual DSOs in the use of existing materials.
Adaptation of any existing materials to reflect current realities, e.g., ARVs.
Development of new materials where necessary.
Design and upload to website and distribute in printed form.
Provision of skills development workshops.

Activity 2: Support DSOs’ access to information through the provision of information portal services through the EPN website. Information is particularly needed that is specifically targeted at DSOs and covers:

Counterfeit drugs
Supplier prices of, for example, ARVs, EDL items
Links to WHO materials relevant to DSOs.

Steps

Design a web space on the EPN website.
Upload materials that already exist or provide links to other organisations’ materials.
Production of a web-based e-newsletter for DSOs that includes information on new materials available on the site.
Research and upload links.
Produce instructions for further uploading.
Promote to DSOs and the wider sector.
Evaluate usage of the information portal.

Activity 3: The facilitation of processes that develop DSO staff and institutional capacities.

Finding and receiving international funding.
Carrying out feasibility studies around DSO production activities.
Strengthening existing activities and DSO quality control laboratories through a process of evaluation and recommendations.
Organisation and process of stakeholders involvement.
Supporting staff and information exchange through the EPN network.

Steps

Create a core feasibility process around DSO production activities.
Create a core methodology for the development of DSO quality control laboratories through a process of evaluation and recommendations.
Create a core meeting and exercise plan that supports the organisation and process of stakeholders’ involvement.
Support staff development and lesson learning through the EPN network’s exchange visits and linking into skill development workshops.

Activity 4: Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options.

Steps

Desk review of existing distribution models.
In-depth study through questionnaire led interviews of DSO distribution methods and their strengths and weaknesses.
Workshop for DSO leaders during which results are presented and the group makes recommendations for DSO distribution models.
Finalise document.
Upload materials to the website and distribute printed copies.

[Objective 3]

Activity 1: Identify appropriate stock management computer software options and make the information available through the EPN website.

Steps

Identification through a short survey of DSO needs for software.
Review of commercially available software in the context of DSO needs.
Interview survey existing DSO software systems and document strengths and weaknesses.
Development of guidance materials for DSOs.
Upload materials to the website and distribute printed copies.

Document du projet ODM (4)

Project logframe

Project description	Performance indicators	Means of verification	Assumptions
Goal: Increasing access to medicines and positive health outcomes			That increased access to medicines results in positive health outcomes
Purpose: Enhance the capacity and sustainability of faith-based DSOs	The capacity and sustainability of DSOs is raised	Self-assessment marked against a baseline of the EDM/EPN study	That the increased capacity of DSOs significantly increases access to medicines
Objectives:
1. Increased capacity of DSO’s to monitor and evaluate themselves for better feedback and management information	Impact indicator Re-use of tool, comparability of data over time, usefulness of results to intervention planning Impact indicator Commitment of DSOs to using the tool	Reporting and self-assessment Reporting and self-assessment	That the results of the EDM/EPN study and feedback meeting accurately identified the priority areas for interventions
2. Increased capacity of DSOs in key organisational, service, and staffing areas	Impact indicator Increased capacity of staff and DSO institutions involved in using the capacity building tool in key areas Impact indicator DSOs re-examine their distribution approaches and are able to make well informed decisions about the most appropriate model for their environment. Impact indicator DSOs re-examine their stock management computer software and are able to make well informed decisions about the most appropriate model for their environment	Self-assessment and post-process feedback Self-assessment and examination of case studies indicating DSO follow-up Self-assessment and examination of case studies indicating DSO follow-up
3. Increased networking between DSOs that supports information sharing and capacity development	Impact indicator DSOs updated and responsive to new information	Self-assessment survey, examples of use of information, monitoring of web visits, and DSO contributions of information
Activities
[Objective 1] 1. Creation of a self-assessment tool to be used to monitor progress against the characteristics of a functioning DSO	Output indicator Completion and testing of tool	Reporting	That a significant number of DSOs are able to participate
[Objective 2] 2. Design and draw together more detailed DSO-specific capacity building tools and “how to” manuals, focussing on quality assurance and other key areas 3. The facilitation of processes that develop DSO staff and institutional capacities 4. Undertake a feasibility study that details the most common distribution models for the DSOs, and compares the strengths and weaknesses behind current DSO distribution services and contracting out options 5. Identify appropriate stock management computer software options and make the information available to the DSOs	Output indicator Completion and testing of tool and manuals Output indicator Number of such activities facilitated Output indicator Document available Output indicator Document available	Reporting Reporting Reporting Reporting	That there are no major changes in the environment that DSOs work in that either make their participation impossible or change the nature of their needs
[Objective 3] 6. Support DSOs’ access to information through the provision of information portal services through the EPN website.	Output indicator EPN website constructed, regularly updated, and carrying relevant information Output indicator Levels of usage of the website and satisfaction of DSOs with the website	Reporting Reporting

Déclaration de EPN sur le Système de Gestion des Chaînes d’Approvisionnement du PEPFAR

A Statement of the Ecumenical Pharmaceutical Network (EPN) on the US President’s Emergency Plan for AIDS Relief (PEPFAR) Supply Chain Management System

Tuebingen, Germany, May 2006

View or download this document in Adode pdf format [.pdf 170Kb]

The Ecumenical Pharmaceutical Network (EPN), comprising Christian Health Associations and hospitals, non-profit drug supply organisations and ecumenical agencies from 29 countries who attended EPN’s Annual Forum and General Meeting from 8th – 13th May 2006 in Tuebingen, Germany, issues this statement on the Supply Chain Management System (SCMS).

We recognise and acknowledge that scaling up medical assistance and care of the men, women and children in our communities who are infected and affected by HIV/AIDS require uninterrupted supply of high quality, low cost products that flow through an accountable system. Therefore, we welcome the intention of SCMS to strengthen existing or establish (where none exist) secure, reliable, cost-effective and sustainable supply chains that meet the care and treatment needs of the people living with and affected by HIV/AIDS.

We note that the SCMS was established 3 years after the launch of President Emergency program on AIDS Relief (PEPFAR). However, the number of patients on ARVs through PEPFAR had increased even before the launch of SCMS. This indicates that some well-functioning supply systems already exist. These should not be destabilized.
In the design of the SCMS, there has been little or no involvement of stakeholders from the countries targeted. There was therefore no opportunity to bring in country-specific issues.
The creation of such a large multi-country supply system will have a negative impact on the existing supply systems because of imbalance in the trading volumes. It is more than likely that manufacturers and suppliers shall give priority attention to this major client at the expense of the smaller existing clients. The plan of supplying more than 120 commodities will take up a large proportion of the Essential Drugs supply needs, rendering the existing supply organizations irrelevant.
There is no adequate assurance that in-country manufacturers and suppliers will be supported to ensure growth in capacity and sustainability.
Whereas the SCMS project proposes to supplement and strengthen the existing supply chain capacity and to collaborate closely with governments, non-governmental organizations and faith-based organizations to strengthen the public health systems, we see a danger of brain drain of human resources from the existing systems to the SCMS.
The SCMS project presents an alternative procurement system, which negates the principles of Sector Wide Approach Strategy (SWAps) of common management arrangements which include working through existing public procurement system.
While the objectives of SCMS may be beneficial to the needs of the people in short-term, there is a real danger in the long-term sustainability beyond the period of PEPFAR funding. There is no clear exit strategy to ensure that the capacity established will be sustained.
The suggestion of voluntary choice in the use of SCMS services for the PEPFAR recipients seems rather theoretical, since decisions will be made at US country missions and not by the recipients of the funds. We find it highly unlikely that a local PEPFAR funds sub- recipient would have the mandate to choose to procure products outside SCMS which is funded by US government.

Recommentations

In order for the SCMS project to succeed in delivering its objectives and to ensure that useful and sustainable capacity is established within the existing public health procurement systems, EPN makes the following recommendations for SCMS action:

An in-country mechanism and forum for continuous dialogue and communication should be established for key stakeholders to review country issues on the system design, identify collaborating stakeholders and provide monitoring feedback. This should include MOH, National AIDS Control Program, public andFBO/NGO Drug Supply Organizations, Pharmaceutical Societies, representatives of Pharmaceutical Manufacturers and PEPFAR awardees, and other donors such as Global Fund, World Bank –MAP programme etc.
There should be clarity in the strategies for addressing the two different situations: countries with in-country supply structures and those without such structures. In the countries with already existing systems, needs/gaps analyses should be the first step in strengthening the existing systems.
Capacity building should target strengthening of the existing Public and FBO/NGO Supply organizations and should be started before the supply activities are started. The capacity building should include recruitment of qualified staff, skills development in logistics (e.g. transport) and other supply chain management issues, contract negotiation, quality assurance and M&E. Capacity building should be a continuous exercise that focuses on use and strengthening of existing local experts.
The SCMS should ensure good knowledge and understanding of the country specific laws, policies and regulations to ensure integration or harmonization since this has a bearing on systems strengthening and sustainability.
Transparency and accountability should be enhanced through participatory M&E. The M&E plan should be clear to all stakeholders from the onset. There should be a strategy for in-country capacity building for M&E of the performance of the country SCMS activities and its impact on the other existing systems.
A clear exit strategy should be designed for each targeted country before the start of the project. This should clearly define the targets to be achieved during the project to ensure that after the end of the project the achievements will be sustained and no crisis situation will occur. This should also include management succession planning by including and developing capacities of local human resources.
The SCMS project must incorporate a comprehensive risk management strategy since the lives of many people will be dependent on its efficient and uninterrupted performance irrespective of environmental and political changes.

We, the members of EPN, in the spirit of goodwill and solidarity, further affirm that the fight against HIV/AIDS deserves concerted efforts. Efforts that bring out the best from all stakeholders to ensure sustainability, effective use of resources, expanded local capacity and the empowerment of people. In view of the above, we urge you to respect the reality on the ground, to give attention to the concerns expressed and to consider the recommendations as the SCMS prepares to implement its plan.

Thank you.

This statement has been signed on behalf of the Ecumenical Pharmaceutical Network (EPN).

Mr. Albert Petersen Dr Eva M A Ombaka

Chair, EPN Board Coordinator EPN

EPN Statement on PEPFAR - October 2004

A Statement of the Ecumenical Pharmaceutical Network (EPN) on the US President’s Emergency Plan for AIDS Relief (PEPFAR)

Moshi, Tanzania, October 7th, 2004

View or download this document in Adobe pdf format [.pdf 31Kb]

The Ecumenical Pharmaceutical Network (EPN), comprised of Christian Health Associations and hospitals, non-profit drug supply organisations and church related development agencies, from 22 countries attending our Annual General Meeting held from 5th – 7th October 2004 in Moshi, Tanzania issues this statement on the US President’s Emergency Plan for AIDS Relief (PEPFAR).

We recognise and acknowledge that scaling up medical assistance and the care of the men, women and children in our communities who are infected and affected by the scourge of HIV/AIDS, must continue. Therefore, we welcome the initiative and the goals of the US emergency response to provide much needed resources for HIV/AIDS care and support; increase the number of patients under treatment; and, contribute towards the improvement of infrastructure required to fight HIV/AIDS. This gives hope for people living with HIV/AIDS.However, as a network of health care service providers, we express our deep concern over some aspects of PEPFAR which have been identified as generally applicable, but to varying degrees in individual beneficiary countries:

PEPFAR’s insistence on FDA approval for all medicines purchased and the ‘buy American’ requirement for medicines other than ARVs, causes needless delay in making life-saving drugs available and may be inconsistent with national treatment protocols.
PEPFAR’s overwhelming preference for brand-name drugs and the barriers to the use of more affordable generic ARVs and drugs for opportunistic infections raise four major concerns:

It introduces a situation where patients are given different brands of the same drug thus creating a multi-cadre patient system in an institution, leading not only to misunderstandings but also a lot of additional work for an already overstretched health staff.
It will be difficult for the institutions to continue providing the same treatment at the end of the PEPFAR programme.
Using drugs approved only by the FDA may kill the local industries and threaten the sustainability of the already existing drug supply chains. This is particularly true of drugs against opportunistic infections, which are produced locally at affordable prices.
Use of expensive branded products, where equally good but cheaper alternatives are available, is not a cost effective use of resources.

In some cases, PEPFAR disregards national drug regulations and local supply chain management systems, which could damage national health systems, especially the pharmaceutical sector.
Treatment requires a lifetime commitment, yet there is currently no long-term strategy to provide a continuance of care at the end of the programme. The high level of donor control and little or no country or local ownership further undermines the sustainability of health care and other services.
In its current form, the implementation of PEPFAR promotes extensive use of US skills and capacities (personnel and institutions) to the detriment of available local expertise with greater understanding of the issues in their local contexts.
There is excessive delay caused by the inherent bureaucracy and conflicting operational rules and regulations. Cumbersome and time consuming documentation requirements; complicated procurement procedures for drugs and other needed items and restrictive expenditure regulations, frustrate and undermine the efforts of institutions trying to implement PEPFAR.
The implementation of PEPFAR is predominantly unilateral, undermining other international efforts such as the ‘3 ones’ (one co-ordination, one strategy and one monitoring/evaluation) and the UN Prequalification Project managed by WHO.

In light of the above, we make the following recommendations:

PEPFAR should remove the restrictions of its funds to purchase only medicines approved by the FDA and the ‘buy American’ clause and instead allow the purchase of nationally approved medicines, generics or brand-name drugs, and antiretrovirals pre-qualified by the WHO.
PEPFAR should address fears of local drug management and supply institutions that they will be harmed by PEPFAR, and commit to strengthen and improve local structures and systems.
PEPFAR should hold extensive consultations with local partners in all areas of the programmes including policy formulation, planning, design, preparation of terms of reference and actual project implementation.
PEPFAR should regularly meet with community constituted advisory and oversight bodies comprised of people living with HIV/AIDS, FBO’s involved in medical delivery, and health care experts among others.
Immediate discussions should start between PEPFAR, other donors, governments and implementing partners on the sustainability of services beyond 2008.
PEPFAR should actively identify and involve local experts resident in the partner countries for the effective implementation of activities.
PEPFAR should dialogue with local implementing partners with a view of recognising and accepting available and relevant local data or data collection systems and the simplification of documentation requirements.
PEPFAR should co-ordinate more effectively with existing international HIV/AIDS programmes including the Global Fund and the WHO ‘3 x 5’ to ease implementation and avoid duplication at local level.

We the members of EPN, in the spirit of goodwill and solidarity, further affirm that the fight against HIV/AIDS deserves concerted effort from all partners to ensure sustainability, effective use of resources, expanded local capacity, empowerment of people living with HIV/AIDS and provision of treatment for as many people as possible. In view of the above, we commit ourselves to play our part in making sure that the PEPFAR programme is implemented to the best interest of those served, the implementing partners and the funding agency.

This statement has been signed on behalf of Ecumenical Pharmaceutical Network.

Chair EPN Board Coordinator EPN

Drug Supply Organizations (DSOs) develop Monitoring and Evaluation (M&E) tool

As part of implementing the action plan developed in the feedback meeting at the conclusion of the EPN/WHO DSO study, a workshop to develop Monitoring and Evaluation (M&E) tools for DSOs was held in Kampala, Uganda from 17th - 19th July 2006. Participants at the activity were representatives from DSOs and Christian Health Associations (CHAs) involved in drug management from Ghana, Nigeria, Cameroon, Uganda, Ethiopia, Kenya, Tanzania, Malawi and Zambia.

By learning how to design survey questions, the participants developed a Monitoring and Evaluation (M&E) tool which is being piloted tested in Zambia, Ghana and Tanzania. To develop the tool, the participants were placed into three working groups, with each group required to evaluate the questions in particular sections of the questionnaire for the DSO.

Each group reviewed the allocated section of the WHO/EPN tool in order to:

Check for and reduce duplicated, redundant/irrelevant, ambiguous questions
Eliminate or rework prompting or leading questions (minimize bias)
Appropriately sequence questions
Allocate questions into the ‘question fit’ tools (one year/ two-year/ six-year)
Check the selected questions and rate against the identified characteristics of a well-functioning DSO as described from the feedback session of the WHO/EPN multi-country study.

The group work produced rough draft questionnaire for the DSO section divided into the three tools i.e. one-year, two-year, and six-year tools. Download the two-year tool in PDF [48Kb] or Excel [122Kb].

Etude dans plusieurs pays des activités d’approvisionnement et de distribution des médicaments des Organisations d’Inspira

Multi-Country Study of Medicine Supply and Distribution Activities of Faith-Based Organizations in Sub-Saharan African Countries [.pdf 2.09Mb - WHO/PSM/PAR/2006.2]

Go to the DSO section of this website...

Multi-country study feedback meeting

EPN, with the support of WHO/EDM (Essential Drugs and Medicines), held a meeting in Nairobi from 1st to 3rd June 2004, which brought together the participants and facilitators of a study on faith-based drug supply organizations (DSOs). View or download the DSO Feedback Meeting Report [.pdf 330Kb].

The objectives of the meeting were:

To review the EPN access guidelines on effective and efficient pharmaceutical services in church health services
To discuss and agree on the draft global report of the multi-country study on faith-based DSOs and develop the recommendations
To develop a plan of action to strengthen drug supply activities in the Network, based on the recommendations of the study and the EPN guidelines.

This meeting led to the development of the DSO project of the EPN Access programme.

Caractéristiques d’une ODM fonctionnel

The DSO feedback workshop group was asked to identify those characteristics of a functioning DSO that could be measured and thus lead to indicators of change. These 14 characteristics were ranked according to investment and measurement priority. The self-assessment tool referred to in the table below is currently being discussed. The combined results of all the self-assessment reports will feed into ‘measurements of change’ against the baseline taken from the 2004 WHO/EPN DSO report, which is likely to require a broader tool.

View or download the EPN Characteristics of a Functional DSO document [.pdf 20Kb].

Rank	Characteristic	Indicator	Means of verification
1	Quality assurance procedures written and implemented	Written copy of SOPs Evidence of implementation	DSO-supplied copy of procedures Records in files. Self-assessment reports.
2	Human resource development programme written and implemented	Written copy of programme Evidence of implementation	DSO-supplied copy of programme No. of staff developed under the program.
3	Appropriately qualified staff for organisational efficiency and effectiveness are employed	Organogram Key staff CVs/application forms	DSO-supplied copy of organogram DSO-supplied copies of CVs/application forms Records of staff appraisal and interview panel reports.
4	Financial policies written and implemented	Written copy of financial policies Evidence of implementation	DSO-supplied copy of financial policies Self-assessment reports. Audits
5	Operational revolving drug fund	Written policies and procedures Financial analysis over time	DSO-supplied copy of policies and procedures Self-assessment Revolving fund account records.
6	Satisfies at least 75% of customer needs	Customer need audit Customer supply records	Self-assessment report
7	Monitor customer satisfaction	Annual customer survey	Self-assessment report
8	Pricing policy available	Written copy of policy Evidence of implementation	DSO-supplied copy of policy Self-assessment report Price review records.
9	Shares and receives price information	Written copy of price catalogue Evidence of dissemination	DSO-supplied copy of catalogue DSO-supplied dissemination list of those outside client list Updated price list Copies of national/ international price lists
10	There is a strategic business plan and budget	Written copy of plan and budget Evidence of implementation	DSO-supplied copy of plan and budget Annual/periodic reports
11	Board and management roles and functions clearly delineated	Written copy of Board terms of reference Evidence of implementation	DSO-supplied terms of reference Minutes of board meetings.
12	There are documentation policies	Written copy of policies Evidence of implementation	DSO-supplied copy of policies Retrievable documents in files.
13	Offers competitive prices to customers	Annual analysis of competitors prices	Feedback from customers. Updated comparative price analysis.
14	Appropriate inventory management system in place	Documented system Evidence of implementation	Documentation records Self-assessment reports

Nouvelles des ODM

This page offers newsletters and announcements from DSOs around the world. Members are encouraged to keep up-to-date with each others' activities, and to share their own newsletters.

The CPS - Nduro - April 2005, Issue 3, Vol. 1

Newsletter:
Nduro_April_2005_Issue_3_Volume1.pdf (270.75 KB)

The CPS - Nduro - April 2004, Issue 2, Vol.1

Newsletter:
Nduro_April_2004_Issue_2_Volume1.pdf (929.59 KB)

Action Medeor - in Tanzania, July,No.2/2006

Newsletter:
Action_Medeor_in_Tanzania_Newsletter_July_2006.pdf (45.56 KB)

DSO website:
www.medeor.org

Mulanje Hospital - Volume 8, Issue 1, 2007

Newsletter:
MMH_Newsletter_2007_1stQuarter.pdf (688.37 KB)

JMS newsletter - March 2007, Issue 3, Vol.1

Newsletter:
JMS_newsletter_March_2007_Vol.1_no.3.pdf (104.37 KB)

DSO website:
www.jms.co.ug

The CPS - Nduro - June 2005, Issue 5, Vol.1

Newsletter:
Nduro_June_2005_Issue_5_VolumeI.pdf (323.66 KB)

The CPS - nduro - May 2005, Issue 4, Vol.1

Newsletter:
Nduro_May_2005_Issue_4_VolumeI.pdf (445.56 KB)

Mulanje Hospital - July 2004, Issue 2, Vol.5

Newsletter:
Mulanje_Mission_hospital_July_2004_Volume5_Issue2.pdf (498.35 KB)

The CPS - Nduro - April 2003, Issue 1, Vol.1

Newsletter:
NDURO_April_2003.pdf (741.14 KB)

Activités des DSO de l'EPN

This page lists activities of interest to DSOs.

EPN activities are listed here, and members are encouraged to submit details of their own activities for inclusion. Please send details to info@epnetwork.org or use our online contact form.

Etude sur le modèle de Distribution des DSO

The 2004 Multi-Country Study for faith-based drug supply organizations (DSOs) conducted by EPN in collaboration with WHO showed that DSOs customers were generally pleased with the services provided. However one area that needed to be improved on was in drug distribution and delivery.

To improve on this situation, the EPN secretariat commissioned a study to be conducted in ten DSOs in Cameroon, DRC, Ghana, Kenya, Malawi, Nigeria, Rwanda, Tanzania, Uganda and Zambia. This study was done in order to identify ways for the DSOs to improve their distribution services. A feedback meeting to discuss the findings and recommendations in this report will take place from 13th – 17th August 2007 in Lagos, Nigeria.

To view the report of the study, click on the link below:

Etude sur le modèle de distribution des organisations d'approvisionnement en médicaments de l'EPN

Porte-affiches

This page enables DSO members and visitors to post messages or announcements of interest to people involved with DSOs.

Please send details of activities to epn@wananchi.com or use our online contact form.

Membres ODM de EPN

Listed here are the names and contact details for the DSOs that are members of the Ecumenical Pharmaceutical Network (EPN).

Èglise Evangélique du Cameroun (EEC) P. O. Box 89 Doula, CAMEROON	Mission for Essential Drugs and Supplies (MEDS) P O Box 14059-00800 Nairobi KENYA
Centrale d’Approvisionnement en Médicaments de l’Eglise Presbytérienne Cameroun (CAP/EPC) P. O. Box 519 Yaounde CAMEROON	Christian Health Association of Malawi (CHAM) P.O. Box 30378, Lilongwe, MALAWI
Organisation Catholique pour la Santé au Cameroun (OCASC) P.O. Box 767, Yaoundé, CAMEROON	Christian Health Association of Nigeria (CHANpharm) Bukuru - Rayfield Road, P.O. Box 6944 Jos, Plateau State, NIGERIA
Cameroon Baptist Convention (CBC) P.O. Box 152 Tiko, South West Province, CAMEROON	Bureau des Formations Médicales Afrées au Rwanda (BUFMAR) P. O. Box 716, Kigali RWANDA
Presbyterian Church in Cameroon (PCC) P.O.Box 19, Synod Office, Buea, S.W Province CAMEROON	Affordable Medicines for Africa (AMFA) Box 62229, Marshaltown 2107 SOUTH AFRICA
Oeuvre de Santé de l’Eglise Evangélique Luthérienne au Cameroun (OSEELC) P.O. Box 6 Ngaoundere - Adamoua CAMEROON	Christian Social Services Commission (CSSC) P.O. Box 9433, Dar es Salaam, TANZANIA
Eglise du Christ du Congo (ECC) Direction des Oeuvres Médicales (DOM) Avenue de la justice no 75, Commune de la Gombe, Kinshasa, DR CONGO	Joint Medical Stores (JMS) Box 4501, Kampala, UGANDA
Catholic Drug Centre (CDC) P.O. Box KA 9712 Airport, Accra, GHANA	Churches Health Association of Zambia (CHAZ) P.O. Box 34511, Lusaka, ZAMBIA

Librairie et liens

This page lists useful documentation and links to further resources of interest to people involved with DSOs.

Members are encouraged to submit their own items of interest that can then be approved by EPN staff and added to the website. Please send ideas to epn@wananchi.com or use our online contact form.

Also consult our library of external publications for DSO related information.