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- Title
Antiretroviral drug supply challenges in the era of scaling up ART in Malawi.
- Authors
Schouten, Erik J.; Jahn, Andreas; Ben-Smith, Anne; Makombe, Simon D.; Harries, Anthony D.; Aboagye-Nyame, Francis; Chimbwandira, Frank
- Abstract
The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This system for ARVs, paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bypassing the government Central Medical Stores, is in place, using the United Nations Children's Fund's (UNICEF's) procurement services. The system, managed by a handful of people who spend limited time on supply management, is characterized by a centrally coordinated quantifi cation based on verifi ed data from all national ART clinics, parallel procurement through UNICEF, and direct distribution to ART clinics. The model worked well in the fi rst years of the ART programme with a single fi rst-line ARV regimen, but with more regimens becoming available (e.g., alternative fi rst-line, second-line and paediatric regimens), it has become more diffi cult to administer. Managing supplies through a parallel system has the advantage that weaknesses in the national system have limited infl uence on the ARV procurement and supply chain management system. However, as the current system operates without a central warehouse and national buff er stock capacity, it diminishes the ability to prevent ARV stock outs. The process of ordering ARVs, from the time that estimates are made to the arrival of supplies in health facilities, takes approximately one year. Addressing the challenges involved in maintaining ARVs through an effi cient procurement and supply chain management system that prevents ARV stock outs through the establishment of a dedicated procurement team, a central warehouse and/or national buff er stock is a priority.
- Subjects
MALAWI; ANTIRETROVIRAL agents; HIV; GLOBAL Fund to Fight AIDS, Tuberculosis, &; Malaria; UNICEF; SUPPLY chain management
- Publication
Journal of the International AIDS Society, 2011, Vol 14, Issue Supp 1, p1
- ISSN
1758-2652
- Publication type
Article
- DOI
10.1186/1758-2652-14-S1-S4