West African THE WORLD BANK Reproductive Health Commodity Security 69435 Development of a Sub-Regional Coordinated Informed Buying System 2005 Hany Abdallah Mimi Whitehouse i THE WORLD BANK West African Reproductive Health Commodity Security Development of a Sub-Regional Coordinated Informed Buying System 2005 Hany Abdallah Mimi Whitehouse DELIVER DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency for International Development (USAID). Implemented by John Snow, Inc. (JSI), (contract no. HRN-C-00-00-00010-00) and subcontractors (Manoff Group, Program for Appropriate Technology in Health [PATH], and Social Sectors Development Strategies, Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing countries to ensure the availability of critical health products for customers. DELIVER also provides technical management of USAID’s central contraceptive management information system. This document does not necessarily represent the views or opinions of USAID. It may be reproduced if credit is given to John Snow, Inc./DELIVER. Recommended Citation Abdallah, Hany, and Mimi Whitehouse. 2005. West African Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buying System. Arlington, Va.: John Snow, Inc./ DELIVER, for the U.S. Agency for International Development and the World Bank. Authorship and Funding This work was conducted by JSI staff, with support from the USAID JSI/DELIVER contract and the World Bank. Contents Acronyms ................................................................................................................................v Acknowledgments .................................................................................................................. vii Executive Summary ................................................................................................................. ix I. Background ......................................................................................................................1 II. Methodology......................................................................................................................3 III. Situational Analysis: Findings from the Readiness Assessment ...................................................7 A. Informational Readiness ...............................................................................................7 B. Operational/Technical Readiness ...................................................................................7 C. Organizational Readiness ..............................................................................................9 D. Policy/Legal Readiness ............................................................................................... 11 E. Proof of Concept: Feasibility Model ............................................................................... 12 IV. Proposed Coordinated Informed Buying Model ....................................................................... 15 A. Summary Recommendations for CIB .............................................................................. 15 B. Phased Approach: Building Blocks ................................................................................ 16 C. Informational and Functionality Requirements: High Level Business Requirements ............... 17 V. Summary of CIB Bene�ts and Estimated Costs ....................................................................... 23 A. Bene�ts ................................................................................................................... 23 B. Costs ....................................................................................................................... 25 VI. Roadmap to CIB .............................................................................................................. 27 References and Documents Consulted ....................................................................................... 47 Appendices A. Contact List .............................................................................................................. 33 B. CIB System Manager Job Description............................................................................. 41 C. Summary of System Development Approach.................................................................... 43 D. Country Selection Criteria: West Africa RHCS Study .......................................................... 45 Figures 1. CIB Building Blocks..................................................................................................... xi 2. Proposed Organizational Diagram ................................................................................. 11 3. Sample of a Supplier Report ........................................................................................ 12 4. CIB Building Blocks.................................................................................................... 16 5. Modes of Communication ............................................................................................ 21 6. System Development Life Cycle .................................................................................... 43 iii West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Tables 1. Countries Visited, Interviewed by Phone, and Contacted ....................................................3 2. Informational Readiness by Country ................................................................................8 3. Operational/Technical Readiness by Country .....................................................................9 4. Organizational Readiness by Country ............................................................................. 10 5. Policy/Legal Readiness by Country ................................................................................ 12 6. Building Blocks—A Phased Approach to CIB .................................................................. 18 7. Data and Information Needs ........................................................................................ 19 8. Speci�c Cited Products or Product Groups for Which a CIB System Would Be Helpful ............. 21 9. CIB Central Information Management—WAHO—Costs ...................................................... 25 10. CIB Country-Level Costs .............................................................................................. 26 11. Roadmap to CIB—Activities by Category ....................................................................... 27 12. Roadmap to CIB—Activities in Sequential Order ............................................................. 29 iv Acronyms ACAME Association des Centrales d’Achat des Médicaments Essentiels AMPPF Association Malienne pour la Promotion de la Famille ARV antiretroviral CAG Central d’Achat de Génériques CIB Coordinated Informed Buying CPR contraceptive prevalence rate CMS central medical store FMOH Federal Ministry of Health FOB free on board INCO international commercial terms INN international nonproprietary name MOH Ministry of Health MSF Médicins sans Frontières MSH Management Sciences for Health PATH Program for Appropriate Technology in Health PPM Pharmacie Populaire du Mali PSP public sector procurement RH reproductive health RHCS reproductive health commodity security UEMOA Union Économique et Monétaire Ouest Africaine USAID U.S. Agency for International Development WAHO West African Health Organisation v Acknowledgments The authors, Mimi Whitehouse and Hany Abdallah, would like to express their gratitude to the individu- als who so generously gave their time to develop the criteria for this system. In particular, thank you to the country partners in Benin, Burkina Faso, Côte d’Ivoire, The Gambia, Ghana, Mali, Niger, Nigeria, and Senegal, who made such thoughtful comments. Many thanks to the West African Health Organisa- tion (WAHO), DELIVER Resident Advisors, USAID Missions, USAID/WARP, USAID/CSL, and the World Bank for their support and assistance on the ground, and to Program for Appropriate Technology in Health (PATH) for their contribution to this study. vii Executive Summary During the Fifth Ordinary Meeting of the ECOWAS Health Ministers, organized by the West African Health Organisation (WAHO) in Accra, Ghana, in October 2004, the Ministers adopted a recommenda- tion for WAHO to begin the implementation of an information sharing system that would enhance each country’s ability to share and access product, supplier, and pharmaceutical market information. At WAHO’s request, John Snow, Inc./DELIVER initiated this implementation, beginning with the design. This report summarizes DELIVER’s �ndings. By starting with a well researched and designed plan for implemen- Information Can Help Bridge the Gap tation, the Coordinated Informed Buying (CIB) system will better meet the needs of the users, and, ultimately, One Latin American country learned be a tool to assist the region in their efforts towards that their neighboring country obtained injectables from another source of supply reproductive health commodity security (RHCS). rather than from a local distributor. The Nine out of the 15 ECOWAS countries provided input, government switched to that supplier and with more than 85 individuals contributing to this the cost decreased from over U.S.$5.50 per vial to U.S.$0.85 per vial. design. Anecdotal information suggests that sharing of various elements of pharmaceutical procurement al- In this case, savings as a result of better ready occurs among countries in the region but in an ad information could translate into the ability to purchase more than 500 times the quantity hoc or limited manner. A CIB system would potentially of injectables for the same total cost, and, capitalize on this kind of experience and build a system- thus, reach more women. atic strategy of regional coordination for information sharing, and, ultimately, improve the buying power for all involved. The overwhelming majority of key informants indicated that a CIB system would be valuable either directly or indirectly for national procurement activities. Across the board, organizations and individu- als interviewed articulated the bene�ts that they perceived for the country in having a CIB system in place. Notably, managers said that the process of building the tool and meeting as like-minded profes- sionals to work as a region would be as valuable as the tool itself. CIB was noted for its potential to provide relevant information; that information would help in understanding what speci�c health com- modity procurements are taking place in both the region and bordering countries (versus the general indices of prices). This document maps a plan for CIB implementation—to start �rst with available data and to make use of existing infrastructure. For data collection, all countries should be invited to share information and should also be invited to use the CIB, regardless of whether a country provides information (i.e., ac- cess to information should not be restricted only to those who provide data). This paper recommends that WAHO take the role of lead coordinator and, prior to proceeding, a CIB System Manager situated at WAHO should be identi�ed to lead the process. The review of current country status, in terms of readiness, was conducted along four dimensions: 1. informational—the availability of data and the degree to which information is used for decision making 2. operational/technical—use of the Internet, preferred means of communication 3. organizational—staf�ng and how groups will interact 4. legal/policy—an understanding of whether legal or policy barriers exist that may hinder informa- tion sharing or acting on information. ix West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Through the synthesis of country readiness (see section III. Situational Analysis) together with the standard software development process, a set of recommendations was developed. The following sum- mary recommendations are organized along the same four dimensions. Informational: • CIB can, and should begin with the data that already exists; namely, with supplier, manufacturer, and product/price reports. These reports respond to such requests for information as who else supplies a particular product, and what are the options for a product in terms of strength and packaging. • CIB should contain procurement data (i.e., the system should be built on transaction-based vs. general reference price information) on high-value products. High value products are those that are either politically high, price changes occur, or are essential to the Ministry of Health (MOH) list; namely, contraceptives, antiretrovirals (ARVs), and vaccines. • In the future, CIB should include data that does not yet exist in a systematic way throughout the region, namely, quality metrics; for example, data on supplier performance and product quality. Operational/technical: • CIB should be built with multiple communication channels in mind. Namely, technology and/or lack of infrastructure should not be a roadblock to building a regional warehouse of information. • As a region, there should be an established ideal that all participants should be trying to reach for the longer term. Thus, for the short term, rather than waiting for common technical platforms, CIB should be initially designed to account for varying levels of technical standards. For example, for those countries already providing data to Web-based sites, information can continue to be provid- ed and accessed via the Web. For those countries that use Excel spreadsheets to capture informa- tion and have no Internet connectivity at work, information can be provided via fax, while the CIB System Manager can provide customized reports via fax, as well as a CD that contains information for general periodic review. • All countries should be invited to provide information, and all countries should have access to in- formation (whether they participate with data or not). By allowing any country to participate and to access information in any way, information can be shared and will provide value. • CIB should be built as a Web-based system, with appropriate security to ensure that, for the pres- ent, it is secure from general public viewing. This responds to concerns about negative reports, which could degrade participation in CIB. Organizational: • A strong central coordinator is necessary for CIB to succeed. WAHO was indicated by interviewees as the organization with a clear mandate to coordinate such an activity. • It is recommended that WAHO include a full-time CIB System Manager, as well as provide the tech- nical resources, detailed later. • In order not to duplicate reporting and existing structures, while WAHO leads and coordinates CIB, they should work with ACAME, thereby leveraging infrastructure already established among Franco- phone countries. • Similarly, WAHO should work with the Ministries of Health to identify parties in each country who will be responsible for further coordination of information provision, as well as dissemination of x Executive Summary reports within each country. For some countries, there may be little need for further delegation; however, in highly decentralized countries such as Nigeria, where each state has its own procure- ment authority, this may require a high degree of coordination. Policy/legal: • According to the majority of interviewees, there are no policy or legal constraints to sharing price and supplier information. • In one country, interviewees noted barriers to sharing price information because of procurement regulations prohibiting others’ use of that information. • At this stage, then, it is recommended that a continuing standard be adopted so that the sharing of information is legal (i.e., contracts with suppliers should not contain clauses regarding the sharing of such information) and that policy continues to support the growth of such regional initiatives. The CIB model described in this paper is Figure 1. recommended for implementation in three CIB Building Blocks steps or blocks. As depicted in �gure 1, and in more detail in section IV.B Proposed Coordinated Informed Buying Mode–Phased Roadmap 3 Approach: Building Blocks, a step-wise ap- focus Longer Term proach to CIB has been designed so that 2 information sharing can start as soon as • Broker, advocate Mid Term possible, and so that delays due to the 1 • Move to supplier development of new processes or collection performance, QA Proof of results of new data can be minimized. However, it • Establish data Concept+ standards and • Link directly to is just as important to have a plan for the deadlines external future, and building block 3 provides some • Collect and share databases what exists, • Establish examples of CIB’s future potential. including technical external standards This phased approach is important in order • Include more databases to start sharing information and witness- • Work with countries and ing results using existing infrastructure. existing country states in the data pool The emphasis of this paper is placed on structures detailing and meeting the needs outlined in building block 1 (of 3) for several reasons. Most importantly, it was noted that within the region, such initiatives as pooled procurement and a Francophone information sharing system were begun with great effort with country participation, but with few results. To ensure that CIB is not just useful but used, beginning sooner with a basic but ef- fective system, rather than later after a long setup period, is critical to success. It should be noted that the �ndings indicate that there is no single barrier that should prevent CIB (all blocks 1, 2, or 3) from being implemented. However, there are known challenges associated with the implementation of the system, and they have been outlined here so plans can be made to address them. • Managing Expectations: Many key informants believed that CIB’s value would be in the reduction of commodity procurement prices. However, there are a number of restrictions, such as setting price ceilings through international competitive bidding (ICB). Furthermore, national policies that give preference to local manufacturers (e.g., allows tender offers from local manufacturers to be a xi West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System percentage—approximately 15% greater than the lowest bid) could impact the lowering of procure- ment prices because the ability to select a lower price supplier may not be in keeping with nation- al policy.1 That noted, there is potential to eliminate poor performing suppliers, which could result in program savings. This could be accomplished in the short term through CIB information on other sources of supply in the region. In the future, this could be accomplished with the addition of a procurement quality component which keeps a record of supplier and manufacturer performance. • Policy Support: Interviewees noted that the CIB implementation and its sustainability require endorsement and support from policymakers and senior program managers. Speci�cally, the project outlined in this paper is recommended for evaluation and subsequent endorsement by the Ministers of Health. • Supplier Reaction: A potential risk is that information sharing may result in the insistence by suppliers to increase the inclusion of con�dentiality clauses in their procurement contracts. As a region, it would be imperative to have a response ready in anticipation of this request. • Decentralization: In particular, Nigeria’s highly decentralized procurement system may mean that their participation in CIB will require additional resources. Initially, CIB may include a subset of information. Some interviewees outside Nigeria noted that this country’s participation would be critical to the success of CIB. Participation with partial information should be considered and anticipated in the initial stage. • Accurate Information: Some respondents to the CIB survey indicated that there can be pressure and incentives to provide inaccurate information. Therefore, it is recommended that, at the techni- cal design workshop, the group establish rules of conduct, and consider whether the CIB System Manager should make random checks against contracts to validate the information provided. • Existing Organizations/Systems: During the time of this readiness evaluation, other systems were identi�ed. Their role (if any), should be clari�ed by WAHO. This includes Union Économique et Monétaire Ouest Africaine (UEMOA) and the WAHO-led ARV Observatory. The following sections are included in this document: background to the CIB, methodology used, situational analysis, proposed design of the CIB system (block 1) summary of CIB bene�ts and esti- mated costs, and a roadmap that outlines the steps needed to complete block 1. The section Proposed Coordinated Informed Buying Model includes the building block concept in more detail, speci�c system requirements, and a list of technical questions to be discussed and resolved by sub-regional partners. The roadmap lists steps and sequencing needed to implement block 1. 1. It should be noted that the example of national policies favoring local manufacturers and/or suppliers is given to highlight the complexities of lowering unit prices through information sharing alone. This paper does not intend to comment on the merits of such national policies. xii I. Background During the Fifth Ordinary Meeting of the ECOWAS Health Ministers, organized by the West African Health Organisation (WAHO) in Accra, Ghana in October 2004, the U.S. Agency for International De- velopment (USAID)-funded John Snow, Inc. (JSI)/DELIVER project presented options for sub-regional strategies that could be considered to support the procurement of high-quality, low-cost reproduc- tive health (RH) commodities. Strategies varied in complexity and degree of sustained commitment required to ensure their application in the West Africa sub-region. Several options were presented, and the Ministers adopted a recommendation for WAHO to begin the implementation of an informed buying system that would enhance each country’s ability to share and access product, supplier, and pharma- ceutical market information. At WAHO’s request, DELIVER initiated this implementation, starting with the design of the system. This report summarizes DELIVER’s �ndings and responds to the Ministers’ request to begin implementation. These �ndings include an initial design of the Coordinated Informed Buying (CIB) system, as well as the next steps needed to begin sharing and accessing information. By sharing information on products and procurement prices, as well as the breadth of suppliers used, countries would be able to increase the impact of their procurement of essential reproductive health commodities. Such a system of sharing and accessing information is called informed buying. A coordi- nated informed buying (CIB) system enhances the information sharing model by integrating a function of systematic aggregation, compilation, and dissemination of information, much like Consumer Reports in the United States or the Médicins Sans Frontières (MSF) “Sources and Prices of Selected Medicines and Diagnostics for People Living with HIV/AIDS�.2 While designed primarily for reproductive health commodities, this CIB platform can also incorporate additional health commodities (e.g., ARVs and essential medicines). It should be noted that CIB is about information only; each country continues to be responsible for funding, organizing, and carrying out their procurements individually. Questions were formulated to guide the design of the CIB system, including the following: • What are the information needs that should be captured and shared between member countries? • What is the feasibility of gathering this information? Does the information to be captured already exist or does it require research/analysis? • How will information flow between countries and how will it be accessed? Who will manage or coordinate the necessary information flow? • Based on the information needs and functional requirements, what suitable architecture and plat- form would meet those needs? Where will that platform be located and how will it be maintained? • What activities must take place to maintain an up-to-date CIB system (research? meetings? data entry?), who will maintain it, and how much will it cost? • What system security is required and at what level of access? • What are the training needs, if any—how many users, where will they be located, how often will training be needed, are refresher courses needed? The next section describes the methodology used for the assessment, followed by the �ndings and recommendations. 2. http://mednet2.who.int/sourcesprices/ 1 II. Methodology The team used a systems development approach to structure the analysis and design of a CIB system. See appendix C for an additional description of the major elements of this approach. The systems development process is iterative. It begins with an understanding of user needs and requirements—in this case, requirements associated with the procurement process for essential reproductive and other health commodities. This initial phase enabled the development of a proposed model for a CIB system. As part of the readiness review, a database was created as a proof of concept to establish that the business processes involved and CIB system model were feasible. Following are the main activities completed in this assessment: • In-depth interviews with potential system owners: Interviews with potential system users were critical to de�ne the content and functional requirements for the CIB system. An interview tool, developed speci�cally for this study, facilitated the systematic and consistent collection of data. The categories selected for interview were based on the following questions: – Informational requirements—What are the business requirements that users perceive during the procurement process that can be addressed through a coordinated or regional strategy? – Operational/Technical readiness—What technical infrastructure exists? – Organizational readiness—What are the existing staff skills and the expectations/attitudes of management and staff toward a CIB system? – Legal/Policy readiness—What factors might limit or hinder a CIB system, and under what conditions? Given the regional scope of the CIB system, multiple attempts were made to obtain the input of all ECOWAS countries. In the end, nine out of 15 countries participated in this review. Input to this study included the participation of more than 85 people. Because of timing and funding constraints, the teams physically visited �ve of the 15 countries (three countries visited by the DELIVER team and two countries visited by JSI teams funded by the World Bank), while efforts were made by phone and e-mail to contact key informants in all countries. Table 1 lists the countries visited and eventually reached, including six Francophone and three Anglophone countries. See appendix A for a more com- plete list of contacts. Table 1. Countries Visited, Interviewed by Phone, and Contacted Countries Visited Countries Interviewed by Phone Other Countries Contacted 1. Burkina Faso 6. Benin 10. Sierra Leone 2. Ghana 7. Côte d’Ivoire 11. Cape Verde 3. Mali* 8. The Gambia 12. Guinea 4. Nigeria* 9. Níger 13. Guinea-Bissau 5. Senegal 14. Liberia 15. Togo * These countries were visited during assessments funded by the World Bank (Ouedraogo and Steele 2005; Kagone and Diallo 2005). All other participants were interviewed in April 2005. 3 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System A cross-section of the following attributes was used as the principal criteria to select representative countries for �eld visits. For additional detail, see appendix D. The criteria developed for country selection were determined by WAHO, DELIVER, and other international and sub-regional partners. 1. Public sector responsible for large procurements of RH products: Countries with a signi�cant RH market were identi�ed as potential candidates for �eld visits. Several factors that influenced this included the presence of a large target population and a relatively high contraceptive prevalence rate (CPR). Countries satisfying this criterion were considered likely �rst movers in adopting a CIB system, as they had the most to gain from information on product sourcing and pricing. Ghana and Nigeria met this main criterion. 2. An active public sector procurement (PSP) organization exists: CIB is likely to be more successful if implementation begins with countries where there is a strong central medical store (CMS). There- fore, more attention was focused on including those countries during the strategy development phase. Burkina Faso, Ghana, and Senegal met this criterion. Other criteria considered for a representative list of countries: In addition to the above, the team needed to consider including both Anglophone and Francophone countries; the possibility of leveraging DELIVER country of�ces or other partner presence for logistical and preparatory support (the case of Mali, Ghana, and Nigeria); and access to the WAHO and the Permanent Secretariat of the Association des Centrales d’Achat des Médicaments Essentiels (ACAME), considered potentially strategically important organizations for CIB (both located in Burkina Faso). In �eld visit countries, the target interviewees included the following stakeholders: • Procurement managers—individuals within the procurement organization(s) who will provide data and/or use CIB to better inform their procurements. • System owners—managers who will make staf�ng allocations and must be able and willing to provide resources to support the CIB. • Program managers, in particular for RH and HIV/AIDS—public sector representatives who ultimate- ly have an interest in obtaining high-quality, low-cost products, and would potentially influence the policy and legal requirements for procurement. • Product testing, registration, and quality control organizations—typically public institutions that influence or determine which products or suppliers are legally permitted to be made available in the country. • Other—in addition, interviewees also included funding or procuring agencies, such as UNFPA and UNICEF, who play a role in providing RH products in the public sector; and technical managers to gauge technical capacity for CIB, among others (e.g., the Ministry of Finance providing �nancing for commodity procurements, cooperating agencies and projects working on procurement or RH related issues, such as Management Sciences for Health (MSH) and RPM Plus Project, USAID/West Africa Regional Program and AWARE/RH and AWARE/HIV AIDS projects). • Review of potential system managers: The assessment team interviewed ACAME, UEMOA, and WAHO, as well as asked interviewees for any other potential organizations that could act as the coordi- nating body. Responses indicated that WAHO had the mandate to act as the system manager with ECOWAS countries, but would require necessary resources to implement CIB. At the time the inter- views took place, WAHO, with support from UNAIDS and WHO, was collecting price information for an ARV Observatory. ACAME was recognized for its existing infrastructure of central medical stores managers, covering eight out of the 15 ECOWAS countries. UEMOA has historically been supportive of regional efforts to make procurements more ef�cient in West African countries. 4 Methodology • Review existing sources: In addition to interviews, the team reviewed sources for product and supplier information in the sub-region. These include publicly available Web-based information sources, such as the Global Fund Price Reporting system3 and other published sources (e.g., the MSF ARV source guide4). The team reviewed the format and content of these sources, and the level of participation. • Development of proof of concept and technical vetting of model: Based on information from the in- terviews and the review of secondary information, the team developed a proof of concept—a basic CIB model. The model was created in Microsoft Access®, and included sample reporting documents that responded to user requirements. The team began the process of validating the model with interviewees during both the �eld visits and phone interviews, and attempted to continue this technical vetting via e-mail and phone interviews. Interviewees were asked to analyze information structure, propose further re�nements to the model to meet their needs, and de�ne their commit- ment to the model and CIB. Ideally, a technical workshop would have been convened to facilitate this technical vetting; however, a number of constraints prevented this from occurring before the completion of this report. This technical design workshop should be organized as part of the CIB implementation. Input from interviewees also provided further information for developing an implementation roadmap for a CIB system. 3. http://www.theglobalfund.org/en/funds_raised/price_reporting/default.asp 4. WHO, also on behalf of UNICEF, the UNAIDS Secretariat, and Médecins Sans Frontières. May 2002. Sources and prices of selected drugs and diagnostics for people living with HIV/AIDS. 5 III. Situational Analysis: Findings from the Readiness Assessment The situational analysis described in this section is organized using four dimensions of readiness: informational, operational, organizational, and policy. In this section, summary and detailed �ndings related to the four dimensions of readiness are reviewed. As expected, countries are at various levels of readiness. It is notable that no country that participated in this discussion, on any dimension, was deemed not ready for CIB. In fact, it was determined that there are no major reasons why CIB should not or cannot be implemented. Not only did the teams verify that data exist for building block 1, but they also learned that some countries are already reporting their procurements, with some cases of coordination in an ad hoc manner. This section also highlights the challenges and risk factors that should be considered as part of the implementation. A. Informational Readiness Informational readiness is strong in the region. This aspect of readiness was assessed based on a country’s ability to share information or data that would be relevant for the CIB system; the informa- tion needs to exist somewhere, and it can be extracted relatively easily. For the data requirements de�ned in section IV.C Informational and Functionality Requirements, almost all countries have the required information. There is a difference, however, between the countries that conduct procurements within the MOH and the countries that oversee contracts conducted by consultants or procurement agents for the MOH. In both cases, it is assumed that the data can be made available in some way, since those interviewed within the MOH were able to produce information. For instance, as part of the Association for Central Medical Stores known as ACAME5, central medical stores in Francophone countries have had the experi- ence of coordinating procurements on a pilot basis, for a limited number of products (Abdallah et. al. 2004). Thus, ACAME can be a potential major source of information for multiple Francophone countries. Risks or barriers regarding informational readiness are: • A potential risk is that by sharing information, suppliers may begin to insist on con�dentiality clauses in their contracts. As a region, it would be imperative to have a response ready in anticipation of this request. Summary statements regarding informational readiness follow: • Not only does data exist for building block 1, but some countries are also reporting on their procurements, with some cases of ad hoc coordination. Table 2 provides readiness statements by country. 5. Association des Centrales d’Achat des Médicaments Essentiels 7 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Table 2. Informational Readiness by Country Country Finding Benin Information sharing is already done via ACAME’s database. Burkina Faso CAMEG has information and regularly provides information to its clients; consolidated reporting is available. Côte d’Ivoire Procurement information is available. The Gambia MOH has procurement information. Ghana The Procurement Unit has information and has shared it with an outside Web-based source, as evidenced by updates to the Global Fund Price Reporting System. The MOH noted that they have been informally called by other country programs to provide information on their ARV supplier experience. Mali Pharmacie Populaire du Mali (PPM) not only has transactional procurement data (product, quantity, supplier) but also keeps a record of suppliers on �le and requests information on suppliers and manufacturers from other medical stores from other countries. Central d’Achat de Génériques (CAG) shares information informally with other organizations. Staff noted that information seeking should be competitive among private suppliers, and that CIB would decrease competition and reduce the number of potential suppliers, which would, in turn, reduce opportunities to obtain lower prices. The technical team reviewing these �ndings has not listed this as a risk, because there are multiple examples in the commercial world6 where better information has not caused prices to increase. Niger It is unknown as to what data exists in the country. Nigeria Information about procurements exists; however, while information is a matter of public record, information is not shared at this time with other organizations or countries. The Federal Ministry of Health (FMOH) (vs. states, hospitals, whose level of ability to share information is unknown at this time) is ready to share information. Senegal Information is obtained informally from neighboring countries on prices. Information on tender results is published on the Internet. ACAME ACAME collects information and has an established network and system to share information. B. Operational/Technical Readiness Part of this readiness review was to learn about the preferred means of communication for CIB, as well as the ease in which information could be obtained (e.g., whether computerized data management tools exist). As described in a later section, technical readiness should not be seen as an obstacle to implementing CIB. While programs and countries are at different stages regarding the availability and use of the Internet as a major source of information, CIB can and should be designed in its initial stage to accommodate all levels of technical readiness. Table 3 provides �ndings, by country. Risks or barriers regarding operational/technical readiness are: • Regardless of countries’ technical state of readiness for a new system like CIB, use may not initially be high due to users’ heavy meeting load and existing work. Thus, it would be prudent, initially, to set up a push system of reports. This has been built into the CIB roadmap. Following are summary statements regarding operational/technical readiness: • Countries are at varied levels of advancement in terms of the state of computerization or access to more virtual communication. However, building block 1 (see Section IV.B. for a description) of the CIB considers these various levels, and allows for information sharing and access via multiple channels. 6. For example, on-time airline pricing together with low-cost market entrants has reduced airfares. 8 Situational Analysis: Findings from the Readiness Assessment • Nearly all respondents indicated some access to the Internet. However, Internet and email are not always available and/or are limited to speci�c hours during of�cial work hours when access can be slow or non-functional due to traf�c. • Despite dif�culties in obtaining lines, all countries have some access to telephone and fax lines and are reachable. Table 3. Operational/Technical Readiness by Country Benin Computerized information is captured. Preferred mode of operations for CIB is via the Internet; additional communication can be done by email. Burkina Faso CAMEG has computerized information that can be captured in Excel. Communication is done via email and the Internet is used. The MOH regularly updates a computerized system that includes reproductive health products, supplier, value, and quantity supplied. Côte D’Ivoire The Internet is the preferred mode of communications for CIB although it was noted that connectivity has not been consistent. An upgrade is planned in May 2005. Automated sharing of procurement information is currently dif�cult due to data existing in MS-DOS. The Gambia E-mail is used for regular communication. It is unknown whether Internet connectivity exists and/or is used on a regular basis. Ghana The regular use of Internet, e-mail, and a computerized procurement system were noted. Mali Internet and e-mail are used regularly. Computerized procurement systems are not used; thus, the collection of data will require more effort. Niger The preferred mode of communications for CIB was the Internet. Nigeria Internet access is inconsistent as this service is not available in all of�ces. Cybercafes exist, but require payment, which individuals (not work) pay out of pocket. The FMOH can send information via e-mail, but an Internet service provider is not yet in place. Senegal Regular use of the Internet as a mode of communication was noted. Results of tenders are published on the government website. ACAME E-mail and phone are used regularly for communication. Internet access is available. C. Organizational Readiness The team reviewed the skills, resources, management expectations/attitudes, and staff expectations/ attitudes toward the CIB. Statements on the skills and resource �ndings, by country, are included in table 4. The �ndings are followed by the proposed structure needed to support CIB. Risks or barriers regarding organizational readiness are: • Decentralization. In particular, Nigeria’s highly decentralized procurement system may mean that their participation in CIB will require additional resources, and, initially, may include a subset of information. Some interviewees outside of Nigeria noted that this country’s participation would be critical to the success of CIB. Participation with partial information should be considered and anticipated in the initial stage. • Accurate information. Some respondents to the CIB survey indicated that there can be pressure and incentives to provide false information. Thus, it is recommended that the group, at the technical design workshop, establish rules of conduct, as well as consider whether random checks by the CIB System Manager against contracts should be made to validate the information provided. • Existing organizations/systems. During the course of this readiness evaluation, other systems were identi�ed. Their role (if any), vis-à-vis CIB should be clari�ed by WAHO. This includes UEMOA and the WAHO-led ARV Observatory. 9 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Table 4. Organizational Readiness by Country Benin Information can be shared through CAME. A staff member, who is responsible for compiling procurement information, already exists. No resources are necessary. Burkina Faso One person is available in CAMEG to provide data, and is already familiar with general requirements for reporting of procurement transactions. In addition, the procurement manager already exchanges information (informally) by telephone. One opportunity for CIB coordination is to take advantage of already established meetings: e.g., ACAME meetings of CMS managers. Côte d’Ivoire To set up CIB, the country will need to determine the point person for the following roles: (1) person responsible for procurement, (2) Director General of the PSP, (3) Deputy Director for Purchases, and/or (4) delegate responsible for ARVs. The Gambia The Chief Pharmacist, who has two staff members, has been proposed as the point person for the update of information. Because most family planning commodity procurement is conducted by UNFPA once a year, collection of data may be a low level of effort. Ghana The point person at the MOH is already responsible for updating the Global Fund’s Price Reporting System, which is online. CIB should ensure that the requirements for participation do not duplicate their work. Mali Within CAG, one of the three current technical staff was noted for being highly quali�ed and appropriate for gathering, documenting, and sharing information. However, it was noted that the amount of time for this new task might require other resources—the level of effort would depend on the volume of work being done, as well as CIB requirements. PPM indicated that the head of the procurement unit would be the responsible party in charge of CIB duties. The Association Malienne pour la Promotion de la Famille (AMPPF) said that current resources were adequate. Niger The public sector central medical store should include the CMS Director of Procurement Coordinator of Information and the Director of Pharmacy. Nigeria Within the FMOH, there is adequate staff in the procurement unit to provide data to the CIB. The number of staff in the states and hospitals is unknown. The 36 states, 15 Federal Teaching Hospitals, and 21 Federal Medical Centers operate autonomously in many ways, and procure a range of RH commodities on their own. It was noted that those purchases are greater than those of the FMOH. Senegal The roles and responsibilities in the procurement process are not clearly de�ned at present. HIV/AIDS, tuberculosis, and contraceptives are handled outside PNA. At the time of review, MSH was assessing organizational/logistics management issues at PNA. At a later stage, the needs for participation should be assessed, in particular, for Senegal. ACAME ACAME has been working and supporting the collection of information for Francophone countries, and it is thought that CIB work would not cause an added workload. Summary statements regarding organizational readiness follow: • All countries have staff either as part of the Ministry or through the country’s procurement agent, who can provide data. For data collection, all countries should be invited to share information. A �rst indication of commitment will be the appropriate representation and participation of coun- tries at the technical design workshop. At that time, priority countries to share information should be included as a topic on the agenda and discussed by the group. To assess organizational readiness, the team focused on the existence of the role of a procurement information manager in each surveyed country. While there are several factors (discussed below) that constitute organizational readiness for CIB, differences in status and organization of the procurement function in each surveyed country results in various levels of responsibility of a procurement informa- tion manager. In addition, the coordination role was discussed with key country informants. Those interviewed noted that a strong central coordinator is necessary for CIB to succeed. Respondents indicated that WAHO 10 Situational Analysis: Findings from the Readiness Assessment has a clear mandate to coordinate such Figure 2. an activity. WAHO has reliable commu- Proposed Organizational Diagram nications for easy correspondence by e-mail, fax, and via the Internet; has Information Building: Share, Search been convening regional meeting and Community has facilities to host; and has experi- Building: Unite ECOWAS ence in-house maintaining servers and Ministers databases. At the time of the review, WAHO was hiring a technical staff WAHO Donors/ member to work on other initiatives Partners that required software development. In addition, WAHO is well suited as the entity to identify and raise operational ACAME Country and policy barriers to the appropriate Procurers levels, as needed, in order to ensure the progress of CIB. Thus, it is recommended Others, role to be defined that WAHO include a full-time CIB Sys- WAHO ARV QA, Nat’l UEMOA Multilaterals tem Manager to function as coordinator. Observatory Labs Support for this new position should be discussed further; however, for the long- term, it is expected that this position, just like other WAHO staff salaries, would be supported as part of the regular operating budget. (See �gure 2 for the proposed organizational diagram.) To avoid duplicating reporting and existing structures, while WAHO leads and coordinates CIB, they should work with ACAME to leverage existing infrastructure already established among Francophone countries. Similarly, WAHO should work with Ministries of Health to identify responsible parties in each country who will be responsible for further coordination of information provision, as well as dis- semination of reports within each country. For some countries, there may be little need for further delegation; however, in highly decentralized countries such as Nigeria, where each state has its own procurement authority, this may require a high degree of coordination. The diagram above depicts the proposed relationship between WAHO and these groups. D. Policy/Legal Readiness The team reviewed whether legal or policy barriers exist that may hinder information sharing or acting on information. Overall, there were no obstacles to providing information. Table 5 provides the �ndings, by country. Risks or barriers regarding policy/legal readiness are: • Policy gives preference to local manufacturers (e.g., allows tender offers from local manufacturers to be a percentage, approximately 15 percent over the lowest bid.) While this policy does not af- fect CIB information going in, it could impact any results regarding lowering procurement prices. Summary statements regarding policy/legal readiness are: • Overall, in particular among PSP entities, there are no policy or legal barriers to sharing informa- tion. Only one country could not share prices (but could share other elements of procurement). • Interviewees noted that the CIB implementation and its sustainability require endorsement and support from policymakers and senior program managers. Speci�cally, the project outlined in this paper is recommended for evaluation and subsequent endorsement by the Ministers of Health. 11 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Table 5. Policy/Legal Readiness by Country Benin Cannot share prices (have shared other information like manufacturer, Q/A results) due to procurement regulations. No restriction on sharing other information. Burkina Faso No barriers cited. Côte d’Ivoire No fundamental barriers. The Gambia Unknown. Ghana No barriers to participation. Mali Have been no policy or legal barriers to information sharing, which has taken place in the past, formally and informally. No reasons cited as to why it could not happen in the future. Niger No barriers, but there are policy needs stated for the harmonization of registration systems, and West African prequali�cation standards. Nigeria No known barriers. Senegal No known barriers. Already share prices. ACAME No known barriers. E. Proof of Concept: Feasibility Model Another way to determine readiness is by developing a proof of concept system. The team constructed a proof of concept model and then veri�ed its validity with key country informants. This was a test on the feasibility of data collection, and to determine whether e-mail and phone communication was suf�cient to collect information for CIB. Just as CIB will be a database that stores information and provides relevant reports, this proof of concept was modeled after CIB as a smaller, limited database with a few relevant reports. Through the request and collection of information, Figure 3. the team was able to assess availability Sample of a Supplier Report of information, whether contacts were appropriate, and how much work and Generic Name (INN) NEVIRAPINE (NVP) Strength (or Name of Dosage Form Type of package Country Concentration) manufacturer infrastructure would be needed to help syrup Ghana CIB succeed. 200mg oral solid None - Clinton Foundation (4) 200mg oral solid 60 tabs per bottle None - IDA (6) The proof of concept was developed 200mg Cipla Ltd. oral solid Ghana (2) 200mg Cipla Ltd. oral solid Burkina Faso (1) in MS Access and designed with a few 200mg 50mg/5 ml Ranbaxy Cipla Ltd. oral solid syrup Benin (2) Burkina Faso (1) reports that responded to expressed Generic Name (INN) Strength (or No Logo Name of Dosage Form Type of package Country needs for information. Data sources Concentration) manufacturer for this report included countries’ Alatech Healthcare Products N/A Alatech Healthcare Products N/A Ghana (5) Ghana (5) procurement reports; central medical Alatech Healthcare Products N/A Alatech Healthcare Products N/A Senegal (5) Burkina Faso (5) store reports; data included in previous Alatech Healthcare Products N/A Alatech Healthcare Products N/A Senegal (5) Burkina Faso (5) evaluations; and information Web- Alatech Healthcare Products N/A Ghana (5) Alatech Healthcare Products N/A Senegal (5) based systems, such as the Global Fund’s Price Reporting System, IDA, Monday, October 24, 2005 Page 11 of 16 the RHInterchange, and the Clinton Foundation. (See �gure 3.) In general, the data collection exercise was most successful when information was requested in person. Several attempts to gather and update data via e-mail met without further response. Thus, built into the roadmap is the need for the CIB System Manager to be available, in person, to collect periodically data in countries that have requested assistance. This data collection would include 12 Situational Analysis: Findings from the Readiness Assessment training and a template that countries could use in the future to provide data on their own. When reports were produced, they were speci�c to a shipment and, in general, single consolidated reports were not available. Thus, a certain amount of work may be required in most countries to either compile the information or to create a new report from a country’s automated system that meets the information needs of the CIB. In addition, including information from multiple sources highlighted the need for standard terminology, displaying value in a single currency, and agreement on the minimum amount of product description needed in order to make comparisons. For example, to con�dently compare prices and suppliers for certain drugs, strength and composition and type of package are extremely important. 13 IV. Proposed Coordinated Informed Buying Model A strong understanding of countries’ needs, combined with an appreciation of each country’s state of readiness, and previous experience building technical solutions provided the basis for making recom- mendations about the appropriate CIB model. The proposed model attempts to create a practical sys- tem that responds to the stated needs, as presented in section III. The model can best be described through the four dimensions: informational, operational/technical, organizational, and policy/legal. Summary recommendations using these �ndings from the nine countries surveyed are outlined in sec- tion A, with more detail in section C. Given varying levels of readiness, a phased approach to building the CIB is recommended as outlined in section B. It should be noted that, as with all software and sys- tems development approaches, this proposed model should be reviewed (in particular section C: High Level Business Requirements) by the users and data providers in a technical design workshop. A. Summary Recommendations for CIB Informational: • CIB can, and should begin with the data that already exists; namely, with supplier, manufacturer, and product/price reports. These reports respond to such requests for information as who else supplies a particular product, and what are the options for a product in terms of strength and packaging. • CIB should contain procurement data (i.e., the system should be built on transaction-based vs. general reference price information) on high-value products. High value products are those that are either politically high, price changes occur, or are essential to the MOH list; namely, contraceptives, ARVs, and vaccines. • In the future, CIB should include data that does not yet exist in a systematic way throughout the region, namely, quality metrics; for example, data on supplier performance and product quality. Operational/technical: • CIB should be built with multiple communication channels in mind. Namely, technology and/or lack of infrastructure should not be a roadblock to building a regional warehouse of information. • As a region, there should be an established ideal that all participants should be trying to reach for the longer term. Thus, for the short term, rather than waiting for common technical platforms, CIB should be initially designed to account for varying levels of technical standards. For example, for those countries already providing data to Web-based sites, information can continue to be provided and accessed via the Web. For those countries that use Excel spreadsheets to capture information and have no Internet connectivity at work, information can be provided via fax, while the CIB System Manager can provide customized reports via fax, as well as a CD that contains information for general periodic review. • All countries should be invited to provide information, and all countries should have access to information (whether they participate with data or not). By allowing any country to participate and to access information in any way, information can be shared and will provide value. 15 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System • CIB should be built as a Web-based system, with appropriate security to ensure that, for the pres- ent, it is secure from general public viewing. This responds to concerns about negative reports, which could degrade participation in CIB. Organizational: • A strong central coordinator is necessary for CIB to succeed. WAHO was indicated by interviewees as the organization with a clear mandate to coordinate such an activity. • It is recommended that WAHO include a full-time CIB System Manager, as well as provide the tech- nical resources, detailed later. • In order not to duplicate reporting and existing structures, while WAHO leads and coordinates CIB, they should work with ACAME, thereby leveraging infrastructure already established among Franco- phone countries. • Similarly, WAHO should work with the Ministries of Health to identify parties in each country who will be responsible for further coordination of information provision, as well as dissemination of reports within each country. For some countries, there may be little need for further delegation; however, in highly decentralized countries such as Nigeria, where each state has its own procure- ment authority, this may require a high degree of coordination. Policy/legal: • According to the majority of interviewees, there are no policy or legal constraints to sharing price and supplier information. • In one country, interviewees noted barriers to sharing price information because of procurement regulations prohibiting others’ use of that information. • At this stage, then, it is recommended that a continuing standard be adopted so that the sharing of information is legal (i.e., contracts with suppliers should not contain clauses regarding the sharing of such information) and that policy continues to support the growth of such regional initiatives. Figure 4. CIB Building Blocks B. Phased Approach: Building Blocks Roadmap 3 This section presents a phased approach focus Longer Term to implementing the CIB. The elements of the summary recommendations made in 2 • Broker, advocate the previous section are sequenced in this Mid Term • Move to supplier section in terms of building blocks 1, 2, and 1 performance, QA 3. Taking this step-wise approach to CIB Proof of results • Establish data Concept+ • Link directly to is important to ensure that the sharing of standards and deadlines external information is started as soon as possible, • Collect and share databases • Establish and to minimize delays due to development what exists, technical of new processes or collection of new data. including external standards However, it is just as important to have databases • Include more a plan for the future, and building block • Work with countries and states in the 3 provides some examples of CIB’s future existing country structures data pool potential. 16 Proposed Coordinated Informed Buying Model Emphasis is placed on meeting the needs as outlined in building block 1 (of 3) for several reasons (see �gure 4). Most important, it was noted that within the region, such initiatives as pooled procurement and a Francophone information sharing system were begun with a great effort by countries, but with few results. To ensure that CIB is not just useful but used, beginning sooner with a basic but effective system, rather than later after a long setup period, is critical to success. Thus, the roadmap presented in section VI Roadmap to CIB outlines steps to take toward establishing building block 1. (See table 6.) Future work to expand to building blocks 2 and 3 will require an iterative cycle of assessment, reas- sessment, and adaptation that will depend on �ndings and accomplishments from building block 1. C. Informational and Functionality Requirements: High Level Business Requirements From the interviews, several common themes emerged around areas of major interest in, and the value- added of, a CIB system. These themes can be organized mainly around the sharing of information relat- ing to the products themselves, suppliers, manufacturers, and the prices obtained for products. This section reviews in more detail the type of information the CIB should contain and what functionality it should include. Major Information Requirements Table 7 displays the major information needs expressed during this assessment. The �rst column shows the informational needs of people responsible for PSP, and is organized by major areas of price, prod- uct, supplier, manufacturer, and others. The second column translates those needs into reports that could respond to those questions. The third column lists the type of data that must be included in CIB to meet the reporting needs. The �nal column classi�es whether the particular information was classi- �ed for building block 1 or building block 2/3. This section should be used as the initial blueprint for the CIB system, to be discussed and further re- �ned at a future technical design workshop. Regardless of when data collection begins (building block 1 or building block 2/3), the CIB system should contain all the listed data elements and reports. The �nal section of this report includes a list of issues that the sub-regional partners will need to review and resolve at a technical design workshop. In this way, comparable information can be collected and reported on, and users of the information will understand what the reports contain. Potential Product Categories In general, all interviewees indicated that CIB would be bene�cial for all products purchased in the public sector. While procurement procedures differed by country (e.g., regarding the pre-quali�cation of suppliers and share of procurement conducted under international competitive bidding procedures), all agreed that information on products and costs was generally valuable in either the preparation or tendering levels of bids. The speci�c categories of products that countries cited as particularly strong candidates for CIB are included in table 8. These include ARVs and HIV/AIDS products, vaccines and immunizations related products, and contraceptives. Table 8 also summarizes the speci�c reasons why CIB would be bene�- cial. Speci�c products should be agreed upon at the technical design workshop. 17 Table 6. Building Blocks—A Phased Approach to CIB 18 Building Block 1 Building Block 2 Building Block 3 Informational • Reports on supplier, manufacturer, product/price. • Establish data standards and deadlines for • Quality reports regarding supplier • Sharing of procurement information for the collection of new information performance, product quality, testing high value products (e.g., contraceptives, (for most countries). facilities, market analysis ARVs, and vaccines). • New data may include testing information (lab, standards used, certi�cations on �le), product quality results (lab results), supplier performance (percent on-time delivery, lead-time). Operational/ • Web-based tool built with ability for updates • Operational standards and ideal are • Direct links are established with Technical online or off-line. established, with a timeframe developed by existing databases in order to automate • CIB System Manager may collect information each country as to when they expect to updates. directly in spreadsheets and oversee data entry. meet them. • More countries and states are entering • All countries are invited to participate. • More countries and states are regularly and accessing information on-line, • Some countries access information via the Web. participating with information, and more without the aid of the CIB System • Some countries request customized reports. users are accessing/requesting information. Manager. • Some countries request CD for information review. Organizational • WAHO is central coordinator, liaising with • WAHO continues organizing regional CMS • Countries are routinely providing individual countries on a regular basis. Managers’ meetings. Agenda topics emerge information as well as accessing and • Each country has a designated contact person that are of interest region wide. requesting additional information. who is in charge of data collection and • Over time, WAHO spends less time gathering • WAHO adopts a regional perspective, transmission to the CIB. information; but can do more analysis/ conducting more cross-country • In the case of Francophone countries participating regional work. analysis of data, and highlights regional in ACAME, WAHO and ACAME work together to opportunities. minimize duplication of requests. • CIB System Manager is responsible for collecting information for CIB. Some countries enter information; CIB System Manager spends a large amount of time gathering data and disseminating information. • CMS Managers’ meeting and establishment of a professional network begins. Policy/Legal • Con�rm that there are no policy or legal • Con�rm that for new information regarding • Continue to uphold a regional practice constraints to sharing price and supplier quality aspects, that there are no policy of not placing restrictions information. or legal constraints to sharing price and on the sharing of information. • For one country, work to see how changes can supplier information. West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System be made to support sharing prices of actual procurements. • Adopt a policy to continue support of the growth of this regional initiative. Table 7. Data and Information Needs Information Need Report Need Data Need Building Block 1 or Building Block 2/3 Price related What price (e.g., FOB) did other By product, list the price and country • Product: international nonproprietary name (INN), dosage, 1 countries obtain for a similar product? supplied. strength, formulation, packaging • Quantity: quantity in lowest units, unit • Price: total price, currency, INCO terms, shipment method • Country • Supplier • Date of Purchase Product related What are options for a particular By product, list the INN, dosage, • Product: INN, dosage, strength, formulation, packaging 1 product: strength, formulation, strength, formulation, packaging. • Supplier packaging? • Date of Purchase What are possible product By product, list substitutions with • Product: INN, dosage, strength, formulation, packaging 2/3 substitutions? What are advantages/ attributes. • Other data elements: To be de�ned further at technical disadvantages, side effects, general at technical design workshop. Need to de�ne elements of pharmaco-vigilance? “advantages/disadvantages�, “elements� What are my testing options? By product, provide testing company • Product: INN, dosage, strength, formulation, packaging 2/3 information • Testing: name of testing company, amount of time it took for testing, testing standard used, certi�cations on �le • Country • Date of Purchase Supplier related Who else supplies a particular product? By product, provide supplier • Product: INN, dosage, strength, formulation, packaging 1 Who are the suppliers supplying a information. • Supplier: name, supplier type (wholesaler, procurement particular product in the region? agent, donor) • Country • Date of Purchase What is the quality record of the By supplier, provide their service record. • Supplier: name, supplier type (wholesaler, procurement 2/3 supplier? Is the supplier a good value? agent, donor) • Supplier Quality: lead-time, whether delivery was on-time or not, if not, length of delay • Product: INN, dosage, strength, formulation, packaging 19 Proposed Coordinated Informed Buying Model • Country • Date of Purchase 20 Table 7. Data and Information Needs (cont’d) Information Need Report Need Data Need Building Block 1 or Building Block 2/3 Which other country is the supplier By supplier, list countries where they • Supplier: name, supplier type (wholesaler, procurement 2/3 registered (for which product)? are registered/licensed. agent, donor) • Product: INN, dosage, strength, formulation, packaging • Country • Date of Purchase • Date Registration Will Expire Manufacturer related In which countries are manufacturers By manufacturer, list countries and • Manufacturer: name 1 registered? products where they are registered • Product: INN, dosage, strength, formulation, packaging • Country • Date of Purchase Does the manufacturer provide good By manufacturer, list products provided • Manufacturer: name 2/3 quality products? with test results • Product: INN, dosage, strength, formulation, packaging • Testing: test results (number of lots total vs. number of lots passed) • Manufacturer: on-time production results • Country • Date of Purchase What is a manufacturer’s market share By product, list total value of all • Product: INN, dosage, strength, formulation, packaging 2/3 for a product? purchases, and itemize by • Manufacturer: name manufacturer the total value and • Quantity: quantity in lowest units, unit quantity purchased. • Price: total price, currency, INCO terms, shipment method • Date of Purchase Other How can regional information about By product, list countries that have • Product: INN, dosage, strength, formulation, packaging 2/3 country-level purchases facilitate recently received shipments. • Country brokering of products between • Quantity: quantity in lowest units, unit countries (e.g., avoid stockouts in one • Date of Purchase country)? West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Proposed Coordinated Informed Buying Model Table 8. Speci�c Cited Products or Product Groups for Which a CIB System Would Be Helpful Product or Group Cited Justi�cation Given All Products • Being systematically better informed of relevant, region-speci�c transactions is a competitive advantage in procurement. ARVs • Prices and supplier market place constantly are changing. • Dif�cult to keep up with most recent information to guide product selection and sourcing during procurement. Contraceptives • These products have typically been donated and procurement related information has generally been outside the realm of national procurement structures. • As donor funding phases out, procurement information through a CIB system will be valuable to local structures or agents. Vaccines • Products are high cost and any opportunity or mechanism to obtain lower prices is bene�cial. CIB Functionality Requirements CIB functionality should be built with the following minimal set of requirements. More requirements may be de�ned during the technical design workshop, and this list should be updated for future refer- ence. The CIB system should: 1. Have proper security features such as username, password, and levels of security (administrator, read-only, read and write access). The concern expressed was that if data were used to make an example out of one country over other countries, this type of use would discourage further participation in CIB. 2. Allow for multiple channels of input, namely, on-line updates, as well as off-line updates. Opera- tionally, at the beginning of CIB, countries may Figure 5. provide information in Modes of Communication any format (hard copy, MS Excel, etc.) to the CIB Country System Manager, who will enters then be responsible for information Person 1 directly into putting the information their own CIB System on-line (see �gure 5). Country sends Person 1 Manager sends system (faxes/e-mails) update to Country Person 1 3. The design should al- information to CIB low for multiple modes System Manager; Information Country Country Systems of report communica- System Manager enters system sends reports to information tion. On-line, ad hoc country directly into automatically sends update report generation should CIB system file to CIB be available, and these system Country reports should be avail- Secretariat obtains reports from CIB able for conversion into system directly standard applications, CIB System such as MS Excel. Opera- Manager inputs information into tionally, at the beginning CIB system of CIB, the CIB system CIB System updates other manager may be the one CIB System systems Other systems running and disseminat- 21 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System ing reports. Interviewees expressed the following preferred modes of communication: Internet, email with Excel attachment, and a CD to query when needed. 4. Convert from multiple currencies into an agreed-upon standard currency. This will allow transactions to be reported in the original currency used and a standard conversion can be ensured by the application of a formula in the CIB. Standards for Reporting Prior to the collection of data, agreement must be reached on standards for reporting. Data standards to be discussed at the technical design workshop are listed below. As the CIB system evolves, the CIB System Manager should update the list of standardized de�nitions. 1. Product list: The group should agree on which speci�c products to include. Each participant should be prepared to discuss which procurement systems would be included in CIB (government-procured, donor-supplied, government-selected supplier, etc.). 2. Product de�nition: The group should agree on standard product de�nitions in CIB. For example, the group could review the product naming convention set up by the Global Fund’s Price Reporting System, which provides generic formulation, as one standard. 3. Price reporting and price smoothing: Consider normalization reporting for having all Free On Board (FOB) prices, regardless of actual international commercial terms (INCO) terms used to ensure com- parable information on price. 4. Unit de�nitions as smallest unit available (cycle, vial, tablet, etc.). 5. Time for testing: How should the duration of time for test results for a product be expressed? Con- sider expressing it in terms of the date it is sampled until the date test results arrive. 6. Standard currency (not necessarily for reporting, but for display in CIB). 7. How the system will handle currency conversion: where will it take the currency exchange rate from, and how often; or should it base the calculation on the day the order was placed or some other date (like payment date, in which case countries will need to report additional information)? 8. Product substitution attributes: What are the key factors for product substitution? 9. De�ne different supplier types: Wholesaler, procurement agent, donor; any others and agree on standard terminology. 10. Discuss how supplier registration works in each country; come to an understanding of what the information in CIB will represent. 11. Product quality: Agree to information that best reflects product quality. For example, CIB could show number of lots passed vs. number of lots tested. Data to be reported will depend on what is decided. 12. Frequency of updates: Establish, as a group, how often updates should occur—as often as when something new is available? Periodically, e.g., quarterly? Based on other real-time information systems, if at all possible? Would it be better to make the design as up-to-date as possible? 13. Priorities: In general, all countries will be asked to contribute data. At the workshop, the group should decide whether certain priority countries must contribute data for the success of the system or not. 14. Data quality: The group should establish rules of conduct regarding data integrity, and consider whether certain checks (e.g., random checks of information by the CIB system manager against contracts) are desired or needed. This responds to a comment made by one interviewee that there could be a tendency to provide false information. 22 V. Summary of CIB Bene�ts and Estimated Costs We have demonstrated that procurement price, quality, and delivery data can be a useful tool to im- prove procurement outcomes in the sub-region by increasing the knowledge and options for country programs. This paper recommends that the sub-region begin the implementation and operation of CIB using the parameters described in building block 1 (see Table 6: Building Blocks—A Phased Approach to CIB). This stage allows CIB stakeholders to realize almost immediate bene�ts while constructing a low-cost, adaptable system. It should be remembered that all analysis on bene�ts and estimated costs depends on the accuracy of the assumptions made. In any setting, it is dif�cult to predict with certainty if the system-wide costs of the CIB mechanism will outweigh some of the tangible bene�ts associated with greater procurement ef�ciency—price, quality, on-time delivery, etc. The costs for CIB will vary widely depending on a number of factors, including number of countries participating; frequency the CIB manager must travel within the sub-region to work with counterparts; number of products tracked; and the complexity, availability, and quantity of data. The bene�ts, as this paper has indicated, are also not guaranteed. The ability of participant country procurement agencies to obtain lower unit prices through the sharing of information may, in fact, create additional challenges such as supplier and manufacturer reluctance to make procurement data public. Taking these factors into consideration, the following bene�ts may be realized based on these assumptions. A. Bene�ts Price The potential bene�ts that may be realized by ECOWAS member states from an operational CIB system are more dif�cult to quantify. Country informants, for example, cited increased coordination and col- laboration resulting from greater information sharing as one desired outcome. The value of this should not be ignored. However, one expectation shared by many respondents in the sub-region is the poten- tial to obtain lower procurement prices through information sharing. In some instances, countries may be able to use CIB information to lower unit prices. It is dependent on both the procurement �nancing source and the country’s own procurement regulations. The international competitive bidding (ICB) process required by the World Bank when its funds are being used does not support or encourage price ceilings for products. If the procurement funds are from government revenues then their requirements must be followed. If these regulations allow price ceilings to be set in the bidding process, then the CIB data can be used in this way. In country X7, for example, one recent study estimated that male condom use, supported by public sec- tor facilities—including social marketing—will cost U.S.$575,000 in 2006 at a cost of U.S.$.03/unit. (Rao 2005) Using the CIB procurement price data, country X may discover that another country in the sub-region is procuring condoms for U.S.$.02, U.S.$.01 lower than the U.S.$.03/unit country X has been paying. As noted above, there are many restrictions that may prohibit the setting of ceiling pric- es. However, if national revenues are used, country X could potentially set a ceiling price of U.S.$.02 in its next condom procurement—saving over $190,000—or multiple times more than the estimated total 7. The references to country X and Y are based on actual data collected through the DELIVER project’s work on comparative commodity pricing. 23 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System CIB system cost. In the same year, country Y is preparing tender documents for Fansidar tablets and other medicines. In the previous year, public sector costs for Fansidar were estimated at U.S.$82,000. The CIB price data sent to the procurement unit indicated that another country participating in the CIB network obtained a unit price of U.S.$.008 less than country Y. Country Y may be able to use the data in its tendering process or in negotiations with suppliers to save over U.S.$25,000. As stated, World Bank procurement regulations do not allow price ceilings to be set. Alternatively, if countries are using their own revenues, or with the consent of a third party �nancing source, a second round of bidding may follow. Countries, including Lithuania, Morocco, and India, have, for example, conducted a negotiating process where the lowest bidders are called together for a meeting with the purchaser who then asks for lower prices. Using CIB information (i.e., knowing what other countries paid) would be a powerful tool for the purchaser in this situation. However, this type of ICB followed by negotiation may not be allowed under some systems. Timely Delivery of Quality Products In addition to the potential cost savings, countries in the region might bene�t from improved quality of the products procured through knowledge of the quality of medicines procured from suppliers to the sub-region. Information on supplier performance and quality testing results is projected to be shared in building block 2 of the CIB system. Poorly performing suppliers, who routinely fail such inspec- tions, can be identi�ed by participant countries, and scrutiny of bidding documents by countries to ensure accuracy, may be an immediate result. Conversely, participant countries can be encouraged to work more closely with those suppliers that have been proven, through CIB data, to provide quality products. Additionally, countries can bene�t by identifying those suppliers who reliably deliver qual- ity products on time. A number of countries in West Africa have experienced problems in the delivery of health commodities, including lengthy periods between order and delivery, limited coordination, and poor communication between the supplier and the program. These problems can and have led to product sitting in port collecting demurrage charges, gaps in the supply, and oversupply. Like data on quality, CIB reports, including past delivery history, can help create more informed buyers, leading to greater scrutiny and veri�cation in the procurement process. Network of Procurement Professionals In addition to the potential commodity speci�c bene�ts, the majority of respondents across the nine countries surveyed indicated that they expect intangible bene�ts as a result of the CIB build- ing process. The process itself—building the network, conducting joint market research, and meeting regularly—is a valuable tool to increase regional commodity security cooperation. Many respondents requested that the CIB development process include scope for procurement managers to gather for a regional meeting. Namely, people would like to learn from each others’ best practices experiences (e.g., what speci�c actions were taken, what policies had to be in place, and how managers reacted to information when conducting procurements). This example underscores the importance of this initia- tive to build, not just a tool, but, also, a network of professionals who can consult with each other to improve their work. Respondents indicated that a network of procurement professionals can result from sustained contact with colleagues in other countries. Best practices, including information management, bidding preparations, and evaluations could be shared as staff communicate procurement data through the CIB system. In Nigeria and Mali, for exam- ple, where in-depth assessments were carried out, procurement staff indicated that they would bene�t from opportunities to meet their counterparts in the sub-region to seek ways to improve information sharing. These intangible bene�ts can contribute to the success of the CIB system and its ability to de- liver the price and quality bene�ts noted above by strengthening buy-in and commitment to reporting. 24 Summary of CIB Bene�ts and Estimated Costs Other Bene�ts Brokering Role The assessment revealed that CIB could not only be a source of information but could also play a valu- able role in facilitating essential medicines procurement, for each country or with a regional scope. In particular, several interviewees saw a brokering role for the organization administering the CIB system. This role would be made possible by the fact that the system would have information on potential procurements for each country. In the event of an emergency stockout or shortage of a product in one country, the CIB management could relatively quickly identify potential neighboring countries that could provide some relief, with some mechanism in place for facilitating the borrowing and sharing between countries. This role is still hypothetical, because, currently, such a mechanism is not formally in place in any regionally acting organization. Harmonize Essential Medicines List A CIB system can also provide a sub-regional report of key aspects of procurement. The report would be based on a compilation of country information or would be based on related country experiences. Examples of what this role could entail range from simple to more complex. For instance, a simple product would be the preparation and dissemination of a list of essential drugs procured by category; such a report would already demonstrate the degree of harmonization of essential PSP lists and facili- tate other on-going concerted efforts in the region to harmonize essential medicines lists. An example of a product that would require more preparation is the analysis and dissemination of procurement and management best practices. B. Costs The following start up and annual operating costs are estimates based on system functions of build- ing block 1. These costs will vary depending on the �nal system design, and will likely increase as the system becomes more complex in building blocks 2 and 3. The costs are divided into two categories: central-level information management and country-level costs. For building block 1, both central and country-level do not require signi�cant, additional expenditures; rather, they will make use of existing resources. Tables 9 and 10 are an estimate of year 1 operating costs. The total costs for central- and country-level operations is expected to be under $70,000, as a number of expenses will be covered through the use of existing resources. Table 9. CIB Central Information Management—WAHO—Costs Category Expense Description Cost Of�ce Space Of�ce Rent Use of existing of space at WAHO headquarters $0 Equipment Computer Server Server will host CIB Web and e-mail functions $2,000 Equipment Internet Connection Dedicated Internet Connection (12 mos.) $3,400 Equipment Fax Machine Used as a back up or alternative by countries and WAHO $400 Human Resources IT Consultant Part-time for one year $12,400 Human Resources Full-time CIB Existing WAHO staff $9,200 System Manager Human Resources Database developer/ manager 50% time $4,800 Human Resources Administrative assistant 50% time $3,000 Operating Costs Electricity, phone line International calls and faxes $2,700 Travel Air ticket, per diem Technical assistance to country programs. $7,500 Subtotal $45,400 25 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System These �gures do not include the costs of a CIB design workshop that is expected to be attended by several member countries, and are covered under separate but related USAID �nanced technical as- sistance. The objective of the workshop is to design and agree upon speci�c system functions and pa- rameters, including reporting intervals, central-level data dissemination and procedures. The estimated costs are also based on the �ndings that participant countries have the human resource and technical capacity to collect and send procurement data to the central level CIB manager, and further possess the political will and have in place the operational procedures to absorb basic operating costs listed in the table. Table 10. CIB Country-Level Costs8 Category Expense Description Cost Equipment Server, Fax Machine, Do not expect any additional hardware, software costs for $0 computers countries for building block 1. Operations make use of the existing communications infrastructure that is in place in-country. Human Resources Country-level Part-time staff to assemble data and send it to CIB System CIB Associate Manager, and to receive and disseminate reports coming from the CIB system, as appropriate Operating Costs Electricity, phone line International calls and faxes $13,500 Data Collection Procurement staff time In countries with decentralized systems, greater resources may $0 and need to be expended to collect data for reporting. Dissemination Travel Annual meeting CIB annual meeting to discuss status, upgrades $ 9,000 Subtotal $22,500 8. Figures represent total costs of 15 participating ECOWAS countries. 26 VI. Roadmap to CIB The sections above describe the current state of information sharing and the environment, de�ne what should be included in the CIB, and how it should function. This section carries this analysis one step further by recommending steps that should be taken to implement the system. These steps are provided in two tables with the same content, but organized as follows: the �rst table lists activities by category (operational/technical, organizational, software application design, and general manage- ment); the second lists the same information, but reordered chronologically, and highlights milestones and dependencies (with asterisks). Both tables 11 and 12 include a designation between key actors, namely, WAHO’s Director General, the CIB System Manager, and all country contacts (including ACAME in this category). Each activity has a primary person responsible for completion, as well as notes for the other persons as to whether their participation, review, or approval is required. These detailed steps focus on the actions necessary to work towards building block 1, in particular. Table 11. Roadmap to CIB—Activities by Category CIB Director System Country General, Seq ID # Task Description Manager Contact WAHO Primary Responsibility = X; Participation Needed = P; Review Needed = R; Approval Required = A 1 Plan and Manage Implementation 4 1.1 Develop indicators. X P, R R, A 4–5 Develop workplan. X P, R R, A ongoing 1.2 Manage and update workplan. X P, R R, A ongoing 1.3 Provide periodic updates to stakeholders (not users, X who are updated through other channels). 2 Operational Readiness 4 2.1 De�ne processes and policies for data submission, X P, R R, A including to ensure data integrity, regular submissions. 4–5 2.2 Develop policies for security administration. X P, R 11 2.3 Collect data for submission, provide training for future updates. X P 12, 16 2.4 Begin with �rst submission of data. X 4–5 2.5 Develop procedures and policies for helpdesk functions. X P, R 4–5, 16 2.6 Prepare and execute operations support plan. X P, R 3 Organizational Readiness 1 3.1 Hire a CIB System Manager. X 2 3.2 Each country designates a contact person. X 2 3.3 Discuss and de�ne relationship between WAHO and ACAME; X WAHO’s ARV Observatory; WAHO and UEMOA. 5 3.4 De�ne and communicate to the CIB System Manager X preferences on providing information to CIB; either directly to CIB or via data collection and input by the CIB System Manager. 19 3.5 Hold annual meeting of professionals to analyze CIB information, discuss improvements. X P 27 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Table 11. Roadmap to CIB—Activities by Category (cont’d) CIB Director System Country General, Seq ID # Task Description Manager Contact WAHO Primary Responsibility = X; Participation Needed = P; Review Needed = R; Approval Required = A 12–14 3.6 Develop training materials. X P, R 17 3.7 Train users. X P 4 CIB Application Development 3 4.1 Plan for technical design workshop: attendees, outcomes, logistics of meeting. X P P 4 Hold technical design workshop. Outcomes include de�nition of success, upon which indicators are based (e.g., 5 countries are participating regularly with information in one year; 5 countries are using information). X P 7 4.2 Conduct requirements analysis and con�guration. X P, R 7 4.3 Develop detailed requirements for the Web-based application. X P, R 8 4.4 Purchase necessary hardware. P X 4–5 4.5 De�ne security requirements. X P, R 9 4.6 Design prototype. X P, R 10 4.7 Develop reports. X P, R 9 4.8 Develop interfaces: discuss with Global Fund, UNICEF, UNFPA, RHInterchange updates to CIB. X P 7–10 4.9 Develop test scripts. X P 11 4.10 Install initial software. X 12 4.11 Conduct pilot test of system and interfaces; execute test scripts. X P 13 4.12 Analyze results and resolve issues. X P 14 4.13 Install production-ready software at WAHO. X 15 4.14 Train system administrators, technical staff. X 16 4.15 Execute production. X P 5 Deliverables and Milestones 6 5.1 * Workplan developed. X R, A R, A 6 5.2 * Policies and procedures for CIB �nalized. X R, A 16 5.3 * CIB software in production. X P 16 5.4 * Data participation begins. P X 18 5.5 * Report dissemination begins. X P 19 5.6 * Annual meeting held. X P 6 Iteration of steps above to design and implement building block 2: hold requirements sessions, set up processes to collect new data in-country; prioritize technical movement/upgrades in some countries previously participating with CIB System Manager assistance; de�ne countries’ hardware/software/ telecommunications requirements; movement towards obtaining supplier performance; Q/A results, direct links with external databases. 7 Iteration of steps above to design and implement building block 3: hold annual meetings and place emphasis on community building, prepare regional picture of procedures, raise areas where supportive policies are needed for harmonization. 28 Roadmap to CIB Table 12. Roadmap to CIB—Activities in Sequential Order CIB Director System Country General, Seq ID # Task Description Manager Contact WAHO Primary Responsibility = X; Participation Needed = P; Review Needed = R; Approval Required = A 1 3.1 Hire a CIB System Manager. X 2 3.2 Each country designates a contact person. X 2 3.3 Discuss and de�ne relationship between WAHO and ACAME; WAHO’s ARV Observatory; WAHO and UEMOA. X 3 4.1 Plan for technical design workshop: attendees, outcomes, logistics of meeting. X P P 4 1.1 Develop indicators. X P, R R, A 4 2.1 De�ne processes and policies for data submission, including to ensure data integrity, regular submissions. X P, R R, A 4 Hold technical design workshop. Outcomes include de�nition of success, upon which indicators are based (e.g., 5 countries are participating regularly with information in one year; 5 countries are using information). X P 4–5 Develop workplan. X P, R R, A 4–5 2.2 Develop policies for security administration. X P, R 4–5 2.5 Develop procedures and policies for helpdesk functions. X P, R 4–5 4.5 De�ne security requirements. X P, R 4–5, 16 2.6 Prepare and execute operations support plan. X P, R 5 3.4 De�ne and communicate to the CIB System Manager preferences on providing information to CIB; either directly to CIB or via data collection and input by the CIB System Manager. X 6 5.1 * Workplan developed. X R, A R, A 6 5.2 * Policies and procedures for CIB �nalized. X R, A 7 4.2 Conduct requirements analysis and con�guration. X P, R 7 4.3 Develop detailed requirements for the Web-based application. X P, R 7–10 4.9 Develop test scripts. X P 8 4.4 Purchase necessary hardware. P X 9 4.6 Design prototype. X P, R 9 4.8 Develop interfaces: discuss with Global Fund, UNICEF, UNFPA, RHInterchange updates to CIB. X P 10 4.7 Develop reports. X P, R 11 4.10 Install initial software. X 11 2.3 Collect data for submission, provide training for future updates. X P 12 4.11 Conduct pilot test of system and interfaces; execute test scripts. X P 12–14 3.6 Develop training materials. X P, R 12, 16 2.4 Begin with �rst submission of data. X 13 4.12 Analyze results and resolve issues. X P 14 4.13 Install production-ready software at WAHO. X 15 4.14 Train system administrators, technical staff. X 16 4.15 Execute production. X P 16 5.3 * CIB software in production. X P 16 5.4 * Data participation begins. P X 17 3.7 Train users. X P 29 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Table 12. Roadmap to CIB—Activities in Sequential Order (cont’d) CIB Director System Country General, Seq ID # Task Description Manager Contact WAHO Primary Responsibility = X; Participation Needed = P; Review Needed = R; Approval Required = A 18 5.5 * Report dissemination begins. X P 19 3.5 Hold annual meeting of professionals to analyze CIB information, discuss improvements. X P 19 5.6 * Annual meeting held. X P ongoing 1.2 Manage and update workplan. X P, R R, A ongoing 1.3 Provide periodic updates to stakeholders (not users, who are updated via other channels). X 6 Iteration of steps above to design and implement building block 2: hold requirements sessions, set up processes to collect new data in-country; prioritization of technical movement/ upgrades in some countries previously participating with CIB System Manager assistance; de�ne countries’ hardware/ software/telecommunication requirements; movement towards obtaining supplier performance; Q/A results, direct links with external databases. 7 Iteration of steps above to design and implement building block 3: hold annual meetings and place emphasis on community building, prepare regional picture of procedures, raise areas where supportive policies are needed for harmonization. 30 Appendices 31 Appendix A. Contact List Burkina Faso Name Organization Function Contact Information Augusta Traore Direction de la Santé de la Famille Attaché Santé Dr. (Ms.) Ndeye Ngone TOURE UNICEF Administrateur de Programme SIDA o: 226-50 30 02 35/09 66/67 nntoure@unicef.org Dr. Conombo K. Sibdou Ghislaine, Direction de la Santé de la Famille, Directrice o: 226-50 30 77 68 Ministère de la Sante dsf@fasonet.bf Dr. Didier R. Bakouan Comité Ministériel de Lutte contre Coordinateur, Médecin de Santé Publique o: 226-50 31 34 01/02 le VIH/SIDA/IST c : 226-70 27 20 34 drbakouan@yahoo.fr Dr. Ida Scholastique Central d’Achat des Médicaments Directrice des Achats et de la Logistique o: 226-55 37 37 50/1/2/3/4 Sawadogo-Millogo Essentials Génériques et des f : 226-50 37 37 57 Consommables Médicaux cameg@cameg.bf Dr. Jean Sakande Direction Générale de la Pharmacie du Intérimaire, Directeur de la Direction o: 226-50 32 46 60, c : 226-70 25 32 59 Médicament et des Laboratoires des Laboratoires f: 226-50 31 44 76 jean_sakande@univ-ouaga.bf Dr. Joseph André TIENDREBEOGO Secrétariat Permanent du Conseil Of�cier de l’ordre National, o: 226-50 32 41 88 National de Lutte Contre le SIDA et Secretaire Permanent les IST, Presidence du Faso Dr. Kabba Joiner WAHO Director General o: 226- 20 97 01 01 / 20 97 57 75 wahoooas@fasonet.bf Dr. KAMBOU Stanislas S. WAHO Directeur de la Recherche et de la Gestion o: 226- 20 97 01 01 / 20 97 57 75 du Système d’Information Sanitaire wahoooas@fasonet.bf Dr. Lagoun ZOU Direction des Etudes et de la Interim, Médécin, D.E.S.S./Gestion des o: 226-50 32 46 62; (226) 76 60 18 95 Plani�cation services de Santé, Ministere de la Santé Dr. MBAYE Amadou Moctar U.E.M.O.A Directeur de la Santé o: 226-50 31 88 73 à 76 moctar.mbaye@uemoa.int Dr. Narcisse Naré Ministère de la des Jeunes Responsable, Interime, Direction de la Santé de la Famille 33 Appendix 1 34 Burkina Faso (cont’d) Name Organization Function Contact Information Dr. Thomas Zoungrana UNFPA NPO/SR-HIV o: 226-50 30 62 39 thomas.zoungrana@undp.org Dr. Wamarou TRAORE Conseil National de Lutte contre Chef, Département Secteur Santé, o: 226-50 36 97 13 le SIDA, Presidence du Faso Secrétariat Permanent Ernest Ouedraogo Direction de la Santé de la Famille Attaché de la Santé, Responsable PF, Gestion de la Logistique Pharmaceutique, Service à Base Communautaire Lazare Bansse ACAME (and CAMEG) Secretaire Permanent (and Directeur Général) o: 226-50 37 37 50/ 51/ 52/ 53/ 54 cameg@cameg.bf Oukouba Ouedraogo Prévention de la Transmission Mère Enfant Pr. MAIGA Moussa A. WAHO Directeur Général Adjoint o: 226- 20 97 01 01 / 20 97 57 75 wahoooas@fasonet.bf S. Nausher M. Ali Ambassade des Etats Unis Conseiller pour les Affaires Politiques, o: 226-50 30 67 23 Economiques et Commerciales alisn@state.gov Ghana Name Organization Function Contact Information Addai Donkoh Ghana Health Service Director, Supplies, Stores, Drugs 233-21-234224, Management (SSDM) Mobile: 0244-461690 Antoine Ndiaye AWARE/RH Commodity Specialist 233-21-786152/53; mobile: 233-24-4471699 Andiaye@aware-rh.org Claudes Kamenga AWARE/HIV Deputy Director, Technical Support 233-21-786102/4; mobile: 233-24-4312271 ckamenga@awarehiv.org Fatimata Sy AWARE/HIV Director 233-21-786102/4; mobile: 233-24-4483133 fsy@awarehiv.org West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Gifty Addico UNFPA Program Manager 233-21-773890-6 gifty.addico@undp.org Ghana (cont’d) Name Organization Function Contact Information Gloria Quansah Asare Ghana Health Service National Family Planning Coordinator, 233-21-684217 Reproductive Child Health Unit gloasare1@hotmail.com Isaiah Ndong AWARE/RH Director 233-21-786152/53 Indong@aware-rh.org Joycelyn Azeez Ministry of Health Procurement Unit 233-20-8176728 joykazeez@yahoo.com Juliana Pwamang USAID/Accra Program Specialist 233-21-228-440 jpwamang@usaid.gov Kristin Cooney USAID/WARP Senior Technical Advisor, Reproductive 233-21-228-440; Health and Child Survival mobile: 233-244-311-927 kcooney@usaid.gov Parfait Edah JSI/DELIVER Resident Logistics Advisor 233-21-78-07-32 pedah@africaonline.com.gh Peter Gyimah Ministry of Health Head, Central Medical Stores petergyimah@hotmail.com Phlibert Kankye Christian Health Association Executive Secretary 233-21-777815 of Ghana (CHAG) Fax/tel: 772226 philibert@chagghana.org Pradeep Goel USAID/Accra Reproductive and Child Health Advisor 233-21-228-440; mobile: 233-24-432-9942 pgoel@usaid.gov Samual Boateng Ministry of Health Director, Procurement and Supply 233-244-269336 Seydou Doumbia USAID/WARP Senior Program Specialist, 233-21-228-440; mobile: 233-244-313-526 Reproductive Health and Child Survival sedoumbia@usaid.gov Ursula Nadolnyi USAID/Accra Health Of�cer 233-21-228-440 unadolnyi@usaid.gov Mali Name Organization Function Contact Information Aboubacar Cisse Ministry of Health Pharmaceutical Advisor Minkaila Maiga DPM Director mmaiga@dirpharma.org 223 2226570 35 Appendix 1 36 Mali (cont’d) Name Organization Function Contact Information Yatassaye Guindo Aicha PPM President and Director General Adama Dembele Procurement Division, PPM Director Siby Checkna Chief Logistics section, PPM Adama Diakhate Procurement section, PPM Alfred Dembele Contraceptive Division Director agencecag@afribornemali.net.2236752578 Nouhoun Sidibe Essential Medicine Division Director Berthe Djenneba Diabate Regulation Division, DPM Chief Toure Mountaga AMPPF Executive Director Fatimata Toure Administrative Division, AMPPF Chief Toure Daouda Makan Training Section, DPM Chief Keita Oumou Keita DRS/DNS Kalifa Traore DRS/DNS Kalifaabd_traore@yahoo.fr 2232226497 Madiou Yattara USAID/Mali myattara@usaid.gov 2232223725 Sorgho Gaston World Bank, Mali Health Specialist Ibnou Diallo JSI/DELIVER Resident Advisor idiallo@jsi.com Nigeria Name Organization Function Contact Information Idriss Garba WAHO Nigeria Liaison Person 08046126586 Dr Victoria Eyo ART NASCP-FMOH Consultant 0803401 1888 Dr. Salao NASCP National Coordinator (cf. Victoria) Dr. Chris Adeyemi UNFPA RH Coordinator 0803 306 8075 Mr. Essan Niangoran UNFPA Representative 803 402 2079 Dr. Yusuf Tambawal FMOH Assistant Director (Supplies) 09 523 0155 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Finance 0803 364 9590 0805 733 8871 Nigeria (cont’d) Name Organization Function Contact Information Dr. K.N. Njepuome FMOH CSGI /BFHI & Consultant Specialist Grade I 0804 4183926 Community Develop. Dr. Bose Adeniran FMOH Head of CLMS 08023056357 Boseade4000@yahoo.com Mr. G.N. Mbong Malaria Control Program, Assistant Director 08035862645 (Environmental Health) Mrs. Olapeju Otsemobar FMOH Malaria Control Program M&E/RBM Nigeria 08038524360 Mr. Mustapha Mohammed FMOH Depart. of Health Planning & Research Deputy Director, Planning 0803 596 4122 Mr. Ra�u O. Adeladan FMOH Principal Health Plan Of�cer, Tenders/ 095238367 Research and Planning Procurement Of�cer 08033118371 Dr. J.Y Jiya FMOH, NOCP Fed. Secretariat, CSG1/Director 0 4135257 , 090 404 163 Dept. of PH 08034030212,08044184777 Professor L. Abou– Ahmadou Bello University Chief Medical Director 0803 3379352, 069-553107/550098, Aguye MBBS,M.Sc Teaching Hospital 069 70546, macoabuth@yahoo.com PMB 06 Shika, Zaria Dr. Oladapo S. Shittu Ahmadou Bello University Of�ce of Medical Advisory Committee (234)69 370085 (of�ce) Teaching Hospital (234) 8037021686 PMB 06 Shika, Zaria olash@skannet.com Dr. Nandul Durfa Gwagwalada Specialized Hospital Chief Medical Of�cer 0805 5456042 Dr. Richard Of�ong Gwagwalada Specialized Hospital Head of Obstetrics Gynecology 08044104065 Mr. Molid Garba Gwagwalada Specialized Hospital Pharmacist 0805 5456042, 0804 410- 3724 mgarba@yahoo.com Mr. O.G Amoosun FMOH Drug Production & Deputy Director 0804 4180893 Distribution Services Dept. dotunmosun@yahoo.co.uk Dr. Ibrahima Alaji Umar Yacubu Gowon Center Project Manager Malaria 0803 4520197 No 20 Yakubu Gowon ibrainyas@yahoo.com Crescent, Askoro Mr. John Okache Yacubu Gowon Center Procurement Of�cer 08034520197 37 Appendix 1 38 Nigeria (cont’d) Name Organization Function Contact Information Dr. M. Kabir National TB & Leprosy National Coordinator 08037038113 Council Programme jfrmkabir@hotmail.com Dr. Omowiyi National TB & Leprosy Staff Member, TB& Leprosy Council omoniyifadare@yahoo.com Council Programme Senegal Name Organization Function Contact Information Alain Kandé ADEMAS Logisticien c: 221-824-61-64 ademas@sentoo.sn Bissenty Corréa USAID/Senegal Family Planning Logistics Specialist o: 221-869-61-00 Brad Barker USAID/Senegal TAACS o: 221-869-61-00 Col. Ibnou Deme Ministère de la Santé et Conseiller Technique No. 1, Point Focal c: 221-631-47-27, o: 221-869-42-45 de la Prévention OOAS demeibnou@yahoo.fr Dr. Daouda Diop PNA Chef Technique et Exploitation c: 221-644-00-33 o: 221-859-50-66 pnas@sentoo.sn Dr. El H. Ousseynou Faye Division SR Directeur Adjoint Dr. Elizabeth Benga-De USAID/Senegal Technical Backstop, RH o: 221-869-61-94 Dr. Ibra Ndoye Conseil National de Lutte Contre Secrétaire Exécutif c: 221-638-71-76, o: 221-869-09-09 le SIDA sensidacons@sentoo.sn Dr. Isabelle Moreira UNFPA Chargée de Programme SR o: 221-823-91-68 Dr. Papa Baba Lyssa N’Dao MSH Conseiller en Logistique c: 221-649-11-77 o: 221-869-14-66 pndao@msh.org Dr. Seynabou Mbengue Sow ADEMAS Directrice Exécutive Jennifer Adams USAID/Senegal SOT3 Team Leader o: 221-869-61-00 Kaba Madigbé JICA Adjoint au Directeur des Programmes c : 221-533-71-40 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System Karim Diop Division VIH/SIDA Pharmacien Senegal (cont’d) Name Organization Function Contact Information Mady Cissé JICA Bureau Régional AFrique Ouest et Centrale c: 221-634-42-80 eofaye@refer.sn Malang Gassama ASBEF Logisticien c: 221-824-25-62 asbefdk@sentoo.sn Maye Diouf Ministère de l’Economie et des Finances Chargée des Programmes de Santé mayediouf@hotmail.com Ramatoula Dioume USAID/Senegal Technical Backstop, HIV/AIDS o: 221-869-61-00 Serigue Abdou Diagne RPMPlus/MSH Conseiller Technique c: 221-869-14-85 sdiagne@msh.org Seydou Nourou Koïta ADEMAS Responsible Marketing Sidy Fall Division SR Logistique c: 221-821-71-55 Sounka Ndiaye USAID/Senegal Monitoring & Evaluation Specialist o: 221-869-61-00 sondiaye@usaid.gov Touty Diack RPMPlus/MSH Consultant RPM c: 221-869-14-79 toutydiack@hotmail.com Others – Contact and Phone Interviews Country Contacts Contact Telephone Niger Dr. Maty, Directeur de la Direction de la Pharmacie, MOH (227) 72 25 31/ 722450 / 971032 Niger Mme DANIA RAKIATOU, Conseiller Technique du MSP/LCE , (227) 72 28 08 /75 31 13 / 96 96 11 Ministère de la Santé Publique et de la Lutte Contre les Epidémies, Point Focal OOAS The Gambia Mr. TAAL Alh. Omar, Deputy Permanent Secretary, Department of State for Health (220) 422 87 09 and Social Welfare, WAHO Liaison Of�cer The Gambia Dr. Mariatou T Jallow, Chief Pharmacist, Department of State for Health (220) 422-5374 and Social Welfare Côte d’Ivoire Eric Coulibaly, Deputy Director for Procurement, Central Medical Stores 225 07 41 04 09 Benin Dr. Cof� Pascal HESSOU, Directeur General, Centrale d’Achats (229) 33 35 36 des Medicaments Essentiels Benin Dr. ASSOGBA Laurent, Point Focal OOAS, Ministère de la Santé Publique (229) 33 74 87/ 04 5531 39 Appendix 1 Appendix B. CIB System Manager Job Description Coordinated Informed Buying System Manager Position Description The West African Health Organisation (WAHO) is undertaking the coordination and facilitation of a regional reproductive health commodity security (RHCS) strategy. To support this strategy, currently under development, regional stakeholders from the ECOWAS countries have indicated a need for an up- to-date, Web-based system for coordinated informed buying (CIB). This system is currently planned to be inclusive of all commodities of high priority to Ministries of Health, including, but not limited to, ARVs, contraceptives, vaccines, and antimalarials. Accountability Objective The Coordinated Informed Buying (CIB) System Manager will lead a dynamic team committed to de- signing, implementing, promoting, and evolving the CIB. In particular, the System Manager will be responsible for maintaining the functioning of the network, principally by ensuring accurate input and output of product and supplier information. The position will require that the individual advocate for the implementation and use of CIB and demonstrate how it can improve health commodity availability. The System Manager will ensure quality and client responsiveness through a participatory process that includes all ECOWAS country stakeholders in the CIB. Speci�cally, the System Manager will work closely with country counterparts to develop, maintain and increase participation and sharing of information. The ideal candidate will guide the development of the software to support their needs. The System Manager will provide guidance and supervision to a technical resource. Principal Responsibilities Responsibilities include but are not limited to the following: • Lead a participatory process to design the CIB, de�ne how the stakeholders will interact in the future, and develop indicators to measure CIB progress. • Manage a short-term solution to gather and generate reports while the Web-based system is being developed. • Launch the CIB. • Develop a strategy for increasing CIB membership (of both data sources and data users). • Promote the use of the CIB potential new members. • Conduct needs assessment of resource and technical capabilities of select countries. • Establish a network of managers who will use the information. • Maintain a steady flow of information for country managers through identi�ed channels (e.g., periodic report generation and dissemination, phone calls, email, one-on-one discussions, newsletters). • Design and develop training materials, and conduct trainings for partners to effectively use the CIB. 41 West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buyer System • Conduct ongoing monitoring and evaluation of performance of the CIB to evaluate its impact on increasing ef�ciency, effectiveness, and transparency of procurement systems and client satisfaction. • Develop overall strategy for and guidance in data analysis to ensure responsiveness to partners and users. • Manage risk mitigation, feature tradeoff, and on-time product delivery. • Highlight areas of risk to the Supervisor. • Modify, improve, and expand CIB based on feedback. • Prepare, advertise, award, and monitor any support or development contracts for hardware and software upgrades/installations. • Make presentations and update regional and international stakeholders, as well as high-level of- �cials on CIB and its progress. Background and Academic Credentials • Software product design or product management experience. • Demonstrated experience in gathering and coalescing design requirements into a product vision. (Relevant experience includes performing competitive analysis, understanding and de�ning busi- ness strategy, and researching user needs.) • Demonstrated ability to work with a team to rapidly produce prototypes and successfully launch products using an iterative development methodology. • Experience with and interest in health commodity issues a plus. • Demonstrated diplomacy skills and ability to work effectively in the West Africa sub-region. • Demonstrated experience working with and coordinating multiple stakeholders. • Demonstrated success in promoting a strategy to advance a cause or issue. • Excellent written and oral communication skills applied in marketing, advocacy, and training settings. • Entrepreneurial experience. • Strong organizational skills. • Experience working with Internet products and technologies. • Degree in a technology-related or business-related �eld (MBA, MSCS, or PhD CS is a plus). • Fluency in French and English required; knowledge of Portuguese a plus. • Willingness and ability to travel (up to 50 percent). This is a full-time position, based in the WAHO of�ces in Bobo Dioulasso, Burkina Faso. 42 Appendix C Appendix C. Summary of System Development Approach Figure 6. System Development Life Cycle Requirements Analysis— Production system and data User acceptance test Design System test Build Unit test “De�nition: System Development Life Cycle (SDLC) is the overall process of developing information systems through a multistep process, from investigation of initial requirements through analysis, design, implementation, and maintenance. There are many different models and methodologies, but, generally, each consists of a series of de�ned steps or stages.�9 These steps are depicted in �gure 6, with this effort highlighted in bold italics. The requirements and analysis have begun, and the actual architectural design, building, and roll out are the next steps to undertake. As noted in �gure 6, this sequence of steps is an iterative one that responds to changing environmental needs and developments. 9. http://www.computerworld.com/developmenttopics/development/story/0,10801,71151,00.html 43 Appendix D Appendix D. Country Selection Criteria: West Africa RHCS Study 1. Representative sample. The study will try to have a representative sample of ECOWAS countries based on their demographic/economic pro�le. Countries would be clustered around socioeconomic characteristics—for example high, mid, or low maternal mortality ratio, and high, mid, or low CPR—and a country would be selected from each cluster. Then, some general characteristics, such as population size and language, would be used to select countries from within each cluster. Speci�c indicators that will be taken into consideration include— A. Social/economic indicators • Infant mortality rate (IMR) • Maternal mortality rate (MMR) • Contraceptive prevalence rate (CPR) • Disease burden (HALE) • Per capita income • Share of commodities provided by public/private sectors • Female literacy rate. B. General characteristics • Language • Population size • Urban/rural split • Current level of stability/unrest. In addition to seeking a representative sample, the following criteria will also be considered: 2. Country experience with regional procurement (e.g., Mali: Association of Central Medical Stores). 3. Country has institutions that may be involved in procurement or local production (e.g., Burkina Faso: WAHO, Ghana/Nigeria: local production). 4. Country has readily available data. 5. Country has substantial reproductive health program and/or has begun commodity security plans/ activities (e.g., Ghana, Mali, Niger, Nigeria). 6. DELIVER or other partner presence (e.g., UNFPA) in the country—facilitate data collection, keep cost lower. 45 References and Documents Consulted Abdallah, Hany, Dana Aronovich, Aoua Diarra, Paul Dowling, Lisa Hare, Meba Kagone, Ali Karim, Raja Rao, and David Sarley. 2004. The West Africa Reproductive Health Commodity Security Study: Summary of Findings from Phase One. Arlington, Va.: John Snow,Inc./DELIVER, for the U.S. Agency for International Development. Kagone, Meba, and Abdourahmane Diallo. 2005. West Africa Reproductive Health Commodity Security and Informed Buying Feasibility Assessment Country Report: Mali. Arlington, Va.: John Snow,Inc./DELIVER, for the U.S. Agency for International Development. Ouedraogo, Youssouf, and Gary Steele. 2005. Informed Buying and Coordinated Informed Buying for Reproductive Health Commodities in the Public Sector: An Assessment of Interest and Potential in Nigeria. Arlington, Va.: John Snow,Inc./DELIVER, for the U.S. Agency for International Development. Rao, Raja. 2005. West Africa Reproductive Health Commodity Security. RH Commodity Pricing: Potential Bene�ts of Pooled Procurement. Arlington, Va: John Snow, Inc./DELIVER, for the U.S. Agency for International Development. RH Interchange. April 2004. rhi.rhsupplies.org William J. Clinton Foundation. March 7, 2005. ARV Price List. New York: William J. Clinton Foundation. 47 THE WORLD BANK