Support for the ASRAMES purchasing centre in Goma (the Democratic Republic of the Congo) in the transfer of product supply responsibilities from the Global Fund to SNAME (National System for the Supply of Generic and Essential Medicines)

Project title: Support for the ASRAMES purchasing centre in Goma (the Democratic Republic of the Congo) in the transfer of product supply responsibilities from the Global Fund to SNAME (National System for the Supply of Generic and Essential Medicines) (EuropeAid Lot4 SIEA-2018-4078)

Contract number: 845600

Name of client: European Union Delegation to Congo (DRC)

Detailed description of project:

The constitution of the DRC dedicates health as a relevant matter of the exclusive competence managed at the provincial level. The provision of health services to the population remains a major challenge and coverage of health facilities remains insufficient. In 2014, 24% of health zones did not have a hospital and only 12 to 15% of health areas had a health centre built in sustainable materials. The average availability of standard precautionary items for infection prevention was 58% and that of essential drugs 20%. Medicines for communicable (chronic) diseases were only available in 20% of health facilities and mainly in hospitals.

Medicines are a key component of health care delivery. Due to the lack of regulation and control of the private pharmaceutical sector, the national public system for the supply of essential drugs (SNAME) remains the essential pillar for the supply and distribution of quality and financially accessible drugs in the DRC.

The national essential drugs supply system named SNAME was set up in 2002 by the Ministry of Public Health to ensure the regular and sustainable supply of quality essential drugs and health products, at an affordable price, to the entire population of the DRC. Its coordination is ensured by the national drug supply program (PNAM) which comes under the Directorate of Pharmacy and Medicines (DPM).

The operation of SNAME is based on 4 principles: (1) public-private partnership; (2) centralization of drug purchases; (3) decentralisation of drug distribution and (4) cost recovery for drugs consumed in order to maintain drug capital.

Purchasing is centralised through the Federation of Essential Medicines Supply Centres (FEDECAME), nonprofit organisation, which in 2021 includes two acquisition centres:

The Western FEDECAME Purchasing Coordination Office (BCAF-Ouest) is located at the level of the general secretariat of FEDECAME

The Purchasing Coordination Office of FEDECAME in the East (BCAF-Est) is located within the Regional Association for the Supply of Essential Medicines (ASRAMES) in the East.

The decentralisation of the distribution is done through the Regional Distribution Centres (CDR), playing the role of public interest services and managed within the framework of the public-private partnership by non-profit organisations. There are 18 CDRs, 16 of which are functional, distributing drugs to health facilities operating in the different health zones, most often through the depots of the central offices of the health zones or through NGOs which support certain health zones. CDRs are private non-profit entities enjoying management autonomy and are members of FEDECAME.

The technical assistance covered by this project provided support for the transfer of responsibilities from the Global Fund to ASRAMES level for its BCAF function more specifically.

The general objective of technical assistance (TA) through this service was to support and accompany ASRAMES in the process of transferring drug procurement and management activities from the Global Fund to ASRAMES and the implementation of activities planned within the framework of the roadmap and certain strategic axes of the ASRAMES strategic plan for the period 2020-2024.

The specific objectives were:

- Consolidation of the Purchasing Coordination Office (BCAF) function of ASRAMES

- Strengthening of the ASRAMES Quality Assurance system

- Strengthening of the order and distribution monitoring and evaluation systems

- Information on indicators, analysis and use of information to guide management decisions.

Type and scope of services provided:

Data analysis and management with the Provincial Health Division to ensure the continuous availability of products for the prevention, diagnosis and treatment of health problems including malaria in the province;

International supply management (e.g. anticipation and organisation of the customs clearance process; planning and organisation of the necessary storage space etc.)

Provincial supply management (e.g. planning of distributions to the Regional Distribution Centres taking into account the storage spaces available etc.)

Financial management (e.g. examine with ASRAMES necessity to establish an independent accounting system for BCAF)

Collection of samples in the provinces indicated in the roadmap

Management and analysis of the Wambo (software/platform) and BCAF supplier database

Monitoring and evaluation

Providing/develop indicators, analysing and using the information to guide the future management decisions

Support in the implementation of recommendations related to the gaps / shortcoming in ASRAMES in the implementation of the roadmap

Support of ASRAMES in: quantification of needs; development and / or monitoring of annual supply plans; periodic analysis of balances on customer orders, communication with customers on the details of the execution of their orders; follow-up of the supplier's orders/communication with customers etc.