Today, an estimated thirty percent of the world's population lacks access to basic essential medicines. This figure climbs well above fifty percent in the poorest regions of Africa and Asia due to a combination of factors, including lack of basic health infrastructure, prohibitive costs, and patent barriers. For more than two decades, Partners In Health has worked to address this stark inequality, acting upon an ethical imperative to supply life-saving medicines and supplies to our patients living in rural Haiti, Peru, Mexico, Russia, Rwanda, Lesotho and Malawi. We have proven that it is not only technically feasible but cost-effective to deliver state-of-the-art treatment in poor countries, both for common diseases and conditions like pneumonia, malaria, diarrhea and obstructed labor that needlessly kill millions of people each year and for complex diseases like AIDS and multidrug-resistant tuberculosis (MDR-TB).
One of the keys to our ability to deliver quality health care and medications has been establishing an effective system for procuring, managing and distributing essential medicines and supplies. The nature and success of this system rest on a commitment to understanding the needs and building on the resources of the communities where we work, and on long-standing relationships with international suppliers and manufacturers that provide low-cost, high-quality generic products, most notably the International Dispensary Association (IDA) based in the Netherlands. In addition, we continue to collaborate with the World Health Organization's Green Light Committee and the Global Fund to Fight AIDS, TB and Malaria in their respective efforts to bring disease-specific drugs to the world's poor.
As with other sections of PIHMO, the information on procurement presented here reflects the particular experience of Partners In Health. When we speak of procurement, for example, we are referring specifically to procurement of medicines and medical supplies, which are the primary focus of the PIH Procurement Department. As a matter of principle and policy, PIH does not charge patients for medications. For that reason, issues like staffing cashiers, security, and financial tracking are not addressed in this section, although we recognize that in some cases organizations might choose to impose a fee or Ministries of Health might require it.
Reflecting the history of PIH and its Procurement Department, this section does not address procurement of other important equipment and supplies, such as computers, generators or cars. Similarly, the structure and procedures of the PIH Procurement Department have evolved within an organization that has a base in the United States supporting purchase and delivery to multiple sites in developing countries. That history undoubtedly influences much of the information and advice presented here. We welcome comments and examples that will enrich the model with lessons derived from experience in other organizations and countries.
Requirements and implications for acquiring, shipping, managing and delivering medicines and medical supplies need to be taken into consideration as part of a comprehensive assessment that covers everything from local health conditions to national regulations for registration and import of medicines. Areas of critical importance for procurement include:
Before you can start purchasing and shipping medicines and supplies, you first need to someplace to store and distribute them. At a minimum, you need a small warehouse and a pharmacy. Neither needs to be an elaborate facility. But they do need to meet some basic requirements for accessibility, security and climate control.
Warehouse
A warehouse must be readily accessible from a road negotiable by trucks delivering supplies. It must be solid enough to protect your stock against damage from weather, bugs and rodents, or unauthorized people. That means, at the minimum, a good roof, solid walls, a door with a lock, and a floor that stays dry during rainy seasons. The warehouse should be equipped with shelves to keep supplies off the floor and avoid damage in the case of a flood. Narcotics must be kept in a separate locked cabinet that is only accessible to managers.
The warehouse should also have reliable electricity for lighting, refrigeration (if you will be stocking vaccines and other supplies that require it), and computers (if you hope to use a computer-based system to manage inventory). Ideally, your pharmacy and warehouse should both be temperature controlled, or at least well ventilated and equipped with ventilation fans.
Dispensary or pharmacy
A pharmacy need be little more than a room with a door that locks, ample shelf space, and a window through which prescriptions can be received and filled. PIH has found it effective to equip both our warehouses and our pharmacies with plastic bins that can be clearly labeled and used to hold separate items, shelved in alphabetical order by drug type (oral, injectable, topical).
Procurement for community-based health projects requires a well-trained team to analyze procurement needs, solicit donations, purchase supplies from vendors, organize and track shipments, manage the arrival and storage of supplies, manage inventories, and oversee the distribution of medications and equipment to patients and clinics. In the case of an organization like Partners In Health that supports partner organizations based in several developing countries, this team includes people based both in the United States - who have easier access to manufacturers, suppliers, donors and shipping companies - and on-site staff who take the lead in receiving, managing and distributing stocks of medicines and supplies where they are needed and for monitoring when new supplies must be ordered.
Based on our experience, we have identified a set of job descriptions that encompass the necessary skills and tasks. Bear in mind that a small organization may rely on a single person to take responsibility for several of these jobs, while a large one may employ several people for one. What's essential is to be aware of the range of tasks and make sure that a capable person is responsible for each of them.
Procurement and operations manager
This position should be filled by someone with experience at preparing purchase orders, dealing with vendors, managing competitive bids, and managing actual and projected budgets and inventories. Depending on the size and location of your project(s), these responsibilities may be carried out on site or, as is the case with PIH, may be covered by a position based at a central location that coordinates procurement for several different projects.
Logistics supervisor
This position should be filled by someone who can split time between the project site(s) and the major port of entry into the country where your organization is working. Experience in customs or shipping is a plus. Ability to conduct business locally is a necessity. This person may initially be hired on a contractual basis and?then employed in a full-time role as the organization's needs expand.
Pharmacy supervisor
Ideally, this position should be filled by a trained pharmacist with managerial experience.
Pharmacy responsibilities:
Warehouse responsibilities:
Site pharmacist(s)
If a pharmacist is not available, this position can be filled by a nurse or other health care worker with pharmacy experience.
Dispensary clerk(s)
Data manager
This position applies in projects that use an Electronic Medical Record (EMR) or stock management system to manage inventories and prevent stockouts. A comparable set of tasks should be defined and assigned for projects that employ a paper-based system.
Drugs, medical equipment and supplies can be acquired through a variety of channels. Governments in some countries have established procurement agencies to acquire and import medicines and health-related commodities. Where this is the case, as with CAMERWA in Rwanda, it is important to work closely with the national procurement agency in order to obtain supplies through authorized channels, while retaining flexibility and approval to procure through other channels if it becomes necessary to avoid stockouts or delays.
Working with the government ensures that you conform with national regulations and are aware of the national procurement mechanisms that are already in place. The government may have resources available to augment your stock of needed supplies. For example, several African countries, including Rwanda, have AIDS initiatives that offer free ARV treatment to Ministry of Health facilities on a national scale. If the government is unable to meet your needs, your project should be prepared to purchase from other sources to augment your supply. It is also possible to help strengthen their systems by providing projections of patients' needs over a six to twelve month period, or beyond.
Additionally, many Ministries of Health have a required essential drug list and shelf life minimums. It is important to maintain relationships within the MOH to assist with negotiations to import short-dated or off-list products in special circumstances or emergencies.
Non-profit organizations working in developing countries are often able to obtain material donations of medicines and medical supplies, either through medical recycling organizations or directly from manufacturers. More information is available in the “Donation” section below.
Purchases can also be made either directly from manufacturers or through procurement agents that specialize in supplying high-quality, low-cost medicines and supplies for health systems and projects in developing countries. Some of these procurement agencies include the IDA Foundation, Médecins Sans Frontières, UNICEF, and the United Nations Development Program (UNDP).
Donations
Donations can come in the form of cash or as material donations of medical supplies. Material donations provide hospitals with essential medical supplies and allow financial resources to be directed toward other priorities: acquiring new laboratory equipment, restocking the pharmacy, or purchasing hospital beds. Financial donations can be used in a number of ways to support a project, but sometimes donors place restrictions on how they can be used.
PIH has established three basic guidelines for handling material donations:
1) Require that donations meet certain standards
2) Manage your donations appropriately
3) Work with medical supply recovery organizations both to procure medical supplies and to redistribute unwanted material donations
1. Donations should meet certain standards
It is imperative that donated medicines and supplies meet high and clearly defined standards for quality. The notion that beggars can’t be choosers, that people living in abject poverty can benefit from anything that is donated, simply does not hold, especially when dealing with medical supplies. We recommend establishing a clearly stated policy of high standards from the beginning to avoid unnecessary confusion with donors. PIH summarizes our donation policy on our website and in other publications to avoid receiving donations that do not conform to our needs and standards:
“Please note that Partners In Health is unable to accept expired or short-dated pharmaceuticals, hazardous materials or used prosthetics of any kind. All donated medical equipment must be in excellent condition, fully operational and electrically compatible.”
2. Manage donations appropriately
It is important for all organizations to manage their donations appropriately. Evidence of donations getting “dumped” can be very damaging to NGOs, corporate donors, and governments. If you are going to receive donations, make sure that the staff at the project site are equipped with detailed lists of expected and needed donations.
Resource-poor settings often do not have efficient modes of trash disposal. So beyond the financial waste of paying to ship unneeded goods, it is important to avoid having to dispose of unnecessary donations once they arrive in country. Good management of donations is important both in building fruitful partnerships with other organizations and in preventing the environmental degradation or harm to the patients that may result from poor practices.
3. Medical recycling organizations
A number of medical recycling organizations can be helpful both in procuring affordable medical consumables and equipment and in redirecting unwanted donations. These organizations specialize in redistributing the tons of excess medical supplies that become available in the United States everyday and redistributing them to organizations that can put them to use.
An important criterion in choosing which one of these organizations to work with is how detailed they are in categorizing their donations. To a clinician or a patient, for example, a Chromic Gut 4-0 suture and a Vicryl braided 1-0 suture are far from interchangeable. So taking donations from a medical recycling organization that chooses to lump them together under 'sutures' can mean a lot more work at your already busy sites.
Other considerations are the costs involved with each organization. Many organizations rely on services fees charged to recipients as a source of income. These fees are normally a percentage of the value of the goods being donated. Some organizations have a flat fee for the contents of a container and the shipping costs. In selecting a medical recycling organization, ask about fees and expected shipping rates to determine the actual cost of receiving donated goods.
Here are some examples of medical recycling organizations. You may find other organizations that are located closer to your project sites through online research or by asking at nearby hospitals.
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Direct Relief International |
Santa Barbara, CA |
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International Aid |
Spring Lake, MI |
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MAP International |
Brunswick, GA |
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Medshare International |
Decatur, GA and San Francisco, CA |
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Afya Foundation |
New York, NY |
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Doc to Dock |
Brooklyn, NY |
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Global Links |
Pittsburgh, PA |
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CURE |
Centennial, CO |
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Remedy |
New Haven, CT |
Purchasing
Partners In Health is fortunate to have unrestricted funding for the purchase of medicines and medical supplies. This gives us flexibility in selecting the sources for our drug purchases. We are able to buy high-quality generic drugs at low prices, and in some cases we work directly with manufacturers to ensure the best prices.
PIH understands that other projects may face restrictions from funders and therefore may be limited in their procurement choices. The information provided below is intended to give a broad range of sourcing options. PIH trusts that projects will use this information in accordance with the rules and guidelines imposed by their governments, funders or funding agencies.
The majority of our essential drugs are purchased from the International Dispensary Association (IDA) in the Netherlands. The IDA Foundation is the world's largest non-profit supplier of high-quality, low-cost generic drugs and medical supplies. They offer a wide range of products, specializing in the pharmaceuticals included in the World Health Organization's Essential Drug List (EDL).The IDA Foundation also provides HIV drugs and testing supplies, and first- and second-line tuberculosis drugs. More on those specific product lines can be found below.
A catalog and product information can be found at http://www.idafoundation.org and initial inquiries can also be directed to IDA through their website. Clients are assigned to a sales and service representative based on the geographic location of the client. Please note, however, that IDA is not able to ship medicines or medical supplies to United States addresses. US-based NGOs can purchase from them but will need to provide IDA with a foreign address for delivery.
Other suppliers provide similar services to IDA, either on a for-profit or not-for-profit basis. These include MissionPharma in Denmark, UNICEF, and MSF Supply (a branch of Médecins Sans Frontières).
If your country or project has unrestricted funds available, you can also purchase directly from the manufacturer. It is often easier, however, to use a procurement agent, like the IDA Foundation or UNICEF for your HIV purchasing. This is especially true if you are purchasing products from multiple manufacturers. Procurement agents can survey the manufacturers and secure the most competitive price. They can also assist in preparing customs documents for importation and making transport arrangements for delivery to international sites.
It is sometimes possible to negotiate reduced prices with vendors by educating them about the charitable aspects of your work, providing quantitative information about your expected spending, and soliciting multiple quotations to allow for competition between vendors. It is important to balance the urgency of your procurement efforts with the need not to be wasteful. Be sure to look into local options before purchasing medical supplies in the United States. When comparing prices from local suppliers it is important to consider the additional cost of shipping abroad and the long-term benefits of strengthening local capacity to meet local needs.
Over time, purchasing can be expected to grow exponentially, along with the number of patients in your catchment area, the range of services provided by your project and the level of available funding. Check with local suppliers, seek meaningful donations (see donation guidelines) and choose generic brands and buy in bulk to save money.
Procurement plans for funding organizations
Global Fund to Fight AIDS, TB and Malaria (GFATM)
Many developing countries have benefited from the HIV-related funding provided by the GFTM. Valuable information can be found on the GFATM website.
The GFATM maintains a policy that regulates how GFATM-funded projects may procure single- or limited-source products, such as some HIV and tuberculosis medications. If your country or project is GFATM-funded, you may already be aware of the procurement policy. This policy was amended in April 2005. Information specific to the procurement policy can be found on the Global Fund website.
Because of our longstanding relationship with the IDA Foundation, PIH has opted to use IDA as the procurement agent for our GFATM-funded work in Haiti and Peru. Another advantage to procuring medicines through IDA or another procurement agent is that such agents are aware of the GFATM rules and will provide quotations with detailed information about the supplier and how the supplier complies with the GFATM policy.
The President's Emergency Plan For AIDS Relief (PEPFAR)
The President's Emergency Plan for AIDS Relief, known as PEPFAR, was launched in 2003 as a five-year, $15 billion global initiative to combat the HIV/AIDS epidemic. Reauthorization of PEPFAR for another five years with an expanded budget of $50 billion appears likely in 2008. During the first five years of the program, funds were targeted to 15 of the most affected countries in the world: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, Zambia.
Funding from the U.S. government normally involves strict and specific guidelines for procurement of drugs, medical supplies and laboratory supplies. If your country or project has received PEPFAR funding, work with your in-country representatives (likely from USAID or the Centers for Disease Control) to learn about the purchasing policies and restrictions.
Projects or countries purchasing HIV drugs with PEPFAR monies or other funds from the United States will find they now have access to a broad range of approved products. The Food and Drug Administration created a “fast-track” application for manufacturers of generic HIV drugs, and as a result many low-cost Indian products are approved for purchase with U.S. grant funds.
Clinton Foundation
The work of the William J. Clinton Foundation has resulted in lower-cost ARV drugs and diagnostic tests for specific sub-Saharan and Caribbean countries. Over 40 countries have taken advantage of these prices, which the Foundation negotiated directly with Indian generic manufacturers.
If the country in which you work is covered by the Clinton HIV/AIDS Initiative, you can access these products through a procurement agent such as UNICEF, UNDP, or the IDA Foundation. A list of the current partner countries can be found here.
Tuberculosis drugs: First-line drugs
First-line tuberculosis drugs are available from a variety of sources, including the WHO Global Drug Facility. Founded in 2001 under the Stop TB Partnership and housed by the WHO, the Global Drug Facility (GDF) originally was mandated to oversee procurement of drug-susceptible TB medications. On May 29, 2007, GDF announced that it had provided "anti-TB drug treatments for 10 million people to 78 countries (over) the past six years”. Other suppliers of first-line medication include the IDA Foundation, and Médecins Sans Frontières. In addition, many national drug systems and Ministries of Health (MOH) supply first-line drugs to tuberculosis-treatment programs within the country. This is yet another reason why it is important to establish links and relationships with the MOH and national and local health providers.
Tuberculosis drugs: Second-line drugs
Although it is possible to purchase second-line TB drugs on the open market, the WHO's Green Light Committee, or GLC, makes reduced-price second-line drugs available to projects that demonstrate proven efficacy in the treatment of multi drug-resistant tuberculosis. Projects make application to the GLC and, once approved, have access to lower cost drugs. The IDA Foundation is currently the contracted procurement agent serving GLC-approved projects. The GLC application process is long; PIH suggests that interested projects contact the GLC Secretariat for information on application deadlines and additional information.
The Stop TB Partnership Coordinating Board, the Stop TB Department of WHO, and the Working Group on DOTS-Plus for MDR-TB agreed to bring together the duties of GDF and GLC in 2006, with full transference of procurement responsibilities to GDF for second-line drugs taking place throughout 2007. As such, the GDF currently negotiates contracts with the procurement agent and monitors its activities, and compiles second-line drug projections for GLC-approved projects. The terms of the new contract with the procurement agent, signed in 2007, allow closer monitoring by GDF of the procurement agent in terms of ordering and procedures.
As of November 2007, funding for a buffer stock of second-line drugs for 800 patients was provided. The drug stockpile is still being established in early 2008. Once created, it will ensure that a ready supply of MDR-TB drugs is always available. The drugs from this stockpile are to be used to avoid stock-outs with existing projects and expedite the launch of new sites.
Medical supplies
A large number of medical supply companies exist in the marketplace today. It is important to narrow this list down by soliciting multiple quotations and comparing pricing and delivery time. Partners In Health has used the following suppliers with varying frequency:
These companies provide us with the majority of medical and surgical consumables needed for our project in Haiti, which includes nine hospitals and four operating rooms. There is a large range of sizes, brands and styles for each product, so it is important to involve staff at the project site with purchasing to ensure that the correct products are selected. It is a misuse of both funds and staff time to purchase and ship supplies that go unused because there is no need for them or they don't work in the setting. When purchasing surgical and laboratory equipment, it is also important to budget and plan for training of on-site staff as an essential complement to the procurement process.
Surgical, laboratory and radiology supplies
The costs of constructing and outfitting surgical suites can be very high. Medical recycling and donor organizations, such as Remedy, International Aid and Direct Relief International can be of help in locating and securing operating equipment, as operating room furniture and supplies are often disposed of unused.
There has been an upsurge in the availability of donated dental and regular x-rays as hospitals and private clinics upgrade to the newly introduced digital x-ray machines. In addition to the x-ray machines themselves, it is also possible to secure donations of related equipment (cassettes, hangers, film, developers etc.) The transport of donated machines requires crating which can add around $2000 to any anticipated shipment costs. However, it has been our experience that even with the associated shipping costs money is still saved over purchasing a new x-ray machine.
The consumables needed for x-rays include film, developer and fixer for processing, and envelopes and tape for storage. Protective clothing for patients and x-ray technicians (gloves, aprons, shields) should also be factored into a radiology budget. Casettes, hangers for drying or a film dryer and a tank for developing are also needed. Paragon Medical and 3endt are two possible suppliers for most of these materials. Replacement parts are occasionally needed, so it is recommended that projects keep as much information as possible for each machine (make, model, serial number) so that parts can be ordered quickly.
The information offered on these topics is general by design. Registration requirements, importation laws and customs procedures vary from country to country and can be complex. Below we offer some general information that can apply to all locations, as well as experiences relevant to the specific countries in which we work: Haiti, Peru, Russia, Rwanda, Lesotho and Malawi.
Shipping and general logistics are a substantial cost of delivering care abroad. Before the decision is made to ship any item, no matter how big or small, it is important to truly exhaust all possible local suppliers. In cases where the item is not available locally, has been donated from abroad, or is only available locally at a substantially higher cost, then international shipping should be used.
There are several options for international shipping, with wide variations in the speed and cost of delivery. Especially for bulky supplies, shipping by sea is far and away the cheapest option, and also the slowest. Shipping by air costs considerably more and is much faster. Just to give a rough idea of the order of magnitude of costs and delivery times, sending a 20-foot container to Rwanda from the United States by ship in early 2008 cost about $7,000 and took 10 to 12 weeks. Sending the same amount by air cost around $20,000 but took only a few days. Similarly, sending the equivalent of a full 20-foot container to Haiti from Europe by air cost almost $25,000, roughly five times as much as shipping it by sea.
Many unpredictable factors can affect the shipping time of a container. Changes in port security procedures can cause delays, even if the container is passing through en route to another country. Customs clearance can be held up by new paperwork or inspection requirements. Local unrest in the destination country or neighboring countries can result in shipments being rerouted or delayed. For these reasons it is essential to have a knowledgeable and well-informed staff person to oversee logistics and customs procedures.
The easiest way to ship large items is to work with a freight forwarder. Forwarders assume all responsibility for the transportation of the shipment from point of receipt to point of destination, including preparing and executing the necessary documentation. Partners In Health has used a number of different freight forwarders including BAX Global, American River International and Pilot Air. However, none of these providers will necessarily always have the lowest price, so some market research is recommended in the form of receiving multiple quotes. Certain freight forwarders, including American River International, have divisions that specialize in international shipping for non-profits and charitable organizations. Although they can’t guarantee cheaper pricing they are more likely to work side-by-side with your organization.
If you are shipping an ocean container of either 20 or 40 feet from and/or to a location that is not near a port, a freight forwarder can cut down significantly on the amount of work this shipment will entail. Freight forwarders can arrange for drainage, which is shipment of a container to the nearest port, and can reserve you space on a specific vessel. If you live near a port and you can find a marine shipping corporation that is willing either to pick up your items and load them or to do a ‘drop and pick’ where they drop off a container at your site and pick it up after giving you time to load it over a span of hours or days, then this may be a cheaper option. PIH has generally used this option for shipments to Haiti from Miami, where groups like Antillean Marine Shipping Corp. and Caribbean American Shipping Corp. both frequently send ships to Port-au-Prince.
It is also possible to arrange your own air shipment on a cargo airline, such as American Airlines Cargo, Martin Air or Amerijet to name a few. This method will require more work by the non-profit but could save you money. Check through the recipient country’s major international airport to see which cargo lines operate frequently. When you arrange your own shipment, it becomes the responsibility of the non-profit, or a contracted local transport company, to get the items to and from the airport at both ends of the voyage. It should be noted that security concerns after September 11 have resulted in closer scrutiny of cargo shipments, especially from new and “unknown” shippers. Check with the freight company well in advance of your shipping date to determine what paperwork or application is required to become a “known” shipper.
If an item is small and needed urgently, DHL, FedEX, USPS or UPS should be used to deliver the item in a safe and secure manner. Request tracking service for your shipment and remember that the cheapest service varies from country to country.
Customs
Customs clearance requirements vary from country to country and can be the most challenging part of international shipping. It is imperative that a representative of the recipient be at the port of receipt. This can be an employee or a customs agent hired for the purpose of assisting with customs clearance. Documentation requirements vary but normally a Certificate of Donation and Packing List are required before the shipment leaves the port. The airway bill or bill of lading should also be provided. Certificates of Analysis for pharmaceutical products must also be provided. Problems at borders are difficult to avoid entirely, but a well-documented shipment, including a detailed list of boxes and their contents, will be well received by a Border Patrol/Customs Officer.
Registration
In general, the manufacturer of a pharmaceutical product is responsible for registering that product in a given country. Most countries have a national drug regulatory authority (NDRA) that oversees product registration. You should contact the Ministry of Health or NDRA in countries where you work to learn more about the need for product registration and the registration status of the drugs you want to import.
The registration process can be long and bureaucratic. A significant amount of data must be provided. A registration dossier includes information on the active ingredient and finished product, including indications, dosing, stability, and bio-equivalency results. The manufacturer must provide a Good Manufacturing Process (GMP) certificate and a Certificate of Pharmaceutical Product (CPP). The packaging, labeling and marketing of the product are also subject to review by the NDRA.
In the case of HIV drugs, some governments have declared health emergencies because of high rates of HIV infection. Where this has occurred, it may be possible to import unregistered drug. This option should be investigated in the countries in which you work.
Additional flexibility can be found in the provisions of the World Trade Organization's TRIPS (Trade Related aspects of Intellectual Property Rights) document, and the related Doha Declaration. Projects are encouraged to study these documents and determine if their country is able to take advantage of the provisions allowing for compulsory licensing and/or parallel importation.
The non-profit Consumer Project on Technology is a great resource for information about intellectual property, compulsory licensing and other trade-related matters.
Importation
Talk with the appropriate Ministry of the government in the countries where you work to determine what is necessary for importation, and what options your organization has. Non-governmental organizations are generally tax-exempt and can import medicines and medical supplies free of duties or taxes with appropriate documentation.
As detailed in the section on community health workers, forging a genuine partnership with poor communities is the key to bringing the benefits of modern medicine to those most in need. Among the most valuable resources that a non-governmental organization like Partners In Health can bring to such a partnership are the abilities to obtain state-of-the-art medicines, equipment and supplies and to manage and distribute them through a complex network of hospitals, clinics, and home visits by clinicians and accompagnateurs. Those abilities, in turn, require an effective procurement system that is well designed, professionally staffed and adequately funded.
This section has outlined some of what PIH has found to be essential characteristics of such a system. Those characteristics include: starting with a careful assessment of the local and national variables that will inform your purchasing decisions and priorities; investigating the existing health care infrastructure at both the local and national levels; implementing an effective system (such as the PIH Electronic Medical Records system) to monitor stocks, project requirements and avoid stock outs; developing relationships with international suppliers and manufacturers that provide low-cost, high quality generic products; and locating established donation programs for which your program may be eligible.
As mentioned at the outset, this section is both informed and limited by the particular experience of Partners In Health. We welcome feedback and lessons from other organizations that are engaged in similar efforts to make quality health care available as a right, not a privilege, in poor communities around the world.
Please find below all the downloadable forms and examples accompanying the PIH Model Procurement section
Establishing and Maintaining Stocks of Essential Medicines and Supplies