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.