Presentation by Charles Allotey of Health Access Network, and CSO representative on 16th April 2009 during the MeTA Ghana CSO & Media Orientation workshop

1. Procurement Supply Chain in Ghana Charles Allotey Health Access Network 16 th April 2009 MeTA Ghana: CSO & Media Orientation

4. Source Of Funds Procurement Agent/Body Point of first warehousing Point of 2 nd warehousing Point of 3th warehousing GOVERNMENT WB GLOBAL FUND USAID CENTRAL MEDICAL STORE Medicines supply systems in GHANA 2007 GAVI ESSENTIAL MEDICINES ARVs MALARIA TB OI ARVs Ped REAGENT Blood safety (+ test HIV) VACCINES CONDOMS Contraceptives MEDICAL SUPPLIES Government Multilateral Donor Bilateral Donor Category of Products color code MOH UNICEF USAID GOVT Of JAPAN UNFPA REGIONAL MEDICAL STORE DISTRICT MEDICAL STORE UN AGENCY Republic of Ghana ITNs D F I D GOVT Of JAPAN FAITH- BASED ORGs POP/ RDF HEALTH FACILITY HEALTH FACILITY FAITH- BASED ORGs FAITH-BASED ORGs DESIGNATED TREATMENT CENTRE UNFPA WHO GDF

5. International manufacturers Local manufacturers Importers CMS Wholesalers Accra NGO distribution RMS Private hospitals and clinics Public hospitals and clinics Mission hospitals and clinics Wholesalers Regions Private pharmacies Licensed chemical shops

7. Factors affecting Medicine Prices along the supply chain R&D and clinical trials Patent Taxes and Tariffs Registration Pricing policy Drug supply Management Manufacturing Drug discovery costs

8. Supply Chain - Impact on Patient Price: Patient price increases by multiple of ex-factory price 17-24 Feb 2008 MeTA CSO Capacity Building Add-on Imported Locally produced Insurance and freight 10-17% NDA 2% Clearance & finance/banking charges 2% Importer (higher for single source products) 20-70% Wholesaler 2-30% 15% Retailer – typically Pharmacy 125% 105% Drug Shop 85% 115% Clinic 250% 145% TOTAL Pharmacy 150 - 250% 120% Drug Shop 120 - 200% 130% Clinic 280 - 375% 160%

10. Markup composition ciprofloxacin