Vertical Programs Total Session Time: 120 minutes
Session 15: Vertical Programs
Total Session Time: 120 minutes
Prerequisites
None
Learning Tasks
By the end of this session students are expected to be able to:
Explain Vertical Programs
List Tasks of vertical Programs
List of vertical Programs existing in Tanzania
Mention Procurement Procedures for Vertical Program Medicines
Resources Needed:
Flip charts, marker pens, and masking tape
Black/white board and chalk/whiteboard markers
SESSION OVERVIEW
Step
Time
Activity/
Method
Content
1
5 minutes
Presentation
Introduction, Learning Tasks
2
20 minutes
Presentation Buzzing
Introduction to Vertical Programs
3
15 minutes
Presentation
Tasks of vertical Programs
4
20 minutes
Presentation
Vertical Programs existing in Tanzania
5
50 minutes
Presentation
Procurement Procedures for Vertical Program Medicines
6
5 minutes
Presentation
Key Points
7
5 minutes
Presentation
Evaluation
SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning Tasks and clarify
ASK students if they have any questions before continuing.
STEP 2: Introduction to Vertical Programs (20 minutes)
Activity: Buzzing (10 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
What are the vertical programs?
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
Vertical programs (also known as stand-alone, categorical or free-standing programs or the vertical approach) refer to instances where “the solution of a given health problem [is addressed] through the application of specific measures through single-purpose machinery”
OR
Are “so called because they are directed, supervised, and executed, either wholly or to a great extent, by a specialized service using dedicated health workers”
In contrast, integrated programrs (also known as horizontal programs, integrated health services or horizontal approaches) seek to “tackle the overall health problems on a wide front and on a long-term basis through the creation of a system of permanent institutions commonly known as ‘general health services.
In many countries, a number of vertical programrs are bundled to address “a circumscribed number of diseases … selected for prevention in a clearly defined population” and delivered together as a cluster in primary care. Examples include service packages such as the WHO Integrated Management of Childhood Illness (IMCI) strategy or harm reduction programrs for HIV.
Vertical Programs [VP] are initiatives, which focus on a particular disease or group of diseases. In early 1980's to 1990's different programs such as Reproductive Health Program, National Aids Control Program, National Immunization Program, National TB / Leprosy Program were under the Ministry of Health but each was operating individually in term of logistics. The research findings in Health sector revealed that, running each programs individually in terms of its logistics functions was expensive and hence duplication of resources.
The integration strengthened Vertical Programs services likewise lowered the operations costs of programs. This resulted into increase the availability of Vertical Programs Medicines, Medical Supplies and Laboratory Reagents to the health facilities.
STEP 3: Tasks of Vertical Programs (25 minutes)
Greater service specialization and concentration
The most important rationale for vertical programrs is driven by the assumption that concentrating on a few well-focused interventions is an effective way of maximizing the impact and time response of the available resources. Waiting for changes in the health system to occur so as to deliver better services would simply be unacceptable for some.
Increased profile for a high-priority disease or service
The support galvanized by the United Nations Children’s Fund (UNICEF) and other partners around universal childhood immunization in the 1980s and 1990s has been replicated more recently for HIV, tuberculosis and malaria –leading to the establishment of the Global Fund as well as disease-specific initiatives such as Roll Back Malaria – and for neglected diseases such as schistosomiasis.
Better accountability
By making clear who is responsible for delivering what and what budget is avalable, vertical programs promote a more transparent environnent for accountability. More transparent governance arrangements and clearer lines of accountability suit bilateral and international agencies, which are publicly accountable
More rapid results in weak health systems
Vertical programs are likely to lead to more rapid results than strategies that attempt to strengthen broader systems as a platform for service delivery, especially in weak health systems.
Better chance of success in weak states
In weak states or states in conflict where health systems are already disintegrated, vertical programs might be the only means of ensuring the delivery of at least selected priority services.
Demand factors
For some programs, the target client group may not be readily accessible to the health system providers. This may be due to several reasons: they are not frequent users of general health services; they face access barriers due to sociocultural factors (such as stigma) that lead to avoidance behaviour or geographical barriers (in difficult-to-reach areas with limited transport); there is a fear of legal action (such as among injecting drug users or sex workers); or inability to pay for services (as is the case for many poor people in low- and middle-income countries).
Services for which health systems do not function
Vertical approaches are likely to be more appropriate if a service is urgently needed but systems are simply too weak and routinely used resources too limited to be able to provide it through the regular channels
STEP 4: Vertical Programs Existing in Tanzania (10 minutes)
There are 9 major vertical programs which operate in Tanzania. These programs are under MoHCDGEC and Health development partners who support health initiatives in this country. These programs are:-
Reproductive Health Program
National Aids Control Program
National immunization Program
National TB/Leprosy Program
Neglected Tropical Disease Program
National malaria Program
Tanzania Food and Nutrition Program
Dental Program and Others.
STEP 5: Procurement Procedure for Vertical Program Medicines (50 minutes)
On the other hand MSD receives Health commodities under the support from various development partners such as :-
Global Fund,
UNICEF,
WHO and
USAID.
All partners either bring in specific health commodities to supplement GOT commodities or direct support in terms of fund for procurement of goods to be delivered to facilities.
Procurement of ARVs- Sources of funding for the program.
Government budget
Global Fund
USG (PEPFAR).
Canadian government
SIDA Sweden
Norwegian government
Clinton Foundation (paediatric drugs) and Etc
Done in the principle of ensuring economy, efficiency and transparency.
Also consideration made on the standards of quality and reputability as well the consideration of the lowest prices being paid for drugs of good quality.
Done by the Medical Stores Department except for PEPFAR supported drugs.
MSD is an autonomous board of the Ministry of Health.
Tenders processes done by the Medical Tender Board of the Ministry of Health.
Procurement procedures follow the Public Procurement Act of 2001
Procurement Planning of ARVs
Done by the National AIDS Control Program with logistic advisers of JSI/Deliver with the MSD.
Involves determining the number of patients to be enrolled together with the funds and stocks available in country.
There is agreement between GOT and USG on support of the drugs from US as partners.
Procurement Methods for ARVs
Mainly International competitive bidding.
Invitation to pre-qualified suppliers.
Tenders advertised through MSD website and local magazines.
Tenders closed after 45 days.
Tender opening, evaluation and awards are done by Medical Tender Board.
Product selection and Quantification
Done by National AIDS Control Program.
Forecasting and ensuring the rational use
Also done by NACP.
The rational use is ensured by the development of the guidelines for the healthcare workers for management of patients with HIV/AIDS.
Quality Assurance
Drugs must be safe, effective and of consistent quality.
WHO prequalification system for ARVs.
Products must also be registered with Tanzania Food and Drug Authority.
MSD: Quality assurance section for quality checks of all ARVs
Important: drugs must adhere to GMP and quality specifications.
Storage and distribution
All ARVs irrespective of their sources (PEPFAR, GOT, CIDA etc) are stored and distributed by the MSD.
MSD has eight zones in the country for the purpose of distribution of supplies to the nearest customers.
Tasks of having The National AIDS Control Program (NACP)
To scale up the Health Sector response to HIV and AIDS and strengthen the health system capacity to support HIV/AIDS interventions.
To promote access and utilization of affordable and essential interventions and commodities for HIV and AIDS, and
To improve the quality of HIV and AIDS interventions to the general public, PLHIV, health care providers and other vulnerable populations
Support of Prevention & Care interventions (Sexually Transmitted Diseases (STD), HIV Testing and Counseling (HTC), Home based Care (HBC), Prevention of Mother to Child Transmission (PMTCT) Blood safety and Laboratory Services)
Procurement of ant TBs and Leprosy medicines (TBL)
Product Selection
A National Drug Policy (NDP) and Essential Drug List (EDL) are used.
The EDL includes WHO prequalified treatment regimens for TB and leprosy in Tanzania.
The NDP contains written guidelines for the donation of products, no duty taxes are imposed on imported
The Tanzania Food and Drug Administration (TFDA) must approve of and register any new TBL commodities before they are permitted to enter the country for use.
Product selection
All commodities are chosen based on quality assurance standards and cost effectiveness.
The essential drug list includes all drugs needed for effective treatment of TB and leprosy, and adheres to the standard treatment guidelines (STGs) for treatment protocols.
Obtaining Supplies and Procurement
It starts with procurement planning: The National TB and Leprosy Program works in coordination with the GDF and the MSD to draft a national procurement plan for the needs of the program.
Who orders in lower level?: The persons responsible for ordering commodities from each level of the supply chain are the RTLC for the regional level, the DTLC for the district level and a focal person or pharmacist at the facility level who coordinates with the DTLC to place orders for commodities based on patient data.
Procurement plans are developed by the program with MSD based on the following:
Current inventory levels,
Issues data which is used as a proxy for consumption data,
Lead times from the suppliers and donors, and established stock levels.
The nationally established inventory control levels should have two months of stock and one month buffer stock at the health facilities; the district and regional levels should have 3 months of stock on hand and 3 months of buffer, and the national
Warehouse should have 12 months of stock with 12 months of buffer.
As the primary donor, GDF is responsible for the issuance of tenders for all first-line treatments of TB; MSD issues tenders for second-line treatments, and each of these only go to pre-approved suppliers.
The WHO is responsible for all procurement of leprosy drugs.
The MSD is only responsible for receiving and distributing leprosy drugs but does not procure them.
Procurement challenges that NTLP faces include chronic global shortages of some commodities, for example streptomycin, making it difficult to obtain and maintain a consistent supply.
Additionally, fixed dose combinations (FDC) of TB medicines have a short shelf life of 24 months which does not always complement procurement plans and shipment schedules.
Tasks of having TB & Leprosy program
To increase case detection, cure rates of TB and leprosy patients and to reduce disability grade II of newly diagnosed Leprosy
To integrate NTLP activities at different levels to conform to the ongoing Health Sector Reform
To develop human resources and strengthen management of TB and leprosy service delivery at all levels
To establish management of multi-drug resistant tuberculosis (MDR-TB) in the country
To strengthen the quality of NTLP management information system with gender mainstreaming at all levels
To determine and monitor the magnitude of TB/HIV and leprosy burden in Tanzania
To involve communities in TB and leprosy care
To implement TB/HIV collaborative program activities in collaboration with NACP and other stakeholders
STEP 5: Key Points (5 minutes)
Vertical programs refer to instances where “the solution of a given health problem [is addressed] through the application of specific measures through single-purpose machinery”
Vertical programs were integrated to facilitate
Coordination of procurement, Storage and Distribution of program medicines, Medical Supplies and Laboratory Reagents.
Managing receipts of all Medicines, Medical Supplies and Laboratory Reagents supplied by different programs and development Partners (Global Fund, UNICEF, World Health Organization and USAID).
Give timely report to the programs on stock status to programs and development
STEP 6: Evaluation (5 minutes)
What does vertical program mean?
What are the Tasks of vertical programs?
Which vertical programs exist in Tanzania?
References
MSH and WHO (2012). Managing Access to Medicines and Health Technology, (3rd Edition). Kumarian Press
MoHSW (2003). Tanzania, Food, Drugs and Cosmetics Act, Government Printers Dar es Salaam
MoHSW (2011). Pharmacy Act, Government Printers Dar es Salaam
United Republic of Tanzania (1971), the drugs and prevention of illicit traffic in drugs act, Government Printers Dar es Salaam
United Republic of Tanzania (2011). Public Procurement Act, Dar es Salaam
MoHSW (2003). The National Health Policy, Government Printers Dar es Salaam
MoHSW (1991). The National Drug Policy, Government Printers Dar es Salaam
United Republic of Tanzania (1993).Medical Stores Department Act, Government Printers Dar-es-salaam
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