Many countries also struggle with the complicated Global Fund procedural and financial requirements, increasing lead times in procurement and causing drug stock-outs, which suggests that the processes need to be harmonized and simplified. On the manufacturing side, limited production of QA API and FPP SLDs is caused by a lack of incentives for suppliers and a lack of competitiveness in the SLD supplier market, which yields higher prices.

USAID’s Approach

Vincent described USAID’s three-pronged approach for making affordable, quality SLDs available around the world. The first approach is to improve and expand the global SLD supply chain, which mainly involves

•   coordinating with GDF4 and other partners on SLD SCM at the global level;

•   improving procurement procedures;

•   harmonizing treatment regimens; and

•   improving the data on SLD needs.

The second approach is to encourage the quality of QA SLDs by taking the following steps:

•   supporting GDF in the market development of quality SLDs;

•   providing technical assistance to FPP and API manufacturers to become PQ;

•   developing public pharmacopeia standards; and

•   improving diagnostic technology.

The third approach, technical assistance at the country level, involves

•   reducing bottlenecks through better quantification and stock-out early warning systems;

•   in-country and regional technical assistance in pharmaceutical management for MDR TB (SLDs and ancillary medicines);

•   development of new training platforms and information systems for SLD management; and

•   promoting active indicator-based surveillance of use of SLDs, the formularies, and co-medication safety.

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4 USAID is a major donor to GDF, providing 31 percent ($14.97 million) of GDF’s budget in 2011.



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