GDF-like structure is retained. The discussion was grounded in a general understanding among workshop participants that approximately 20 percent of SLDs procured worldwide are donor-funded and purchased through GDF, while the remaining 80 percent are procured independent of donor-funding mechanisms and GDF, typically by the governments of middle-income countries to serve their patients.

Some participants cited the importance of GDF or another centralized purchasing mechanism. For example, Andre Zagorski, Principal Technical Advisor for TB, Center for Pharmaceutical Management, MSH, suggested that the 20 percent of countries whose drug procurement is donor-funded and facilitated by GDF would not be able to acquire enough funding to develop sufficient procurement capacities to procure drugs autonomously (and not through a centralized purchasing mechanism) within the near term.

Several participants noted that the housing of GDF within the WHO structure—and bound by WHO procurement and hiring policies—has led to certain inefficiencies in procurement processes. On the other hand, some participants noted that the hosting of GDF within the WHO infrastructure might not be the principal impediment. Prashant Yadav, University of Michigan, commented, for example, that UNITAID is an example of a WHO-hosted partnership that has been successful at adopting innovative financing, procurement, and hiring practices. Robert Matiru, UNITAID, also noted that the GDF mechanism has seen success in the area of delivery of FLDs notwithstanding its being hosted by WHO, citing the benefits, networks, connections, and access to beneficiary governments that WHO provides GDF. Matiru further urged the participants not to focus solely on concerns about whether the hosting mechanism is optimal or not, because GDF’s functions are only one segment in the supply chain; both he and Zagorski suggested that pooled procurement and other innovative financing tactics could address the fundamental inefficiencies without requiring structural reform. Similarly, Myriam Henkens, MSF, commented that the question of whether a centralized procurement mechanism is used, whether it is housed within or outside WHO, is not alone sufficient to address the many needs in improving the supply chain, as there are multiple other activities and responsibilities that must be allocated to other entities (e.g., countries), including product registration and development of treatment protocols.

Participants also discussed considerations arising due to the fact that the market is segmented into the 20 percent that are donor-dependent and the 80 percent that are not. Tracy Sims, Vice President, Eli Lilly & Co. Foundation, suggested that perceptions of these different populations have implications for decisions about issues such as logistics and forecasting. He offered three options for moving forward:



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