Improving Efficiency: A Rapid Evaluation Of ARV Procurement, Storage, Distribution, And Dispensing In Kazakhstan

The evaluation aimed to assess supply chain problems specific to oblast-level ARV procurement, distribution, and dispensing, including a policy review and possible policy recommendations. The evaluation identified several challenges in the current ARV procurement, storage, distribution, and dispensing system in Kazakhstan. Firstly, Oblast AIDS Centers are required to have stock and budget at zero at the end of each financial year, which directly impedes stock management and leads to cumbersome negotiations and artificial gimmicks. Revoking these rules and ensuring that written protocols are updated would be the first step to increased efficiency and effectiveness. A larger issue is that ARV procurement, storage, distribution, and dispensing is decentralized to Oblast AIDS Centers that directly negotiate and contract with the ARV distributor SK Pharmaceuticals. At this level, there is little PSM expertise, and Oblast AIDS Centers have literally no room for negotiation or improvement of prices or delivery. Contracting with SK Pharmaceuticals is particularly unfavorable to Oblast AIDS Centers that are in a weaker position, such as those with smaller numbers of people living with HIV (PLHIV) or with smaller health budgets. The evaluation also identified a convoluted and inefficient decentralized budget approval process with the Ministry of Health (MOH). The budget forecasting and approval chain is poorly equipped and does not currently have written guidance or description of Roles and Responsibilities. This artificially inflates work burden, decreases accuracy, quickly outdates data, and eventually disorganizes PSM. To address these challenges, the evaluation recommends that a well-staffed Republican AIDS Center (RAC) centralizes PSM and supply relationships, and contracts directly at a national level with SK Pharmaceuticals to increase the Centers' bargaining power. Additionally, the budget forecasting process should be reengineered, streamlined, and approved by the national MOH with written guidance and description of Roles and Responsibilities. The evaluation also highlights the importance of scaling up ARV Forecasting and Stock Management software across the country and providing adequate training to ensure that Kazakhstan's AIDS centers have a world-class ARV distribution system to respond to the HIV epidemic.