Members discussed the implications of treatment guideline changes on commodities within the supply chain. Economic losses commonly occur when new treatment guidelines state that certain commodities are no longer recommended for use. How do we know when changing guidelines will be “worth it”? This discussion was facilitated by Gilbert Rwangarinda from Rwanda.
Original message: “I would like to put in front of you this topic concerning the impact of treatment guideline change to global health supply chain: How the public health is matched with economic losses when shifting from one regimen to another or significantly changing the algorithm of disease diagnosis. Should health policy makers take into account the health commodities losses to be encountered before implementing the revision of treatment guidelines?”
“There is a need to seek a balance between increasing access to new life saving interventions (be they drugs, testing algorithms or technologies) and minimising waste from existing ones. In the end it’s about maintaining a delicate balance -we cannot deny the people we serve lifesaving interventions but we must minimise waste from existing products by proper planning.” (Abiola Ojumu, Nigeria)
“I think there is no need to reject the drugs that have been successfully used by the doctors for years, just because the new, more effective have been included into new treatment protocols, and soon after this arrived in the medical store. They should phase out in natural way, through consumption by the patients.” (Igor Novykov, Ukraine)
“Treatment Guideline or regimen change is inevitable as science and findings are ever changing. At the same time supply chain systems should be designed in such a way that they are responsive to policy changes.” (Gashaw Shiferaw, Ethiopia)
“The guideline change is not a sudden decision. It takes a lot of time including the survey/study and its adoption by decision makers. In case the study is adopted, the decision makers might take enough time to sensitize the end users and the stock managers and inform them accurately about the new guideline/policy to be implemented in given time in order to let them enough time to get prepared. This will allow them to distribute and consume their stock, and minimize the loss caused by the change of guideline.” (Ignace Ndekezi, Rwanda)
“Treatment guideline changes should also be considered when making assumptions during a forecasting exercise. A program can decide to undertake a gradual phase out of a product while introducing the new product over a pre-determined period. We should remember that pipeline for commodities to be phased out includes not only quantities within the country but orders already placed, shipments from manufactures etc. which cannot be cancelled overnight.” (Matthew Attah, Nigeria)
“For me, the one KEY thing that needs to be done in order to minimise wastage due to treatment guidelines changes is to make sure that the team that makes decisions regarding changes to treatment guidelines at National Level includes a person who has responsibility for supply chain issues. In this way, supply chain issues are taken into account as part of the decision making process, when treatment guideline changes are being considered, rather than after changes to guidelines have been decided.” (Jennie Lates, United Kingdom)