Ecumenical Pharmaceutical Network (EPN)

Facilitating the development of compassionate just and sustainable quality pharmaceutical care in and through the church health care system

©EPN Publications 2007

3.3.2 ARV access and barriers studies by Albert Petersen, Difaem 28

3.3.3 Church perspectives by Bridget Ben-Naimah, EPC, Ghana 28

3.4 GROUP WORK 3.4.1 Future directions for each programme area and identifying the missing gap 30

3.5 EPN PAG 2004: Follow up – PEPFAR and Supply Chain Management System (SCMS) 31

DAY THREE – WEDNESDAY 10TH MAY 2006

4.0 EPN AGM/TWENTY-FIVE YEAR CELEBRATIONS 33 4.1 EPN ANNUAL GENERAL MEETING 33 4.2 TWENTY-FIVE YEARS EPN CELEBRATIONS 33 4.3 EPN FORUM 2006 PARTICIPANTS’ FEEDBACK 35

DAY FOUR – THURSDAY 11TH MAY 2006

5.0 TRAINING: 5.1 MONITORING AND EVALUATION 37 5.2 NETWORKING 38

DAY FIVE – FRIDAY 12TH MAY 2006

6.0 CONCLUSION 6.1 HEALTH AND HEALING by Beate Jakob 39 6.2 CONCLUSION ON TRAINING AND DEPARTURE 39

CONTENTS Page

ABBREVIATIONS

AIDS Acquired Immune de ciency syndrome

ANARELA+ African Network of Religious Leaders Infected or Affected by HIV/AIDS

APROMESTO Association Protestante des Œuvres Médico-sociales du Togo

ARV Antiretroviral

BftW Bread for the World

BNF British National Formulary

CDC Catholic Drug Centre

CEPCA Conseil de Eglises Protestantes du Cameroun

CHA Christian Health Association

CHAM Christian Health Association of Malawi

CHASL Christian Health Association of Sierra Leone

CHAZ Christian Health Association of Zambia

CISS Community Initiative Support Services

CMC Christian Medical Commission

CSO Civil Society Organization

DAC Development Assistance Criteria

Difaem Deutsches Institut für Ärztliche Mission

DSO Drug Supply Organization

EAA Ecumenical Advocacy Alliance

EDL Essential Drugs List

EHAIA Ecumenical HIV/AIDS Initiative in Africa

EPC Evangelical Presbyterian Church

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ABBREVIATIONS

EPN Ecumenical Pharmaceutical Network

HBC Home Based Care

HIV Human Immunode ciency virus

HRH Human Resources for Health

LWF Lutheran World Federation

M&E Monitoring and Evaluation

MoH Ministry of Health

MoU Memorandum of Understanding

NGO Nongovernmental organization

PAC Pharmaceutical Advisory Committee

PAG Pharmaceutical Advisory Group

PEPFAR President’s Emergency Plan for AIDS Relief

PLWH People living with HIV

PMTCT Prevention of mother-to-child transmission

PP Pharmaceutical Programme

PRUM Promotion of rational use of medicines

SCMS Supply Chain Management System

SOP Standard Operating Procedures

TL Treatment Literacy

TWG Technical Working Group

UNICEF United Nations Children’s Fund

VCT Voluntary Counselling and Testing

WCC World Council of Churches

WHO World Health Organization>> 7

EPN Forum 2006

1. INTRODUCTION

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In 2004 at the Pharmaceutical Advisory Group (PAG) meeting in Moshi, Tanzania, a decision was made to change the name of the meeting to the EPN Forum.

Though it had been scheduled for 2005, the first Forum was held in Tuebingen, Germany in 2006 to coincide with the twenty-five year celebrations of the formation of EPN [(formerly the Pharmaceutical Programme of the World Council of Churches (WCC)] and the 100 year celebrations of Difaem, a partner of EPN and CFPO for Germany.

A total of 83 participants from 29 countries attended the week-long forum held at Difaem.

The General Theme of the EPN Forum was “Ecumenical Health Services in Action”. When looking at all these services symbolized as a tree, Difaem, WCC and the Christian Medical Commission (CMC) were recognized as roots and the CHAs as branches of this tree.

Several presentations were made on the first day of the Forum on the development and the history of these three “root” organizations from their formative years to their present status. The role of the CHAs and their role in the health and healing ministry were highlighted and discussed.

On the second day, the spotlight was on EPN as one of the fruits of this “tree,” and the Network was presented in action and from various angles, according to the three programme areas.

The third day of the agenda focused on the members’ Annual General Meeting (AGM). During the meeting the members took time to discuss Network issues including the membership guidelines, the organizational strategy mid-term review, the move of the Francophone office to Nairobi and the plans for the coming year.

During the last two days of the Forum, the participants of the Forum were equipped with skills in either Monitoring and Evaluation (M&E) or in Networking.

The week-long agenda was fully packed with activities and presentations with the participants giving feedback during the evaluation of the meeting that the agenda was quite full and intense. The full results of the evaluation are included in this report.

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A special activity during the Forum was the official launch of the EPN website.

This report presents a summary of the themes discussed and the activities that took place during the forum. The minutes of the members’ AGM are presented separately.

All the presentations are available from the secretariat.

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Marion

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Godfrey

Samuel

Listening attentively to the proceedings

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Marion concluded by saying that the government has difficulties in dealing with different denominations and hence the existence of CHASL which made it is easier for the government to deal with one body. CHASL is a collaboration body which is important in various activities including the importation of medicines and medical supplies.

Beate then asked the panellists what the future tasks for each of the CHA’s were.

In her response Marion said that the poor cannot afford other health services other than what is offered by CHAs hence it is crucial to keep these services well maintained.

Godfrey replied by highlighting the largest challenge of CHAs as the lack of human resources which had resulted in the formation of a technical working group for human resources to address the problem.

Samuel told the participants that CHAK wants to strengthen the mandate of faith on the ground. It also wants to cut out an image as an FBO and not a CSO, which speaks out for the poor and stands in faith. It intends to have a legal framework to partner with the government. CHAK also wants to expand and sustain its mission through a strategic approach, conduct research and document lessons learnt.

John highlighted the main challenges for CEPCA. They included the lack of human resources for health and the challenge of setting up of the legal framework to incorporate the three main denominations (protestant, catholic, indigenous) in Cameroon to be one voice.

In her response Ruth gave the example of the government-run schools which had been run down before the government handed them back to the church to manage. She said that the government is yet to hand over the running of the health system to the church and added that there is a need for advocacy for equity in resource mobilization between rural and urban areas. She also emphasized the need for capacity building since CHAs train more than 70% of health personnel. She praised the church as a leader as it started home-based care training and Prevention of Mother-to-child transmission (PMTCT). She termed the CHA “a bridge between Church and government.” She concluded by saying that in communities within Malawi, the largest challenge in accessing quality health care is its high cost.

2.4 Strong partnerships: The example of World Health Organization

2.4.1 Collaborating in Access to medicines

2.4.2 Collaboration with Civil Society and Faith-based Organizations

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Hans Hogerzeil the Executive director of Medicines, Policies and Standards, WHOhighlighted the collaboration between the world body and the ecumenical bodies formed by WCC and CMC. He mentioned the first work done by his department was the development of the emergency health kit for use in refugee camps. The second was the development of the drug donations guidelines which was done in collaboration with the Pharmaceutical Programme (currently EPN). He reminded participants that PAG developed the first guidelines before WHO and that the PAG guidelines have been very useful for WHO in developing the interagency guidelines.He highlighted that WHO and EPN still continue to work together in different areas. An example is that the EPN coordinator is as a member of the WHO expert committee on essential medicines. He mentioned WHO’s future plans to continue its global work at grass-root level by working more with NGOs through information sharing and project implementation.

He also referred the participants of the Forum to the issue of human resources for health (HRH) which he described as a human rights and ethical issue. He drew the participants’ attention to the WHO monthly Bulletin (May 2006) in which he had written an article on HRH. He concluded by saying “the under privileged deserve quality health care as a human right and not out of compassion.”

Rev. Canon Ted Karpf highlighted the collaboration that exists in ensuring access to medicines between civil society organizations/CSOs and EPN. He thanked EPN for taking a lead in HIV/AIDS treatment literacy. He stressed the important role played by FBOs particularly in HIV/AIDS and said that 40 percent of HIV/AIDS work is done by FBOs.

He emphasized the work done in the 3 by 5 initiative whose aim was to have three million PLWH on ARV treatment by 2005. Though this target was not achieved, over one million people were on treatment by

the end of 2005 and the prices of ARVs had been lowered significantly. He attributed this to the work done largely by FBOs. He reported that from the 3 by 5 initiative, WHO had learnt that access to treatment and affordability of medicines were key issues that needed to be addressed to ensure that ARVs reached the under privileged in society. He highlighted WHO’s future in HIV/AIDS which includes the expansion of testing and counselling services to maxi-mize prevention, ensuring treatment scale up and strengthening of health systems.

The afternoon session of the first day was chaired by EPN board member Sara Bhattacharji, CMC, Vellore.

The aim of the interview session was to learn from founding members of the Pharmaceutical Advisory Group (PAG) on how this group had evolved over the years to become the EPN Forum. Jane Masiga from MEDS and Hans Peter Bollinger from EPN Ouagadougou interviewed the following persons: Nina Urwantzoff (Misereor), Helmut Hess (Bread for the World), Jaap Breetvelt (former advisor to donors and former chair of PAG), Rainward Bastian (Difaem), Christel Albert (former pharmaceutical advisor; now called coordinator), Dan Kaseje (former director of CMC), Henk den Besten (participant in first PAG), and Eva Ombaka (current coordinator of EPN).

Some of the panellists gave a brief idea of how things were at the beginning: Jaap said that in 1979/80 sufficient stocks of medicines were difficult to come by especially in disasters when prices of the commodities went up. ICCO therefore accepted the challenge to offer relief supplies during disasters and emergencies.

Henk said that in 1981 during the first PAG, CMC hired a consultant to conduct field work. The consultant was instrumental in visiting countries, gathering information and also took up the role of liaison officer. From May 1982, ICCO was responsible for this position before four other organizations joined them in 1984 as part of PAG.

2.5 “Impressions” of key actors in the 25 Years EPN work

2.5.1 In the beginning

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Manoj Kurian of WCC puts his journalism skills to good use

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Jaap continued by saying that as PAG members they were glad that participants from CHAs joined the group as there was a need to improve distribution of essential medicines particularly in these settings.

Rainward highlighted the main challenge at the time as the difficulty in supplying essentialmedicines hence the support of the formation of Drug Supply Organizations (DSOs).

Jaap further explained the situation by saying that the beginning of PAG was a meeting called by WCC. The participants at the PAG meetings were a group of friends who initially met annuallyand later twice a year. Later a steering committeeknown as the Pharmaceutical Advisory Committee(PAC), which met more regularly, was formed. Key people in the PAC included Sr. Joan Devine, Dr. Deborah Raditapole, Bishop Joop and Dr. Lugdz of CHANPHARM (an EPN member).

Christel said that she joined the PAG in 1987. Her previous experience in the essential drugs concept and use of essential drugs list in Tanzaniaand Somalia were useful for her work.

2.5.2 Donors speak out: what attracted them to EPN?

Past and present coordinators:Christel Albert (left) and Eva Ombaka (right)

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According to Christel, who was the coordinator of the then Pharmaceutical Programme of WCC, despite the achievements made to develop the PAG, there were many challenges. Key among them was travelling to many parts of the world and the lack of knowledge about the essential drugs list by those in practice. Christel highlighted the two major achievements of the Pharmaceutical Programme as the development of the drug donations guidelines in 1988, a four-paged document which later became a core part of the WHO interagency donations guidelines. She was also pleased with the continuous participation of Africa in PAG, with Latin America and Asia stimulating policy thinking and development.

Christel left her position as coordinator in 1992. Her position was taken up by EvaOmbaka. Christel asked Dan Kaseje why CMC choose an African and particularly Eva to take up the leadership of the programme, Dan’s response: “It was not a difficult decision. It was a PAG discussion and the mood shifted with the people wanting an African. She was an outstanding candidate without much comparison.”

When asked what attracted them to offer support to the goal of the PAG, the donors gave their reasons as:

Nina said that they felt that they shared common interests and values. These included faith and a need to make public health care available for the poor.

Jaap explained that the reason they were attracted to EPN was that there was a move by the mission sector to use local personnel and finances. This was good because this would empower communities in regards to pharmaceutical issues in poor countries particularly in Africa.

Henk said that there was interest in church (faith-based) supply organizations because churches were good at organizing activities and active in planning and budgeting.

When asked why the programme moved from Geneva to Nairobi, Eva responded that there were changes in WCC regarding health work and an evaluation of the PP showed that running an office from Geneva was expensive. Jaap explained the move further by noting that there was need to manage the resources in the best possible way.

The challenges encountered with the move included the fundraising for the move, identificationof which country to move to and the process of moving and settling. After deliberations WCC and CMC decided to move the programme to Nairobi. MEDS and Sr. Devine volunteered to offer local support in the relocation while Community Initiative Support Services (CISS) offered assistance during the move and hosted EPN for many years before the latter became an independent Network

There were positive outcomes as well as challenges experienced during the move. There was a Memorandum of Understanding (MoU) signed between CISS and WCC but it was difficult to understand who owned the programme and who gave the mandate for the activities done. There was also the concern that with the move to Nairobi the partners would feel that the PP was no longer addressing the needs for which it had initially been developed for. With these concerns, there was a need to develop a more clearly defined entity. In a meeting of CHAs held in Harare, Zimbabwe there was an agreement to form a Network. The CHAs present at the meeting and other stakeholders were expected to identify the issues and work together to provide a voice for what would become the Network.

When asked if their expectations as donors were met after the move, Jaap said that ICCO has been supporting EPN for 25 years which showed the level of loyalty and commitment they had and continue to have in EPN. Helmut Hess said that BftW “welcomed the move” while Rainward said that it was an important move. On his part Henk den Besten described the move as “an elephant bringing a baby” – it took long but it was good for the development of EPN.

2.5.3 Moving from Geneva: The challenges

2.5.4 The challenges and changes encountered in Nairobi

2.5.5 Donor expectations

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2.6 Introduction of EPN today

2.6.1 Evolution of the Network

2.6.2 EPN Website launch

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This session was led by Eva Ombaka, EPN Coordinator and Albert Petersen, EPN board chair. Both highlighted the Network’s evolution in three phases, namely: Phaseone which was a consultant-based programme which provided reports to PAG members and which met twice a year. Phase two which was as a consultancy in CMC, with the PAG meeting once a year, the formation of the Pharmaceutical Advisory Committee (PAC) and the move of the programme to Nairobi in 1997. Phase three which was developed from recommendations of evaluations that indicated a need for ownership and greater participation by all partners. The programme was then converted into a Network with member involvement in Network affairs. During this session the relationships amongst the secretariat, the Network members and the Country Focal Point (CFP) organizations and persons were also discussed.

In 2005 EPN began the re-designing and restructuring of its website to make it user-friendly. The official launch of the ‘new’ website had earlier been scheduled for 2005. However due to unforeseen circumstances the launch had to be postponed to 2006. Before the official launch, Heather Budge-Reid the consultant who developed the website took the participants of the Forum through the basics of web design. The site was officially launched over glasses of champagne. The participants were pleased with the outcome of the new product and described it as “it looks good,” “excellent” and “it looks beautiful.”

Participants celebrate the launch of the EPN website over a glass of champagne

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The proceedings of the second day were chaired by Samuel Mwenda of CHAK. The day began with devotion by Beate Jakob. She based the devotion on Luke 19: 1- 9, the story of Zacchaeus, the tax collector.

The day focused on the activities of the Network and the progress of the 2004 – 2007 organizational strategy. Various presentations were made on the three programme areas of the Network.

In the Networking programme, the three presentations made were: How we work byEva Ombaka, How we communicate by Hans Peter Bollinger and, How we advocate by Natalia Cebotarenco and Sara Bhattarchaji.

In her presentation Eva Ombaka highlighted the importance of participation in the Network activities by its members. She emphasized that while results are not instant, it was crucial that members actively participate in networking. She mentioned the importance of the participatory approaches that have been used in the Network i.e. the joint development of the strategy and design of projects, the active participation of members in project activities, regular feedback and management of the Network by Technical Working Groups and the board.

Hans Peter Bollinger, EPN programme officer in Ouagadougou, highlighted the place of communication within the Network. He outlined the channels of communication

DAY TWO: TUESDAY 9TH MAY 2006

3.1 Programme 1: Networking

3.1.1 How we work

3.1.2 How we communicate

3. THEME: EPN IN ACTION

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Hans Peter Bollingeraddresses the participants

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used within the Network and to whom the communication is channelled. He explained that communication occurs between Network members and from the EPN offices to the Network members mainly through the communications officer and the bilingual secretary. Network members either through CFPs or individually also communicate to the EPN offices. He gave the challenges of communication mainly as trying to make the Network model work and gave the example of developing the CFP booklet which required every CFP to respond to a questionnaire which would be used to develop the booklet.

Participants wait their turn at the microphone to ask questions and to make comments after a presentation

After the presentations, the participants were given an opportunity to ask questions and make comments on all the presentations. On communication Moses Manohar of ICSA suggested that a schedule be developed for the publications to be sent out. Nina from MISEREOR inquired on the coordination of DSOs, access studies, HIV/AIDS and the function of the board members. She also enquired on the outcome of networking and if there would be opportunities within the Network for partners to interact and exchange ideas.

Isaac Annan of CDC in Ghana inquired on the possibility of promoting rational use of medicines for children with the Ministry of education.

Raphael Edou from BETHESDA wanted to know if there are possibilities of linking advocacy at national and international level.

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Christina de Vries of I/C consult wanted to know how the Network plans advocacy with other WCC-based Networks e.g. EAA, EHAIA.

In response, the suggestions were accepted. It was pointed out that the role of the secretariat was to act as a coordinating body since activities happen mainly at country level. Thus the role of the CFPs was pivotal in the work of EPN. To the question regarding the function of the board, the coordinator reported that it sets policy, provides professional and financial oversight including approval of annual work plans and is also an immediate back-up support to the secretariat on matters needing immediate attention and action from the Network. The varied professional and regional makeup of the board helps to ensure balance.

On networking, it was agreed that there was a need for more networking involving both members and partners. Some of the positive outcomes so far included: speaking as one powerful voice on various issues e.g. the PEPFAR statement and learning from each other. The coordinator also mentioned the need for more advocacy work and improved networkingamongst members. It was hoped that the different in-country activities planned for the 25 year celebrations would increase Networking at country level.

Regarding the networking of networks (EAA, EHAIA), the coordinator said that the Network and these organizations worked closely in areas of HIV/AIDS e.g. in the Treatment Literacy workshops and in the baseline studies. It was agreed that more networking would need to be done.

Hans Peter Bollinger of EPN – Ouagadougou added that plans were underway to improve the members’ databases at the Nairobi and Ouagadougou offices. He emphasized the importance of having all members registered with forms duly filled, so as to make the distinction between the different types of members and partners.

Natalia Cebotarenco of DrugInfo – Moldova said that to improve RUM among children, the target should be the teachers who would be in a position to implement the RUM activities among the children.

Panelists of the access to essential medicines session (left to right) Ruth Hope Mwandira (CHAM), Samuel Mwenda (CHAK), Jane Masiga (MEDS), Kodjo Tsogbe (APROMESTO)

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Jane Masiga of MEDS challenged EPN to look into the issue of illegal drugs and acquire more feed-back from DSOs. She also inquired on the sustainability of the DSOs. These were noted as key areas for future attention

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Isaac Annan of CDC said that there was an ARV policy in Ghana, while Chipupu Kandeke of CHAZ requested for training in Zambia on TL. Donna Kusemererwa of JMS mentionedthat JMS was active in drug regulation and that drug donations, though minimal, needed to have set compliance standards. She said that it was important for the government to hold round table discussions with all parties concerned in drug donations to avoid duplications. Other issues raised were on laboratory tests, role of VCT and access to both ARV and nutritional needs.

In reaction to some of the issues, the coordinator said that training and capacity building could be organized for Network members. Possible support could be from, for example, the Clinton Foundation, PEPFAR and the Global Fund. On the issue concerning laboratory tests, she said that this was an advocacy issue which the Network members should take up. She challenged the present church leaders, as leaders of the community, to encourage members to go for Voluntary Counselling and Testing (VCT) to defeat stigma and discrimination brought about by HIV/AIDS. On his part Albert Petersen of Difaem said that it was crucial that the number of VCT centres should be increased in the rural areas. He also said that it was crucial that mission hospitals offer free ART services including offering food and nutrition where possible in resource-poor settings.

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They included: the setting up of a parallel system which could overshadow the activities of the local systems already in place, the lack of mention of an exit strategy, the lack of local partners in the SCMS and loss of jobs for local communities should the SCMS come in with their own expertise. The Network members therefore requested for transparency, dialogue and real partnerships, contracts with professional inputs, equal engagement of local partners, integration as far as possible, capacity building, strengthening systems and commitment to an exit strategy.

One result of the discussion was that the secretariat in consultation with members would develop a statement on SCMS clearly articulating the concerns and suggested recommendations to be sent to the SCMS leadership. (The final statement is included as annex 8.2)

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Participants take time to sing and dance during the celebration dinner

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Participants view the different foods at the celebration dinner

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6.1 Health and healing with Beate Jakob

Representatives from CHAs where invited to a half day discussion led by Beate Jakob of Difaem on studiesDifaem planned to undertake with WCC on the understanding of the healing ministry by church leaders,health workers and volunteers. The CHA representatives agreed that there was a need in their countriesand churches to re ect on and discuss the healing ministry. They said that the studies were timely and theywould be glad to give their support to the studies. They were informed that the results of the rst studywould be presented to the participants at the next CHA annual meeting in January 2007 in Tanzania.

6.2 Conclusion on training and departure

On the last day of the Forum, the training on M&E was concluded and the participants bade each otherfare-well after an intense week of learning and fun.

6. CONCLUSION

7. VOTE OFTHANKS:

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Thanks to Difaem and its staff for organizing and hosting the EPN Forum 2006. Thanks also to the EPN donors for their generous contributions in making the Forum a special one. Only due to their support was EPN able to: • invite a broader number of participants, especially CHAs • have simultaneous French translations which made it possible for the French-speaking participants to follow the proceedings and make valuable contributions

The contributions of the following partners are appreciated:MISEREOR, Catholic diocese Rottenburg/Stuttgart, Paul Lechler Foundation, WCC, Evangelical Lutheran Mission Hermannsburg, Mission One World Bavaria, EED, Action Medeor and Difaem. We also appreciate the active involvement of all the participants at the Forum and the organizations for agreeing to release the participants.

EPN Forum 2006

DAY FIVE – FRIDAY 12TH MAY 2006

8.1 GROUP WORK

8.1.1 Networking Programme

a) The key critical issues that need to be addressed in Networking are: Communication

8. ANNEXES

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• Electronic communication is highly efficient. However this is plaguedby computer viruses which may cause computers to crash resulting in loss of work. • Most Network member organizations use old computers which have less storage space hence slow speeds which can be frustrating to work with particularly when receiving large attachments via email. These sometimes hinder communication as they take too long to download. It is therefore important that attachments are sent only when necessary and if the recipient can download them. • Members site insufficient time to read and respond to the numerous numbers of emails that they receive in a day. Therefore messages sent should be as short and as clear as possible. • Insufficient frequent face to face contact is also a hindrance to communication within the Network. Members would prefer to meet more frequently to enhance communication. • CFPs need to dedicate more time for EPN activities.

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b) Missing aspects in the access to essential medicines programme

Key issues missing in the access to essential medicines programme are strategies for:

sustainability of DSO supply systems and programmesadvocacy in access to essential medicines.

c) What EPN can do

EPN should develop tools for information sharing amongst its members as well as develop governance guidelines for DSOs.

Network members should be encouraged to be IT compliant to necessitate easier communication and information sharing.

EPN can develop management software for use in DSOs warehouses e.g. for inventory purposes which can be used in member DSOs.

d) What EPN members can do

EPN member DSOs should collaborate amongst themselves to share best practices as well as for advocacy, research and capacity building.

They should also develop quality assurance methods and strategies as a team and not as individual DSOs. These strategies and methods can then be adapted to suit every DSO.

Members should conduct horizontal knowledge transfer amongst themselves and inform the secretariat of these communications.

Advocate for regulations to be implemented to avoid donations of expired or irrelevant drugs.

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a) The key critical issues that need to be addressed in HIV/AIDS treatment are: The cost of laboratory tests which are often a barrier to HIV/AIDS

treatment. This is because though the HIV test is free in most VCT centres; other tests can only be conducted at a fee which in most cases the patient has to pay for. This cost is prohibitive to most people in resource poor settings making access to treatment difficult.

Most treatment centres are only available in urban areas. This leaves those in rural areas with little or no access to treatment. Those in a position to do so (often very few, if any) have to travel long distances to access treatment. This makes adherence to medication a problem.

The lack of infrastructure needed to access treatment is missing in rural areas. Bad roads, insufficient means of communication etc. hinder communication and/or travel to health centres or health workers.

The issue of stigma is still a problem. In some communities patients on ARVs are discriminated against by members of the communities. This hinders some people from accessing available treatment.

Another critical issues is the lack of micro finance schemes to cater for people living with the HIV (PLWH). Most of finance schemes are not willing to partner with PLWH hence a need to develop micro financing schemes for people living with the virus to start up income generating activities.

8.1.3 HIV/AIDS programme

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b) Missing aspects in the HIV/AIDS programme

Most EPN member organizations do not have work place policies on HIV/AIDS. This makes the implementation of some recommendations developed during workshops and meetings difficult.

There is also a lack of cohesiveness within the different church denominations (especially Francophone) as they do not work in partner ship in areas of advocacy, research, training etc.

A strong advocacy voice on behalf of members in trying to work with big organizations is needed. The members’ voice is often not heard over that of the ‘big’ organizations in areas of advocacy and yet members may have key points to add as they deal with the population at the grassroots level.

Another important missing issue in HIV/AIDS is the lack of current documented data on various issues concerning HIV/AIDS treatment in most member organizations/countries

Ways of addressing the fears/challenges in HIV/AIDS treatment e.g. lost grants which result in lack of continuity of treatment programmes need to be addressed.

HIV/AIDS treatment literacy workshops organized by EPN need to address other issues e.g. PMTCT and the role of the church.

The presence of EPN is not felt in Francophone organizations as it is felt in Anglophone ones. Network members need more technical support to carry out research and conduct other activities in regards to HIV/AIDS treatment.

Strategies on capacity building of Network members in advocacy and lobbying in HIV/AIDS issues need to be developed e.g. EPN’s voice in the issue of paediatric treatment is not heard.

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c) What EPN should/could do

EPN should commission a study to collect information on HIV/AIDS treatment from the Network members for advocacy as well as other purposes e.g. baseline, starting points etc.

EPN also needs to appoint a resource person to facilitate advocacy, research as well as train in advocacy and lobbying within the Network.

CHAs in Anglophone countries need to be challenged to support their Francophone counterparts in areas of advocacy and research.

EPN should also strengthen the Francophone areas to associate more with the church by giving more technical support within Francophone member organizations.

d) What can/should EPN members do

CFPs with assistance from the national members in each country should organize a national event for EPN members where members in a particular country work together as a team on a particular issue, then present their action plans to the larger EPN. This will not only motivate other Network members to do the same but to also have work plans with objectives and goals for particular projects in the various programme areas.

Members’ should be challenged to make their competencies available to other members. This can be done by setting up a system where members have an exchange programme of resource persons.

Members should also engage in resource mobilization to support the ecretariat when the need arises. E.g. offering to cater for the cost of extra staff/interns.

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8.1.4 The missing programme

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a) Critical issues which need to be addressed in the missing programme

Advocacy is one of the issues that need to be addressed in the “missing programme.”

There is a need to document and share best practices as well as to identify key challenge areas e.g. counterfeit drugs, inappropriate drug donations etc and then develop strategies to alleviate them.

The sharing of materials in different languages to cater for both Anglophone and Francophone members is crucial.

a) How EPN should/could address the gaps

To address the issues of the missing aspect of the Network, the secretariat is encouraged to sensitize its members to use the EPN website to get information on the general developments of the Network.

The secretariat should clarify the Network’s communication structure (done through the organogramme).

The secretariat should encourage or facilitate exchange visits amongst member organizations to share and learn from each others experiences.

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b) What members should do

Network members should use the EPN website as much as possible to receive and share information.

Members should organize face to face meetings (apart from the EPN Forum) on a regular basis to share information on best practices, lessons learnt etc. regarding EPN issues.

CFPs should inform their superiors/board members of the roles they play in EPN activities and the importance of working with EPN. The CFPs could also request that their job descriptions allocate time to duties related to the Network’s activities.

Network members are encouraged to include EPN activities in their activity proposals to partners/donors. This will highlight the Network’s activities as well as those of the member organization.

The members should ensure allocation of time to present Network reports and acknowledge Network activities during country events.

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8.2 PEPFAR SCMS STATEMENT A Statement of the Ecumenical Pharmaceutical Network (EPN) on theUS President’s Emergency Plan for AIDS Relief (PEPFAR) Supply Chain Management Sys-temTuebingen, Germany, May 2006

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The Ecumenical Pharmaceutical Network (EPN), comprising Christian Health Associations and hospitals, non-profit drug supply organizations and ecumenical agencies from 29 countries who attended EPN’s Annual Forum and General Meeting from 8th – 13th May 2006 in Tuebingen, Germany, issues this statement on the Supply Chain Management System (SCMS).

We recognize and acknowledge that scaling up medical assistance and care of the men; women and children in our communities who are infected and affected by HIV/AIDS require uninterrupted supply of high quality, low cost products that flow through an accountable system. Therefore, we welcome the intention of SCMS to strengthen existing or establish (where none exist) secure, reliable, cost-effective and sustainable supply chains that meet the care and treatment needs of the people living with and affected by HIV/AIDS.

However, as a network of health care service providers and Drug Supply Organizations, we have discussed the SCMS strategy from the information availed to us at our meeting and do wish to express the following issues of concern:

1. We note that the SCMS was established 3 years after the launch of President Emergency program on AIDS Relief (PEPFAR). However, the number of patients on ARVs through PEPFAR had increased even before the launch of SCMS. This indicates that some well-functioning supply systems already exist. These should not be destabilized. 2. In the design of the SCMS, there has been little or no involvement of stakeholders from the countries targeted. There was therefore no opportunity to bring in country-specific issues.

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3. The creation of such a large multi-country supply system will have a negative impact on the existing supply systems because of imbalance in the trading volumes. It is more than likely that manufacturers and suppliers shall give priority attention to this major client at the expense of the smaller existing clients. The plan of supplying more than 120 commodities will take up a large proportion of the Essential Drugs supply needs, rendering the existing supply organizations irrelevant. 4. There is no adequate assurance that in-country manufacturers and suppliers will be supported to ensure growth in capacity and sustainability. 5. Whereas the SCMS project proposes to supplement and strengthen the existin supply chain capacity and to collaborate closely with governments, non-governmental organizations and faith-based organizations to strengthen the public health systems, we see a danger of brain drain of human resources from the existing systems to the SCMS. 6. The SCMS project presents an alternative procurement system, which negates the principles of Sector Wide Approach Strategy (SWAps) of common management arrangements which include working through existing public procurement system. 7. While the objectives of SCMS may be beneficial to the needs of the people in short-term, there is a real danger in the long-term sustainability beyond the period of PEPFAR funding. There is no clear exit strategy to ensure that the capacity established will be sustained. 8. The suggestion of voluntary choice in the use of SCMS services for the PEPFAR recipients seems rather theoretical, since decisions will be made at US country missions and not by the recipients of the funds. We find it highly unlikely that a local PEPFAR funds sub-recipient would have the mandate to choose to procure products outside SCMS which is funded by US government.

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RECOMMENDATIONSIn order for the SCMS project to succeed in delivering its objectives and to ensure that useful and sustainable capacity is established within the existing public health procurement systems, EPN makes the following recommendations for SCMS action:

1. An in-country mechanism and forum for continuous dialogue and communication should be established for key stakeholders to review country issues on the system design, identify collaborating stakeholders and provide monitoring feed back. This should include MOH, National AIDS Control Program, public and FBO/NGO Drug Supply Organizations, Pharmaceutical Societies, representatives of Pharmaceutical Manufacturers and PEPFAR awardees, and other donors such as Global Fund, World Bank –MAP programme etc.

2. There should be clarity in the strategies for addressing the two different situations: countries with in-country supply structures and those without such structures. In the countries with already existing systems, needs/gaps analyses should be the first step in strengthening the existing systems.

3. Capacity building should target strengthening of the existing Public and FBO/NGO Supply organizations and should be started before the supply activities are started. The capacity building should include recruitment of qualified staff, skills development in logistics (e.g. transport) and other supply chain management issues, contract negotiation, quality assurance and M&E. Capacity building should be a continuous exercise that focuses on use and strengthening of existing local experts.

4. The SCMS should ensure good knowledge and understanding of the country specific laws, policies and regulations to ensure integration or harmonization since this has a bearing on systems strengthening and sustainability.

5. Transparency and accountability should be enhanced through participatory M&E. The M&E plan should be clear to all stakeholders from the onset. There should be a strategy for in-country capacity building for M&E of the performance of the country SCMS activities and its impact on the other existing systems.

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We, the members of EPN, in the spirit of goodwill and solidarity, further af rm that the ght against HIV/AIDS deserves concerted efforts. Efforts that bring out the best from all stakeholders to ensure sustain

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ability, effective use of resources, expanded local capacity and the empowerment of people. In view ofthe above, we urge you to respect the reality on the ground, to give attention to the concerns expressedand to consider the recommendations as the SCMS prepares to implement its plan.

Thank you.

This statement has been signed on behalf of Ecumenical Pharmaceutical Network.

Mr. Albert Petersen Dr. Eva M A OmbakaChair, EPN Board Coordinator EPN

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6. A clear exit strategy should be designed for each targeted country before the start of the project. This should clearly define the targets to be achieved during the project to ensure that after the end of the project the achievements will be sustained and no crisis situation will occur. This should also include management succession planning by including and developing capacities of local human resources.

7. The SCMS project must incorporate a comprehensive risk management strategy since the lives of many people will be dependent on its efficient and uninterrupted performance irrespective of environmental and political changes.

8.3 BENEFITS OF MEMBERSHIP/PARTNERSHIP

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1 OCASC – Stella Feka – there have been enormous benefits including book donations, information exchange and the provision of working tools such as the pharmaceutical guidelines. The inclusion of OCASC in seminars and workshops has helped to build our capacity. 2 ICSA (Moses Manohar) – ICSA has benefited from being a member of EPN through receiving periodic information from EPN through the newsletters, through EPN’s assistance in setting up the ARV microbiological lab in 2005 and through the presence of an EPN board member at the ARV drug release function in 2005. 3 CHASL (Marion Morgan) – CHASL has benefited from EPN membership through the sponsorship of a consultant pharmacist from Ghana to conduct training for CHASL dispensers on essential drug use, sponsorship of CHASL staff to participate in a RUM course in Kenya and by receiving important information through the newsletters (e-Pharmalink and Netlink). 4 IMA (Don Padget) – EPN has provided networking opportunities through the annual meetings which has provided IMA with links to other organizations and information sharing possibilities. IMA appreciates being kept up to date on EPN members’ activities. 5 CBC (Nathan Wanyu) – CBC has used the EPN 25 pharmaceutical guidelines to develop a five-year strategic plan and a Standard Operating Procedure for pro curement and production services. CBC has also benefited from participating in the Access to medicines study. 6 MEDS (Jane Masiga) – Since the early stages MEDS has been working with EPN through PAT hosting which meant learning, growth, improved image, increasing support of access to drugs and strengthening of quality assurance. MEDS has also benefited from Difaem’s assistance in various ways, including capacity building. 7 CHAZ (Chipupu Kandeke) – EPN is a capacity builder and with them you go places!

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8 CHANPHARM (Matthew Azoji) – CHANPHARM has benefited through information exchange and reception through Netlink and e-Pharmalink newsletters.9 ECWA (Grace Ebuga-Miner) – EPN has contributed immensely to the growth and development of ECWA through networking. EPN has made eye drop bottles accessible for ECWA and is also in the process of linking ECWA with an eye drop manufacturing factory in India.10 MEMS (Peace Nyankojo) and CSSC (Marsha Macatta-Yambi) – MEMS and CSSC (both in Tanzania) are grateful for the partnership they have with EPN particularly in the Access to essential medicines programme. Through the studies in the . programme, collaboration and team building between the two organizations has improved and there has been sustainability and ownership of the access study. 11 ECCMY (Habtamu Woldeyes) – Difaem sent a consultant for a monitoring and evaluation exercise to ECCMY12 CHAK (Samuel Mwenda) – CHAK through its partnership with MEDS benefited through the P.A.T. programme. Difaem has offered technical support for spare parts and supported 50 patients on ARV treatment.13 WHO (Hans Hogerzeil) – EPN reminds WHO why WHO exists. WHO receives information from EPN (secretariat) and feedback from members, makes the work better and joyful.14 PROVIDA (Josefa Castro) – Belonging to EPN has given us the opportunity to meet other organizations with similar aims and whose experiences can be an example to PROVIDA. EPN has shown us that organizing a Network and keeping it working is not impossible. Many thanks to EPN and God’s blessings to all members as we celebrate the 25th anniversary.

8.4 FEEDBACK OF EPN FORUM

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General information: 83 participants, 34 questionnaires returned (41%) Are you: a member( 25) associate member( 2) funder of EPN( 1) Other( 6) 1. When did you last attend an EPN Forum/PAG meeting? First time (12) Moshi 2004 (13) Geneva (7) Other, please specify (2)

2. How would you rate the overall organization of the EPN Forum 2006? Very poor (0) Poor (0) Fine (2) Good (19) Very good (13)

3. How would you rate the usefulness of the themes of the discussions: a) Day I: 10 years of Difaem and 25 years of EPN Not useful (1) Useful (11) Very useful (19)

b) Day II: EPN in action Not useful (0) Useful (13) Very useful (22)

4. What topics can you suggest for the future EPN Forum? Training in advocacy / Training of pharmacy assistants / How to the strengthen the francophone CHAs / Good distribution practice (GDP)/Financing of DSOs/HIV/AIDS and gender mainstreaming/Anti malarials (new treatment protocol) in the context of availability and affordability / DSOs (follow up) / ARV state of the ART / HSRs and consequences for churches the present and future role of CHAs / drug donations / advocacy strategies / challenges with paediatric drug supplies / Capacity building / Pricing manipulation of drugs by manufacturers and suppliers / Subjects from evaluation of EPN activities and EPN network problems / The gaps identified in group work / How to make visible the effort of EPN in the world / Training in advocacy / Advocacy on access to drugs by rural communities /Sustainability of CHS, DSOs / advocacy strategies / presentations by some representatives supplies/ manufacturers of drugs / PMTCT – role of the church outside the medical model / Rational drug access and use / HIV/AIDS paediatric treatment / Case studies of best practices / Drug registration / Update on SCMS / Self medication / Use of ARVs / Production of drugs in Africa / Relationships with public health services (church-state)

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5. What would you like to be done differently next EPN Forum?Emphasize on small group discussions / Avoid late evening discussions (not beyond 7p.m.) / Lighter agenda / Allocate more time to rest, spread the discussions over more days / Initial preparation so that the participants can get access to the bureau for obtaining currency/local cur rency / Facilitate the possibility of having starter packs/SIM cards for communication / Involvement of the CFPs present to also share or make presentations since most of the presentations were done by the EPNsecretariat or EPN board members / More opportunity for information exchange between members, less presentations, more interactive group work, more energizers, less packed programme / Exchange of actual experiences related to SCM issues / Case studies of member organizations / Program is useful but too packed / Evaluation of EPN activities / More refreshing and better accommodation / More interactive and come up with new members and best practices from countries / More small groups/group work / The sitting plan – a more round or \ square arrangement where we face each other / More group work to allow for more participation / Work hour should be 8.30 – 19.00hrs / Updates on new global health policy issues / Include some entertainment and social events for team building thus strengthening Network / Tuebingen and Difaem were exceptional hosts. It will be hard to match / Reduce time of meeting – its too long / To get accommodation in the place of conference

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8.5 LIST OF PARTICIPANTS: EPN FORUM 2006/GERMANY

First Name Last Name Organization Country EMAIL1 Aagje Papineau Salm The Netherlands2 Albert Petersen Difaem Germany petersen.amh@difaem.de3 Andreas Mueller MMI Germany andreas.mueller@missolinik.de4 Anna Eisenhoffer WCC Switzerland aes@wcc-coe.org5 Astrid Berner-Rodoreda BfdW Germany a.berner-rodoreda@brot-fuer-die-

welt.org6 Barthélémy Dossou Bodjrenou BETHESDA Bénin bethesda@intnet.bj7 Beate Jakob Difaem Germany jakob@difaem.de8 Beatrice Kintaudi ECC DR Congo leonkintaudi@sanru.org9 Bernd Ludermann Journalist Germany bernd.ludermann@t-online.de10 Bridget Ben-Naimah EPC Ghana stevelibadzo@yahoo.com11 Chipupu Kandeke CHAZ Zambia kandeke@zamnet.zm12 Christel Albert Germany c.albert@netcologne.de13 Christina de Vries I/C Consult The Netherlands christina.de.vries@icco.nl14 Christine Haefele Action Medeor Germany Christine.Haefele@medeor.org15 Clarisse Rasoarimalala SAF/FJKM Madagascar safdir@wanadoo.mg16 Dan Kaseje TICH Kenya adminkisumu@tichafrica.org17 David Jamieson SCMS USA scmsinfo@pfscm.org18 Donald M. Padgett IMA USA donpadgett@interchurch.org19 Donna Kusemererwa JMS Uganda donnak@jms.co.ug20 Dorothea Hege-Voelksen PCC Cameroon dorothea.hege@freesurf.ch21 Dorothy Hanson EECMY Ethiopia hagodcares@ethionet.et22 Meelom Kaboré EPN Burkina Faso epn.burkina@fasonet.bf

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23 Etienne Bazié ODE Burkina Faso ode@cenatrin.bf24 Eva Ombaka EPN Kenya epn@wananchi.com25 Gabi Hettler Difaem Germany hettler@difaem.de26 Godfrey Biemba CHAZ Zambia Godfrey.biemba@chaz.org.zm27 Grace Ebuga-Miner ECWA Nigeria ecwapharm@yahoo.com28 Guido Miglietta Caritas Italiana Italy gmiglietta@caritasitaliana.it29 Habtamu Woldeyes EECMY Ethiopia habtamu@eecmy.org30 Hans Hogerzeil PSM/WHO Switzerland hogerzeilh@who.int31 Hans Peter Bollinger EPN Burkina Faso epn.burkina@fasonet.bf32 Heather Budge-Reid Kirkwood

CommunicationsFrance heatherbr@kclinfo.com

33 Helmut Hess BftW Germany h.hess@brot-fuer-die-welt.org34 Helmut Scherbaum Tropenklinik Germany scherbaum@tropenklinik.de35 Henk den Besten IDA Solutions The Netherlands hdbesten@idasolutions.org36 Ione Bertocchi ASSOMESCA CAR betharramites.bouar@tiscali.it37 Ingeborg Meijer Difaem Germany38 Isaac Annan CDC Ghana ike_annan@yahoo.com39 Jaap Breetvelt The Netherlands j.breetvelt.kerkinactie@pkn.nl40 Jacqueline Nyagah EPN Kenya epn@wananchi.com41 Jacqui Patterson PACANET USA jpatters1@yahoo.com42 Jane Masiga MEDS Kenya jmasiga@meds.or.ke43 Jérôme Wolo Dispensaire

KirkissoyeNiger jérômewolo@yahoo.fr

44 Jochen Bitzer Difaem Germany bitzer@difaem.de45 Johannes Bielefeld Diocese Rottenburg Germany JBielefeld@bo.drs.de46 Johannes Schaefer Tropenklinik Germany schaefer@tropenklinik.de

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47 John Essobe CEPCA Cameroon dsfemec@yahoo.fr48 John Kirkwood Kirkwood Communi-

cationsFrance jkirkwood@kclinfo.com

49 Jokebed Damoaliga AEAD Burkina Faso philippe.aead@fasonet.bf50 Jonathan Mwiindi AIC Kenya hivmgr.kh@kijabe.net51 Josefa Castro PROVIDA Peru jecastcob@yahoo.es52 Julia Zelm Diplom-Interpreter Germany julia.zelm@t-online.de53 Juma Mkanda ZACH Zimbabwe mkanda@zach.org.zw54 Kirere Mathe Melchisedec Centre

Médical Evangéliquede Nyankunde

DR Congo kireremathe@yahoo.fr

55 Kodjo Tsogbe APROMESTO Togo ktsogbe@yahoo.fr56 Lazarus Koech CISS Kenya lazkoech@yahoo.com57 Leon Kintaudi ECC DR Congo leonkintaudi@sanru.org58 Lilies Njanga EPN Kenya epn@wananchi.com59 Lorna Muhirwe UPMB Uganda lmuhirwe@upmb.co.ug60 Manoj Kurian WCC Switzerland mku@wcc-coe.org61 Marion Morgan CHASL Sierra Leone chasl@sierratel.sl62 Marsha Macatta-Yambi CSSC Tanzania marsha@cssc.or.tz63 Matthew Azoji CHAN Pharmaceuti-

calsNigeria obiazoji@yahoo.com

64 Meika Joa Difaem Germany joa@difaem.de65 Moses Manohar ICSA India icsa@vsnl.com66 Natalia Cebotarenco Drug Info Moldova Moldova druginfo@dim.moldline.net67 Nathan Wanyu CBC Cameroon cbchbpharmacy@yahoo.com68 Nina Urwantzoff Misereor Germany urwantzf@misereor.de69 Nympha Que CHAM Malawi nympha@malawi.net

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70 Peace Nyankojo MEMS Tanzania peacen@mems.or.tz71 Rainward Bastian Difaem Germany bastian@difaem.de72 Raphael Edou Bethesda Hospital Bénin raphaedou@yahoo.fr73 Richard Peters WEM Germany wem@wem-hamburg.de74 Richard Wagner AMFA South Africa richardw@hollard.co.za75 Ruth Mwandira CHAM Malawi rhmwandira@cham.org.mw76 Samuel Mwenda CHAK Kenya mwenda@chak.or.ke77 Sara Bhattacharji CMC India s_bhattacharji@cmcvellore.ac.in78 Solofo Andrianalitsimba SAF/FJKM Madagascar safdir@wanadoo.mg79 Stella Feka SCS Cameroon stellafeka@yahoo.fr80 Ted Karpf WHO Switzerland karpft@who.int81 Ulangul Tilekeeva RDU association of

KyrgyzstanKyrgyzstan ulangul@mail.ru

82 Ursula Wagner AMFA South Africa ursulaw@hollard.co.za83 Vijay Aruldas CMAI India varuldas@cmai.org

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