Resource Type: Report
Authors: Matt Kukla and Pascal Verhoeven
Published: 3/1/2016

Resource Description: As international guidelines and the President’s Emergency Plan for AIDS Relief (PEPFAR) policies for HIV epidemic control increasingly focus on “test and treat” (UNAIDS 90-90-90 and fast-track mandates), expanding access to and coverage of antiretroviral treatment (ART) for people living with HIV (PLHIV) has received heightened attention. This focus highlights the greater need to manage the procurement and supply chain systems for antiretroviral drugs (ARVs) and pharmaceuticals to treat key opportunistic infections among PLHIV. While many pharmaceuticals are available in Vietnam at prices and quality on par with international standards, procurement for some (such as ARVs) is not.

These obstacles drive up ARV prices and inhibit access, particularly in markets where domestic sourcing has been limited. Prices paid by the National Target Program (NTP) for HIV/AIDS for the procurement of imported ARVs have historically been higher than those paid by the Global Fund or PEPFAR. When donors reduce or eliminate funding in 2018, the Government of Vietnam (GVN) will be forced to procure these ARVs at higher prices unless it addresses the situation. At best, this will lead to substantial inefficiencies in HIV/AIDS spending; more likely it also will result in reduced coverage of ARVs for PLHIV. To avoid either scenario and realize its 90-90-90 objectives by 2020, the GVN must take action to eliminate these obstacles.

The Ministry of Health (MOH) on behalf of the Prime Minister of Vietnam has therefore requested that the Health Finance and Governance (HFG) project present a proposal for the introduction of a Central Procurement Unit (CPU) for pharmaceutical products (including ARVs) offered in the public health system. However, the design, governance, and implementation of a CPU are not yet clear. HFG also is to identify practical, short- and long-term options for domestically financing and purchasing ARVs. While the CPU is expected to be Vietnam’s long-term vehicle for procuring ARVs, the GVN needs financing strategies that address methods for generating new (or existing) ARV resources and improving efficiencies through ARV payment and reimbursement mechanisms.