UNICEF Essential Medicines Covid-19 UNICEF Essential Medicines Covid-19 The overall goal of the programme is to mitigate the consequences of COVID-19 on health systems with the provisions of essential health commodities to ensure the continuation of essential health services delivery. The programme will be implemented by UNICEF in close collaboration with the Zambian health authorities. The programme is intended to support Zambia’s health system to promote resilience in the continuation of essential health services through ensuring Essential Health Commodity (EHC) security, specifically focused on vaccines and essential medicines and commodities for reproductive, maternal, new-born, child and adolescent health (RMNCH) services.

The programme is aimed at serving an estimated 375 000 infants and 380 000 pregnant women with routine vaccination services nation-wide and an estimated 1 000 000 people with primary health services including Reproductive, Maternal, New-born, Child and Adolescent Heath care in the 4 provinces that are included in the Sida/USAID-funded RMNCAH/N Programme 2016-2020 (Eastern, Southern, Luapula and Muchinga) for a period of up to 6 months. Approximately 5 000 health workers in 983 Health centres and 48 hospitals in the 4 provinces will be equipped with Personal Protective Equipment (PPEs) and Infection Prevention and Control (IPC) supplies to enable them effectively to deliver the life-saving routine essential health services. The proposed activities to be supported by this project are intended to address the current situation in Zambia emanating from the corona virus pandemic. During planning and development of the programme, there has been close coordination with the Ministry of Health and other donor partners, most notably EU, DFID and USAID, who will also support similar interventions in other provinces in Zambia. Broadly, the interventions will include: 

i) procurement of traditional vaccines (those are not supported by Gavi) to continue routine immunization services for 6 months; 
ii) procurement of essential medicines for general curative services as well as Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) services for 6 months; 
iii) procurement of PPEs and IPC supplies for primary health care facilities and hospitals workers and Community-Based Volunteers (CBVs) for 2 months; 
iv) procurement of oxygen concentrators for all hospitals in 4 provinces as well as rehabilitation of Oxygen Plants at 2 hospitals including University Teaching Hospital (UTH) in Lusaka; 
v) in-country distribution of supplies at the designated sites (last-mile delivery) and end-user monitoring; 
vi) technical support to design/adapt service delivery to the circumstances resulting from the COVID-19 response; and 
vii) operational support to organise primary health care services outreach, specifically immunizations, in selected hard to reach and low performing districts.

The contribution's total budget is 52 Million SEK of which more than 80 percent constitutes costs related to procurement of medicines, vaccines, PPE and other supplies as well as costs related to freight and safe distribution of supplies to the final end destination. Other budget posts include technical support to Health personnel and continuous follow-up of the programme to ensure that primary health care services of good quality can continue to be delivered to the most vulnerable despite restrictions due to covid-19.  The budget is reasonable given the relative uncertainty regarding the supply and availability of essential commodities on the global market at any given time. Det övergripande målet med programmet är att mildra konsekvenserna av covid-19 på hälsosystemet genom tillgång till livsnödvändiga mediciner, vacciner, skyddsutrusning och övrigt materiel för att säkerställa löpande primärhälsovårdsverksamhet.  Programmet kommer att genomföras av UNICEF i nära samarbete med zambiska hälsomyndigheter. Programmet är avsett att bidra till ett motståndskraftigt zambiskt hälsosystem genom att garantera ett kontinuerligt utbud av livsnödvändiga mediciner, vaccin och förnödenheter för kvinnor, barn och ungdomar under covid-19 pandemin.  Programmet syftar till att försäkra tillgången till vaccin för 375 000 spädbarn och 380 000 gravida kvinnor över hela landet samt nödvändiga basmediciner för primärhälsovård för uppskattningsvis 1 000 000 i fyra provinser (Eastern, Southern, Luapula, Muchinga) i upp till 6 månader. Cirka 5 000 hälso- och sjukvårdspersonal i 983 hälsocentraler och 48 sjukhus i 4 provinser kommer att få personlig skyddsutrustning (PPE) och infektionsförebyggande materiel för att kunna bedriva effektiv primärhälso- och sjukvård. De föreslagna aktiviteterna som stöds av detta projekt är avsedda att hantera den nuvarande situationen i Zambia som härrör från coronaviruspandemin. Vid planering och framtagande av förslag till insats har nära samordning skett med hälsoministeriet och andra givare, företrädesvis EU, DFID och USAID, som liksom Sverige planerar stöd med liknande inriktning till övriga provinser i Zambia.  I stort sett kommer aktiviteterna att omfatta: 

i)upphandling av traditionella vacciner för att kunna genomföra det rutinmässiga barnvaccinationsprogrammet i 6 månader; 
ii)upphandling av nödvändiga läkemedel för allmän hälso- och sjukvård samt för mödra- och barnhälsovård i 6 månader; 
iii)upphandling av PPE och infektionsförebyggande materiel för vårdpersonal och volontärer vid hälsocentraler och sjukhus i 2 månader; 
iv)upphandling av utrustning för syrgasbehandling för samtliga sjukhus i de fyra provinserna samt rehabilitering av större syrgasanläggningar på 2 sjukhus inklusive University Teaching Hospital (UTH) i Lusaka; 
v)distribution av varorna till angivna platser och patientuppföljning. 
vi)tekniskt stöd för att anpassa verksamheten till omständigheterna kring covid-19 
vii)operativt stöd för att organisera hälso- och sjukvården på landsbygden, i synnerhet vaccinationsprogrammet, i särskilt svåråtkomliga och lågpresterande distrikt.

Insatsens totala budget uppgår till 52 MSEK varav mer än 80 procent utgörs av kostnader för inköp av mediciner, vacciner, skyddsutrustning och andra förnödenheter samt kostnader relaterade till flygfrakt, transport och säker distribution av varorna ända fram till hälsoklinikerna. Övriga budgetposter inkluderar tekniskt stöd till hälsopersonal samt kontinuerlig uppföljning av verksamheten för att tillse att primärhälsovård av god kvalitet kan fortsätta att ges till de mest behövande trots restriktioner och övriga hinder som en följd av covid-19. Budgeten bedöms rimlig utifrån en mängd osäkerhetsfaktorer avseende det rörliga utbudet och tillgången till de specifika varorna på den globala marknaden. The goal of the proposed programme is to mitigate the consequences of Covid-19 on the health system with provision of essential health commodities to ensure the continuation of essential health services delivery in 4 provinces of Zambia. The programme is intended to promote resilience of the health system as a mitigation for Covid-19 impact by ensuring essential health commodity security especially focused on vaccines, essential medicines and supplies for reproductive, maternal, newborn, child and adolescent health services.

The partnership with UNICEF has been significant in achieving the planned results as per its 1st interim progress report submitted in June 2021. Significant contributions of the partnership were reported in mitigating the impact of COVID-19 in Zambias health systems, especially with regards to sustaining the continuity of life-saving essential health services and building the resilience of the health system. Both Sida and UNICEF therefore, proposed and agreed to further expand the partnership to sustain Essential Health Commodities security. 

The aim of the program is to access 1 million people with curative treatment, including COVID-19 and Reproductive, Maternal, Newborn, Child, and Adolescent (RMNCAH) services, in 983 Primary Health Care (PHC) facilities and 48 hospitals in 4 provinces for 9 months (increased from 6 months); 5,000 health workers in 983 PHC facilities and 48 hospitals equipped with Personal Protective Equipment (PPEs) for 4 months to ensure continuation of essential health services; An estimated 4,000 new-born received quality essential new-born care services in 7 hospitals 1) University Teaching Hospital (UTHs) Childrens Hospital, Lusaka, 2) UTHs Women and Newborn Unit, Lusaka, 3) Mansa, 4) Chinsali, 5) Choma, 6) Chipata and 7) Katete (ER-4).

More specifically, the key objectives are:

- Procurement, pre-positioning, and in-country distribution of traditional vaccines for routine immunisation: BCG and bOPV for a total of six months requirement of the entire country.
- Procurement of cold chain equipment to revitalise and strengthen the cold chain systems in four provinces.
- Training of primary level health workers and CBVs in 10 high-risk districts of four provinces.
- Operational support to PHC facilities and community outreach in 10 high-risk and/or hard-to-reach districts of four provinces.
- Procurement, pre-positioning, and in-country distribution of the United Nations' Interagency Emergency Health Kit (IEHK)-2017 that comprised of all essential medicines and commodities for reproductive, maternal, neonatal, child and adolescent health services in four provinces for nine months.
- Procurement of itemised essential drugs for Emergency Obstetric and New-born Care (EmONC) services for three months.
- Procurement of Medical Oxygen services equipment (concentrators, cylinders, and flowmetres).
- Rehabilitation of Oxygen plants at UTH children's Hospital, UTH adult Hospital, Lewanika General Hospital, and Mansa General Hospital to improve treatment of COVID-19, and other critical patients.
- Training of hospital staff on the operations and maintenance of oxygen plants.
- Last mile delivery and end-user monitoring of all three (basic, supplementary and renewable) types of IHEK-2017 kits, itemised EmONC drugs, and medical oxygen services supplies at health facility levels.
- Procurement, pre-positioning, and in-country distribution of Personal Protective Equipment (PPEs) and Infection Prevention and Control (IPC) supplies.
- Last mile delivery and end-user monitoring of PPEs and IPC supplies.
- Last mile delivery and end-user monitoring of IEHKs, medical oxygen equipment, PPEs, and IPC supplies at health facility levels.
- Procurement of medical equipment (neonatal resuscitators, neonatal warming systems) to strengthen the ENC services.
- Establishment of a centre of excellence for Essential New-born Care (ENC) at UTH Children Lusaka.
- Training of doctors and nurses at national and provincial level hospitals on ENC Services in four provinces.