Addressing In-Country Transportation Bottlenecks Eliminates Needless Waste and Shortages of HIV Drugs

{Photo credit: MSH}Photo credit: MSH

Throughout Côte d'Ivoire, more than 110,000 HIV & AIDS patients receive anti-retroviral drugs. These patients rely on a smoothly functioning supply chain that allows medicines to reach local health centers in a timely manner. When recent assessments identified that many sites within the country were not receiving drugs as scheduled, the Supply Chain Management System (SCMS), managed by Management Sciences for Health in Côte d'Ivoire, began identifying challenges and mobilizing solutions. SCMS has worked in Cote d’Ivoire since 2005 to provide high quality medicines for the care and treatment of people affected by HIV/AIDS and to deploy innovative supply chain solutions. 

Anti-retroviral drugs arrive in Côte d'Ivoire from pharmaceutical producers around the world. Upon arrival, these medicines—much of which SCMS procures for Cote d’Ivoire—are  warehoused in a central medical storage center operated by the Ivorian government, called the Pharmacie de la Santé Publique de Côte d'Ivoire, or the Public Health Pharmacy. Based on needs determined at public health centers, specific drugs are then carefully scheduled for delivery. 

Here's where the challenge lies: while the amount of drugs to be distributed has grown dramatically over the last decade, the capacity to deliver them has not kept up. Simply put, sometimes the government doesn't have enough working trucks to deliver medicines to health centers on time, creating bottlenecks and that can lead to costly consequences. If scheduled deliveries are postponed because trucks are not available, some sites will run out of stock, leaving their patients without medicine. Additionally, extended delays can cause those drugs to sit in central storage past their expiration dates. If they spoil, the drugs unfortunately must be destroyed. 

"We want the sites in Côte d'Ivoire to focus on providing the best treatment for their patients, not worrying about whether or not the drug shipment will arrive when scheduled," said Adama Doumbia, senior manager for country operations at SCMS in Côte d'Ivoire.

SCMS assessed the cause of these bottlenecks and mobilized workable solutions. Based on the findings, SCMS worked closely with the Ivorian Ministry of Health to create a cost-effective and reliable solution to get more trucks and drivers on the road. SCMS brought in a third-party logistics provider with a large fleet of available trucks to help alleviate delays along seven distribution routes.

Now if there's a transportation shortage, the government can quickly coordinate with SCMS to arrange for additional trucks and drivers to deliver these shipments on the last leg of the journey from central storage to the treatment sites. Although SCMS set out initially with a focus just on ensuring the speedy delivery of medicines to treat HIV/AIDS, the project soon recognized that a significant cost savings was possible by loading trucks with both HIV and non-HIV related medicines. 

Most of the medicines transported with SCMS assistance are directly used in the treatment of HIV/AIDS, but no empty space within trucks is wasted. If there is extra room, the trucks are loaded with other essential medicines bound for the same public health centers. This has allowed SCMS to further reduce bottlenecks within the public health supply chain without any added costs. And when patients receiving anti-retroviral treatment have access to a wider range of medicines, health outcomes are better overall. 

"With this outside transportation assistance, we can decrease needless spoilage and greatly improve the reliability of getting these shipments in the field," Doumbia said.

SCMS is working with the Ivorian government to scale-up these results throughout the country.

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