Saving Lives through Better Communication and Coordination: Supply Chain Management System in Ethiopia

{Photo credit: Warren Zelman, Ethiopia.}Photo credit: Warren Zelman, Ethiopia.

HIV and AIDS patients worldwide depend on lifesaving drugs to extend their lives and improve their quality of life. In Ethiopia, where an estimated 2.2 million people are living with HIV and AIDS, access to these lifesaving medicines, particularly for people living outside of the capital city, means depending on an efficient and effective pharmaceutical supply chain to get the medicines to keep them alive.

The Supply Chain Management System (SCMS), a US President’s Emergency Plan for AIDS Relief (PEPFAR) project administered by the United States Agency for International Development (USAID), plays an important role in coordinating efforts between Ethiopia’s Pharmaceutical Fund Supply Agency’s (PFSA), the federal agency mandated to supply the entire country with essential drugs, and the complex health operations managed by regions, zones, and woredas.

The result is better supply chain functions, from forecasting and supply planning to procurement, distribution, and monitoring.

Ethiopia’s Oromia Region has faced difficulties coordinating the competing supply chain functions carried out by PFSA, at the federal level, and the health departments at the zonal level. The lack of coordination from regional governmental authorities was having a negative impact on providing reliable pharmaceutical services to a highly vulnerable population depending on lifesaving medicines.

Illustrative of this problem is the case of Arsi, Oromia’s second largest zone. Arsi has 90 health facilities: 3 hospitals and 87 health centers. In Arsi, two parallel supply chain systems for essential medicines—PFSA and the Zonal Health Department—were delivering to the same health facilities, causing double orders, overstock, and wastages of pharmaceutical commodities.

In March 2012, the situation in Arsi was compounded when the Oromia Regional Health Bureau doubled the number of health facilities that provided prevention of mother-to-child transmission of HIV (PMTCT) services and antiretroviral therapy (ART) across the region. This scale-up effort led to major supply chain concerns in Arsi.

The Zonal Health Department of Arsi requested SCMS to provide technical and financial support for a logistics review meeting to come up with a durable solution to the parallel supply chains.  SCMS, working collaboratively with the regional health bureaus, has provided assistance countrywide to Essential Pharmaceutical Technical Working Groups (TWGs) to hold meetings to discuss supply chain problems and identify solutions. During the meeting in Arsi, the TWG determined that a shortage of health professionals at health centers and limited information sharing between PFSA and the Arsi Zonal Health Department were underlying problems that led to the lack of coordination.

SCMS worked with PFSA and the Arsi Zonal Health Department to create an action plan to collaboratively address the gaps in human resources and information sharing. As a result, the Zonal Health authority hired 43 pharmacy professionals between August 2012 and April 2013 to address the human resource constraints. In addition, district health offices began collecting bimonthly reports and requisition reports from all health centers and sharing them with PFSA. This information sharing allows both PFSA and the Zonal Health Department to more effectively meet patient needs without wastage.

Since the initial meeting, PFSA has increased the direct delivery of products to zonal health facilities, thereby streamlining supply chain operations. PFSA now distributes products directly to 81 percent of the total number of health facilities. ART and PMTCT sites’ distri­bution rates also rose from 69 percent to 95 percent.

Getting the right drugs, in the right quantities, to the right people at the right time is the goal for any supply chain management system. In Ethiopia, the complex health network requires both communication and coordination at the various levels of health authorities to meet this goal. SCMS plays a crucial role in brokering more effective communication and coordination within Ethiopia’s health system so that Ethiopians living with HIV and AIDS can access the lifesaving medication they need.

The Partnership for Supply Chain Management (PFSCM), a partnership of Management Sciences for Health (MSH) and John Snow, Inc. (JSI), holds the SCMS contract with USAID. MSH manages SCMS's office in Ethiopia.

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