Centralizing Supply Chain Systems for Tuberculosis Medicines in Uganda

In Uganda, management of tuberculosis (TB) medicines is fully decentralized. Like other government and private programs, the Ministry of Health’s (MoH) National Tuberculosis and Leprosy Program (NTLP) procured and supplied tuberculosis (TB) medicines independently to district stores. As a result, parallel supply chain systems emerged alongside the main essential medicines system: Resources and costs were duplicated, overall medicine orders and supplies lacked coordination (which led to expired medicines or stock outs), and at facilities, health workers spent more time making independent orders for different medicines.

The Uganda MoH passed a policy in 2011 to integrate and harmonize supply chain management activities of essential medicines including TB medicines. The harmonization aimed at having one reliable system where planning, procurement, distribution and monitoring of medicines availability can be easily tracked. Following the directive, NTLP shifted responsibilities of procurement, storage, and distribution of TB medicines and related supplies to the central warehouse, the National Medical Store (NMS).

To achieve a successful transition, however, supply chain management processes and information system functions for NTLP and NMS needed synchronization.

Working with the NTLP, the USAID-funded Securing Ugandans’ Right for Essential Medicines (Uganda SURE) Program, led by MSH, supported the centralization by organizing meetings to bring stakeholders together to establish a logistics transition framework with required controls and initial performance measures.

Today, because of greater collaboration between NMS and the NTLP, a new committee has been formed to oversee the process and assure that full transition takes place by 2013. The collaboration has also accelerated decision-making on key areas of change. For example, NMS has standardized product selection and procurement of all anti-TB medicines based on World Health Organization (WHO) guidelines and has resolved to use WHO pre-qualified suppliers. This will ensure that all anti-TB supplies are of internationally approved quality and have standardized packaging. In addition, SURE’s role as coordinator has contributed to an uninterrupted supply of anti-TB medicines at all TB treatment facilities, including private not-for-profit, private for-profit, and government clinics.

The transition is proving beneficial. At lower levels of the health care system, where ordering and delivery schedules for anti-TB medicines and supplies are already harmonized with the essential medicines schedule, facility staff have a more streamlined ordering process; all orders are made at once and deliveries are received in one package, which helps the facility better manage their medicines and supplies.

Once the transition is successfully completed, Uganda will have a harmonized supply chain system with standardized processes that is more cost-effective than before. SURE’s ongoing promotion of collaboration among all major stakeholders ensures that transition to the new system will be sustainable.