Ensuring Continuous Supply of HIV Drugs to Affected Communities in Côte d’Ivoire: SCMS in Brief
The Supply Chain Management System (SCMS) has been providing technical assistance since 2005 to Côte d’Ivoire’s central medical store, the Pharmacie de la Sante Publique (PSP)—later re-named the Nouvelle PSP (NPSP)—to strengthen the management of products in the health system. SCMS is a project under the US President’s Emergency Plan for AIDS Relief (PEPFAR) administered by the US Agency for International Development (USAID).
This assistance is helping the Ministry of Health (MOH) make significant progress in strengthening the public health supply chain at the central level, with the transformation of the central pharmacy from a state-owned public enterprise into a not-for-profit, apolitical organization, run on the basis of sound business principles.
While the performance of the supply chain at the central level has been improving, the performance at the local level remained weak. Health facilities in the districts continued to experience stockouts of HIV products (32 percent in 2012) and large volumes of expired products were taking up valuable storage space (101 tons of obsolete pesticides were identified at the PSP in 2012).
Local supply chain challenges
In May 2012, PSP conducted their semi-yearly review of stock status and commodity management at 217 sites including district pharmacies, hospitals, and health centers with technical and financial support from SCMS, which revealed numerous challenges faced by the health facilities:
- At least one tracer product was out-of-stock at 32 percent of the sites on the day of visit despite the availability of products at the PSP
- Only 24 percent of sites had the recommended stock level of HIV/AIDS-related products
- USD $185,000 worth of unusable products (mostly ARVs that were no longer prescribed) were stocked at sites, taking up valuable space
- At 46 percent of sites, pharmacists and/or medical warehouse staff were not trained in logistics management
Results from the review suggested that these challenges existed due to the lack of adequately trained staff to effectively manage medications at local-level health facilities. Only a small number of health facilities had trained pharmacists at the management level and staff managing ARVs did not have sufficient training. Due to the lack of resources (trained staff, vehicles, fuel) and lack of know-how, monitoring of the system was insufficient. Additionally, the review found that the logistics management and information system (LMIS) was not being used effectively due to poor reporting, monitoring, and feedback.
Launch of the Decentralized Supply Chain Management project
Following a series of technical discussions with the MOH of Côte d’Ivoire, USAID, and PEPFAR, SCMS offered to assist the MOH in strengthening the logistics management of health products at the local level by implementing the Decentralized Supply Chain Management project (D-SCM). D-SCM provides technical assistance aimed at reducing stockout rates, delivery delays, logistical shortcomings, and improves the system of product distribution from district depots to service delivery points (SDPs).
To improve the effectiveness of the management system, D-SCM introduced an intermediary level of supervision, namely the position of regional pharmacists. This position bridges the gap between the 82 district pharmacies and the central level.
SCMS positioned five sub-offices in Abidjan, Bouaké, Abengourou, Man, and Gagnoa for implementation of the D-SCM. These offices work closely with regional and district pharmacists to increase the availability of HIV/AIDS products and essential drugs at SDPs by focusing on capacity building of regional pharmacists, health district pharmacy managers, regional and general hospitals, and health centers.
Collaboration for sustainability and success
To complement the LMIS, SCMS looked for an existing civil society mechanism to collaborate with that could issue alerts regarding stockouts and other problems and found a strong partner with RIP+ (Réseau Ivoirien des organisations de personnes vivant avec le VIH — the Ivorian network of organizations of people living with HIV).
In 2013, the Chairman of the Board of Directors of RIP+, drew attention to stockouts of HIV-related products in his letter to the MOH and the Embassy of the United States where he urged them to take the necessary steps to improve the situation. Following the letter, RIP+, together with UNAIDS and the International Foundation for Therapeutic Solidarity (Fondation Solidarité Thérapeutique International) initiated the establishment of an early alert system, Système de Réponse Rapide (SAR). SAR enables fast reporting on drug stockouts found at SDPs and enables district pharmacists, regional pharmacists, and NPSP to identify challenges and take corrective actions to avoid recurrence.
Through a memorandum of understanding signed in March 2014 with RIP+, D-SCM utilizes SAR to improve availability of HIV medicines and other essential goods at SDPs. Regional SCMS offices work closely with RIP+ zonal delegates to collect data and feedback, which allows for a more efficient and rapid response in the case of stockouts or technical challenges and to conduct better analysis and gain understanding of fundamental weaknesses in the supply chain.
SCMS provides training on supply chain management, implementation, and usage of SAR reporting tools, which SCMS also helped develop, to zonal delegates and members of RIP+. Additionally, SCMS procures IT and communication equipment and hosts regional coordination meetings for RIP+ delegates.
The collaboration between SCMS and RIP+ is a strong example of how close cooperation between the public health system and civil society can benefit patients. Making the SAR an integral part of the LMIS optimizes the management of antiretroviral drugs and other HIV medications and ensures continuous access to HIV medicines and services at all levels of the public health supply chain.
Supply Chain Management System (SCMS), established in 2005, supplies lifesaving medicines to HIV & AIDS programs around the world and is led by the Partnership for Supply Chain Management (PFSCM), a nonprofit organization established by Management Sciences for Health (MSH) and John Snow, Inc.
This story originally appeared on the SCMS website in PDF format.