KwaZulu-Natal, South Africa: Innovating Solutions for Pharmaceutical Leadership, Governance, and Supply Chain Efficiency

 {Photo Credit: KZN PPSD}The KZN Provincial Pharmaceutical Supply Depot.Photo Credit: KZN PPSD

The KwaZulu-Natal (KZN) Provincial Pharmaceutical Supply Depot (PPSD) procures and supplies pharmaceuticals to approximately 550 health facilities in the South African province. In July 2013, it took the PPSD an average of 27 days to process and prepare for dispatch a health facility’s main order for medicine. The PPSD was therefore faced with a pressing question: How can we reduce the time to complete a facility’s main order?

The answer was found through Management Sciences for Health’s (MSH’s) Pharmaceutical Leadership Development Program (PLDP), implemented by MSH through the US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, together with onsite support from the US President’s Emergency Plan for AIDS Relief (PEPFAR)/USAID-funded Supply Chain Management System (SCMS) in logistics management and process reengineering. The combination of support provided by MSH through SIAPS and SCMS was instrumental in improving leadership, governance, pharmaceutical, and supply chain processes at PPSD.

Tackling Challenges and Innovating Solutions

Developed by MSH, the PLDP is a structured program that utilizes a team-based, action-learning approach to problem solving. Participants are provided with skills and tools that they use to produce measurable organizational results.

From February 2013 to February 2014, Provincial Head Office staff worked with PPSD pharmacists to tackle the challenge through the PLDP. The SCMS Logistics Advisor and SIAPS PLDP facilitators supported teams to conduct a detailed analysis of the ordering process. The team cleared the backlog of orders by fast-tracking orders for bulky items to relieve space, and using time originally reserved for stock taking to expedite outstanding orders. PPSD staff responsible for managing orders were involved in defining their roles and responsibilities, evaluating workloads, and reorganizing processes. In addition, in coordination with SIAPS information technology experts, the team developed and piloted a Microsoft Access™-based tool for tracking orders at each stage of the process.

By February 2014, the average time taken to process a main order at the PPSD dropped from 27 days to 13 days (see Figure 1 below). PPSD then endeavored to sustain these achievements and improve other processes.

[Figure 1: PPSD Main Order Process and Number of Days for Each Stage of Main Order Process]Figure 1: PPSD Main Order Process and Number of Days for Each Stage of Main Order Process

Quality Management System improves service quality, client satisfaction, staff morale

With the continued assistance from SCMS, PPSD engaged in the creation of an integrated Quality Management System (QMS) to reinforce control, consistency, and accountability in all processes to improve efficiency and effectiveness in facility operations. The QMS Committee now meets every two weeks to discuss quality initiatives and address deficiencies identified by external regulatory authorities. These interventions have improved the quality of services offered, enhanced the satisfaction of clients, and improved staff morale.

Changing Minds, Sustaining Results

PPSD successfully sustained efficiencies and further reduced the time to process orders. From April to October 2015, more than 3,260 main orders were placed, with the estimated average time for processing these orders reduced to 10 days.

The results speak for themselveseven changing the mind of a skeptic. “[A colleague] wasn’t too sure about PLDP, because there are so many trainings that waste time, with people sitting in conference rooms instead of doing service delivery, and with no target or results,” said Vusi Dlamini, KZN Pharmaceutical Services.

But, after seeing the team presentations [the colleague] said, ‘I have changed my mind. I endorse it.’ [The colleague] saw the evidence.

The coordination and integration of MSH SIAPS and SCMS interventions within the PPSD increased supply chain efficiencies and improved commodities availability. Through the complementary nature of the technical assistance provided by MSH and partners through SIAPS and SCMS, pharmacists have also developed management and leadership skills, and have implemented changes that have resulted in improved pharmaceutical service delivery.

The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, funded by USAID, builds on the achievements of its predecessor, Strengthening Pharmaceutical Systems (SPS)—both led by MSHby working to ensure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes. Learn more about SIAPS here.

The Supply Chain Management System (SCMS), established in 2005 under the US President’s Emergency Plan for AIDS Relief (PEPFAR) administered by USAID, supplies lifesaving medicines to HIV and AIDS programs around the world and is led by the Partnership for Supply Chain Management (PFSCM), a nonprofit organization established by MSH and John Snow, Inc. Learn more about PFSCM here.

[This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.] {Photo: Gwenn Dubourthournieu}This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.Photo: Gwenn Dubourthournieu