Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa Workshop Summary (2014) / Chapter Skim
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4 Challenge: Ineffective Supply Chains
4 Challenge: Ineffective Supply Chains
Pages 43-68
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From page 43... ...
• Establishment of therapeutic committees at health institutions to conduct coordination efforts and consider information on needs, stocks, and supply chain logistics. • Reduction of the number of tiers between central warehouses and patient distribution points.
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From page 44... ...
According to Yadav, investment in supply systems reflecting true market potential, and not current perceived demand, is needed to get the supply chain out of this trap. Yadav highlighted some of the differences between supply chains in developed and emerging market pharmaceutical systems, such as those found in developing countries.
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Procurement processes can be archaic, he said, and lead times from manufacturers long. Yadav suggested that the government's control on distribution can lead to weak incentives and poor information flow along the length of the supply chain.
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Although surveys are relevant for evaluation, effective supply chains are based on high frequency or continuous information feedback. A few participants stressed the importance of regular monitoring of systems to check the availability of products and the number of patients in need every month.
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Private-Sector Medicine Supply Chains Within the private sector, Yadav explained that most pharmacies rely on a "cash-and-carry model," in which products are bought directly from the wholesaler rather than through a distributor. While large retail pharmacies may receive some form of credit from the wholesaler, smalltown rural pharmacies are typically not extended credit and must purchase medicines on a cash basis.
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From page 48... ...
Although some manufacturers register their products out of corporate social responsibility, given the high costs and relatively small market size, Yadav noted that many do not. When manufacturers choose not to register products in a country, this leaves few or no supply sources, which leads to higher prices, a lack of availability, or both.
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However, the complexity and multi-dimensionality of the problem can not be an excuse for inaction, Yadav said. Lessons can be learned from successful supply chains for other consumer products in SSA (Yadav et al., 2013)
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LESSONS LEARNED FOR ADDRESSING INEFFECTIVE SUPPLY CHAINS As previously mentioned, five example programs addressing access to medicines were presented during the workshop to facilitate exploration of best practices and lessons learned from other programs. The examples were selected by planning committee members and included two country-level programs, an infectious disease project, and two noncommunicable disease programs.
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can help to accurately forecast the amount of medication needed. Noncommunicable Disease Programs Diabetes • Government support and buy-in that treatment for non communicable diseases is a priority may help increase health care budgets to purchase medicines.
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See Appendix A for full discussion and references. CHALLENGES AND OPPORTUNITIES FOR ADDRESSING INEFFECTIVE SUPPLY CHAINS In preparation for the focused discussion on supply chains, Giorgis summarized the issues for supply chains that were discussed in the presentations and example programs.
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From page 53... ...
A few suggestions by different participants were offered as opportunities to improve coordination among tiers of the procurement chain, including the use of mobile technology to improve information flow and the establishment of therapeutic committees at health institutions. One participant noted that these committees could consider information on needs, stocks, and supply chain logistics and conduct coordination efforts across the supply chain.
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54 ESSENTIAL MEDICINES FOR MNS DISORDERS IN SSA prepositioning of medicines and raw materials might improve, reducing the time for delivery of essential medicines.
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systems. Hand- and over- country-specific the supply chain Potential for collected data stocking.b,d,g challenges.
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Reduced stock-outs have developed groups on including data Establishment of and over- training partnerships for collection and training programs stocking.b,c,f,g,h programs training.b,d analysis, flowing on supply chain focused on from each tier in data collection and supply chain the supply chain analysis.b,d,g data; World system.b,c,g Health Organization.a,b, d,e
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A lack of quality, Learning and Best practices Improved Relevant Consider vertical timely leveraging from vertical forecasting of need. program programs information, information programs are Reduced stock-outs administrators specifically including data systems of other integrated into and over- from other focused on collection and vertical supply MNS supply stocking.b,c,f,g,h disease areas.b,g chronic and/or analysis, flowing chain programs chains.b,g nonfrom each tier in for the broader communicable the supply chain system.b,g diseases.b,g system.b,c,g 57
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From page 58... ...
Deficiencies in Training of supply Increased Increased number Industry Connect with and allocation and chain staff at knowledge of the of qualified staff. partners; develop training of human multiple tiers supply chain Integration of new telecommunica- relationships with resources for within the system and training tions; groups focused on supply system.e,g understanding of opportunities into government training in supply chains.a,b,d,e,g importance of current programs.
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Deficiencies in Training of all Increased Increased number Training Connect with allocation and levels of health knowledge of the of qualified staff. institutions; training programs training of human care providers supply chain Integration of new organizations focused on supply resources for about supply system.
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Inclusion of supply chain workers in determining human resource needs for health care systems.a,c,d,e,g,h
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Lack of The use of mobile Development of Improved Information Network resources coordination at all technology for algorithms or information flow. technology may differ across levels of the across tiers or reporting tools.
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To include needs, stocks, and procurement Transparency of directors. b,g communication supply chain managers.
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chain managers; case-by-case basis chain, including warehouses and through Removal of some manufacturers; (e.g., country, multiple steps/ patient understanding of portion of tiers distribution region)
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Inefficiencies Improvement in Decreases in time Reduced time and Governmental Transportation across different transportation and cost for cost of agencies; supply inefficiencies tiers of the supply among central medicines to transportation. chain managers; might be countrychain including warehouses and arrive at Reduced stock-outs.
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From page 65... ...
Inefficiencies Complementary Competition Improved Governmental Presence of across different and/or multiple resulting in lower efficiency and agencies; supply complementary or tiers of the supply procurement prices associated availability of chain managers; other procurement chain, including agencies.c,d,g with medicines. Reduced manufacturers; agencies might be multiple steps/ procurement.b,c,d,f,g, stock-outs.a,b,c,d,e,f,g,h distribution country h layers.a,b,c,d,e,f,g,h centers; private specific.b,d,g,h distributors.b,g,h 65
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Long procurement Early and frequent Improved Reduced lead-time Public Integrated lead times with consultations with transparency with for procurement, procurement information little transparency manufacturers.c,d,f, all eligible stock-outs and agencies; system across g,h of the suppliers. Ability overstocking.
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From page 67... ...
Long procurement Increased working Timeliness of Agency is able to Central banks; N/A lead times with capital funds for procurement pay for desired Ministry of little transparency national medicine initiation and medicines when Finance; World of the supply prepayment.c,d,f,g procurement is Bank; IFC.c,g,h procurement agencies.b,c,g optimal. Reduction process.a,b,c,d,e,f,g,h in financial approval-related delays in ordering.b,g a e Atalay Alem Mamuye Mussie b f Tarun Dua Ismet Smaji c g Mapoko Ilondo Prashant Yadav d h Jafary Liana Paul Zintl 67
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