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Lesego A, Were LPO, Tsegaye T, Idris R, Morrison L, Peterson T, Elhussein S, Antonio E, Magwindiri G, Dumba I, Mtambirwa C, Madzikwa N, Simbi R, Ndlovu M, Achoki T. Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study. BMC Health Serv Res 2024; 24:557. [PMID: 38693548 PMCID: PMC11061988 DOI: 10.1186/s12913-024-11028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system. METHODS This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 - 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis. RESULTS Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period. Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices. CONCLUSION It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.
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Affiliation(s)
- Abaleng Lesego
- Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya
| | - Lawrence P O Were
- Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya
- Department of Health Sciences & Department of Global Health, Boston University, Boston, U.S.A
| | - Tsion Tsegaye
- Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya
| | - Rafiu Idris
- Global Fund to Fight AIDs, Tuberculosis and Malaria, Geneva, Switzerland
| | - Linden Morrison
- Global Fund to Fight AIDs, Tuberculosis and Malaria, Geneva, Switzerland
| | - Tatjana Peterson
- Global Fund to Fight AIDs, Tuberculosis and Malaria, Geneva, Switzerland
| | - Sheza Elhussein
- Global Fund to Fight AIDs, Tuberculosis and Malaria, Geneva, Switzerland
| | | | | | - Ivan Dumba
- National Pharmaceutical Company of Zimbabwe, Harare, Zimbabwe
| | | | - Newman Madzikwa
- National Pharmaceutical Company of Zimbabwe, Harare, Zimbabwe
| | - Raiva Simbi
- National Pharmaceutical Company of Zimbabwe, Harare, Zimbabwe
| | - Misheck Ndlovu
- Medicines Control Authority of Zimbabwe, Harare, Zimbabwe
| | - Tom Achoki
- Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya.
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Lesego A, Tsegaye T, Were LPO, Sakvarelidze G, Garg S, Morrison L, Nigussie S, Githendu P, Achoki T. Assessment of the Global Fund-supported procurement and supply chain reforms at the Ethiopian Pharmaceuticals Supply Agency: a mixed-methods study. BMJ Open 2023; 13:e073390. [PMID: 38101834 PMCID: PMC10729206 DOI: 10.1136/bmjopen-2023-073390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) partnered with the Ethiopian Pharmaceutical Supply Agency (EPSA) in 2018-2019 to reform procurement and supply chain management (PSCM) procedures within the Ethiopian healthcare system. This assessment sought to determine the impact of the reforms and document the lessons learnt. DESIGN Mixed-methods study incorporating qualitative and quantitative analysis. Purposive and snowballing sampling techniques were applied for the qualitative methods, and the data collected was transcribed in full and subjected to thematic content analysis. Descriptive analysis was applied to quantitative data. SETTING The study was based in Ethiopia and focused on the EPSA operations nationally between 2017 and 2021. PARTICIPANTS Twenty-five Ethiopian healthcare decision-makers and health workers. INTERVENTION Global Fund training programme for health workers and infrastructural improvements OUTCOMES: Operational and financial measures for healthcare PSCM. RESULTS The availability of antiretrovirals, tuberculosis and malaria medicines, and other related commodities, remained consistently high. Line fill rate and forecast accuracy were average. Between 2018 and 2021, procurement lead times for HIV and malaria-related orders reduced by 43.0% relative to other commodities that reported an increase. Many interview respondents recognised the important role of the Global Fund support in improving the performance of EPSA and provided specific attributions to the observed successes. However, they were also clear that more needs to be done in specific critical areas such as financing, strategic reorganisation, data and information management systems. CONCLUSION The Global Fund-supported initiatives led to improvements in the EPSA performance, despite several persistent challenges. To sustain and secure the gains achieved so far through Global Fund support and make progress, it is important that various stakeholders, including the government and the donor community, work together to support EPSA in delivering on its core mandate within the Ethiopian health system.
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Affiliation(s)
| | - Tsion Tsegaye
- Ethiopian Procurement and Supply Agency, Addis Ababa, Ethiopia
| | | | - George Sakvarelidze
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Sunil Garg
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Linden Morrison
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | | | - Patrick Githendu
- The Global Fund to Fight AIDS Tuberculosis and Malaria, Grand-Saconnex, Switzerland
| | - Tom Achoki
- Africa Institute for Health Policy, Nairobi, Kenya
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Kaplan WA, Cellini CM, Eghan K, Pilz K, Harrison D, Wirtz VJ. Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities. J Pharm Policy Pract 2023; 16:60. [PMID: 37131256 PMCID: PMC10153779 DOI: 10.1186/s40545-023-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. METHODS A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including 'patient-centered' pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. RESULTS From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public-private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. CONCLUSION Public-private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.
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Affiliation(s)
- Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Carlotta M Cellini
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Kwesi Eghan
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA
| | - Kevin Pilz
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Denise Harrison
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
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Boakye G, Gyedu A, Stewart M, Donkor P, Mock C, Stewart B. Assessment of local supply chains and stock management practices for trauma care resources in Ghana: a comparative small sample cross-sectional study. BMC Health Serv Res 2021; 21:66. [PMID: 33441147 PMCID: PMC7805234 DOI: 10.1186/s12913-021-06063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care. METHODS Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability. RESULTS There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3-57 vs 0-9 stock-outs, respectively; p = 0.05), duration of stock-outs (median 171 vs 8 days, range 51-1268 vs 0-182 days, respectively; p = 0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p = 0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r2 = 0.72; p value for each covariate between 0.17-0.34). CONCLUSIONS Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.
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Affiliation(s)
- Godfred Boakye
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Ghana Armed Forces, Accra, Ghana
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Melissa Stewart
- Foster School of Business, University of Washington, Seattle, USA
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Harborview Injury Prevention & Research Center, Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Barclay Stewart
- Harborview Injury Prevention & Research Center, Seattle, WA USA
- Department of Surgery, University of Washington, Seattle, WA USA
- Department of Surgery, Division of Trauma, Burn and Critical Care Surgery, UW Medicine, Harborview Medical Center 325 9th Ave, Box 359796, Seattle, WA 98104 USA
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Hasselback L, Dicko M, Viadro C, Ndour S, Ndao O, Wesson J. Understanding and addressing contraceptive stockouts to increase family planning access and uptake in Senegal. BMC Health Serv Res 2017; 17:373. [PMID: 28549472 PMCID: PMC5446687 DOI: 10.1186/s12913-017-2316-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Senegal’s government has pledged to reduce contraceptive stockouts, which have been frequent in public sector health facilities. An innovative distribution system called the Informed Push Model (IPM) addresses supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators. Following promising pilot results, Senegal’s Ministry of Health and Social Action committed to a three-year (2013–2016) expansion of IPM to all public health facilities nationwide. Methods From August 2014–July 2016, IPM’s six logisticians made 29,319 visits to restock public sector health facilities. During these regular facility visits, the logisticians conducted a physical inventory to flag contraceptive stockouts (no usable stock of any single method available) and asked facility staff to identify the primary reason for documented stockouts. Our descriptive study examines stockout trends over the course of IPM scale-up. We also describe trends in contraceptive consumption over the three-year period using facility-level data collected by the logisticians. Results Contraceptive consumption rose by 91% over 35 months in the first three IPM regions, and by 118% in the next five regions (over 26 months). After scale-up to 1,394 health facilities, nationwide consumption rose by 48% over one year. On average, logisticians documented stockouts at fewer than 2% of facility visits. In comparison, two pre-IPM studies in 2011 identified stockouts of selected modern contraceptives at 60–70% of facilities visited, with 84% of clients reporting stockouts in the past year. Six factors (including consumption spikes, IPM-preventable causes, and community outreach) explained most remaining stockouts. Conclusions IPM has been highly successful in ensuring full availability of contraceptives across regions and health facilities. The model also has facilitated the flow of essential data on consumption and stockouts from facilities up to district, regional, and central-level managers. These achievements highlight the relevance of professionalizing supply chain management while continuing to mitigate stockouts through enhanced stakeholder communication and improved training, coaching, and supervision of third-party logistics operators. Supply reliability is critical in shaping demand for and regular use of contraception. The government is transitioning the IPM to full management by the National Supply Pharmacy.
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Affiliation(s)
- Leah Hasselback
- Formerly IntraHealth International, Sacré Cœur Cité Keur Gorgui, derrière siège, SONATEL Lot R73, Dakar, Senegal
| | - Modibo Dicko
- IntraHealth International, Sacré Cœur Cité Keur Gorgui, derrière siège, SONATEL Lot R73, Dakar, Senegal
| | - Claire Viadro
- IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC, 27517, USA
| | - Soussaba Ndour
- IntraHealth International, Sacré Cœur Cité Keur Gorgui, derrière siège, SONATEL Lot R73, Dakar, Senegal
| | - Oumy Ndao
- IntraHealth International, Sacré Cœur Cité Keur Gorgui, derrière siège, SONATEL Lot R73, Dakar, Senegal
| | - Jennifer Wesson
- IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, NC, 27517, USA.
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