Transcript Zambian MOH Essential Drug Logistics System

Zambian MOH Essential
Drug Logistics System
November 2009
Zambian MOH Essential Drug Logistics System
ED/OI/Malaria/FP
Malaria
2009-2011
OI
Laboratories 2007-9
HIV test 2006-8
ARVs 2006
Zambian
s
people
Goal of the Pilot
Test two different logistics system models to select one
(or a combination/variation) that can be rolled out
nationally, in order to significantly improve the
availability of essential drugs at service delivery sites.
Pilot Funding Sources
JSI
TO1 – PEPFAR
TO1 – Family Planning
TO1 – MCH
TO3
World Bank
Crown Agents
World Bank
The Pilot Logistics System Similarities with Earlier Systems
• Uses a Max/Min Inventory Control System (pull
system)
• Collects dispensed to user data, stock on hand,
and losses/adjustments from every site in the
system, and sends the data to the Logistics
Management Unit at MSL
• Follows a monthly reporting/ordering period
• Distribution of products is integrated with other
products on the MSL trucks going to the
districts and hospitals
The Pilot Models
System A
• District Store
remains as
stockholding point
• MSL supplies a
consolidated order
every month to
district stores
System B
VS
• District Store
converted to crossdocking point
• MSL supplies
goods packed for
individual facilities
to districts
Key Pilot Activities
Baseline
study
Training
of
trainers
Adapting
central
level
software
J09
F
M
Hiring of
commodity
planners,
supervisors,
and data
specialists
MoH-led
stakeholders
System Design
Workshop
Final
Evaluation
37 workshops to train 668
participants
A
M
J
J
A
S
O
N
D
J10
Implementation with monitoring & supervision
F
M
Stock Outs
DHOs vs Health Facilities
Baseline January 2009
80%
70%
60%
50%
40%
30%
20%
10%
0%
DHO stock
out
HC Stock out
Pilot trainings through Sept 2009
37 trainings and 668 participants
An estimated 170 trainings for 3,400 participants
will be needed for national roll out
Reporting Rates
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
The 73.9% reporting rate at the
beginning of the pilot was mainly due to
the intensive training given to facility
staff.
The improved reporting rates are helped
by continuous monitoring, supervision &
follow up of facilities in the pilot.
Apr-09
May-09
Jun-09
Jul-09
Aug-09
Selected products reported
stock out trends
Amoxicillin
Benzylpenicylin
CTX
Condoms
Depo-Provera
AL 4*6
Key Challenges
• Full supply principal: ensure timely, reliable,
sufficient & quality products
• Sufficient, quality storage space
• Dedicated logistics vehicles
• Funding & availability of fuel
• Dedicated district pharmacist technicians
(use of commodity planners)
• Availability of candidates for training with
the minimum skills required at HC/HP level
• Attrition rate of trained staff
Cost Scenarios (estimated)
• Current costs to sustain the 16 pilot districts
July to December 2010: USD 300,000
• MSL additional costs to sustain MSL only
activities for all districts: (4% current +)
– Version A = 0,5% of stock throughput
– Version B = 1% of stock throughput
• Cost of CP’s and vehicles all districts
– 2% of stock throughput
• Other countries in region range from 7 to
12% of stock throughput for logistics
activities (district level only)
Expected Benefits
Addresses 2 key priorities in the Fifth National
Development plan (FNDP) on essential drugs:
• To ensure availability of adequate, quality,
efficacious, safe and affordable essential drugs
& medical supplies at all levels, and
•To significantly improve availability, distribution
& condition of essential infrastructure &
equipment so as to improve equity of access
to essential health services.