GAVI Study – Outsourcing the Distribution Component of Vaccine and Medicine Supply Chains

This report focuses on how to outsource the physical distribution of vaccines and medical products to a private sector Logistics Service Provider (LSP) in sub-Saharan Africa. It analyses existing approaches to outsourcing, the challenges encountered and lessons learned.
A number of outsourcing examples have been identified within the focus countries of Uganda, Zambia, Mozambique, Senegal, Nigeria, Ghana, Kenya, Tanzania and Malawi. These are primarily for the distribution of ambient medical products and are often funded by, or supported with Technical Assistance (TA), from donors. Many are elements of vertical supply chains and some are part of the government operated Central Medical Store (CMS) supply chain. There are just two examples of outsourced vaccine logistics that have been identified, a public private partnership in South Africa, and one in Nigeria.
Many government supply chains are operating with limited transport capacity, which limits their ability to make last mile deliveries, and results in health workers collecting commodities from the next tier in the supply chain.
Outsourcing is often used as a means to improve efficiencies, access new capabilities or access additional capacity, and has proven successful in the majority of cases. Outsourcing is also an option when financing for an asset is not available which this is becoming an increasingly important issue now as donors are reluctant to pay for warehouses and trucks for Central Medical Stores. Task-shifting (the reallocation of duties in order to allow organisations to focus on their core mission) is another reason to outsource. Despite the successes there are still are host of barriers and challenges, which limit further progression in some countries, and for some organisations.

At the end of a piece of work such as this there are always a large number of people that have provided support and information to enable the necessary outcomes to be achieved. It is impossible to name them all but we freely acknowledge our debt to everyone that helped us to complete this programme of work.
In particular we also acknowledge the time offered and input provided by those at the front line; those working in the Ministries of Health and Central Medical Stores of our focus countries who took time out of their busy days to speak with us, and on whose shoulders the health of nations rest. A special thank you to all those who participated in our interviews, often at short notice and over a crackly line, for sharing their time and expertise so freely. Where no specific reference is provided the insight can be directly attributed to them. We would like to take this opportunity to thank the members of the GAVI Private Sector Working Group for their guidance.
This was a broad study, undertaken in short timelines and we have been unable to get input from everyone that we wanted to, simply due to practicalities and other commitments. Yet we have compiled a worthwhile report which we hope will be of practical benefit to all interested parties, whether government organisations, NGO’s, donors or private sector LSPs.