Project Summary
The Problem The impact of limited drug availability is clear; treatable illnesses go untreated, the health of the community suffers severely, and progressive development comes to a standstill. In Kano, which has a population of over 9 million, there is one medical store to serve the state. The standard ambulance is a Toyota Hyus and there are just three of these to serve over 600 health facilities. The ambulances serve two main hospitals only and each individual health facility is responsible for collecting its own supplies from Central Medical Stores. The Process Transaid’s role in the consortium was to provide and manage a technical expert to undertake interviews to collect data from key stakeholders. Transaid also advised on the transport and distribution aspects of the study, developing tools for measuring the capacity of government and third party transporters to manage a distribution operation. The project aimed to understand the following: • The key costs of distributing medical goods to from state medical stores to health facilities Partners Massachusetts Institute of Technology (MIT), Village Reach The Results The Impact
Much funding is invested in drug supply chains and the establishment of warehouses for drug supplies in central locations within Nigeria and other developing countries. However, little attention in paid to how these drugs will reach populations who live off the beaten track in that remote ‘last mile’. Therefore, drug supply chain investment to improve the health care of an entire population does not always achieve the desired result. It has been suggested that government drug supply chains could be strengthened if they were supplemented with private sector capacity.
There are very few examples of strong public health supply chains in Africa. However, the private sector is continually able to put consumer goods onto shelves in most rural place which presents opportunities for learning. Poor availability of medical supplies can result from a number of factors including inadequate forecasting, lack of data on products consumed, lack of capacity at Central Medical Stores, funding constraints and lack of operational management. The problem of poor infrastructure including poor quality warehousing and impassable roads is also a factor.
Transaid was contracted as part of a consortium of organisations specialising in drug logistics to carry out research in Kano state, Nigeria to improve drug availability in rural areas. The consortium looked at the existing capacity on the ground and conducted an evaluation of the Central Medical Stores to manage fleets and drug distribution. The quality of small transport operators that could be used for outsourcing was also reviewed. The aim of the project was to provide a framework for distribution and outsourcing recommendations.
• The cost and performance of third party logistics providers to distribute essential medicines throughout the health system.
• Outsourcing opportunities in public distribution systems of essential medicines from the state level to the last mile, and the associated benefits, risks and implications for sustainability.
• The institutional policy and governance arrangements that need to be in place to enable successful outsourcing.
An initial report containing preliminary findings has been produced and submitted to stakeholders who are keen to understand whether the inclusion of private sector elements in the government drug supply chain will lead to a more efficient system. While there seem to be many opportunities to outsource transport, there are relatively fewer opportunities to outsource warehousing due to the quantity and variety of drugs that pass through Central Medical Stores.
Implementation of the findings will result in greater availability of drugs at a lower cost, thereby improving the health of the inhabitants of Kano. The best practice guidelines produced on the outsourcing of medical supplies will be used as a global template by the UK Department of International Development for future projects.
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