Lessons Learned: Strengthening Laboratory

Supply Chains

August 16, 2006Ronald Brown, MA, CLS(NCA), CHE, MT(ASCP)

JSI/DELIVER Country Experience

• Countries of work: Ghana, Kenya, Uganda, Zambia

• Interventions include: – Laboratory Services and System Assessments, – Logistics System Design and Rollout, – Forecasting and Quantification, – Standardization, – Procurement, – Donor Collaboration

I. Assessments of laboratory systems are critical for identifying areas for improvement and serve as a baseline for monitoring.

• In one country, the assessment enabled stakeholders to:

– Identify key policy issues requiring attention, including roles and responsibilities for procurement and distribution of lab supplies.

– Develop a costed implementation plan that identified funding implications and gaps associated with each scenario.

II. Stakeholder collaboration through a coordinating body can reduce duplication and maximize limited resources.

• In another country, a national laboratory technical working group composed of MOH, donors, NGOs/FBOs, and other stakeholders developed an operational plan that:– outlines each stakeholder’s current

and planned activities,

– will be used to monitor progress,

– will serve to help mobilize resources

III. Standardization of laboratory techniques and tests is key for effective supply management.

• Standardizing laboratory procedures by level is critical for:

– accurate quantification and procurement

– efficient and effective management of lab supplies and supply chains

– development of a system-wide quality assurance schemes

• The standardization process should be representative and consultative to ensure effective implementation

Benefits of Standardization • In one country, the standardization process involved

representatives from all levels in the system and resulted in:

– Reduction of the number of items in the system by 10 fold

– Definition of standard operating procedures for testing services, instrumentation by level, and procedures for logistics management

– Efficiency and economy of scale in procurement of supplies for CD4 count, ALT, Creatinine testing

– Opportunity for an external QA program

IV. In the absence of usage data, service statistics data should be used for quantification and procurement

• In two countries where usage data was not available for quantification:

– Standardization of the test menu, techniques and supplies was conducted

– The number of supplies necessary for each test, service statistics and adjustments for stockouts were used to estimate needs

– Results of the quantification were used for national procurement decisions

V. Systematically designing a logistics system is a necessary step in enhancing availability of laboratory supplies

• In another country a key system design decision was to link procedures for ordering and resupply to logistics reporting, thus increasing the likelihood of reporting rates

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