Zambian MOH Essential Zambian MOH Essential Drug Logistics System Drug Logistics System

November November 20092009

s

HIV test 2006-8

Laboratories 2007-9

OI

MalariaED/OI/Malaria/FP 2009-2011

Zambian people

ARVs 2006

Zambian MOH Essential Drug Logistics Zambian MOH Essential Drug Logistics System System

Test two different logistics system models to Test two different logistics system models to select one (or a combination/variation) that can select one (or a combination/variation) that can be rolled out nationally, in order to significantly be rolled out nationally, in order to significantly

improve the availability of essential drugs at improve the availability of essential drugs at service delivery sites.service delivery sites.

GoalGoal of the Pilot of the Pilot

JSI

TO1 – PEPFARTO1 – Family Planning

TO1 – MCHTO3

World Bank

Crown Agents

World Bank

Pilot Funding SourcesPilot Funding Sources

The Pilot Logistics System -The Pilot Logistics System -Similarities with Earlier SystemsSimilarities 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 ModelsThe Pilot Models

System A

• District Store remains as stockholding point

• MSL supplies a consolidated order every month to district stores

System B

• District Store converted to cross-docking point

• MSL supplies goods packed for individual facilities to districts

VSVS

Key Pilot ActivitiesKey Pilot Activities

J09 F M A M J J A S O N D J10 F M J09 F M A M J J A S O N D J10 F M

Baseline study

Adapting

central level

software

37 workshops to train 668 participants

Hiring of commodity planners,

supervisors,and data

specialists

MoH-led stakeholders

System Design

Workshop

Training Training of of

trainerstrainers

Implementation with monitoring & supervision

Final Evaluati

on

Stock OutsStock Outs DHOs vs Health Facilities DHOs vs Health Facilities

Baseline January 2009

Pilot trainings through Sept 2009 37 trainings and 668 participants

An estimated 170 trainings for 3,400 An estimated 170 trainings for 3,400 participants participants

will be needed for national roll outwill be needed for national roll out

Reporting RatesReporting Rates

The 73.9% reporting rate at the The 73.9% reporting rate at the beginning of the pilot was mainly beginning of the pilot was mainly due to the due to the intensive training intensive training given given to facility staff.to facility staff.

The improved reporting rates are The improved reporting rates are helped by continuous helped by continuous monitoring, monitoring, supervision & follow up of facilities supervision & follow up of facilities in the pilot.in the pilot.

AmoxicillinAmoxicillin

CondomsCondoms

BenzylpenicylinBenzylpenicylin

Depo-ProveraDepo-Provera

Selected products reportedSelected products reportedstock out trendsstock out trends

CTXCTX

AL 4*6AL 4*6

Key ChallengesKey Challenges

• Full supply principal: ensure timely, Full supply principal: ensure timely, reliable, sufficient & quality productsreliable, sufficient & quality products

• Sufficient, quality storage spaceSufficient, quality storage space• Dedicated logistics vehiclesDedicated logistics vehicles• Funding & availability of fuelFunding & availability of fuel• Dedicated district pharmacist Dedicated district pharmacist

technicians (use of commodity planners) technicians (use of commodity planners) • Availability of candidates for training Availability of candidates for training

with the minimum skills required at with the minimum skills required at HC/HP levelHC/HP level

• Attrition rate of trained staffAttrition rate of trained staff

Cost Scenarios (estimated)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 BenefitsExpected 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 accessto essential health services.