Life-saving supply chains help reduce malaria deaths

A joint project of the World Bank and the Zambian government is helping to improve the availability of life-saving drugs at remote clinics. Countries like Zambia, which are working to provide quality health care, often face bottlenecks in keeping remote health clinics stocked with essential medicines, according to Daphna Berman, a communications consultant for the Strategic Impact Evaluation Fund at the World Bank. “This isn’t necessarily because they can’t afford sufficient drugs and supplies,” she writes in a World Bank post. “Delivery may be stymied by bad roads and poor communications systems. Or the distribution process may have been established for a centralised system and can no longer keep pace with the growth in clinics in faraway settlements. “Zambian officials faced these problems first-hand a few years ago when they realised that life-saving malaria medicines weren’t getting to remote, rural clinics. As a result, deaths from malaria were not dropping despite the availability of treatments. Working with the World Bank, Zambian health authorities piloted different distribution strategies through a programme that led to the restructuring of the supply chains to clinics. Now more than one third of the country’s 74 districts operates under a new distribution system which allocates drugs according to need. John Bosco Makumba, an operations officer in the World Bank’s Zambia office, is quoted as saying that the logistics challenge – apart from poor roads that slow down trucks to less than 500 kilometres a day – was the logistics “push” system used by the government. The government supplies identical health centre kits to all clinics regardless of the epidemiological profile, which means that an area that is malariaendemic gets the same amount as areas with fewer cases – or even none at all. This approach leads to shortages in some areas and overstocks in others. Other logistics challenges include insufficient storage facilities. The government doesn’t have sufficient staff to run supply chain management, and so pharmacists – and as it is, there aren’t enough of them – are left to handle health logistics for their districts. Despite these challenges the rerouting of drugs to clinics where they are needed has resulted in a reduction in malaria deaths. A “hybrid” system which combines a demand-driven (pull) approach with the existing “push” model is now being implemented. However, the success of the programme has resulted in a new challenge, according to Makumba – there is now a greater demand for the drugs, which in turn is raising the costs of distribution and storage to provide drugs in the deep rural areas. The programme is now focusing on improving transport and storage of the drugs, most of which are temperature and time-sensitive.