In Ghana, the country’s more than 23,000 nurses and pharmacists work on the frontline of the health supply chain. They are the final link in the chain of workers, who make sure that medicines and other health supplies are available for patients and clients who need them. As such, their logistics skills are vital for keeping the shelves stocked with lifesaving health commodities.
Health workers and logisticians have historically received most of their logistics training after they enter the workforce through what is known as in-service training (IST). However, because IST is costly and often must be repeated as workers change jobs, new and more sustainable ways of training the logistics workforce are needed.
In 2007 the USAID | DELIVER PROJECT began to develop a new approach to preparing health workers and logisticians for the supply chain management tasks that are often part of their jobs. The project launched a pre-service training (PST) program to work with universities and colleges in low- and middle-income countries to introduce courses in supply chain management. So far, 11 countries have initiated new courses and strengthened existing curricula, including Ethiopia, Ghana, Mozambique, Nicaragua, Nigeria, Tanzania, Malawi, Pakistan, Rwanda, Zambia, and Zimbabwe.
Ghana, which was added to the program in 2013, has embraced PST for all nurses and pharmacists in schools across the country. Supply chain training is available as part of the curriculum in all three universities that offer a pharmacy degree and in 109 nursing and midwifery schools, as well as four other health institutions. By October 2015, an estimated 21,800 nursing and midwifery students will have received formalized supply chain management training, which far exceeds the 600 or so nurses and midwives reached annually through in-service training workshops and on-the-job training. Pharmacy students have received supply chain management training since 2014, with approximately 440 students graduating each year.
If PST remains in place, an estimated 133,440 students will have graduated with supply chain management training by 2020, providing a growing health workforce qualified to manage the supply chain for the drugs and other health supplies they will need for patients. The cost savings of such an approach can be significant. In a 2014 study of the PST program in Ethiopia, the results showed that the cost of training a health worker using IST was six times greater than training a graduating student using PST. Even when factoring in that not all students would end up working in the public sector, the approach would be a valuable alternative. Over time, PST can also help solidify supply chain management as a foundational part of the health system, rather than an afterthought.
Ghana’s swift integration of SCM in the schools of higher education is not typical. It often takes years for schools and governments to make the transition from IST to PST, and advocacy is key in garnering support from these institutions. In the case of Ghana, the schools were going through a reform process, and lecturers and administrators were ready for new ideas. Schools of pharmacy were introducing a Pharm D degree and nursing schools were reviewing and upgrading their curricula.
To fully integrate new SCM learning and effective teaching practices, the project provided assistance for curriculum review and development, trained lecturers and instructors, donated teaching materials, and is currently providing some follow-up support. These efforts are helping to ensure that future SCM courses can be taught without project support, supporting the country ownership of its supply chain capacity building while empowering both lecturers and students.
SCM courses for pharmacy students are now more rigorous with in-depth focus on core supply chain topics and hands-on training and field visits that prepare the students for the real life situations they will face when graduating. Nurses and midwives also have better SCM training, and SCM topics are now included in their national exit exam.
While PST can take a long time to catch on, countries ultimately benefit by building centers of SCM knowledge within their own schools and universities and having a sustainable source of health professionals qualified to ensure that needed drugs and supplies are available. A new cadre of health workers with a high level of understanding of SCM will positively influence the availability of health supplies and the quality of health care for years to come.
Learn more about the USAID | DELIVER PROJECT’s work in the Ghana: Future Healthcare Workers Diversify Skillset to Reduce Stockouts case study.