As consensus grows for a ‘hot spots’ strategy on HIV, consideration of supply chain implications is crucial

AIDS 2014 is my third International AIDS conference.  For the first two conferences I was working as director of communications for the Supply Chain Management System (SCMC), a project of PEPFAR administered by USAID.  Because of my position on SCMS, I always listened for mentions of supply chain implications of the broad issues being discussed at this global conference;  people often forget that life-saving commodities don’t develop, test, register, market, manufacture, buy and sell, ship, store, and deliver themselves.

Most notable in Mexico City in 2008 was the virtual absence of the topic of supply chain management from the agenda and from remarks made by speakers.  Four years later, however, partly due to the success of SCMS, supply chain management was mentioned time and again by speakers in Washington, DC, in 2012.  Many of those mentions came from US government representatives, including then Secretary of State Hillary Clinton and Global AIDS Coordinator Eric Goosby.

At this year’s conference in Melbourne, I’ve noticed a lack of attention again to supply chain management.  Perhaps that’s because people now take for granted that logistical issues must be taken into account when designing public health responses.  Why mention something that you already know to be true?

I hope that’s the case.  A key discussion point at this year’s conference is the need to be smarter with our HIV investments, focusing our greatest resources on the hot spots of the epidemic: those populations—geographic areas and high-risk groups—most impacted by the disease.  The supply chain implications for these strategies will be huge.  For example, as a country refocuses its response from low-impact geographic areas to high-impact ones, the volume of medicines and other commodities moving to the high-impact areas will grow significantly.  Without proper planning for forecasting and supply planning, warehousing, and distribution, the supply chain could collapse under its own weight.

As we discussed at last night’s satellite event, sponsored by JSI, MSH and Imperial Health Sciences, one way to successfully manage this transition will be to move the responsibility for warehousing and distributing public health commodities from the public sector to the private sector.  A bit surprisingly, our speaker from Zimbabwe, Dr. Owen Mugurungi, Director of STI HIV AIDS and TB of Zimbabwe’s Ministry of Health & Child Welfare, made an impassioned appeal to do just that.

Dr. Mugurungi’s remarks reflect a growing consensus, led by the World Bank and other key partners, that Ministries of Health should get out of the business of supply chain management and contract with the private sector wherever possible and practicable.  Some countries, including Botswana, Cote d’Ivoire, Nigeria and South Africa, are taking steps in the right direction.  I hope that by the time we convene in Durbin for AIDS 2016 that Zimbabwe and other countries will add their names to the ever growing list.

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