The Zambian population most often struggles with diseases such as malaria; opportunistic infections from HIV, such as tuberculosis and pneumonia; and diarrheal diseases. The country’s health facilities need a steady and sufficient supply of medicines for these diseases all year round – they are essential medicines. The Ministry of Health (MOH), with its partners, aims to maintain that secure supply of commodities by procuring the required health commodities in sufficient quantities so that the medicines are available where they are needed, when they’re needed.
To ensure commodity security, there are several systems in place and corresponding activities conducted to procure these essential medicines. The USAID | DELIVER PROJECT and the Supply Chain Management System (SCMS), implemented by JSI, support the MOH in supply chain management of health commodities. The commodity logistics systems are critical in reporting the consumption of commodities at facility level. This data is compiled into reports that are sent to the district and subsequently submitted to the Logistics Management Unit of Medical Stores Limited (MSL). The consumption data is the basis upon which each facility is re-supplied with stock for their patients. With essential medicines, facilities used a health kit, which was a standardized box of medical supplies containing medicines for treating malaria and diarrhea, certain antibiotics, pain killers and surgical supplies. All health facilities received these kits from MSL regardless of the facility’s demand and consumption. This is named a ‘push’ system as commodities were ‘pushed out’ into the facilities.
With the health centre kit system, the consumption or wastage of medical commodities was not reported, which lead to challenges in accounting for stocks. The Essential Medicines Logistics Improvement Programme (EMLIP) was launched in 2009 in 27 districts to address the availability and distribution challenges in the public health sector; the program allowed clearer visibility of commodity supplies at the facility level by enabling health facilities to request and requisition their commodity needs to their district community medical office (DCMO), which then sent the order to MSL to process. In contrast to the old system, this was known as a ‘pull’ system as facilities drew from MSL according to their needs.
However, EMLIP faced some challenges as it rolled out initially, one of them being late procurement of some commodities. This resulted in stock outs at some facilities. To address this challenge, the MOH, with strategic partners such as JSI, designed a hybrid of the pull and push systems; this new system married the strengths of both systems in order to provide a seamless supply of commodities to all health facilities in the country, which in the long-term strengthens the country’s health system. Over time, the MOH will review the Health Centre Kit (HC Kit) to make it more user-friendly for the facility, ensuring only commodities needed by the facilities are kitted.
In the new EMLIP Hybrid System, health centers receive a monthly predetermined quantity of supplies through a baseline kit for essential commodities. The DCMO allocates the kits to each health centre and Health facilities also order supplementary (bulk) supplies through the logistics system. Each health facility is required to submit their monthly report to their DCMO for review and onward submission to MSL, thus reporting the consumption of commodities in the kit and the bulk supply. Districts stores will hold stock of 28 supplementary commodities to supply to the health centre in order to provide equitable distribution of commodities; MOH has set a ceiling on these 28 commodities which will support and address emergency needs.
This key component helps lead to commodity security – the kit ensures a certainty of supplies, yet allows facilities to adjust the commodities they receive by ordering from the supplemental supply. This flexibility can make a big difference in how a facility serves its clients. By having all commodities available in the quantities that they are required, health workers no longer have to wait until a new health kit arrives to dispense the needed drugs; the drugs are readily available.In addition, health workers need not stock up on supplies that are not required in their facility– they can be redistributed to centers needing those stocks, or sent back to the DCMO, thus reducing wastage due to expiry. By reporting consumption of supplies from the health centre kit and from supplemental supply, district and provincial supervisors are better able to plan the needs of their facilities and reduce instances of low stock availability.
The EMLIP Hybrid system will be rolled out to all districts in Zambia starting from June in a phased out approach, and while many health workers still need to be trained in using the system, there is much anticipation as its value in improving the health system is tangible.