On a documentation tour of Nigeria earlier this month, I visited sites in four states plus the capital, Abuja, to document the progress of SCMS and find out how well the country is doing in managing its public health medicines and other supplies. The tour was a study in contrasts: One state boasts a central medical store that is ISO Certified and has a computerized system that helps manage inventory and orders. Nearby, a private hospital has a small, well organized and air-conditioned room dedicated to the storage of AIDS medicines. On the other hand, in a neighboring state, the central medical store lacks even basic equipment. Its dedicated staff, after a recent SCMS training in warehouse management, is taking a first step to improve their operations by requesting wooden pallets to reduce the risk of water damage to boxes that currently sit on the floor.
In Nigeria, a PEPFAR implementing partner picks up a shipment of HIV test kits from SCMS’s local distribution center Photo credit: David Fombot
A highlight of my trip was a visit to the warehouse in Abuja that was built with private funds to support coordinated “pooled” procurement by some 20 President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partners (IPs). Operated in a partnership between RTT, a South Africa-based company (also an SCMS team member organization), and MDS, a Nigerian company based in Lagos, the facility is a fully equipped pharmaceutical compliant warehouse. The day I visited, the loading dock was a hub of activity. Several IPs – Institute of Human Virology, Nigeria, Partners for Development and Vanderbilt/Friends in Global Health and AXIOS—were picking up their bi-monthly supply of HIV test kits.
The warehouse also stores life-saving anti-retroviral medicines as part of the coordinated procurement program led by SCMS to forecast needed quantities for commodities and then procure them at the best value from international suppliers.
As I entered the warehouse from the loading dock I found a facility operating at its maximum capacity of 768 pallet spots. Modern racking was filled with pallets of medicines and test kits while a forklift operator was busy rearranging stock to make better use of space. Clinton Foundation Health Access Initiative, and UNITAID are also using the facility after seeing the success of the PEPFAR/USAID-funded program. Management of the warehouse is currently considering leasing additional warehouse space to meet the increasing demand.
The innovative pooled procurement program started about three years ago and has been a notable success. Working together, IPs prepared a forecast of ARVs and developed a supply plan for the Country Operational Plan. The quantification exercise provided IPs the first aggregate figure, $105 million, for total ARV needs for the coming budget year. During quarterly meetings, IPs share information on their current stock of commodities and their anticipated future needs based on data from their respective sites. SCMS processes the information and provides a comprehensive report to IPs, the Government of Nigeria and USAID.
Coordination among IPs has improved greatly over time. At first, SCMS played an advocacy role; encouraging IPS to redistribute stock among each other to avoid stocking out or risk expiration. Now, SCMS simply provides the information in a report. IPs then review the information and proactively approach each other with offers to share or requests for needed commodities with SCMS continuing to monitor this activity. The results have been impressive: Since May of 2010, partners have transferred at least $2.1 million in ARVs among themselves to prevent stockouts and expiries. Every dollar saved can be reinvested in PEPFAR’s and USAID’s life-saving HIV/AIDS program in Nigeria. From the money saved by preventing costly emergency orders and loss through wastage, to the benefits of coordinated distribution, Nigeria’s approach to pooled procurement shows how patients benefit when partners work together for the good of all.