The World Bank, The UK Department for International Development, and USAID recently released the results of a logistics pilot project in Zambia, in which the availability of various medical supplies was improved. This is the first of a three-part series in which I talk with two of the team members and finish with some personal reflections. In this first article in the series, I interview Monique Vledder, senior health specialist at the World Bank and supervisor of the project.

AHL: Could you tell us a bit more about the background of this project? Why was it initiated?

MV: We have been involved in supporting the government to implement malaria prevention programmes like bednet distribution in Zambia since 2005. However, over the course of our programmes we realised that, although the government was quite successful in preventing malaria, the people who still were infected could not get adequate treatment due to a lack of malaria treatment drugs at the rural health centres. Our analyses showed that those drugs were available at the central level and district level; but somehow they did not arrive at the health centres. Clearly, there was an issue with the supply lines between MSL (the central medical store), the districts, and the centres. We partnered with other major donors like the UK and US governments as well as JSI and Crown Agents as implementers, and with MIT to ensure academic support. Our joint analysis pointed towards placing commodity planners at the district level as the most promising option. When we discussed this with the Zambian government, we were given a strong commitment for for a pilot project to try this out.

AHL: So what exactly did the pilot entail?

MV: The pilot included 24 districts, 8 of which were used as controls (continuing the use of the ‘old’ system), and in 16 districts we implemented either of two models. Those 24 districts represent about a quarter of the whole country, so especially for a pilot project we had very good coverage. Model 1 involved the placement of a commodity planner at each of the districts. Their tasks were to facilitate communication with the health centres about commodity needs and levels and to prepare orders to MSL. Once the orders were filled and had arrived at the district warehouse, they would also be responsible for packing and dispatching the orders to the health centres.

Model 2 was very similar to model 1, but in this model the separate orders for the health centres would already be collated at the central level and would arrive pre-packed at the district level; the commodity planner was only responsible for preparing the order and for forwarding the packed order to the health centres.

AHL: And the results?

MV: They were spectacular, especially in the districts that used model 2. For example, availability of the main drugs for artemisin-based combination therapy (ACT) improved from an average of about 50 per cent to nearly 90 per cent. If we would extrapolate this to the whole country, this alone would prevent more than 16,000 deaths a year. But, of course, the effects have been much wider than just ACT; although the commodity planners concentrated on malaria supplies, availability of other supplies like antibiotics and contraceptives has increased as well.

When I started on this project, I did not know much about the logistics side of public health, but these results have made it very clear to me how important supply chain management really is for the people’s health.

AHL: So what do these results mean for other programmes? And perhaps other countries?

MV: Of course you cannot translate the results one-on-one to other programmes or settings, but what this trial has made clear is that a relatively modest investment in supply lines can deliver spectacular results. In most developed countries, supply chain management takes up more than ten per cent of the cost of the supplies themselves; in Zambia this was less than half that percentage. Whether you should aim for a similar proportions as in developed countries remains an open question, but it seems to be clear that a modest increase could lead to greatly improved health outcomes. However, I must say that we have not yet finalised our cost-effectiveness analyses; although it was fairly easy to to quantify the extra costs involved, it was not so easy to calculate cost savings, e.g. in model 2 the cost of labour that was no longer needed for repacking at the district level. Nevertheless, even if the cost savings turn out to be very modest, we expected that the improved access to medication and the resulting lives saved would make it more than worthwhile.

I think it is important in this sense to think of integrated supply lines. Although this project was initiated as part of the malaria support, the focus was on supporting the supply of all essential drugs.The results for other pharmaceuticals as for example antibiotics or contraceptives was positive as well. I think that shows that we could make even more gain if we could move away from the disease-based silos and work on approaches to strengthen an integrated supply chain

AHL: What happened after the trial ended? Are the commodity planners still active?

MV: Yes, they are; and, in fact, the districts that were not included in the trial as well as the model 1 districts were so impressed with the results that they are now requesting the country-wide implementation, and the Ministry of Health now has committed to a phased roll-out across all districts.

AHL: This project involved a large number of partners: besides the World Bank, people from DFID, USAID, JSI, Crown Agents, MIT, and of course the Zambian national and district governments were involved. Was it difficult to coordinate such a big group of actors?

MV: I think we were lucky in that that Zambian government gave us a clear commitment and took ownership of the pilot. What also helped was that we all had fairly clearly defined and complementary roles with a minimum of overlap. Thirdly, sufficient funding for the whole project duration was safeguarded from the start. And finally, monitoring and evaluation were integrated into the trial from the start, making it possible to present a result that could be accepted by all parties. All this meant that we could work very well together with a minimum of conflicts; it also meant that we could draw upon each other’s strengths to get things done.

[Image: Malaria dreams by Ashley Jonathan Clements. Some rights reserved.]

Related Posts

1. The Zambian logistics pilot project (II)
2. How to get things done: more on the logistics of logistics

• Crown Agents are looking for senior procurement specialists for their office in Arlington VA (USA) and Malawi; procurement specialists for Mongolia and Malawi; an ARV logistics officer for Botswana; a procurement consultant for Tanzania; a supply chain operations manager for Malawi; an SCMS deputy country director for Rwanda; a logistics assistant for their office in London (UK); public procurement advisors for several countries; and a team leader for Malawi
• Save the Children is looking for an operations director, a senior procurement specialist and two roving logistics specialists for Haiti; a senior manager procurement, contracts and compliance for the West Bank/Gaza; and two senior logistics specialists to be based in Washington DC (USA).
• Maxwell Stamp is looking for a project costing and procurement specialist for Laos
• UNICEF is looking for a procurement assistant for their office in Geneva (Switzerland), a contracts officer for their office in Copenhagen (Denmark), and a supply and logistics specialist for North Korea. Sorry, no links, they still hide their vacancies behind a registration process.
• DanChurchAid is looking for a field logistics officer for Katanga (Congo DRC).
• Merlin is looking for deputy logistics coordinators for Côte d’Ivoire and Congo (DRC); a logistician for Congo (DRC); logistics managers for South Sudan, Kenya, Pakistan, Congo (DRC), and the Central African Republic; a logistics/administration officer for Gode (Ethiopia); senior logisticians for Grand Kru and  Montserado (Liberia); and a surge logistics officer for South Sudan.
• JSI is looking for a deputy chief of party SCMS for Nigeria.
• Concern Worldwide is looking for a transport manager for Haiti; an assistant country director systems for Afghanistan; and a general systems manager and a logistics and administration coordinator for Zambia.
• The IRC is looking for logistics managers for Congo (DRC) and Haiti.
• The IFRC is looking for a trainee logistics delegate for based in Kuala Lumpur (Malaysia), an operation coordinator for Guatemala, a head of support services based in Panama City (Panama), a procurement delegate for Haiti, and a senior procurement officer based in Geneva (Switzerland).
• MSH are looking for a senior program associate – supply planning/MIS/M&E for Bangladesh.

[Image: Job opportunities by Coffeechica. Some rights reserved.]

Related Posts

1. Latest job opportunities (May 4, 2010)
2. Latest job opportunities (May 12, 2010)
3. Latest job opportunities (February 28, 2010)

• Mary’s Meals are looking for a logistics manager for Malawi.
• Oxfam GB is looking for a logistics coordinator and a procurement manager for Haiti; and an HSP supply and logistics coordinator (based in their HQ in England).
• IMC is looking for a logistics manager for Haiti, an operations manager for Sudan, and a logistics coordinator for Congo (DRC).
• UNICEF is looking for a logistics manager for Haiti.
• MSH are looking for a technical deputy director for Bangladesh.
• UNFPA is looking for a humanitarian logistics specialist, based in their HQ in New York (USA).
• ACTED is looking for a country logistics manager for Sudan, country logistics & security managers for Chad and Iraq, a logistics intern for Chad, and a pharmaceutical procurement manager for their HQ in Paris (France).
• JSI is looking for a deputy chief of party SCMS for Nigeria, and a supply chain advisor intern.
• Solidarités are looking for a logistics coordinator for Kenya/Somalia; a logistics support officer and a logistician for Haiti; and a flying logistician based in their HQ in France.
• Merlin is looking for a supply chain manager for Pakistan.
• Creative Associates International is looking for a procurement manager for Sudan.
• The British Red Cross is looking for logistics and procurement delegates for Bangladesh and Haiti.
• PSI are looking for an associate procurement & logistics officer, a procurement & logistics officer, and a voluntary pooled procurement & logistics officer, all for their HQ in Washington, D.C. (USA)
• The PNG Advisory Support Facility is looking for a procurement manager and operations advisor.

[Image: Job opportunities by Coffeechica. Some rights reserved.]

Related Posts

1. Latest job opportunities (February 28, 2010)
2. Latest job opportunities (June 11, 2010)
3. Latest job opportunities (May 4, 2010)