Zambian MOH Essential Drug Logistics System

1. Zambian MOH Essential Drug Logistics System November 2009

2. Zambian MOH Essential Drug Logistics System ED/OI/Malaria/FP 2009-2011 Malaria OI Laboratories 2007-9 HIV test 2006-8 ARVs 2006 s Zambian people

3. Goal of the Pilot Test two different logistics system models to select one (or a combination/variation) that can be rolled out nationally, in order to significantly improve the availability of essential drugs at service delivery sites.

4. Pilot Funding Sources JSITO1 – PEPFARTO1 – Family PlanningTO1 – MCHTO3World BankCrown Agents World Bank

5. The Pilot Logistics System -Similarities with Earlier Systems • Uses a Max/Min Inventory Control System (pull system) • Collects dispensed to user data, stock on hand, and losses/adjustments from every site in the system, and sends the data to the Logistics Management Unit at MSL • Follows a monthly reporting/ordering period • Distribution of products is integrated with other products on the MSL trucks going to the districts and hospitals

6. The Pilot Models • System A • District Store remains as stockholding point • MSL supplies a consolidated order every month to district stores • System B • District Store converted to cross-docking point • MSL supplies goods packed for individual facilities to districts VS

7. Key Pilot Activities Baseline study Training of trainers MoH-led stakeholders System Design Workshop Adapting central level software Final Evaluation 37 workshops to train 668 participants J09 F M A M J J A S O N D J10 F M Implementation with monitoring & supervision Hiring of commodity planners, supervisors, and data specialists

8. Stock Outs DHOs vs Health Facilities Baseline January 2009

10. Pilot trainings through Sept 2009 37 trainings and 668 participants An estimated 170 trainings for 3,400 participants will be needed for national roll out

11. Reporting Rates The 73.9% reporting rate at the beginning of the pilot was mainly due to the intensive training given to facility staff. The improved reporting rates are helped by continuous monitoring, supervision & follow up of facilities in the pilot.

12. Selected products reported stock out trends Benzylpenicylin CTX Amoxicillin AL 4*6 Depo-Provera Condoms

13. Key Challenges • Full supply principal: ensure timely, reliable, sufficient & quality products • Sufficient, quality storage space • Dedicated logistics vehicles • Funding & availability of fuel • Dedicated district pharmacist technicians (use of commodity planners) • Availability of candidates for training with the minimum skills required at HC/HP level • Attrition rate of trained staff

14. Cost Scenarios (estimated) • Current costs to sustain the 16 pilot districts July to December 2010: USD 300,000 • MSL additional costs to sustain MSL only activities for all districts: (4% current +) • Version A = 0,5% of stock throughput • Version B = 1% of stock throughput • Cost of CP’s and vehicles all districts • 2% of stock throughput • Other countries in region range from 7 to 12% of stock throughput for logistics activities (district level only)

15. Expected Benefits • Addresses 2 key priorities in the Fifth National Development plan (FNDP) on essential drugs: • To ensure availability of adequate, quality, efficacious, safe and affordable essential drugs & medical supplies at all levels, and • To significantly improve availability, distribution & condition of essential infrastructure & equipment so as to improve equity of access • to essential health services.