Following an announcement made in March 2017, the US Agency for International Development (USAID) launched a CFA24bn (€36m) programme to strengthen Côte d’Ivoire’s health care supply chain management system. Known as Integrated Health Supply Chain Technical Assistance (IHSC-TA), the programme aims to increase the capacity of supply chain managers, and support the collection, use and analysis of data for planning, decision-making and problem resolution in the delivery of health care products.
The IHSC-TA programme is set to run until March 2022, building upon the work of USAID’s previous Supply Chain Management System, which came to an end in November 2016. The project is set to be headquartered in Abidjan, with regional offices in Abengourou, Bouaké, Gagnoa and Man, and implemented by international development company Chemonics.
IHSC-TA will echo improvements that were made to the health sector’s supply chain management system over the past few years, as a result of efforts by both internal and external actors. Following a review of the previous public health supply chain body, the New Pharmacy of Public Health ( Nouvelle Pharmacie de la Santé Publique, Nouvelle-PSP) was established in November 2013 to manage the availability, procurement and delivery of necessary medication to 82 health districts and about 200 of the largest health care facilities around the country. Nouvelle-PSP has succeeded in securing the supply chain of pharmaceutical products from the point of conception to the initial phase of distribution – that is, to university, district or regional health centres. However, interactions beyond this point – with the end consumer, for example – have yet to be fully regulated. The resulting gap in data collection limits the efficiency of the procurement process, and leads to bottlenecks and the mismanagement of medical products.
As in many markets, technology is playing a key role in improving supply chain management. For example, an electronic system is being rolled out nationwide to help with ordering logistics by providing inventory and consumption information through the use of a single identification number for every product and patient. A 2016 audit by the Global Fund to Fight AIDS, Tuberculosis and Malaria highlighted the increased use of the logistics management information system and health management information system, crediting the tools with increasing the availability and quality of critical health data.
Room For Improvement
The audit also drew attention to some flaws in the current system. It noted the limited role of national disease programmes in overseeing the supply chain – leading to stock levels being out of line with programme data – and a lack of monitoring with regards to product quality, consumption and payment to procurement agents. The report also noted that the Nouvelle-PSP still had a number of significant gaps in inventory control and reporting.
During 2016 a combination of these factors led to several stock-out periods for essential products, including drugs and rapid diagnostic tests for malaria. Fortunately, stock reserves and flexible arrangements at the health facility level ensured that consequences for patients were limited. Poor stock management on the part of the National Tuberculosis Control Programme also led to $65,000 worth of expired medication in 2016. Furthermore, in September 2016 a damaging fire at the Nouvelle-PSP expedition warehouse resulted in the loss of equipment and products awaiting shipment.
Nevertheless, the work of Nouvelle-PSP and assistance from international development agencies has allowed Côte d’Ivoire to make major strides in improving its supply chain management through increased oversight and the expanded use of information systems. The financial and technical support being provided by USAID’s IHSC-TA programme through to 2022 should result in further improvements to the management of health care delivery throughout the country.