Sinette Goosen Supply continuity for malaria programs during the COVID-19 crisis

Each year, on World Malaria Day we evaluate how new developments in the market can help supply chain stakeholders improve the outcomes of malaria programs in low-and middle income countries.

This year, we look at the impact of supply chains on malaria programs through the lens of the COVID-19 pandemic.

We know that the already fragile humanitarian- and public health supply chains will come under increased pressure owing to the global measures that have been implemented to curb the spread of COVID-19. Even with risk mitigation measures in place, supply chain stakeholders in the public sector will have to dramatically improve coordination to ensure access to malaria prevention, diagnosis and treatment services is not compromised by the efforts to limit the spread of the new disease1.

For humanitarian- and public health supply chains improved coordination means:

  • increased engagement among stakeholders,
  • expanding supply sources through prequalification,
  • creative problem solving,
  • leveraging alternative modes of transport, and
  • sharing more resources and assets.

Through efforts to better coordinate, organizations have the opportunity to showcase their expertise in supply chain- and risk management, by proactively advising clients such as principal recipients, and government procurement units, on how to best adjust their forecasting, procurement, warehousing, and logistics activities to minimize stockouts during the COVID-19 pandemic.

From a supply chain, and procurement perspective, there are several key activities (downstream and upstream) that are typically implemented as a standard practice to prevent stockouts, but one such activity that stood out to us –  in the face of COVID-19 –  is supplier diversification. In line with this, we found two recent global malaria commodity sourcing developments to be especially relevant during these crisis times.

These developments include:

  1.   New additions to the World Health Organization (WHO) list of prequalified in vitro diagnostic products2 to offer a wider range of fit-for-purpose testing products (for varying epidemiological situations), and to mitigate over-reliance on single products and/or suppliers.
  2. Changes to operational guidance from the Global Fund to Fight AIDS, Tuberculosis and Malaria to make competitive bidding of malaria rapid diagnostics tests (MRDTs) a standard practice thereby reducing the instances of single sourcing3.

More prequalified MRDTs

Since 2018, the WHO updated the list of prequalified in vitro diagnostic products to include a wider range of malaria diagnostic products from four suppliers with production facilities across India and South Korea.  Please see Table 1 below for products and manufacturers.

Table 1: Additional MRDTs included in the WHO prequalified list4

MRTD ManufacturerProduction siteYear of prequalification
STANDARD Q Malaria P.f/P.v Ag
SD Biosensor, Inc.South Korea2020
STANDARD Q Malaria P.f Pan
Ag Test
SD Biosensor, Inc.South Korea2020
STANDARD Q Malaria P.f Ag
SD Biosensor, Inc.South Korea2020
AdvDx Malaria Pf Rapid Malaria
Ag Detection Test
Advy Chemical Pvt Ltd.,India2019
Alere Malaria Ag P.fStandard Diagnostics, Inc.South Korea X 2 sites2019
First Response®Malaria Ag. P.f./P.v. Card TestPremier Medical CorporationIndia2019
First Response® Malaria Antigen P. falciparum (HRP2) Card TestPremier Medical CorporationIndia2018
First Response® Malaria Ag. pLDH/HRP2 Combo Card TestPremier Medical CorporationIndia2018
First Response®Malaria Ag. P.f./P.v. Card TestPremier Medical CorporationIndia2018
SD BIOLINE Malaria Ag P.f/P.f/P.vStandard DiagnosticsSouth Korea2018

In general sourcing terms, a wide and diverse supplier base, and product range, translates to less risk, more competition, and more opportunities for a healthy market. A practical approach for mitigating sourcing risk suggests that two suppliers are used, with meaningful quantities allocated to both  (at least 25% of orders to each), and that the suppliers’ manufacturing, warehouse and distribution sites are not all in the same region5.

Under normal global trading conditions, one would say that there is sufficient diversity in the ranges of malaria tests, manufacturers, and production sites, especially when taking the Global Fund’s list of approved MRDTs6 into consideration as well. However, under the unique circumstances of global lockdown measures, even the most logical and practical of sourcing strategies are tested to their limits; and there is already evidence of the strain in the market.

For example, the Global Fund has already reported moderate risk for the delivery of diagnostics products, mainly because of the COVID-19 lockdown in India. However, the donor also stated that there will be some supply continuity thanks to the geographical diversity of suppliers (in their case Thailand, China and South Korea). This is testament to the importance of having production sites in various regions.

Further, a Notice of Concern has recently been issued to one of the prominent global suppliers of MRDTs. In cases like this, where one supplier’s stock is temporarily affected, it is critical that enough alternative sources are available.

For PFSCM, it is important that this market remain vibrant and healthy, and advocates that malaria initiatives remain a priority to suppliers upstream. From the Ebola outbreak in West Africa from 2014 to 2016, we have learned that one cannot neglect existing health programs when new disease outbreaks strike. For example, during the peak of the Ebola outbreak, stockouts of rapid diagnostics tests were reported8, and the malaria mortality rate increased and surpassed Ebola deaths9.

More suppliers at the table

As mentioned above, having multiple suppliers in various locations, not only ensures supply continuity, but also promotes innovation, drives competition, and builds local economies10 (in the case of local sourcing).

In line with this, another positive development that is bringing more suppliers to the table of malaria programs, is the Global Fund’s update to its Operational Guidance for Procurement of Malaria Rapid Diagnostic Tests.

The update to the guidance, which was confirmed in November 2019, will promote competitive bidding for diagnostics becomes the standard practice; ending the option for countries to single source. In the past some countries did single sourcing of MRDTs as product training across all health facilities and malaria programs were aligned or standardized. Health care workers were thus trained on one main type of MRDT product. Sourcing from multiple suppliers could have possibly negatively impacted health program outcomes during that time.

Malaria tests have now become so similar in use and function, that they are considered interchangeable.

Last year, the Global Fund determined that countries have demonstrated effective use of multiple types of RDTs (targeting the same species) at the same time, and thus training and supervision should be independent of product brand to ensure health workers are able to use the product(s) available at any given time.

Again, from a supply chain and procurement perspective, we welcome this development. When it comes to a practical approach, competitive bidding has many benefits. PFSCM has first-hand experience in this. For us, competitive bidding is considered a standard practice.

An example of the effectiveness of competitive bidding comes from within our own organization. In 2018, we achieved significant cost savings in excess of $800 000, for the procurement of a large order of MRDT kits for an East African country.

The savings came to light after PFSCM proposed competitive bidding for the order of 307,469 packs comprising 25 MRDT kits each. The shipment, comprising more than 10, 40-foot containers, was also tendered to ensure the best delivery and service is achieved.

Table 2: Advantages and disadvantages of competitive bidding

Stimulates healthy market dynamics for best pricing and service levels.More procurement effort.
Reduced risk of production delays, recalls and quality issues.Multiple in-country registrations.

Table 3: Advantages and disadvantages of single sourcing

Good supplier relationships.Lack of market competition could affect pricing and service levels.
Less procurement effort.Risk of production delays, recalls and quality issues.
Long-term forecast and planning for improved production scheduling and framework agreements.
Once-off, in-country registration.


When it comes to MRDTs, countries will continue to procure tests based on the epidemiologic context of malaria in that country, and in alignment with national treatment guidelines and WHO policy. Therefore, it is especially important that enough affordable, high-quality same species and multi-species tests are available and prequalified.

Having enough products prequalified, is only one effort to limit supply risk. The procurement strategies, such as competitive bidding versus single-sourcing, also need to be in place to make sure countries, and procurement agencies, can access these products in an affordable manner.

By prequalifying more products, the WHO is improving the resilience of sourcing strategies for malaria diagnostics, and by encouraging competitive bidding the Global Fund is helping international and local markets grow.

Malaria programs will continue to face uncertainties, and pressure in the face of COVID-19, but by acting upon lessons from the past, and planning for the future, supply chain stakeholders can coordinate their efforts to limit stockouts and ensure the fight to end malaria is not overshadowed by COVID-19.


  1. WHO Epidemics
  2. WHO Diagnostics
  3. The Global Fund Procurement
  4. WHO Prequalification List
  5. Harvard Business Review
  6. The Global Fund Prequalification List 
  7. The Global Fund COVID-19 Response
  8. PLOS ONE Journal
  9. The Global Fund COVID-19 Response Peter Sands
  10. JAGGAER Procurement

Sinette Goosen World AIDS Day 2019: Supply Chains in the Fight to End HIV/AIDS

The Partnership for Supply Chain Management (PFSCM) was established to improve and strengthen supply chains and health systems to bring lifesaving HIV diagnostic, prevention, and treatment products to countries with a high number of HIV infections.

PFSCM set up shop in 2005 when the HIV crisis was at its peak with more than 30 million people infected on the African continent alone. For over a decade the organization executed one of the largest public heath supply chains in history, making a lasting impact in the lives of millions of people.

Today, the fight to end HIV is still at PFSCM’s core, and each year on World AIDS Day, we reflect on the importance of public health supply chains in ensuring:

  • HIV and other healthcare commodities reach the point of care, on time and in full.
  • Best-value, and best-quality products are procured to make available funds go further.
  • Recipients have access to value-added rental agreements that enable them to use the best in diagnostics, medical devices, and laboratory equipment, at a reduced total cost of ownership.
  • Infrastructure, such as storage facilities, are developed along the supply chain to ensure compliant pharma-grade storage of products.
  • Chain of custody is enforced through technology that captures information about shipment location, product integrity, and patient consumption.
  • Ethical practices are upheld in all phases of the supply chain to reduce waste, and prevent counterfeit products from entering the supply chain.

Today, PFSCM also reflects on a decade’s worth of work in supporting one of the biggest donor-funded projects on the globe.

Over the last 10 years, PFSCM has:

  • Procured and delivered $2.9 billion worth of HIV commodities – including test kits, condoms and antiretrovirals (ARVs) – to low- and middle-income countries helping diagnose, prevent and treat HIV.
  • Procured enough of the bestselling one-a-day ARV product to treat at least 11.4 million people for a year.
  • Seen the cost of the top procured one-a-day ARV treatment drop from around $17 per unit in 2010 to below $6 in 2019.
  • Purchased more than 2.6 million boxes of the bestselling HIV rapid diagnostic test (HRDT) kit. Enough to test 260 million people once.
  • Seen the cost of the bestselling HRDT kit decrease from around $111 in 2010 to around $82 in 2019.
  • Delivered more than 10940 shipments of HIV products to over 70 countries. Countries that procured most HIV commodities: Malawi, Tanzania, Mozambique, Uganda and Nigeria.

PFSCM Perspective: Procurement, Quality Assurance and Logistics

PFSCM buys HIV commodities from the leading global suppliers of diagnostic and pharmaceutical products, ensuring reliable quality, and supply.

Our suppliers have either been approved by a Stringent Regulatory Authority (SRA) or prequalified by the World Health Organization (WHO).

PFSCM also prequalifies suppliers to maintain and grow a supplier network for our clients. Our prequalification audits cover aspects of the WHO’s cGMP and “A Model Quality Assurance System for Procurement Agencies” (MQAS).

Further, we work closely with country recipients and manufacturers to facilitate forecasting and demand discussions for better production and storage planning.

For example, earlier this year, PFSCM was alerted of the tragic HIV outbreak in a poor southeastern town in Pakistan. We reacted promptly to release extra, and emergency shipments of HRDTs and ARVs needed to test and treat hundreds of people – mostly children.

PFSCM’s procurement unit worked closely with various vendors to determine- and release available stock, and plan for the immediate replenishment to supply the new and ongoing orders to Pakistan.

PFSCM also collaborated with the donor and recipient country to clear the waivers as soon as possible. Overall, PFSCM’s freight estimation and purchase order was prepared in only two hours and the supply- and waiver lead time was reduced by 7 to 10 days.

In terms of storage planning, PFSCM has continued to make a notable impact in Uganda in 2019.

In Uganda — one of the top countries for the procurement of HIV products — PFSCM entered a public-private partnership to manage a transit warehouse which takes pressure of the Central Medical Stores (CMS). Products are moved to the transit warehouse before further distribution to the CMS, this prevents products overstaying at ports of arrival and accruing demurrage and detention costs.

The facility has been a great solution for the storage of large amounts of HIV commodities arriving in Uganda. In 2019, Uganda acquired more than $60 million worth of HIV commodities through PFSCM, and over the last 10 years the country purchased almost $360 million worth of products.

In addition, PFSCM participates in global meetings such as the WHO suppliers’ gatherings, the ARV Procurement Working Group and the Global Accelerator for Paediatric Formulations, to stay abreast of developments and treatment guidelines in the HIV sector, while contributing to the development of policies for best procurement practices that drive optimal public health program outcomes.

Most recently, PFSCM strengthened its expertise in areas related to self-testing, medical devices, early infant diagnosis, laboratory equipment, and viral load testing.

A new chapter

For the last 10 years, PFSCM served as the procurement services agent for ARVs for the Global Fund to Fight AIDS, Tuberculosis and Malaria’s Pooled Procurement Mechanism (PPM).

In September this year, PFSCM retired as the PSA for ARVs, and was awarded new product categories:

  • Rapid diagnostic tests (HIV and malaria)
  • Viral load and early infant diagnosis tests
  • Other diagnostics
  • Laboratory and medical supplies and equipment

PFSCM has extensive experience managing these product categories, which are among the most complex health products to source, procure, transport, and store.

Between 2006 and 2016, PFSCM and its partners collaborated to manage the procurement and distribution of laboratory commodities for The President’s Emergency Plan for AIDS Relief’s Supply Chain Management System.

During this time, PFSCM procured more than $500 million worth of laboratory items, developed an innovative laboratory quantification tool, facilitated training courses for laboratory staff, and vetted local vendors for in-field office managed procurement, among other technical support services.

In the meanwhile, we have been procuring various rapid diagnostic tests kits for the Global Fund PPM, and have also procured many non-pharma and laboratory products for both PPM and non-PPM clients.

PFSCM still procures and ships ARVs globally for other clients, and remains an expert supply chain manager in this field.


Sinette Goosen World Malaria Day 2018: Reflecting on the public health supply chain with a focus on IRS

Globally, the efforts to end malaria in endemic, high-burden countries are vast and ongoing.

The fight against malaria brings together thousands of entities, from researchers, manufacturers, governments, and funders, to humanitarian groups and non-government organizations (NGOs). Supporting these institutions in their work is a myriad of interwoven service providers (SPs), executing many unseen tasks.

Among these SPs is the public health supply chain, working diligently to ensure:

    • Best value and quality products are procured to make available funds go further.
    • Commodities reach the point of care, on time and in full.
    • Infrastructure, such as storage facilities, are developed along the supply chain to ensure compliant pharma-grade storage of products.
    • Chain of custody is enforced through technology that captures information about shipment location, product integrity, and patient consumption.

On World Malaria Day 2018, the Partnership for Supply Chain Management (PFSCM) reflects on some of its most recent successes achieved in sourcing and moving complex and sensitive malaria commodities to some of the hardest-to-reach places on earth.

Sourcing and moving malaria commodities: IRS focus

PFSCM has been procuring and delivering malaria commodities for the Global Fund to Fight AIDS, Malaria and Tuberculosis since 2009.

Since then, more than 1,600 shipments of malaria commodities, worth more than $527 million, have been delivered to more than 45 countries for the Global Fund.

Commodities include artemisinin-based combination therapy (ACT), malaria rapid diagnostic tests (MRDTs), insecticide-treated bed nets and indoor residual spraying (IRS) products.

In recent years, PFSCM has refined and streamlined processes for the procurement and delivery of IRS products specifically.

IRS in a nutshell
Indoor Residual Spraying (IRS) is the application of long-acting chemical insecticides on the walls and roofs of all houses and domestic animal shelters in a given area, in order to kill the adult vector mosquitoes that land and rest on these surfaces.

The primary effects of IRS toward curtailing malaria transmission are:

  • To reduce the life span of vector mosquitoes so that they can no longer transmit malaria parasites from one person to another;
  • and to reduce the density of the vector mosquitoes.

In some situations, IRS can lead to the elimination of locally important malaria vectors. Some insecticides also repel mosquitoes and, by so doing, reduce the number of mosquitoes entering the sprayed room, and thus human-vector contact.

In terms of IRS, PFSCM mostly procures and ships a World Health Organization Pesticide Evaluation Scheme (WHOPES)-approved long-lasting microencapsulated formulation of the organophosphate insecticide, pirimiphosmethyl. The product is specifically designed for use in IRS programs to provide up to one year’s residual control of mosquitoes and other public health pests. It is effective against pyrethroid resistant Anopheles, Aedes, and Culex species.

PFSCM Senior Procurement Specialist Martin Mugisha says the procurement and shipping of IRS products comes with unique challenges, especially for public health supply chains.

“The sensitivities relating to IRS products are intertwined. These include complex sampling; pre-shipment inspection and quality control testing processes; relabeling; multiple shipments owing to the hazardous classification of products; limited delivery periods to various developing countries; constraints in order placement; and a lack of awareness and education about the role supply chains play in supporting IRS programs.”

Quality control testing, sampling, and pre-shipment inspection: Product quality is of utmost importance to PFSCM, and quality control batch testing is continuously undertaken.

PFSCM works with a WHO-prequalified laboratory in Belgium to execute the critical batch testing, which is especially important for pirimiphosmethyl — although pirimiphosmethyl is a trusted product, quality testing is done on each batch, owing to the hazardous classification of the product.

Further, quality assurance measures include sampling and pre-shipment inspections often undertaken by renowned inspection, verification, testing, and certification company Standard Global Services (SGS).

Sampling and/or pre-shipment inspections may be pursued at SGS’s own discretion, or as a result of a client request or a specific country requirement.

These safety measures are essential in safeguarding humans and the environment. By managing the quality testing process firmly and partnering with world-class laboratories, PFSCM reduces the cost and lead time of quality testing.

Relabeling for country-specific languages: Another important IRS supply chain activity is the translation of user directions and relabeling of the products. This ensures that country-specific language pairs — such and English and French, and English and Portuguese — are clear and accurate for safe and easy use by spray operators and others involved.

This process requires specialized outsourced services, which are undertaken at the manufacturing facility and coordinated by the procurement agent.

Moving hazardous products: The WHO has classified pirimiphosmethyl as a Class U product, meaning it is unlikely to present acute hazard to humans and the environment. Pirimiphosmethyl presents no significant risk to spray operators or householders when used as directed.

However, for the shipment of large quantities of the product, regulations pertaining to the shipment of hazardous cargo need to be followed. These requirements increase the complexity of the shipping procedure and may result in several vessels being used per order to comply with the allowable amount of dangerous goods per ship.

PFSCM has longstanding agreements with reputable freight forwarders who have extensive experience in managing hazardous cargo in a safe and cost-effective manner.

Time-sensitive products: IRS products need to be delivered before the spraying seasons start. Spraying usually occurs before the rainy seasons, and provisions for the in-country distribution and spray operator training need to be made.

PFSCM actively engages with stakeholders to align processes for smooth delivery of goods.

Constraints in order placement: Forecasting and order placement at the in-country level can be challenging, especially when data is in short supply and resources limited. Accurate forecast data plays a crucial role in manufacturer production scheduling and stockholing.

Improved forecasting data generates market confidence and encourages vendors to enter into long-term agreements with SPs, thereby also ensuring that recipients can enjoy better product pricing and stable supply.

The procurement agent and supply chain SPs need to be flexible and agile in responding to the consumption patterns of public health supply chains in developing countries, and need to drive advancements in this area for optimized spend.

Lack of awareness about the role of supply chains: Stakeholders need to be educated on the importance of collaboration, especially where roles start overlapping. Quick execution of waiver applications, accurate monitoring of warehouse capacity, and attention to details such as the availability of staff for unloading cargo can make a significant impact on a project.

In the public supply chain space, PFSCM often acts as advisor and educator, traveling to engage with stakeholders in person, to ensure all parties understand their roles and are equipped to fulfil their responsibilities.

“Having navigated these challenges and barriers for some years, PFSCM has become an expert in the field of IRS procurement logistics,” notes Mugisha.

Adapting to an ever-changing malaria environment
The malaria landscape is evolving, with drug and pesticide resistance, diminishing funding, environmental concerns, counterfeit and stolen goods, and a need for increased supply chain efficiencies driving new treatment innovations.

With new innovations, the supply chain will need to adapt and gear up for temperature-controlled conditions for new vaccines, while contemplating how new biomedical nanotechnology drug delivery systems will impact on the future of public health supply chains and patient care.

Working with SGS

PFSCM and SGS have a well-established business relationship, with SGS playing a key role in PFSCM’s operations for over a decade now.

SGS facilitates the pre-shipment inspections and sampling of IRS products as per client or country requirements.

In 2018, PFSCM and SGS again had the opportunity to share knowledge and engage about ways of streamlining quality assurance systems in the unique IRS environment.

The collaboration has proven exceptionally fruitful ahead of a major consignment of IRS products due for delivery to Mozambique by mid-2018.

Mugisha explains that stakeholder engagement such as this has been essential in orchestrating complex IRS deliveries.

“IRS shipments comprise many individual processes and products, and therefore the harmonious alignment of QC testing and pre-shipment inspection is critical to ensure the order not only arrives on time, but also in its entirety,” stresses Mugisha.

He adds that direct insight into the specialized tasks managed by SGS, as well as continuous interaction, has helped PFSCM simplify quality assurance procedures to reduce lead time, proactively manage risks, and, ultimately, ensure that the most critical logistics step is well executed.

Further, the efficiency of the quality assurance process is also accelerated by reputable vendors offering excellent quality products.

“The outstanding track record of the pirimiphosmethyl we procure is a contributing factor to the success we have had in reducing quality assurance lead time,” notes Mugisha.

Proactive approach in harmonizing major 2017 IRS deliveries to Mozambique

In 2017, PFSCM made inroads in engaging with IRS program stakeholders and aligning various parallel processes for the shipment of IRS products to Mozambique.

In August 2017, PFSCM orchestrated the delivery of a large consignment of IRS commodities to be used in the Mozambique Ministry of Health’s IRS campaign, which took place around October 2017.

The milestone consignment of 33 containers was shipped via 3 ports of entry, across more than 2,000 km, to 7 regional warehouses in Mozambique.

PFSCM Senior Logistics Services Specialist Jerome Sabatier says it was critical that the shipments were delivered on time, that sufficient compliant storage was available in all seven regions, and that the quality sampling and logistics was done in a cost-effective manner.

“This shipment entailed many complex facets. To save time and money, we conducted the product quality testing early in the preparation phase and tendered part of the shipment to save about $50,000. Apart from this, we anticipated that poor infrastructure, language barriers, and bureaucracy would likely attribute to the complexity of distribution.”

Sabatier explains that PFSCM took a proactive approach to solving the logistics challenges and visited several of the designated warehouses, ports, and in-county stakeholders to ensure all requirements were met before the 33 containers of IRS were delivered.

Further, PFSCM also greatly improved supply chain communication channels by building rapport with in-country stakeholders, such as the logistics SPs, agents, warehouse managers, and other institutions.

“Through the in-country groundwork, we avoided many pitfalls, such as incorrect delivery addresses, availability of labor for offloading at warehouses, and import waiver delays.”

The team not only succeeded in ensuring successful deliveries, but also managed to create awareness about the importance of this malaria prevention project and the shipment of commodities that make it possible.

By sharing their expertise and conveying a genuine sense of responsibility, the PFSCM team motivated the various stakeholders to uphold the same level of ownership.

Price reduction to yield future savings

Meanwhile, earlier in 2017, PFSCM negotiated a 17% price reduction on pirimiphosmethyl. Prior to these negotiations, the pricing for this IRS commodity had remained the same since 2014.

The price reduction is expected to yield significant savings on future procurements and will contribute to saving more lives.

Applying refined strategies for IRS to Mozambique in 2018 and expanding into Zimbabwe

In 2018, PFSCM will again deliver a large consignment of IRS products to Mozambique.

In total, 27 containers will be delivered to 3 provinces in preparation for the spraying season, which is again due to start in October.

In addition, an order of 10 containers will also be delivered to Zimbabwe.

For these shipments, PFSCM will leverage the groundwork done and relationships built in 2017 and will again:

  • Actively engage with stakeholders; and
  • Reassess warehouses inspected in 2017.

This year, PFSCM has already achieved major successes by saving $133,000 on ocean freight cost through spot-bidding and strategizing with SGS.

Navigating the Sahel region with SMC products
At the start of 2018, PFSCM received a large order for seasonal malaria chemoprevention (SMC) commodities to be delivered to Africa’s Sahel region between July and September 2018. SMC is a relatively new, highly effective intervention to prevent malaria in children under five years of age, those most vulnerable to the disease’s effects.

SMC is a complete treatment course of amodiaquine plus sulfadoxine-pyrimethamine (AQ+SP), which is administered in up to four monthly doses to children aged 3 to 59 months during the peak malaria transmission season (July to December) in the Sahel region.

The $5 million project will see 15 million co-blisters of AQ+SP procured and distributed to three African countries: Burkina Faso, Chad, and Nigeria. More than 3 million infants and children will likely benefit from this preventive treatment in these regions in 2018.

PFSCM Senior Client Account Manager Eva van Tol says this is an exciting and challenging project for PFSCM. In Burkina Faso and Chad, products will be delivered to a central location, from which further distribution will be undertaken by PFSCM partners, such as CAMEG. In Nigeria, PFSCM will leverage its in-country expertise to assist the Malaria Consortium with in-country distribution. The products are procured as part of the ongoing ACCESS-SMC prevention program, which is a UNITAID-funded project led by the Malaria Consortium in partnership with Catholic Relief Services.


Sinette Goosen A look at the supply chain implications of TB regimen changes

Even though tuberculosis (TB) is a curable disease, it is still, according to the World Health Organization (WHO), responsible for 4,500 deaths a day.

The reasons behind this are complex and interwoven, ranging from educational and social issues, to a lack of early detection and missed detection opportunities, combined with long diagnostic processes and increasing drug resistance, among others.

Massive global endeavors to address the ever-evolving challenges through research, development, and investment are ongoing. One area of focus for the WHO and global stakeholders is the development of simpler-to-use drugs and treatment regimens that will encourage higher treatment adherence and simplify logistics, while reducing drug resistance.

In 2018, the WHO has already released some new recommendations and treatment guidelines for drug-resistant tuberculosis. These will be incorporated into the Consolidated Guidelines for Treatment and Care of Drug-resistant TB later this year.

Commitment and accountability to manage transition of the TB supply chain

The Partnership for Supply Chain Management (PFSCM)’s Global Supply Chain Director Wesley Kreft says public health supply chains can lead in the fight to end TB through commitment to — and accountability for — effective regimen transitions.

“It is normal for health programs to change — in fact, it is essential to ensuring successful outcomes in changing global markets and environments. The problem is that public health supply chains face unique challenges that often make quick implementation of changes difficult.”

Two such challenges are:

  • The time it takes to make and implement decisions in the public health supply chain; and
  • The operational and logistical weaknesses that hamper flexibility.

According to a report co-authored by PFSCM partner organization Management Sciences for Health (MSH) and entitled Tuberculosis regimen change in high-burden countries, countries committed to considering a change spend about one year on decision making and about two years to roll out or implement changes.

The report — which was compiled after conducting 166 interviews with country stakeholders in 21 of the 22 TB high-burden countries — also found that stakeholders are more often concerned with the program-based implications (logistics and cost) of the change than they are with the patient-focused implications (side effects).

Kreft explains that several logistics and cost factors — such as accurate forecasting, proper phasing out of old and excess products, availability of quality local sources, and uncertainties about future product pricing — need to be addressed during a transition.

He adds that these factors can be difficult for public health supply chains to manage when working with limited resources.

However, Kreft stresses that there are key principles that can be followed to aid in efficient transitions.

1. Preparing and closely monitoring the supply chain

To successfully implement new regimens, the supply chain must align with program changes to ensure proper budgeting, demand forecasting, supply planning, and procurement.

“Regular small orders need to be placed in the introduction phase, and stock and consumption need to be closely monitored to ensure all patients on old regimens can complete their treatment, while enough stock is already available for those newly diagnosed patients. The overlap of these activities should also be finely tuned to ensure as little stock destruction as possible. It is a sensitive process that has both advantages and disadvantages tied to the nature of the TB regimen.”

2. Minimizing risks through vendor pre-qualification and engagement, accurate forecasting, demand planning

Further, Kreft adds that there is also a risk that countries may return to old regimens if new products cannot be produced locally at reasonable prices, local product quality does not meet international standards, or global supply cannot meet demand.

To minimize these complications, it is important for countries to assess the suitability of local sources early in the transition and to determine how national and international guidelines can be harmonized to ensure local economic growth and regulatory compliance.

The challenge is balancing the need for “buying local” with the obligation toward international quality standards.

Countries are always battling the cost-quality dilemma, but pre-qualification groundwork can help governments to bridge the gap between in-country and international regulatory commitments, notes Kreft.

Further, accurate forecasting, demand planning, and vendor engagement is essential to ensure suppliers keep up with demand.

3. Supporting countries that will transition from donor support

In addition, in cases where countries are receiving highly subsidized or free products, there is a risk that the products may become too expensive when countries graduate from donor-funded programs.

“It is important that clear stakeholder engagement is maintained and that agreements or contingency plans are in place for countries with limited budgets or expected future financial constraints.”

Kreft concludes that bringing together multi-sectoral expertise may help countries respond faster to treatment guideline and regimen changes, thereby increasing commitment and accountability in the fight to end TB.