Case Study: strengthening health procurement and supply chain management systems in Zimbabwe

UNDP is working in close collaboration with partners and national authorities to strengthen the national supply chain management system for health products in Zimbabwe, including with the national medicines regulatory authorities on quality monitoring and control. This support has formed part of UNDP’s broader health systems strengthening interventions implemented through its partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

Initially, UNDP’s support to the government on procurement and supply chain management (PSM) entailed a range of interconnected activities including:

  • carrying out a comprehensive assessment of the national pharmaceutical supply chain system in 2013 and using the findings to develop a costed action plan;
  • working with the the Ministry of Health and Child Care, the Global Fund Country Coordination Mechanism and key partners to mobilize funding to implement the endorsed costed action plan regularly reviewed;
  • working with the the Ministry of Health and Child Care and partners in developing strong quantification processes for health products through a robust and inclusive quantification working group using well established quantification tools;
  • strengthening health products quality assurance processes and capabilities of the Medicines Control Authority of Zimbabwe (MCAZ);
  • working with the National Pharmaceutical Company (NatPharm)—the central medical store—and in coordination with other development partners to develop their capacity and enhance stock management and optimize their services to the health care system since 2011;
  • carrying out a comprehensive assessment of the medical laboratory supply chain system in 2016 and developing a costed action plan for implementation during 2018-2020;
  • developing a viral load reagent rental agreement strategy for HIV viral load testing with key suppliers of in-vitro diagnostics equipment

Together, this support has promoted the population’s increased access to quality assured essential medicines and other health products for malaria, HIV and tuberculosis, and beyond, and improved the quality of health services.

Additional examples of the support provided for different aspects of the supply chain are described below.

Inventory and distribution: The capacity of both NatPharm and the Ministry of Health and Child Care to store and manage inventory and distribute essential medicines has been developed through:

  • the renovation and building of new NatPharm regional storage warehouses in key provinces such as the regional store in Masvingo;
  • the renovation or construction of new pharmacy stores to improve storage conditions at the Ministry of Health and Child Care service delivery points;
  • the provision, installation and end-users training for two pharmaceutical grade incinerators for waste disposal located in NatPharm stores;
  • the development of a national waste management plan and standard operating procedures
  • collaboration with the Ministry of Health and Child Care and partners to build an eLMIS to ensure supply chain real-time data visibility
  • improvements to cold chain storage and distribution systems through the provision of cold room compressors in the central warehouse, refrigerated trucks and data loggers;
  • the provision of new trucks to NatPharm to imporve the health products distribution services to health facilities;
  • equipment of health facilities with solar power systems ensuring sustainable sources of electricity for cold chain and controlled temperature to store vaccines, medicines and diagnostic tests, and to provide back-up power to the electronic health information system at the health facility level
  • the provision and maintenance of laboratory equipment.

Procedures and systems for inventory management. The infrastructural support has been complemented by improvement of warehouse organizational and operational processes and the development of standard operating procedures for inventory management with the support of a supply chain expert embedded in the NatPharm management team, for technical assistance. Together with other health partners, UNDP is supporting the Zimbabwe Assisted Push System (ZAPS). The system standardizes processes for primary health-care facilities in terms of ordering and receiving the products. The ZAPS support makes essential medicines more evenly available to facilities and hospitals and improves accuracy of supply chain information. The ordering team leaders from the district travel to each health facility should agree on the ordering interval, support the counting of all stock, record losses and adjustments, record days out of stock, calculate quantities required for each product and place orders with NatPharm. The completed orders for all health facilities in the catchment area are sent to the nearest NatPharm branch for processing and the subsequent delivery of orders to individual facilities.

Human resources for PSM. Staff from NatPharm and the Ministry of Health and Child Care have engaged in online postgraduate PSM training, which led to international qualifications. In addition, staff from NatPharm and the Ministry of Health and Child Care have completed training and assessment to obtain accreditation from the Chartered Institute of Purchasing & Supply.

Quality assurance. UNDP has been working with the Medicines Control Authority of Zimbabwe (MCAZ) since 2010 to develop capacity to provide quality assurance of all health products being procured. Through financial support from the Global Fund, UNDP, with partners, has supported MCAZ to improve the infrastructure, equip and develop the capacity of its chemistry laboratory, and obtain the status of a quality control (QC) testing laboratory prequalified by the World Health Organization (WHO) in 2014. MCAZ now acts as a QC laboratory for nationally procured and distributed medicines, and also for other countries in the region that do not yet have a WHO-prequalified laboratory. Since the WHO prequalification of chemistry laboratory, UNDP has been using MCAZ QC testing services to test and monitor the quality of the pharmaceutical products procured with Global Fund grants, in line with the Global Fund quality assurance policy for pharmaceutical products. Consequently, acknowledging the demonstrated competency of MCAZ, UNDP has established a long-term agreement with MCAZ to conduct the QC of medicines for other countries where UNDP acts as interim Principal Recipient for Global Fund grants and/or provides health procurement support.

Pharmacovigilance system strengthening. The pharmacovigilance system was also upgraded for the reporting of adverse drug reactions, from a paper-based to an electronic system through international technical assistance in 2017.

Continued support for the management of health products through UNDP’s long-term partnership with national institutions, the provision of technical assistance and mobilization of donor investments to complement domestic funding for PSM activities has enabled Zimbabwe to demonstrate capacity and leadership towards achieving good-quality pharmaceutical services to the population.

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