Building a Public Health System One County at a Time: Tambura County, South Sudan

South Sudan, Africa’s newest country, is building its public health system from the ground up—from physical infrastructure to a regulatory system. The US Agency for International Development (USAID)-funded Systems for Improved Access toPharmaceuticals and Services (SIAPS) program is working with South Sudan’s Ministry of Health (MoH) to meet the tremendous challenges of creating an entirely new pharmaceutical management system for a population suffering under some of the worst health care conditions in the world.

Push vs. Pull System

In push systems, quantities of supplies and the schedule for their delivery to facilities are determined at a higher level (usually central level with little or no input from lower levels).

In pull systems, facilities provide information on actual consumption and needs estimates to higher levels.

Challenges in South Sudan’s Pharmaceutical Service System

The majority of the South Sudanese population does not have access to modern health services. It has one of the highest maternal and infant mortality rates in the world and its citizens suffer from a variety of infectious and non-communicable diseases. There is little infrastructure and few trained personnel, which is compounded by weak planning and coordinating mechanisms at the state and county levels.

In the pharmaceutical sector there are significant challenges including:

  • Multiple vertical supply chains supported by different donors
  • Complex pharmaceutical supply management system due to uncoordinated parallel procurement systems and/or poor donation practices
  • A push system that results in over and under-supply of some items
  • Weak information management system that does not provide timely and reliable medicine consumption/morbidity data
  • Poor storage facilities and conditions
  • Lack of transport and communication system
  • Shortage of qualified pharmaceutical personnel at all levels
  • Lack of adequate legislation and enforcement mechanism to regulate the practice of pharmacy and assure safety and effectiveness of pharmaceuticals and medical devices

Training Health Care Workers in South Sudan: The Key to Sustainability

Since 2011, SIAPS and its predecessor project have been providing critical training on pharmaceutical management to health workers in the MoH, county health departments, and health care facilities for all ten counties of South Sudan. SIAPS trained health workers to use Project Management Information Systems (PMIS) tools to generate, analyze, and make available information needed to make crucial decisions. Health workers were also trained in using a Logistics Management Information System (LMIS) tool, which works to ensure a continuous supply of drugs by generating reports on:

Drugs dispensed to patients

  • Drug stock balances
  • Stock losses
  • Stock adjustments
  • Drugs received

Tambura County’s Drug Supply: The Right Drugs at the Right Time

Central Medicine Store, Tambura County, South Sudan

Located in Western Equatoria State, Tambura County is poor, remote, and struggling to overcome the effects of decades of civil war.  Yet, finding solutions to complex problems is not new for the people of Tambura County.  When it came time to fix the broken pharmaceutical system, with the help of SIAPS, Tambura County’s health authorities took the initiative to shift away from the push supply system for pharmaceuticals to a pull system.

With SIAPS’s training in pharmaceutical information management tools, each county health department uses the LMIS tool to analyze the data needed to make decisions about inventory and then send the report to the Central Medical Stores in Juba. The pull system allows Tambura County health facilities to prevent accumulation, damage, and expiry of unused medicines and other medical products.  This system also helps health facilities maintain a buffer stock to mitigate the effects of delays from the Central Medical Stores. Tambura County is the only county that has switched to the pull system to date.

Investing in human resources is a key element in building effective and efficient pharmaceutical management systems. Tambura County’s health workers took their SIAPS-sponsored training to the next level of operationalization—building its public health system one county at a time.