SIAPS Voices: How good logistics management strengthens health systems

A Q&A with Alan George, SIAPS technical advisor for supply chain management

How does strengthening pharmaceutical systems make for stronger supply chains? And how does that translate into access to medicines?

Having strong pharmaceutical systems is essential to having an efficient supply chain in the same way that having an efficient supply chain is essential to a strong pharmaceutical system. They are intertwined! You can’t really have one without the other. Sometimes people make the mistake of thinking about the supply chain as if it was only a matter of delivering goods and avoiding stock-outs. It is much more than that. Pharmaceutical systems strengthening and supply chain management have plenty in common. For example:

  • They both have an integral view of an entire system.
  • They both have an effect on the processes, information flows, and funding streams that create value on a product or service, from its design to its delivery to the final user.

Value is defined by the needs of the user/client. So in the case of health care, the user needs the right quantity of the right life-saving medicines of the right quality to be available at the right health facility, at the right time, and at the right price. To achieve this, a health system relies on the supply chain to be efficient, and the supply chain relies on the health system as its enabling environment: good governance frameworks, capable staff, robust information systems, healthy finances, and proper prescribing practices and use of medicines.

Can you give me an example of a SIAPS project in which you participated that shows that relationship?

The first project I worked on with SIAPS took place in the Dominican Republic. We were tasked with evaluating the supply chain of HIV patients’ blood samples and TB patients’ sputum samples for laboratory testing. People usually think of a supply chain as just products and goods. In reality, if there is a demand for anything then most likely there is a supply chain involved. In this case, there are patients who need to have their samples drawn in a health facility and sent to a laboratory for testing, and they need to receive the results of those tests. There had been problems like samples damaged in transportation, delays in the return of test results, and results getting lost on the way.

For that project, we needed to have an integral view of the existing processes, like how patient info is captured in the community; how the samples are drawn, stored, and transported from the health facility; and how the samples are received at the laboratory for testing. We needed to understand the information flow—what patient intake forms exist, which forms are sent with the samples, do receiving forms exist, and which relevant data points are contained in all those forms that would help monitor the efficiency of the system—and the funding streams—What are the costs? Who pays what? We assessed the capacity of the staff who worked with and managed these networks and the general system oversight and governance. Very long story short, we designed improved processes and information flows, determined the costs of the new supply chain, trained users in the new processes, and created standard operating procedures and performance indicators that would help with the oversight and efficiency of the new supply chain.

Alan George

What are some recent big advances in the field?

Supply chain management is always advancing. It’s such a “young” field, even in the commercial/private sector, that literally every day there are new aspects to it. In terms of the global health sector, an amazing technology is unmanned aerial vehicles (UAVs), popularly known as drones. Some of my SIAPS colleagues are probably bored by now because of how much I talk about drones and their applications for health supply chains! Of course, this is still a nascent technology and there are some regulatory kinks being worked out, but I’m sure we will see widespread use of UAVs all over the developing world, transporting life-saving medicines to hard-to-reach populations. In fact, there are several UAV manufacturers focused only on delivery of public health goods and services, such as lab samples, essential medicines, and other applications. Together with global health implementers, they have been running trials in several countries for the past 12 to18 months, including in Malawi and the Dominican Republic.

You have a background in supply chain and logistics management in the private sector. What can global development professionals learn from logistics management?

Logistics management can’t function without data to drive its decisions or show the success of its activities. Historically, public-sector health care professionals have not put a lot of emphasis on data to back up interventions or on numeric results to show achievements in systems strengthening or health outcomes. We tend to tell the story of what we’ve done without really backing up those claims with results. When I am writing quarterly reports, I often wonder, “So what? Where’s the hard evidence that this improved processes, and how did that change the health system for the better?”

Development could also benefit from using more robust commercial information systems, such as Enterprise Resource Planning software. Global health professionals working in supply chain management seem to want to develop a different information system for every disease program in a country. This is because donor funds are often earmarked for a specific disease. But there are systems that have already been used in all sorts of industries that we could tap into, adapt, and implement.

What have you learned while applying your experience to the global health sector?

It’s been a huge learning experience for me! I came from a company that develops energy management and automation resources. In English, that means anything from an electrical wall socket used at home to the automated light switches we have in our SIAPS offices that turn off after a period of not sensing movement. The warehouses were partially automated and information systems were completely connected to the point that I could manage a warehouse’s stock in a different country from my desk.

All of this is to say that it has been a good experience to take a step back and see where global health pharmaceutical supply chains are and where they can and should go. By strengthening pharmaceutical systems—providing strong regulatory frameworks, skilled professionals, interconnected information systems, sustainable financing, and oversight—we can make sure that the enabling environment is right for supply chains to mature.