Mali is a low-income country with a high disease burden. The under-five mortality rate between 2006 and 2012 was 95 per 1,000[1]. The country sees 2.3 million cases of malaria per year[2] and has a high fertility rate of 6.1 children per woman and a maternal mortality ratio of 368 deaths per 100,000 live births[3]. In 2013, the Programme de Développement Socio-Sanitaire identified an unreliable procurement system as a root cause of weakness in the pharmaceutical supply chain. A nonfunctional logistics management information system (LMIS), a lack of skilled providers, incomplete implementation of and lack of compliance to pharmaceutical guidelines, and a lack of coordination among stakeholders were contributing factors. SIAPS provided technical assistance to the Ministry of Health (MoH) through the Directorate of Pharmacy and Medicines (DPM), national programs for malaria; family planning (FP); maternal, newborn, and child health; HIV/AIDS; nutrition; and Ebola; Regional Health Directorates (DRS), Pharmacie Populaire du Mali (PPM), and health facilities. Interventions focused on improving governance and transparency of pharmaceutical systems; building the capacity of pharmaceutical supply management; and improving the availability, quality, and use of logistics management information for informed decision making.
Project Highlights
OSPSANTE training session [Click to enlarge]Established a functional LMIS
SIAPS supported the DPM to redesign the LMIS. New standard operating procedures and training materials were developed for all levels of the health system, from the central level to community health centers. Training, mentorship, and on-site supportive supervision built the capacity of pharmaceutical stock managers to improve stock management and data collection and to significantly increase the logistics data reporting rate. A total of 24 master trainers were trained, and as of September 2017, they had trained 1,926 staff (1,492 males and 434 females). SIAPS implemented OSPSANTE, a web-based dashboard that provides an early warning system to key public health priority programs.
Strengthened coordination among supply chain stakeholders
The manager of a community health center dispenses family planning medicines [Click to enlarge]A national coordination mechanism, the Comite National de Coordination et de suivi de la gestion des medicaments (CNC), was established with clear terms of reference and was endorsed by the Minister of Health in 2013. The CNC is chaired by the MoH’s Pharmaceutical Technical Advisor. A quantification subcommittee and technical working groups (TWGs) for malaria, FP, MNCH, TB, HIV, and nutrition were established under the CNC.
Regular quantification was accomplished using Quantimed, Reality Check, PipeLine, and other supply planning tools.
Coordination mechanisms were set up at the regional level in Sikasso, Mopti, Segou, Kayes, Koulikoro, and Bamako.
Regular quarterly coordination meetings were conducted to identify and overcome bottlenecks in the health system.
CNC members were trained on quantification and OSPSANTE; malaria TWG members were trained on Quantimed and PipeLine; and FP TWG members were trained on Reality Check and PipeLine.
Improved capacity of PPM
PPM developed its first five-year strategic plan (2015-2019).
PPM was supported to preselect a vendor for the Warehouse-in-Box (WiB) foundation—a fabricated warehouse that can be rapidly deployed and expanded to meet the country’s commodity storage needs.
SIAPS supported PPM to develop a comprehensive product catalog.
Results
The percentage of SIAPS-supported health facilities that completed and submitted an LMIS report for the most recent reporting period increased from 8% in 2012 to 94% in September 2017.
Percentage of district warehouse and health facilities with stock-outs of a pre-selected group of medicines for three days or more in the last three months [Click to enlarge]The percentage of health facilities using consumption data to inform ordering increased from 50% in 2012 to 93% in September 2017.
The stock-out rate of medicines decreased from 50% in October 2012 to 18.8% in September 2017 at the district level (district warehouses) and from 35.1% in September 2012 to 26.7% in September 2017 at the facility level.
The technical coordination committee for pharmaceutical management and its subgroups met 39 times, and 26 international, national, and local civil society organizations regularly participated in monitoring pharmaceutical management operations.
The percentage of stock records that correspond with physical counts for a set of indicators for medicines in MoH storage and health facilities increased from 16.25% in June 2013 to 96.56% in September 2017.
The official ground breaking ceremony for the WiBs in Bamako and the Kayes, Koulikoro, and Mopti regions was held on August 15, 2017; health, political, and administrative authorities of the country attended.
OSPSANTE was handed over to the DPM and the Agence Nationale de Télésanté et d’Information Médicale; senior staff from both departments were trained on the tool.
Project Legacy
The LMIS interventions were led and implemented by the DPM, and technical skills have been transferred to local actors. There has been a continuous transfer of competencies from SIAPS staff to MoH staff. The tools introduced and implemented in Mali will make data available for informed decision making. SIAPS has transferred all technical competencies for quantification, LMIS, and warehouse management to the DPM, PPM, and DRS. A Logistic Management Unit will have a significant impact on on the ongoing activities. Challenges remain to fund the continuous implementation of the interventions; however, the MoH has taken the ownership of most pharmaceutical sector strengthening interventions by including them in its annual work plan and budget through support from ongoing USAID programs in Mali.
Background
