In West Africa, ministries of health are increasingly maturing in their understanding of supply chain and how it can advance the availability of essential medicines to the last mile. When looking to reform or establish effective supply chains, however, the development of a comprehensive supply chain strategy doesn’t always translate into sustainable implementation. We believe the primary reason for this is unclear Public Health Supply Chain governance framework and mechanisms.
Supply chain governance brings together key decision makers and appoints an entity with overall responsibility to ensure that supply chain solutions are integrated across the entire system and is an essential component of effective supply chain transformation.
One of the biggest challenges in public health supply chains in West Africa is coordination. Different stakeholders, from government departments to suppliers and donors, are responsible for getting products into the system to meet patient needs, but having multiple points of input places an enormous strain on a system and ultimately affects its ability to deliver those medicines to the last mile.
There needs to be harmonisation of the system from a strategic level. Governance is a mechanism that ensures seamless coordination between the many parties across a public health supply chain and contributes to better decision making, protocols, accountability, monitoring and action plans.
Well executed governance also allows for better integration of new interventions and provides a holistic understanding of how different components of a supply chain will be impacted by a change in one part. This is important because different groups are focused on their own objectives and may not always understand how their product or solution can actually be integrated with another to increase the efficient delivery of both to patients at their point of need. Governance, however, unifies targets and objectives.
Governance is also vital for interpreting and applying insights that are increasingly available through tools like IT-based visibility systems. These systems produce valuable data, but one centralised entity needs to interpret the data across the supply chain and apply the learnings to have a meaningful impact. In some West African countries like Côte d’Ivoire, there is important data available to inform the strategic level of supply chain performance, and supported by effective governance this can significantly increase the effectiveness of a supply chain.
Although strategy and governance need to be aligned for a supply chain to function effectively, it’s not always clear which should come first.
At the Africa Resource Centre (ARC), we have seen that there is no right or wrong answer to this question. The answer depends on a country’s particular context or the maturity of its existing supply chain. Still, in general, we advocate for governance being put in place ahead of strategy. Growing a ministry of health’s understanding of supply chain management requires cooperation and a clear governance plan.
In some cases, ministries of health find this approach challenging as having a clear supply chain strategy is a more tangible outcome. Still, even the best strategies can fail at the implementation stage without sufficient governance in place to oversee their execution.
Governance provides a framework that is mutually agreed upon by key stakeholders, which will ultimately be accountable for putting strategies together and making sure the necessary resources are available to implement them.
A central governance mechanism can help bridge gaps and foster alignment in cross-ministerial or cross-departmental decisions. It can draw together stakeholders from all levels of the supply chain, including districts, larger demand points like hospitals, and last mile service points, to develop an achievable supply chain strategy.
Another challenge that arises from the absence of a clear governance framework is the misperception that supply chain is just about central medical stores. There are many more stakeholders involved in supply chain than is often initially realised.
In addition, supply chain is often missing from public health strategy documents and without specific key performance indicators to work towards, implementation and monitoring become difficult. A supply chain governance structure will advocate for supply chain inclusion in these key public health strategy documents, assign ownership and ultimately define accountability for supply chain performance. Given the integral role of supply chain in making medicines and healthcare commodities available to the last mile, it will contribute to the effectiveness of the public health system as a whole.
A responsive supply chain can support ministries of health in their objectives by allowing for both incremental and widespread changes to increase the availability of medicines across all levels of a public health system. A responsive supply chain is achieved through a governing body coordinating and unifying different supply chain elements so that there is good planning, adequate infrastructure, and pooling of resources.
Where one central entity is responsible for implementing and monitoring supply chain strategy, it can communicate and define protocols and reporting lines across levels so that decisions can be made at the right time and in all the areas where they need to be implemented. A responsive supply chain with a good governance framework can also weigh up the “quick wins” that can be achieved with the more long-term components of supply chain transformation like advocacy, policy reform and stakeholder collaboration. All of which will ultimately contribute to increased availability of medicines and healthcare to all who need them.
Fatime Ndao Dieye has ten years of experience in program management. She is the Senior Program Officer at ARC West Africa in charge of Private Sector and Academia activities.
Jemina Iroegbu Harry has 11 years of extensive experience across all functional areas of the supply chain management field. She is currently working with ARC as a Supply Chain Technical Manager.