National healthcare supply chains are complex. Often, disconnects exist between the various departments or levels of government responsible for aspects of healthcare. By improving visibility throughout the supply chain, the efficacy of the entire system can be advanced.
In 2018, Nigeria’s Federal Minister of Health (FMoH) Professor Isaac Adewole began receiving reports about the high rates of expiries of life-saving medicines held at state medical stores. Many of these medicines were supplied to the state by federal health programmes, so it was ultimately his responsibility to address the problem. But these reports didn’t help him to understand why these drugs were being wasted rather than getting to the people who need them.
Professor Adewole and his staff had access to data and dashboards from the federally operated Central Medical Stores (CMSs) and six zonal stores (each hosted within a state store) around the country. The CMSs were all running an Enterprise Resource Planning (ERP) system called Navision to manage their warehouses. They could monitor the stock levels of commodities to prevent, diagnose or treat HIV, tuberculosis, malaria, as well as contraceptives and other national programme commodities. They could see alerts warning of potential expiries or looming stock-outs, and ensure mitigative action was taken. However, they lacked the same level of visibility into state medical stores, which distribute other essential medicines and health commodities, often through drug revolving funds.
Professor Adewole and his ministry oversaw an ambitious national supply chain reform agenda to move from a fragmented and vertical disease programme-driven distribution system to a streamlined, efficient, cost-effective and sustainable public health commodity supply chain.
Success of these initiatives depends on greater visibility into every level of the supply chain, and the ability to convene national and state-level officials to address the gaps and bottlenecks that better supply chain visibility uncovers. ARC has been engaged for its expertise and ability to leverage a broad array of private sector supply chain talent.
To manage this complex effort, the FMoH established a project management office (PMO), providing staffing, office space, and ICT equipment. ARC supported the PMO by recruiting and seconding staff and leveraging its private sector relationships to provide expertise to the office.
Key steps included:
Once the infrastructure and workflows are improved, state stores will be ready to adopt information technology to further improve their efficiency.
This is when the visibility opportunity really begins to achieve its promise. Any warehouse management systems used at the state level can be linked to the visibility dashboard at the FMoH so that real-time data can be exchanged, problems or risks identified, and collaborative action between the federal and state stakeholders taken to resolve issues.
To ensure buy-in from key players, Professor Adewole leveraged an existing quarterly meeting of policymakers, including all state health commissioners and the chairman of the National Primary Health Care Development Agency, to present data about, discuss, and resolve supply chain challenges.
The Warehouse Visibility project is ongoing, but the incremental improvements in state Central Medical Stores demonstrate what can happen when local stakeholders are supported to make changes within their power, when local policymakers can reach out and engage experts from the private sector, and when senior officials like the Minister of Health and the State Commissioners of Health take real ownership of health system reforms and drive change.
ARC has responded to the local demand for solutions by leveraging its network of advisors across Africa, and its strong connections with the private sector and broader donor community.
 Nigeria Supply Chain Policy for Pharmaceuticals and Other Healthcare Products. 2016. Abuja, Nigeria: Federal Ministry of Health.