Providing reliable access to quality and affordable medicines and health products to communities continues to be a challenge for ministries of health in Francophone West Africa. In other instances, donor-funded public health interventions face sustainability challenges due to structural readiness.

January 25, 2023
Africa Resource Centre


Providing reliable access to quality and affordable medicines and health products to communities continues to be a challenge for ministries of health in Francophone West Africa, despite several last mile distribution strategies (such as an informed push model in Togo and Senegal). In other instances, donor-funded public health interventions face sustainability challenges due to a lack of structural readiness during transition phases.

In Senegal, the public health supply chain (PHSC) comprises several stakeholders, including the directorates and services of the Ministry of Health and Social Action (MoHSA), technical and financial partners and actors across several levels. The MoHSA adopted the Yeksi naa model, a last mile distribution strategy based on the use of third-party logistics (3PL) providers. The model showed initial success but subsequently failed at the scale-up stage. The Government and its technical and financial partners mandated ARC to evaluate the supply chain in 2019 and 2021 with the following objectives:

  • Identify the dysfunctions that led to the failure of Yeksi naa when it was scaled up.
  • Design a new sustainable public health supply chain operating model and transformational roadmap.

The evaluation outcomes validated that multi-structural reforms are needed for the MoHSA to achieve its primary healthcare objectives and realise value from last mile distribution solutions such as Yeksi naa. These reforms must take cognisance of the complex webs of interdependencies between various supply chain functions, such as sustainable funding (provided for in advance) being critical for ensuring reliable and uninterrupted third-party distribution services.


The studies that ARC carried out over six months adopted the following participatory and inclusive methodology:

  1. Project governance and organisation

ARC engaged the MoHSA early in the process and secured project sponsorship from the Secretary-General, who provided institutional leadership and oversight. The Secretary-General’s buy-in compelled ownership and active participation from health system stakeholders who were organised into multi-disciplinary technical, and steering committees and contributed to, stabilised, and validated the study’s findings and recommendations.

  1. Data collection and analysis

We interviewed health system stakeholders at the strategic and operational levels. This included MoHSA directorate leadership and people at the national pharmacy and regional, district and health facilities, including donor and private sector representatives. The outcomes of these interviews and excerpts from several institutional and literary documents formed the bulk of our qualitative data sources. At the same time, historic and actual quantitative data such as stock, health products storage facility capacities and locations, sales, demand, and supply data were collected and analysed using Excel and modelling tools.

  1. Design of solutions

ARC conducted a comparative review of existing private sector operating models while leveraging industry best practices to design a fit-for-purpose new PHSC operating model. We then submitted this proposal for validation and stabilisation amongst the health system stakeholders to arrive at a consensual and acceptable model.


The study resulted in ARC identifying PHSC challenges and tailoring solutions to address these weaknesses.

Main challenges

  • Limited end-to-end visibility due to an un-integrated information systems landscape.
  • Inadequate coordination mechanisms and unclear ownership and accountability for PHSC management.
  • Insufficiently skilled and scaled human resources, particularly in technical areas, due to limited skills building and talent retention approaches.
  • Incoherent performance monitoring linked to scant supply chain performance targets and the absence of tools that support proactive decision-making.
  • Insufficient funding for supply chain operations due to weak resource mobilisation organisation and complex financial flows.

Main recommendations

  • Positioning of supply chain planning at the strategic level of governance, enabled by structured coordination mechanisms for integrating health system stakeholders into the resource planning process.
  • Homogenisation of information systems, supported by implementing modern planning and data capturing tools across the supply chain.
  • Optimising product distribution by outsourcing last mile distribution. ARC found this to be more cost effective and better leverage advanced planning approaches to improve stock coverage across the health system.
  • Strengthening the PHSC financing mechanism by simplifying the health products distribution margin recovery process and establishing a coherent national supply chain budget line.
  • ARC also developed a five-year strategic roadmap, which detailed dependencies and prerequisites for each solution, to help achieve an incremental and de-risked implementation approach to the new operating model.


The evaluation catalysed a mindset shift amongst the Government and partners. This enabled them to view the supply chain as an ecosystem with linkages and to identify the following main dependencies across various intervention areas:

  1. Governance and strategic planning: The positioning of governance entities and structured coordinating mechanisms will support more effective supply chain planning.
  2. Supply chain financing and governance: A multi-disciplinary governance entity is critical for ensuring the holistic identification, estimation and mobilisation of the material, financial and human resources required across all tiers of the health system.
  3. Distribution and human resources: In an outsourcing scenario, 3PLs with the ability to provide advanced stock and distribution management expertise, infrastructure, and tools should be leveraged to perform non-core delivery tasks. Otherwise, the health system will be pressured to scale up human resources at the peripheral levels.
  4. Information systems and supply chain budgets: The coherency of supply chain budgets that integrate short- and long-term IT costs determines the maturity of the IT landscape, which is a critical element for achieving visibility and data availability.

The study demonstrates that it is possible and beneficial for technical partners to adopt an inclusive approach to solutions design.

It further emphasises the relevance of government ownership in large-scale public health supply chain interventions. This resulted in successful technical assistance to the MoHSA, which remains committed to ensuring the sustainable relaunch of the Yeksi naa distribution model and driving the implementation of the study’s recommendations with the support of health system partners such as United States Agency for International Development (USAID), the World Bank and The Global Fund to fight AIDS, Tuberculosis and Malaria.

Download the case study here.