REVOLUTIONIZING PHARMACEUTICAL SUPPLY CHAINS IN RESOURCE-LIMITED COUNTRIES: RETHINKING CAPACITY BUILDING STRATEGIES
Surendar Angothu
Asst. Professor, Department of Pharmacognosy, Princeton College of Pharmacy, Hyderabad, Telangana, India
Boggula Ratnakumari
Asst. Professor, Department of Pharmacognosy, Princeton College of Pharmacy, Hyderabad, Telangana, India
1 INTRODUCTION
One of the Millennium Development Goals' targets is to ensure that all developing nations have easy access to essential medicines. Improved access to essential medicines, particularly those for HIV/AIDS, malaria, and tuberculosis, has been the result of international programs over the past decade, such as the World Bank, the United States Agency for International Development, and the Global Fund to Fight Aids, Tuberculosis, and Malaria. By the end of 2013, GAVI had received pledges totaling US$8.2 million for new and underused vaccines, while the Global Fund to Fight AIDS, Tuberculosis, and Malaria had received pledges totaling $30.5 billion and contributions totaling $25.6 billion. In addition, in their 2014 budgets, the President's Emergency Plan for AIDS Relief (pepfar) allocated US$3.2 billion exclusively for HIV and AIDS in Africa.
Even though these efforts are admirable, the availability of commodities alone will not improve the impact on communities and livelihoods as a whole. The availability of essential medicines that are guaranteed to be of high quality must be linked to effective pharmaceutical supply chain management systems. Life-saving medications can be purchased, distributed, and used in a rational manner with the help of effective pharmaceutical supply management systems.
Pharmaceutical supply chain management systems remain weak in many resource-constrained nations, particularly in Africa, despite decades of
significant investment in these systems in terms of resources and effort. Systems strengthening, capacity building, and technical assistance (TA) mechanisms have all been used to invest resources.
The preceding raises the question of whether these initiatives have largely failed to improve supply chain efficiency.
If the response is "no," then we ought to inquire about the reasons why systems continue to be weak; If the answer is
"yes," then we ought to inquire as to the reasons behind the persistence of conventional, often ineffective, decades- long approaches to capacity building.
A combination of the negative and positive responses to the question above is the most appropriate response.
Pharmaceutical supply chain management systems have seen some success in Sub-Saharan Africa, from Swaziland in the south to Sudan in the north, or from Zanzibar in the east to Liberia in the west. For instance, the Medical Stores Department (MSD) in Tanzania is said to function at an above- average level, while the MSDs in Rwanda and Zambia (to pick two randomly) are also said to be effective. These successes can be partially attributed to partners who have long supported supply chain programs at the central level as well as local efforts (political will). On the not- really sure side, the Focal Clinical Stores (CMS) in Malawi has kept on being tormented with difficulties. This is despite the fact that the Global Fund employed a full-time technical assistance agency for more than two years (from 2011 to 2013).
In addition, Ghana's procurement system is regarded as acceptable, whereas Liberia's National Drug Service is confronted with numerous difficulties.
Direct technical assistance has occurred in all of the aforementioned instances, indicating that the various TA mechanisms have had varying degrees of success.
Not only medical stores face difficulties in Africa's supply chain systems. Systems for supply chain management continue to lack the necessary human resources in most nations. The majority of countries in the Sub-Saharan region, with the exception of South Africa, delegate to cadres who lack the necessary training or qualifications to manage medicines and other peripheral goods. In Liberia, some of the dispensers who manage medicines at service delivery points have less than seven years of formal education, while in Malawi, medicines are dispensed by assistants with no training in dispensing functions.
Medical caretakers and birthing specialists shoulder the greater part of the store network capabilities at the wellbeing office level, yet most of them have not get any preparation on the best way to oversee medications. The majority of functions and skills are acquired on the job. Short training courses have frequently been offered by TA agencies over the years. It has been reported that these courses have little to no long-term impact.
Both technical and managerial skills are required for supply chain management. Technical skills are more concerned with product handling, whereas managerial skills are concerned with resource planning and management.
To improve supply chain efficiency, comprehensive and trustworthy data are required for the proper management of activities and functions as well as for decision-making purposes. The absence of reliable data at all system levels, from the central to the smallest service delivery
units, hinders supply chain efficiency in the majority of African nations. The quantification and forecasting of commodity requirements as well as the formulation of policies require such data.
It is essential to accurately quantify needs if facilities are to have sufficient stock of medicines and other products related to them in a timely manner. Medicine shortages can result in fatalities or financial losses, both of which are undesirable events. The preparation of procurement and supply management plans—the primary instrument for monitoring the performance of grants—
requires that commodity requirements be quantified based on consumption data for the Global Fund and other donor-funded programs. A quick look at some of the grants that have been awarded by the Global Fund reveals that a number of nations continue to use issues data as a proxy for consumption in order to quantify their requirements. This demonstrates that despite the number of TA agencies supporting the systems, data availability remains a challenge. To ensure that service delivery data, particularly for commodities, is readily available, technical assistance should invest more in capacitating programs.
In addition to the foregoing, irrational use of medicines persists across developing nation states. Worryingly, there is still a high rate of antimicrobial overuse. This has extreme ramifications for antimicrobials opposition, which would hit hardest the nations that can't bear more up to date age anti-toxins.
Despite receiving prolonged technical assistance, these nations continue to face the aforementioned obstacles.
We advocate for a new strategy and contend that the time has come for a paradigm shift in the event that capacity building and technical assistance programs aimed at increasing supply chain efficiency have largely been ineffective. For a variety of reasons, we argue that the time is right now. First,
organizations like the People that Deliver Initiative (PtD, 2014) and the Reproductive Health Supply Coalition (RHSC, 2014) are actively working to promote supply chain efficiency worldwide. Furthermore, beneficiary nations are calling for change. They have been increasingly integrating approaches to addressing challenges in supply chain systems because they are aware that long-lasting solutions depend on their ability to solve their own problems. For instance, Rwanda has developed an integrated supply chain system that oversees the majority of goods from a single repository to service delivery points.
With few to no shortages of essential medicines and other products, this strategy seems to be working well for the country. Finally, new approaches to capacity building for supply chain systems necessitate the involvement of the recipient nation and the assistance of capacity building services agencies in order to be acceptable and effective. This way, the process will continue even if the user exits the system. This argument is based on the fact that the majority of programs have a fixed duration and that developing nations frequently lack the capacity to manage program terminations.
To expand on this argument, we provide a fundamental definition of what we mean by capacity building services.
2 WHAT IS CAPACITY BUILDING?
The process of improving an individual, group, or unit of an organization's capacity to carry out tasks in an efficient, sustainable, and effective manner is known as capacity building. Training is frequently mistakenly equated with capacity building. Workshops are currently viewed as a "magic bullet" for overcoming any obstacle in the current strategy for building pharmaceutical supply chain management capacity.
Training is suggested as a solution in the event that there is a performance gap.
Individual abilities, on the other hand, are
just one component of a much larger set of factors that make up the capacity to consistently and effectively carry out particular tasks over time. Without adequate supplies and equipment, proper motivation, management support, and a positive relationship with the community they serve, individual health workers, regardless of their level of expertise, are unlikely to effectively deliver essential medicines or services. Limit building administrations are expected for these areas to guarantee execution objectives are accomplished.
2.1 Attributes of capacity building for pharmaceutical supply chain management systems
Managers and policymakers are concerned about capacity because it makes it possible for good performance and increases efficiency in the pharmaceutical supply chain. For instance, a healthcare facility that frequently experiences stock-outs of pharmaceuticals may require additional capacity for quantifying their requirements (such as interventions tailored to the particular performance objective of commodity supply). As a result, a method tailored to the underlying cause of the issue would be necessary for a capacity development strategy to enhance pharmaceutical supply. In this perspective limit can be seen as a moving objective. Capacity can rise or fall at any given time. It usually progresses over time in stages that show that you are more ready to influence performance. As a result, capacity building is an ongoing process whose stages are referred to as "development outcomes."
2.2 Why is Capacity Building Necessary?
In the context of systems for supply chain management, resources are invested with the ultimate objective of providing the populace with essential medicines and
goods related to them. The most money is spent on medicines in every hospital system. Additionally, proper medicine management is synonymous with thrifty financial management because medicines are costly commodities. It costs money to let medicines expire at a facility, while non-delivery, late delivery, or shortages cost lives. As a result, it is critical that those in charge of managing these necessary resources do so effectively and efficiently. For individuals and organizations alike, new or improved capabilities are often required to translate newly acquired skills into sustained performance. In this sense, capacity refers to the capacity to effectively utilize resources and maintain gains in performance despite gradually decreasing levels of external support. In this paper, we concentrate on the sustenance with less external support, i.e., the capacity of supply chain systems in developing nations to sustain performance in the face of gradually decreasing levels of support from TA agencies and donor contributions.
2.3 Capacity building for Procurement and Supply Management (PSM) systems: The Global Fund Model
Several nations have benefited from the Global Fund over the past ten years. In contrast, large commodity-based programs in developing nations have been supported by other programs like PEPFAR and PMI, which typically came packaged with ready-to-use TA. In contrast, the Global Fund model requires that the country or Principal Recipient (PR) be in charge of implementing the program. The achievement of particular programmatic benchmarks is used to measure success.
The Worldwide Asset awards considers framework reinforcing mediations remembering effective money management for HR for wellbeing. Global Fund PRs are encouraged to identify challenges in procurement and supply management (PSM) and implement
interventions to address these challenges in this context. However, despite the fact that the Global Fund has been in operation for a number of years, many recipient nations' PSM systems remain inadequate and continue to significantly increase grant signature lead time. This strengthens the need for a paradigm shift in how TA is provided and raises questions about why systems remain weak despite years of material and financial investments.
The Global Fund established the Procurement Support Service to facilitate grant recipients' access to Capacity Building Services/Supply Chain Management Assistance (CBS/SCMA) and Voluntary Pooled Procurement (VPP) in an effort to address the PR PSM challenges mentioned earlier. The procurement support service was a coordinated approach to assisting nations with supply chain management issues and bottlenecks in the procurement process in order to speed up access to medical supplies and pharmaceuticals. The CBS/SCMA component focused on both short-term and long-term interventions with the goal of making sure that in- country or programmatic PSM systems get better and stay around. The SCMA/CBS model claimed to give PRs the ability to identify their own TA requirements and hire them to boost grants' performance. However, only a few PRs appear to have benefited from the CBS program's speculation. It is unclear why a program with so much promise has not been strengthened or expanded to have a lasting effect.
With the goal of capacity- development interventions that result in a measurable improvement in performance, innovative approaches that build on success factors of assistance should be used in addition to focusing on the countries and programs that received the assistance. The progress of numerous limit improvement endeavors has been restricted by the way that they center
around specialized factors, while basic social and political obstructions are disregarded. The significance of top-level commitment and leadership, a favorable external environment, and the effective management of organizational change processes is highlighted by evidence as well as experiences in other areas. When thinking of a new way to make TA programs for supply chain management more effective, all of these factors would need to be taken into account.
Even though training programs are still important, they should not be viewed as the "magic bullet" for building capacity. However, for these to be effective, they need to address the underlying issues. Sustainable training should begin with the creation of appropriate curricula for various performance levels and the various cadres involved in supply chain functions in order to build capacity in supply chain management. These include programs for pharmacists, pharmacy technicians, and sometimes nurses. The majority of pharmacy curricula in Sub-Saharan Africa lack sufficient supply chain management content. However, pharmacists are increasingly being replaced by supply chain managers.
Other cadres should take advantage of the opportunity to hold this crucial position for ensuring commodity security.
3 CONCLUSION
Throughout the long term there has been expanded financing endeavors pointed toward further developing production network frameworks of low-pay nations. It has been demonstrated that these efforts have little effect. How a country builds its capacity to manage medicines and related goods needs to change fundamentally.
REFERENCES
1. United Nations, United Nations Millennium Declaration.2014.
2. TERG. The Technical Evaluation Reference Group (TERG). The Five-Year Evaluation of the Global Fund: Study Area: Health Impact
of Scaling up against HIV, Tuberculosis and Malaria. Evaluation of the Current Situation and Trends in 18 countries. 2014.
3. The Global Fund to Fight Aids, Tuberculosis and Malaria. Procurement Support Services, Capacity Building Services/Supply Chain Management Assistance (CBS/SCMA) process. 2014.
4. http://www.pepfar.gov/documents/organizat ion/222643.pdf.
5. Fox LM, et al. Rwanda Health Governance Report. Bethesda, MD: Health Systems 20/20 project, Abt Associates, Inc.2010.
6. Yadav PP. August Analysis of the Public, Private and Mission Sector Supply Chains for Essential Drugs in Zambia. (A Study Conducted for DFID Health Resource Center under the Aegis of the META Project).
2007;1:25.
7. Dirk H, et al. Constraints to Implementing the Essential Health Package in Malawi. Plos One. 2011.
8. http:/www.nice.org.uk/media/AF1/73/HowT oGuideChangePractice.pdf.
9. Porco TC, et al. When Does Overuse of Antibiotics Become a Tragedy of the Commons? 2012.
10. http://www.peoplethatdeliver.org/
11. http://www.rhsupplies.org/
12. Kaplan A. August. Capacity Building: Shifting the Paradigms of Practice. Development in Practice. 3/4 10 (10th Anniversary Issue):
2000;517-526.
13. http://www.theglobalfund.org/documents/co re/financial/Core_PledgesContributions_List_
en.
