In this three part series, Jay Heavner, Director of Knowledge Sharing and Communication at Supply Chain Management System (SCMS), highlights his experiences visiting three countries in Africa to observe SCMS project sites.
In March, Diane Reynolds, Supply Chain Management System (SCMS)’s country director in South Africa,wrote about President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s partnership with the government of South Africa to help bring down the price of antiretroviral drugs (ARVs) in that country. ThisBridging Fund program has been a game-changer for South Africa as it rapidly scales up HIV/AIDS treatment, so I jumped at the opportunity to visit the country and see first-hand the impact of this innovative initiative.
One of the most memorable experiences of my recent trip was a site visit to the KwaZulu-Natal Provincial Pharmaceutical Supply Depot near Durban. Although one of ten provincial depots, it stores and distributes an impressive 32 percent of the country’s lifesaving ARVs to 28 hospitals and 600 clinics in the province. Before arriving, I heard about the depot’s dream team who worked wonders to accommodate a large influx of ARVs in a warehouse that was already stretched to capacity.
To understand their achievement, consider the following:
- The depot was designed 27 years ago to serve a population a fraction of the current one and before the first case of AIDS was reported in South Africa.
- Most ARV regimens in South Africa still use three separate pills in combination rather than have patients take one pill containing three different medicines (fixed-dose combination).
- More than 500 pallets of ARVs were occupying 27 percent of the total space in the depot the day I visited, meaning that the staff are managing all other public health commodities in roughly three quarters of the space they used to have available.
- The ARV stock turns at the hub are almost weekly; monthly stock turns at any warehouse would be considered an accomplishment.
The team who runs the depot is a passionate bunch. When I asked how they pulled off such an amazing feat, one replied, “Each person here is a perfectionist. We are the people who have to do it. The implications of not doing it are too great.”
And they plan, and communicate. And they also get creative: To make more room, they reclaimed a section of the dispatching area of the warehouse and contracted with a courier company to do dispatching off-site. They closed an area of the depot once used for manufacturing creams and similar items to create a dedicated section for the PEPFAR-funded ARVs. Their staff use small, hand-operated forklifts rather than normally sized ones to maneuver the tight spaces in the ARV store rooms. Working with SCMS staff, they designed a system for about half of their treatment sites to receive ARVs through direct delivery from SCMS’s central warehouse, bypassing the depot completely.
The dream team has a long-term goal they are pursuing with equal energy: a new 15,000 m2 warehouse to be built next door to their existing facility. Conceived with design and engineering support from SCMS, the new depot is scheduled to open in 2013 in anticipation of South Africa’s new National Health Insurance program.
The head of pharmaceutical services remarked, “We may be the dream team, but we have lived through a nightmare” after a very late start in scaling up HIV/AIDS treatment programs in South Africa. That may be so, but their work has helped deliver lifesaving ARV medicines to some 460,000 people on treatment in their corner of the world.