Lessons Learned: Strengthening Laboratory Supply Chains August 16, 2006Ronald Brown, MA, CLS(NCA), CHE, MT(ASCP)

JSI/DELIVER Country Experience Countries of work: Ghana, Kenya, Uganda, Zambia Interventions include: –Laboratory Services and System Assessments, –Logistics System Design and Rollout, –Forecasting and Quantification, –Standardization, –Procurement, –Donor Collaboration

I. Assessments of laboratory systems are critical for identifying areas for improvement and serve as a baseline for monitoring. In one country, the assessment enabled stakeholders to: –Identify key policy issues requiring attention, including roles and responsibilities for procurement and distribution of lab supplies. –Develop a costed implementation plan that identified funding implications and gaps associated with each scenario.

II. Stakeholder collaboration through a coordinating body can reduce duplication and maximize limited resources. In another country, a national laboratory technical working group composed of MOH, donors, NGOs/FBOs, and other stakeholders developed an operational plan that: –outlines each stakeholder’s current and planned activities, –will be used to monitor progress, –will serve to help mobilize resources

III. Standardization of laboratory techniques and tests is key for effective supply management. Standardizing laboratory procedures by level is critical for: –accurate quantification and procurement –efficient and effective management of lab supplies and supply chains –development of a system-wide quality assurance schemes The standardization process should be representative and consultative to ensure effective implementation

Benefits of Standardization In one country, the standardization process involved representatives from all levels in the system and resulted in: –Reduction of the number of items in the system by 10 fold –Definition of standard operating procedures for testing services, instrumentation by level, and procedures for logistics management –Efficiency and economy of scale in procurement of supplies for CD4 count, ALT, Creatinine testing –Opportunity for an external QA program

IV. In the absence of usage data, service statistics data should be used for quantification and procurement In two countries where usage data was not available for quantification: –Standardization of the test menu, techniques and supplies was conducted –The number of supplies necessary for each test, service statistics and adjustments for stockouts were used to estimate needs –Results of the quantification were used for national procurement decisions

V. Systematically designing a logistics system is a necessary step in enhancing availability of laboratory supplies In another country a key system design decision was to link procedures for ordering and resupply to logistics reporting, thus increasing the likelihood of reporting rates

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