1. Zambian MOH Essential Drug Logistics System November 2009

2. s HIV test 2006-8 Laboratories 2007-9 OI Malaria ED/OI/Malaria/FP 2009-2011 Zambian people ARVs 2006 Zambian MOH Essential Drug Logistics System

3. Test two different logistics system models to select one (or a combination/variation) that can be rolled out nationally, in order to significantly improve the availability of essential drugs at service delivery sites. Goal of the Pilot

4. JSI TO1 – PEPFAR TO1 – Family Planning TO1 – MCH TO3 World Bank Crown Agents World Bank Pilot Funding Sources

5. The Pilot Logistics System - Similarities with Earlier Systems Uses a Max/Min Inventory Control System (pull system) Collects dispensed to user data, stock on hand, and losses/adjustments from every site in the system, and sends the data to the Logistics Management Unit at MSL Follows a monthly reporting/ordering period Distribution of products is integrated with other products on the MSL trucks going to the districts and hospitals

6. The Pilot Models System A District Store remains as stockholding point MSL supplies a consolidated order every month to district stores System B District Store converted to cross- docking point MSL supplies goods packed for individual facilities to districts VS

7. Key Pilot Activities J09 F M A M J J A S O N D J10 F M J09 F M A M J J A S O N D J10 F M Baseline study Adapting central level software 37 workshops to train 668 participants Hiring of commodity planners, supervisors, and data specialists MoH-led stakeholders System Design Workshop Training of trainers Implementation with monitoring & supervision Final Evaluation

8. Stock Outs DHOs vs Health Facilities DHOs vs Health Facilities Baseline January 2009

10. Pilot trainings through Sept 2009 37 trainings and 668 participants An estimated 170 trainings for 3,400 participants will be needed for national roll out

11. Reporting Rates The 73.9% reporting rate at the beginning of the pilot was mainly due to the intensive training given to facility staff. The improved reporting rates are helped by continuous monitoring, supervision & follow up of facilities in the pilot.

12. Amoxicillin Condoms Benzylpenicylin Depo-Provera Selected products reported stock out trends CTX AL 4*6

13. Key Challenges Full supply principal: ensure timely, reliable, sufficient & quality products Full supply principal: ensure timely, reliable, sufficient & quality products Sufficient, quality storage space Sufficient, quality storage space Dedicated logistics vehicles Dedicated logistics vehicles Funding & availability of fuel Funding & availability of fuel Dedicated district pharmacist technicians (use of commodity planners) Dedicated district pharmacist technicians (use of commodity planners) Availability of candidates for training with the minimum skills required at HC/HP level Availability of candidates for training with the minimum skills required at HC/HP level Attrition rate of trained staff Attrition rate of trained staff

14. Cost Scenarios (estimated) Current costs to sustain the 16 pilot districts July to December 2010: USD 300,000 MSL additional costs to sustain MSL only activities for all districts: (4% current +) – Version A = 0,5% of stock throughput – Version B = 1% of stock throughput Cost of CP’s and vehicles all districts – 2% of stock throughput Other countries in region range from 7 to 12% of stock throughput for logistics activities (district level only)

15. Expected Benefits Addresses 2 key priorities in the Fifth National Development plan (FNDP) on essential drugs: To ensure availability of adequate, quality, efficacious, safe and affordable essential drugs & medical supplies at all levels, and To significantly improve availability, distribution & condition of essential infrastructure & equipment so as to improve equity of access to essential health services.