Could the private sector supply remote rural health posts in Zambia?

Back in June (27/6/12), on our first visit to see Zambia’s Minister of Health, the Hon Dr Kasonde, to brief him on ColaLife, he asked us to consider how some of the thinking behind ColaLife could be applied to the problem of supplying Health Posts.

Health Posts are the first level of contact between the Ministry of Health and the people. There are already lots of them (I’m not sure how many) but the government has pledged to establish another 650 so that no citizen is more than 5km away from a Health Post.

This is a huge commitment. Health Assistants are being training to run these Health Posts but there is anxiety about how they will be supplied. There are significant challenges supplying the existing Health Posts so how will an additional 650 be supplied?

Anyway we offered to give this some thought to this and Jane, Beth, Rohit and I developed this concept note for Dr Kasonde.

Download (PDF, 141KB)


This was based on one of the scenarios we developed during the planning stages of ColaLife. The foundations of this concept are:

  1. Health Posts are numerous and remote when looked at from the perspective of  public sector organisation tasked with supplying them
  2. But there will almost certainly be a shop nearby
  3. The shop keeper will already be making regular journeys to the district centre to buy commodities to bring back to his/her shop
  4. Why not pay the shop keeper to collect a kit of essential medicines for the Health Post once a month
  5. When the Health Assistant confirms receipt of the kit the shop keeper gets paid into their mobile phone-based account

There are potentially benefits all round from this approach. The shopkeeper improves his or her livelihood and the Ministry of Health does not have to gear up to undertake this momentous task itself.

Worth a try I would have thought. What do you think?

Health Post under construction in  Magobo, Katete District, Zambia
A new Health Post under construction in Magobo, Katete District, Zambia

Comments

  1. What a great idea. You must be so excited and wish that things could move faster!

    When I was in Kalabo I was asked if I had anything for a tooth ache so basic pain medication would be a big help.

    Kalabo district has the highest poverty levels in the country–80% of the population in the province lives in poverty. Western Province also has the lowest adult literacy rate as families cannot afford the cost of school uniforms to send their children to the few government schools available. Due to a lack of skilled labour and industry, few opportunities exist to add value to the many agricultural and aquaculture commodities that the area produces.
    Overall, poverty, gender inequality, socioeconomic disenfranchisement, food insecurity and HIV (currently at a prevalence rate of 15% and trending upwards in Kalabo district) have had a negative impact on the community.

    The question is can the vast amounts of medical supplies required be reliably and safely transported. Would the health assistant be able to place an order for specific medications via her cell phone or a hand written order form in remote areas where cell phones are too far from towers to work such as Luoke West, Western Province.
    I know Mr. M Mualuka who is now a councillor in Luoke West due to his volunteer work with World Vision. Mr. Mualuka runs a small shop in his village and he paddles in his dug out canoe to Kalabo, 6 hrs there and 10 hours back to pick up supplies. If the Ministry of Health would contact all of these councillors , as they do have meetings, they could pick up the medical supplies for their areas when they meet. I am not sure how often the meetings would take place. If you want Mr. Mualuka’s phone number to initiate this process, email me at medwoman@sympatico.ca but until the rains stop you probably won’t reach him.

    The folowing is an article from Avert.org

    Reliable supply chains for Aids ARV’s

    Ensuring there are no interruptions in treatment requires a guaranteed supply of antiretroviral drugs from the factories where they are produced, to the treatment centres in perhaps remote areas of a country. Laboratory supplies, testing kits and information also needs to pass along the supply chain.

    In order to be cost-effective, accurate forecasting of the necessary quantity of drugs is needed. Over-purchasing of ARVs can put strains on money and storage space, and may lead to wasting of drugs with limited shelf-life.53 Under-estimating may lead to stockouts and the need to purchase costlier emergency supplies.54 One report found stockouts were ‘commonplace’ in China, India, Uganda, Russia and Zimbabwe.55 It was conservatively estimated that 30 people were dying daily in Free State, South Africa, after ARVs ran out towards the end of the 2009 financial year.56 Such events not only adversely affect those who desperately need to begin treatment but also patients who are on treatment already and who may develop drug resistance.

    The transportation phase of the supply chain requires delivery tracking and needs to account for potential customs barriers. Special refrigerated containers may also be needed. In unstable regions theft of the drugs may be a concern and armed escorts and decoy trucks are known to protect expensive deliveries.57

    Intermediate storage of the medication – such as in large regional warehouses – needs to be safe and secure and be able to efficiently process orders and distribute ARVs to health facilities. Similarly, local facilities should be able to safely and securely store medication at controlled temperatures.58

    All of these requirements mean that the costs involved in distributing the drugs are higher than the antiretroviral drugs themselves. World Health Organization’s Director of HIV/AIDS, Gottfried Hirnschall, points out:

    “About 20 to 30 percent of the costs related to treatment are drug-related costs, and the other 70 to 80 percent are systems and delivery costs…We need to shift the conversation towards asking how we can use resources that we have more efficiently and effectively.”59
    The massive international logistical exercise involved in creating a reliable supply chain for thousands of vital deliveries has meant the consortium that operates PEPFAR’s supply chain, the Supply Chain Management System, was the organisation that received the most money from PEPFAR in 2007.60

  2. Sorry One more thing!

    The closest bank to Kalabo is in Mongu at least 75km away, so depositing the money into the shop keepers account via their cell may be an issue.
    Maybe the shop keepers would rather be paid in vegetable seeds, which they could pick up at the distribution centers.
    This is a tangible product which is greatly needed in the rural areas and you would be doing preventative medicine by feeding the people as well.