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Improvements to Warehousing Support Scale-up of HIV/AIDS Programs in Namibia
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The Challenge Namibia has rapidly expanded access to antiretroviral therapy (ART) to reduce morbidity and mortality among people living with HIV/AIDS. As of September 2005, 11,829 people were on treatment, and antiretroviral medicines (ARVs) occupied just over 140m2 of floor space at Central Medical Stores (CMS). However, scale-up of ART services increased the number of patients—and therefore the need for commodities to support treatment—by almost 500 percent in the last three years. The number of patients is projected to grow to 87,900 adults and 6,400 children by 2013.
CMS began to face acute storage space constraints due to inadequate racking and outdated equipment. At the request of the Ministry of Health and Social Services (MoHSS), SCMS conducted an assessment of storage infrastructure, handling and distribution at CMS and developed recommendations aimed at optimizing use of space and other warehousing infrastructure.
Installation of packet racking more than doubled general storage capacity. . .and increased floor area dedicated to ARVs six-fold.
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Program Implementation Conducted in April and May 2008, the SCMS assessment uncovered critical gaps in many areas. A pioneering initiative in HBC logistics, the assessment encompassed all 13 regions of Namibia and included 116 respondents. It solicited information through four types of data collection tools and covered key areas of logistics management, including information systems, inventory control procedures, HBC kit distribution and reporting methods, and monitoring and supervision of storage conditions. Respondents were selected through a combination of targeted and systematic random sampling. They included nongovernmental organization/community-based organization managers in charge of home-based care, ministry representatives in the Family Health Division, primary health care supervisors, home-based caregivers, clinic nurses, and persons responsible for the pharmacy or storeroom where HBC supplies are stored and managed.
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Results and OutcomesThe assessment revealed a largely unplanned system of HBC kit distribution, with 87 percent of respondents reporting random receipt and distribution. Stockouts were frequent, stock balances irregularly monitored, and storage areas insufficient. Written guidelines were lacking for proper storage and for supervising those with critical logistics responsibilities. Most respondents did not have documented distribution schedules or their own transportation to convey kits to service delivery points when they received supplies from the MoHSS. One in three respondents had encountered expired products in kits, while two in three had received kits without packing lists. The assessment concluded that Namibia’s HBC supply chain system must be systematically strengthened to sustain the needs of the country’s palliative care program. Based on study results, the MoHSS has endorsed a supply system redesign to ensure kits are continuously available for HBC providers and integrate HBC kits into the overall pharmaceutical supply system.
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