Country Overview

To meet the need for a significant national scale-up, the Government of Rwanda has introduced a national coordinated procurement and distribution system for health commodities.

In just five years, the number of patients on treatment for HIV/AIDS increased 100-fold in Rwanda, from 400 in 2003 to over 80,000 in 2010. Existing health systems and supply chain networks have struggled to keep pace. To meet the need for scale-up, the Government of Rwanda introduced a national coordinated procurement and distribution system for health commodities. The Centrale d'Achats des Médicaments Essentiels du Rwanda (CAMERWA), the Rwandan national essential medicines procurement organization, operates the national medical stores and has sole responsibility for procuring, storing, and distributing antiretrovirals (ARVs) and HIV test kits. CAMERWA's primary objective is to create a fully modernized and professional procurement, warehousing and distribution organization by implementing best practices from the commercial sector.

SCMS has forged an important partnership with CAMERWA, Pharmacy Task Force (PTF), the National Reference Lab and other stakeholders and implementing partners to build in-country supply chain capacity and drive down the costs of medicines for the country's HIV/AIDS program. The long-term goal is to make CAMERWA ready to receive funding directly from the US Government to procure for HIV/AIDS programs—increasing capacity to perform locally and provide medicines at the best price to the people of Rwanda.

Key Objectives

• Improve and increase the quantity and quality of the basic information required for forecasting and supply planning of all HIV/AIDS commodities.
• Assist CAMERWA to become eligible for grant recipient status.
• Improve product flow, implement effective warehouse management, standardize best practices in procurement and modernize operations.
• Strengthen storage and management capacity at the district level and improve distribution systems to districts.
• Support the Government of Rwanda’s program of decentralization through implementating active distribution of commodities at the central, district pharmacy and health facility levels.
• Improve the capacity and capability of district pharmacies and health facilities.
• Identify and pursue opportunities to strengthen procurement of drug commodities to meet scale-up requirements.

Activities and Impact

Warehouse management: To support CAMERWA in comprehensive restructuring of all warehouse management operations, SCMS provided technical assistance in warehouse best practices, redrafted standard operating procedures and reviewed the existing stock management system. CAMERWA has reduced the receipt process of drugs into the warehouse from 15 to 5 days, improving inventory control and stock reporting. Time to fulfill orders was reduced by half which lowered overtime costs. New shelving for the warehouse increased storage capacity by 64 percent which improved layout and product mapping. Accuracy of monthly reporting on stock levels and inventory is improving, alerting managers to potential stockouts before they occur. Monitoring and supervision of ARVs is more effective and customers are receiving ARVs in a timely manner.

Technical assistance: The implementation of active distribution has taken longer to mobilize than expected, but remains a cornerstone of the Government of Rwanda’s decentralization policy. SCMS, in close collaboration with CAMERWA and the MOH’s PTF, assessed actions to date and developed a revised strategy for implementation.  It includes the establishment of a project executive team led by the PTF and a project operation team led by CAMERWA. Active distribution represents a fundamental change in process and responsibilities with the national health supply chain. Program success will require considerable commitment, political will, and dedicated resources.

Pharmaceutical procurement: Rwanda's lack of a national drug authority and harmonized list of essential drugs has hindered efforts to improve procurement of pharmaceuticals. Working to remedy the situation, SCMS has supported the development of a drug coding system and submitted the final guidelines known as the National Master Drug List and Rwanda Coded Drug List to the MOH's eHealth Group and the PRF. The drug coding system will help improve pharmaceutical management and affordability, and increase consistent availability of medicines.