Rolling Out an Integrated Logistics System in Tanzania to Meet Ambitious Scale-up Goals

The Challenge

The government of Tanzania has set an ambitious goal for scaling up antiretroviral (ART) therapy: to have an estimated 700 care and treatment centers (CTCs) providing ART services to 250,000 clients by the end of 2008, 350,000 clients by the end of 2009, and 440,000 clients by the end of 2010. Implementing an unprecedented scale-up of this size and scope requires a robust logistics system. In collaboration with the country’s National AIDS Control Programme (NACP), SCMS reviewed critical impediments to the national ARV drug scale-up plan. It was clear that the Medical Stores Department (MSD) could not conduct monthly deliveries to all CTCs. Compounding the distribution issue, many of the CTCs were reporting late, or not at all. The difficulties of unsynchronized reporting and delivery times, along with the introduction of ARV drug refilling sites in health centers and dispensaries, posed a serious logistical challenge to the entire scale-up process.

Program Implementation

At the request of NACP, SCMS redesigned the logistics system to better accommodate the scale-up plan. The new system requires antiretrovirals (ARVs) and HIV test kits to be distributed simultaneously with essential medicines in the country’s integrated logistics system (ILS), a single method for ordering all commodities designed to maximize MSD’s distribution resources and capacity.

CTCs will track consumption and include quantities of ARV drugs required for clients who are new to the program or to a regimen when placing orders. A critical element of the new system is its use of ART initiating sites and resupply sites. Patients who start treatment at initiating sites can pick up their monthly supplies closer to home and can be referred back to initiating sites if they have problems.

SCMS successfully collaborated with NACP and other partners involved in care and treatment to design a national rollout training strategy for the 692 identified initiating and resupply sites. Based on the regionalization activities, partners International Center for AIDS Care and Treatment Programs (ICAP), Clinton HIV/AIDS Initiative (CHAI) and Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) contributed to rolling out the training in their respective regions. Before training rollout, SCMS conducted five regional sensitization workshops that included MSD zonal store managers and district and regional health management teams. Participants were introduced to the new systems and given the opportunity to discuss their roles in ensuring continuous and timely availability of ARV drugs and HIV test kits in the CTCs.

The sensitization activity was followed by a trainer of trainers (TOT) workshop, including 27 selected Ministry of Health and Social Welfare (MOH&SW) staff and other USG partners. Using this type of training strategy, the TOTs conducted 15 classes simultaneously in five different regions.

Results and Outcomes

National rollout of the program, completed in November 2008, has resulted in training of over 1,500 service providers in 21 mainland regions. Through a participatory approach, the entire design process has enhanced the overall technical capacity and skills of NACP, MSD and US government partners in creating a better-functioning logistics system—one that ensures that care and treatment will be received by hard-to-reach and underserved populations.