Building a Strong Information System in Zimbabwa's Fragile Environment

The Challenge

Zimbabwe has one of the world’s highest rates of HIV prevalence; 15.6 percent of adults live with the virus. In response, Zimbabwe’s National antiretroviral therapy (ART) services.  Program offers ARV services to about 152,000 adults and children, of an estimated 500,000 people needing treatment. SCMS works with the Zimbabwe Ministry of Health and Child Welfare (MOHCW)  to design, implement and support a strong ARV ordering and distribution system based on a manual and a computerized logistics management information system (LMIS). Despite the country’s political and economic challenges, this structure is operating efficiently to deliver HIV/AIDS-related commodities without interruption to 115 sites nationwide.

Program Implementation

Pharmacists and logisticians at the MOHCW AIDS & TB Programme Logistics Subunit manage HIV/AIDS commodities upstream (forecasting, supply planning, donor coordination and procurement) and downstream (warehousing, LMIS, and distribution). They use logistics and service statistics data from treatment sites which are compiled in the Zimbabwe Information System for HIV/AIDS Commodities (ZISHAC) to manage the country’s entire ARV logistics supply chain. They provide quarterly updates to forecast national needs and procurement plans, monitor the national pipeline to ensure stakeholders are promptly resupplying, efficiently manage commodities, and manage a fleet of three insulated van body trucks for treatment site distribution. Monthly quantifications and stock updates are discussed with partners to highlight any gaps and overlaps, and mobilize or switch resources.

On a bi-monthly basis, a forced-ordering max-min pull system is used in ordering. Treatment sites must submit consumption/requisition forms to the Logistics Subunit. Those that do not will not receive stock. This incentive for timely ordering has led to good reporting rates, while safety stocks and the ability to send emergency orders have limited drug stockout risk.

Results and Outcomes

The system has been operating for more than a year, with encouraging results. Monthly reporting rates vary from 84 percent to 92 percent, providing good data for quantification and distribution. Due to Zimbabwe’s communication challenges, on-time (<5 days after the end of the reporting period) reporting rates are lower, though. The MOH will continue to monitor this indicator and propose measures for supporting treatment sites to speed up order submission and possibly review the reordering interval. Stockout rates are low (below 1 percent), indicating excellent first-line, second-line, and pediatrics ARV availability in all 115 treatment sites.

Good LMIS reporting rates from ARV treatment sites enable successful forecasting and distribution, ensuring quasi-full availability at the site level. Pull systems encourage treatment sites to send orders regularly and enable quantities needed to be calculated correctly. As the experience in Zimbabwe has demonstrated, even in a fragile environment, it is possible to run a simple and efficient ARV in-country supply chain, as long as managers can base their decisions on reliable data.