Zikhathazile Mkwananzi (photo at right), who tested positive for HIV in 2007 and started treatment in 2009, is the picture of health. She transitioned to TLD provided through PEPFAR funding in October 2019 and is receiving a multi-month prescription. The owner of Anabas Cleaning Services, she gets ARVs from Mpilo Central Hospital, the very same hospital where she once worked as a cleaner before starting her own business.
Zikhathazile's story demonstrates the success of Zimbabwe's public health system which, despite many challenges, is very close to reaching the global 90-90-90 goals for HIV/AIDS testing, treatment, and viral load suppression by 2020. All three measures are above 80 percent in Zimbabwe.
Reason 1: Effective warehousing
The public heath supply chain starts with six warehouses operated by NatPharm, Zimbabwe's central medical store. GHSC-PSM procures and delivers HIV/AIDS and other commodities to NatPharm warehouses, where the commodities are stored with others procured for the Ministry of Health and Child Care (MOHCC), the Global Fund to Fights AIDS, Tuberculosis and Malaria, and other donors.
Electrical outages have not impacted NatPharm warehouses. In Bulawayo, for example (see photo), there are two generators, one of which is shared with a neighboring hospital.
As a result, HIV/AIDS commodities continue to flow in and out of NatPharm warehouses. In the photo to the right, the antiretroviral medicine known as TLD is picked and packed in Bulawayo along with other medicines to be boxed up and delivered to health facilities.
GHSC-PSM contracts with a local accounting company to conduct a stock audit of NatPharm's warehouses every six months. The audits consistently find good NatPharm performance.
Reason 2: Reliable delivery to health facilities
Zimbabwe, along with Haiti, is one of only two countries in which GHSC-PSM delivers health commodities directly to health facilities.
Hastings Mukandawire is one of the GHSC-PSM drivers who staff a fleet of 15 delivery trucks. Instead of operating a parallel supply chain, GHSC-PSM works alongside NatPharm, delivering HIV/AIDS and other commodities to all 1,800 health facilities throughout the country.
At times, MOHCC distribution has been impacted by fuel shortages. GHSC-PSM has minimized the impact through significant effort and coordination by our transport managers. Our truck drivers can access fuel at filling stations that accept U.S. dollars, where fuel queues are significantly shorter than regular stations. Fuel station managers will also sometimes call when new shipments arrive.
Reason 3: A highly functioning logistics management unit
GHSC-PSM also provides 23 staff – like Lemson Machibiza in the photo to the right – to MOHCC. The supply chain experts are housed at NatPharm warehouses to run the MOHCC's Logistics Unit.
Logistics Unit staff work behind the scenes, serving as an interface between health facilities, NatPharm and MOHCC, and helping manage Zimbabwe’s public health supply chain.
When needed, they deploy trucks to redistribute commodities between health facilities to prevent understock, stockout, overstock and expiry. They serve as a check on deliveries, verifying that they have arrived on-time and in the needed quantities.
Logistics unit staff also provide training on a range of topics, including for health facility staff on the use of the MOHCC’s and GHSC-PSM’s technology platforms for reporting stock levels and ordering commodities.
Reason 4: A well-functioning logistics management information system
NatPharm and GHSC-PSM operate integrated logistics management information systems (LMIS) that are used to manage the public health supply chain, including at health facilities.
In the photo the left, Timothy Shumbayaonda – a pharmacy technician with the MOHCC – supports staff at Dingumuzi Clinic to place orders for HIV/AIDS commodities through the GHSC-PSM supported LMIS. The clinic is one of 16 that he travels to each quarter to verify deliveries, manage stocks, and place orders.
Because of strong staffing and systems to support the LMIS, all of the more than 1,400 public ART sites in Zimbabwe report data through the management information system.