Medicines are Available Even When Power is Not In Zimbabwe, a strong partnership ensures that HIV/AIDS commodities reach the patients who need them

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.

However, the public health system is reaching a crisis point. Doctors are on strike, especially in the capital of Harare, and many health workers are only going to work two or three days a week, leaving many patients without the care they need.

Daily electrical outages began in May of 2019. Lasting anywhere from 10 to 24 hours, they frustratingly occur during working hours. Except for those fortunate enough to have solar panels, health facilities and others rely on generators. However, with gasoline prices averaging well over $5.00 a gallon, the cost of running generators is too high for many. Petrol and diesel shortages leave some generators sitting idle.

Remarkably, while the overall health system in Zimbabwe is facing many challenges, the HIV/AIDS supply chain continues to perform relatively normally. Here are a few reasons why.

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.

At NatPharm warehouses, staff store and prepare health commodities for delivery to health facilities in their regions.

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.

Left to right clockwise: Plumtree District Hospital, Dingumuzi Clinic and Mpilo Central Hospital.

Life-saving ARVs and other PEPFAR-supported commodities, including TLD, are typically fully stocked at health facilities. Close tracking of HIV/AIDS commodities shows that 96.5 percent of health facilities had stock of tracer products from July to September 2019.

The strong partnership between the MOHCC, NatPharm and GHSC-PSM shows that a public health supply chain can continue to function in the face of significant obstacles.

All photos by Tafadzwa Ufumeli

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