USAID Grant: Strengthening Uganda’s Essential Health Commodities Supply Chain

The current supply chain is long and complex, with many players and many potential points of disruption. Outside the country the supply chain players include manufacturers, procurement agents, transport companies, and customs clearance agents. Within the country, six key entities are responsible for working together to ensure the availability of essential medicines and other health products in the public health system:

1. Ministry of Health (MOH) technical programs are responsible for product selection, forecasting, procurement planning and coordination with donors, and monitoring stock levels within the system;
2. The National Medical Stores (NMS), a parastatal, is charged with the efficient and cost effective procurement, storage, processing of orders, and distribution of health commodities to the district level on behalf of the MOH. USAID, and other donors such as UNFPA and the Clinton Foundation, procure and ship products to the country and NMS is paid a fee to store and distribute the commodities to districts.
3. Joint Medical Store (JMS) is private sector organization that procures essential medicines and health supplies; private, NGO and MOH facilities can buy their commodities from JMS (the latter when NMS is stocked out of an item). JMS also serves as a second outlet for some donated products which are provide free to NGO facilities.
4. The National Drug Authority (NDA) is a parastatal that regulates the quality and registration of pharmaceutical and medical commodities imported into Uganda.
5. The fifth ‘entity’ is comprised of the health facilities that order, manage and dispense health commodities, and District Health Offices (DHO) and Health Sub-districts that are responsible for budgeting, planning, monitoring, and processing facility orders to the NMS.
6. Another important player is the Ministry of Finance which is responsible for releasing funds to NMS and the MOH on a timely basis.

Despite some success in improving supply chain management over the past 8-10 years, there are still many improvements needed. All of the above players somehow contribute to the problems and there is no short-term silver bullet. Some of the problems can be resolved in the short-term such as improved communications between the parties and better storage infrastructure and inventory management at NMS. Other improvements will take longer, such as removing the regulatory and financial obstacles that currently impede the performance of the NMS. Until the central MOH, in particular, has sufficient money and trained personnel to take on key logistics management functions, USAID and other donor partners will need to continue providing substantial assistance to ensure that key logistics management functions are carried out to avoid total collapse. PROPOSED ACTIVITY: Please find below the results framework that USAID intends to be the basis for this activity for logistics and commodities. USAID intends to avail this grant opportunity for competition, and is in the activity design phase, consulting with ministry and donor stakeholders, and that this information is being shared for informational purposes only. This process may take one to three months. RESULTS FRAMEWORK:

Activity Title: Securing Ugandans’ Right to Essential Medicines (SURE)

Activity Objective: Strengthening Uganda Supply Chain for Essential Health Commodities

Result 1: Improved commodity security framework for essential health commodities

IR 1.1 GoU demonstrates commitment to improving financing of health commodities

IR 1.2 Improved legal and regulatory framework to promote effective and efficient national supply chain

Result 2: Improved capacity and performance of Ministry of Health and National Medical Stores in their supply chain management roles and responsibilities

IR 2.1 Clarified roles and responsibilities and improved communication within MOH and between MOH and NMS

IR 2.2 MOH capacity and performance improved in forecasting, procurement planning, budgeting, management of logistics information, monitoring and evaluation

IR 2.3 NMS capacity and performance improved in procurement, warehousing, distribution, customer service, and security

IR 2.4 Anti-theft policies, procedures and tools in place and functioning

Result 3: Improved capacity and performance of District Health Offices and health facilities in their supply chain management roles and responsibilities

IR 3.1 District health office capacity and performance improved in planning, budgeting, procurement, reporting, distribution, monitoring, and securing essential health commodities

IR 3.2 Health facility performance improved in quantification, ordering, inventory management, record keeping, reporting, and securing essential health commodities

IR 3.3 Stock outs of key health commodities reduced in all target districts

Thank you for your interest in USAID programs.

The current supply chain is long and complex, with many players and many potential points of disruption. Outside the country the supply chain players include manufacturers, procurement agents, transport companies, and customs clearance agents. Within the country, six key entities are responsible for working together to ensure the availability of essential medicines and other health products in the public health system:

1. Ministry of Health (MOH) technical programs are responsible for product selection, forecasting, procurement planning and coordination with donors, and monitoring stock levels within the system;
2. The National Medical Stores (NMS), a parastatal, is charged with the efficient and cost effective procurement, storage, processing of orders, and distribution of health commodities to the district level on behalf of the MOH. USAID, and other donors such as UNFPA and the Clinton Foundation, procure and ship products to the country and NMS is paid a fee to store and distribute the commodities to districts.
3. Joint Medical Store (JMS) is private sector organization that procures essential medicines and health supplies; private, NGO and MOH facilities can buy their commodities from JMS (the latter when NMS is stocked out of an item). JMS also serves as a second outlet for some donated products which are provide free to NGO facilities.
4. The National Drug Authority (NDA) is a parastatal that regulates the quality and registration of pharmaceutical and medical commodities imported into Uganda.
5. The fifth ‘entity’ is comprised of the health facilities that order, manage and dispense health commodities, and District Health Offices (DHO) and Health Sub-districts that are responsible for budgeting, planning, monitoring, and processing facility orders to the NMS.
6. Another important player is the Ministry of Finance which is responsible for releasing funds to NMS and the MOH on a timely basis.

Despite some success in improving supply chain management over the past 8-10 years, there are still many improvements needed. All of the above players somehow contribute to the problems and there is no short-term silver bullet. Some of the problems can be resolved in the short-term such as improved communications between the parties and better storage infrastructure and inventory management at NMS. Other improvements will take longer, such as removing the regulatory and financial obstacles that currently impede the performance of the NMS. Until the central MOH, in particular, has sufficient money and trained personnel to take on key logistics management functions, USAID and other donor partners will need to continue providing substantial assistance to ensure that key logistics management functions are carried out to avoid total collapse. PROPOSED ACTIVITY: Please find below the results framework that USAID intends to be the basis for this activity for logistics and commodities. USAID intends to avail this grant opportunity for competition, and is in the activity design phase, consulting with ministry and donor stakeholders, and that this information is being shared for informational purposes only. This process may take one to three months. RESULTS FRAMEWORK:

Activity Title: Securing Ugandans’ Right to Essential Medicines (SURE)

Activity Objective: Strengthening Uganda Supply Chain for Essential Health Commodities

Result 1: Improved commodity security framework for essential health commodities

IR 1.1 GoU demonstrates commitment to improving financing of health commodities

IR 1.2 Improved legal and regulatory framework to promote effective and efficient national supply chain

Result 2: Improved capacity and performance of Ministry of Health and National Medical Stores in their supply chain management roles and responsibilities

IR 2.1 Clarified roles and responsibilities and improved communication within MOH and between MOH and NMS

IR 2.2 MOH capacity and performance improved in forecasting, procurement planning, budgeting, management of logistics information, monitoring and evaluation

IR 2.3 NMS capacity and performance improved in procurement, warehousing, distribution, customer service, and security

IR 2.4 Anti-theft policies, procedures and tools in place and functioning

Result 3: Improved capacity and performance of District Health Offices and health facilities in their supply chain management roles and responsibilities

IR 3.1 District health office capacity and performance improved in planning, budgeting, procurement, reporting, distribution, monitoring, and securing essential health commodities

IR 3.2 Health facility performance improved in quantification, ordering, inventory management, record keeping, reporting, and securing essential health commodities

IR 3.3 Stock outs of key health commodities reduced in all target districts

Thank you for your interest in USAID programs.