Zambia's medical stores plays a pivotal role in ensuring its 1500 health facilities are adequately equipped with the right medical supplies to manage high incidences of malaria, HIV/AIDS, tuberculosis and other life threatening diseases for a population of 13.2 million.
The Zambian government established Medical Stores Limited (MSL) in 1976 to store and distribute medical supplies but years of poor management led to spiralling debts in excess of US$1.3 million, inconsistent stock availability and low employee morale.
Eight years ago, the Zambian government committed to working with Crown Agents to transform MSL into a professionally run and financially sound institution that would ensure the reliable delivery of vital medicines. Government 'buy-in' and collaboration between Crown Agents and the Ministries of Health and Finance have been crucial.
When the programme launched in 2004, the government formed a board of empowered and willing representatives from the Ministries of Health and Finance, civil society, the private sector and MSL to monitor the performance and direction of its medical stores operations.
Building capacity throughout the organisation was a key priority from the outset to ensure improvements to financial management; infrastructure including purchasing new vehicles and handling equipment; supply chain management and the upgrading of information technology and facilities.
Another challenge involved restoring employee morale to improve staff attendance and reduce stock leakages. We worked with unions to bring pay in line with market rates and we increased staff incentives and benefits including pensions, performance related bonuses, personal development opportunities, free staff meals and a free staff bus.
Our approach to capacity building included shadowing and mentoring existing employees to strengthen their skills and finding the best candidates locally to fill vacancies in financial management and pharmaceutical standards. We also identified a senior logistics manager at MSL with the potential to become the director of logistics and we provided an intensive programme of development, including an online Masters course in Logistics to develop technical and soft skills in leadership, staff management and business management.
We worked with employees to establish proper financial controls including budgets and forecasts for better financial management and improving the management of pharmaceutical quality assurance, storage and distribution.
MSL is now a demand-led organisation that is recognised as a model for medical operations in sub-Saharan Africa and it is being emulated and adapted by the government of Botswana.
Stock availability has doubled, 95 per cent of orders are delivered on time; distribution costs have been reduced by 32 per cent and the majority of partners now route their commodities through MSL, creating a single coordinated logistics organisation.
Donor confidence in MSL's performance has grown and many partners including the World Bank, Department for International Development (DFID), USAID, SIDA and the UNFPA continue to invest in and help develop the organisation.
The World Bank and DFID funded a pilot project to directly distribute medical supplies from central to facility level, by-passing midway stockholding points and doubling both paediatric malaria treatments and antibiotics to fight respiratory and HIV infections. This distribution model, which will be rolled out to 27 districts by the end of 2012, is expected to deliver malaria treatments to an additional 110,000 children per year and could save 27,000 child lives by 2015 when scaled up nationally, representing a 37% reduction in child mortality due to malaria in the country.
Crown Agents' relationship with MSL is evolving into more of an advisory capacity rather than full hands-on support as the institution becomes increasingly self-sufficient. We are currently recruiting a new managing director locally to lead MSL's future development and we are looking at ways to strengthen procurement and drive the last mile distribution of essential health products to improve the availability of medicines in local pharmacies and health centres.
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