Ingraining trust and resilience in supply chains

For people to get the health products they need, we need robust, modern supply chains. And for that to happen, data, appropriate infrastructure and strong governance are all requisites

What aspects of supply chain management are key for creating trust and resilience in health?

Trust speaks to whether patients can count on a supply chain system to deliver what they need when they need it. Resilience relates to how agile a system is in responding to changes to ensure patients’ needs come first. For health systems to have impact, individuals must trust they can get the health products they need from that system. Supply chains play a critical role in achieving these six ‘rights’: the right product at the right cost at the right place and time, in the right quantity and of the right quality.

All supply chain functions must work effectively and in concert to achieve these six rights. A mature system has a favourable regulatory and policy environment, adequate, empowered supply chain professionals staffing the system, a robust design, an eLMIS (logistics management information system) that provides end-to-end data visibility, and appropriate infrastructure.

Even as supply chains mature, focusing on three key aspects – namely, patients and human-centredness, data and its use, and financing – can build trust and resilience. Are supply chains designed to best serve end users? If so, that drives the data collected and how it’s used. Funding for health products is always constrained, but with robust data, managers can make informed and strategic decisions and maximise the effective and efficient use of funds. For example, if programmes have enough data, they can forecast their estimates for health products, and use those estimates to strategise on what to provide for free, what to subsidise and what people will pay for.

Programmes do not need perfect data to run a supply chain. Supply chain actors can start with the data they have and use that more effectively. Because supply chains are dynamic, data use can be considered in the context of continuous improvement and through a lens that considers people, process and technology alongside data. When people have the skills and agency to make decisions, can follow a structured process, and technology can support the use of data, supply chain actors can use their data to inform operational, tactical, management and strategic decisions and actions at all levels.

Strategically, for example, providing paracetamol for free may not optimise the use of programme funds, but might be essential to retain the trust of a mother with a sick child who seeks care at a dispensary and expects to receive the medication from her provider. Similarly, routinely available data that signals to managers that there’s a shock – like Covid-19, a climate change event or an outbreak – helps drive their decisions on how to change inventory policies or orders.

Who is leading in ways that create trust and resilience?

Countries that have invested in the digital transformation of their supply chains stand out as examples I am familiar with. Tanzania has a well-advanced eLMIS, as do Zambia, Ethiopia, Ghana, Rwanda and South Africa. End-to-end data visibility that includes community-level logistics data is also increasingly important. However, robust data availability is not enough. Data has to be translated into actions and decisions about funding, policies and so on to respond to changes or shocks in ways that always prioritise patients. Many of the countries I mentioned are at various stages of maturity in achieving this level of resilience.

Underlying the effective use of data for resilience and trust is the need for strong, capable leaders and governance systems. Supply chain professionalisation is an important enabler for advancing supply chain maturity. Resilient supply chains require empowered directorates within ministries of health, staffed by professionals who can advocate for changes in financing, policy, regulation and direction setting when a shock occurs. Rwanda, Uganda, Kenya and Tanzania are exploring how to invest in professionalisation to achieve this goal.

As countries and public health supply chains mature and evolve, the private sector has an important role to play in enhancing trust and resilience. Across the continent but especially in Nigeria, Ghana and Kenya, innovators are disrupting traditional supply chains, raising the bar for how supply chains function and what patients can expect. Countries such as Kenya are acknowledging the importance of a total market approach that incorporates private players to expand access and choice for patients and customers. A woman, for example, might get her kids vaccinated through the public system because it’s trusted and free. But she might prefer a pharmacy for her contraceptive needs or to get her antimalarials.

What are the key political choices that must be made now?

Future-facing supply chains are resilient, respond to patients’ needs and use resources strategically to accommodate constraints, looking at the country’s intended health outcomes. Digitalisation, supply chain professionalisation, local financing of products and local manufacturing are all potential game changers but must be accompanied by intentional investments in supply chains. Expanding access to build trust must consider equity as a key political choice for governments. In summary, key political choices must encompass an enabling and diverse environment for the context, funding for supply chain systems and products, and intentional, human-centred approaches for operationalising future-facing supply chains. ▪