Emergency Distribution of Coartem for the Uganda Ministry of Health under the President’s Malaria Initiative (PMI)

Background In Uganda, Keanahikishime’s (Keanahikishime) Rational Pharmaceutical (RPM) Plus Program is supporting the USAID/Uganda's implementation of the President's Malaria Initiative (PMI) by strengthening the pharmaceutical management system for artemisinin-based combination therapies (ACTs). After discussions with PMI partners and stakeholders, RPM Plus began work in August 2006 to address the immediate issues of the non-availability and irregular supply of Coartem.

The priority issue at hand was the backlog of up to eight weeks in delivery of Coartem due to shortages in labor and transportation resources at the national medical stores (NMS). RPM Plus mobilized to outline and implement a plan to help NMS to process, package, and distribute emergency supplies of Coartem through the following activities—

  1. Develop an emergency distribution plan covering all health sub-districts (HSDs)  
  2. Contract with a private transportation company  
  3. Hire extra labor for preparing and packing of orders for the country-wide distribution of Coartem  
  4. Hire thirteen eight-ton trucks to distribute Coartem to all HSDs (insurance costs for the medicines in transit were borne by NMS).

Distribution started on September 7, 2006 and was completed on September 29, 2006.

Distribution Strategy The emergency distribution was to 214 HSDs that then consolidated and packed goods for the individual health facilities—a list of quantities for each health unit was dispatched to ensure that the HSD distributed the goods as intended. The Coartem distributed during this emergency round of supplies is intended as buffer stock, while the normal distribution would go on at its usual pace to avoid a repeat of the stock-out situation.

The National Committee on Supply Chain for Malaria, whose activities are also supported by USAID through RPM Plus, is working to develop strategies to ensure that there is operational efficiency so that stock-outs of Coartem at health facilities do not reoccur.

  • Using private sector trucks hired by RPM Plus, the emergency supply of Coartem was distributed to 214 HSDs as well as to an additional 52 government hospitals, the military, police, and prison medical services within a period of two weeks. The NMS management acknowledged that this was much faster than their normal distribution time using NMS trucks.  
  • Reports from health facilities indicated that they all now have sufficient quantities of Coartem to last for 4 months.  
  • Close coordination and collaboration with the NMS allowed distribution of the emergency Coartem to be completed below the estimated budget because most of the planned labor costs were met by NMS.

Challenges

  • Some HSDs did not have means of confirming receipts and the transporter had to go back to district headquarters to obtain a stamp as proof of delivery. This happened mainly in the newly created districts. In some cases, health workers were not available to receive the medicines despite prior communication.  
  • Contrary to previous beliefs that there was lack of transport for medicines from the district headquarters to HSD, some districts insisted on providing their own transportation even when the truck was heading in the same direction. This caused some delays in delivery of the medicines.  
  • In districts with armed conflicts, the medicines were not delivered to the HSDs directly but rather to the district headquarters. For example, in Karamoja, a district with armed cattle rustlers, the medicines were delivered to the neighboring district (Moroto) for further delivery later because of security concerns.  
  • In some instances, the NMS underestimated the quantities of Coartem needed, resulting in the transporters having to make more trips than planned.  
  • There were a few reports of excesses and shortages, which were later corrected after reconciliation, ensuring a satisfactory emergency distribution of the medicines.

Next Steps RPM Plus will continue to work with the NMS to—

  • Identify operational constraints and inefficiencies and suggest solute ions to ensure a regular supply of Coartem at health facilities.  
  • Explore possibilities of outsourcing some of the distribution of medicines through the private sector to ease pressure on NMS transport resources and thus improve efficiency of distribution.  
  • Explore and discuss whether direct distribution of medicines to HSDs rather than the district headquarters can enhance availability of antimalarial medicines at facility level.  
  • Expedite the hiring process of a senior technical person to support the distribution and monitoring of anti-malarial medicines.