Operationalizing Drug Revolving Funds to provide health supplies for mothers and families in several Nigerian states

A DRF works to strengthen the health system closer to the patient by creating sustainable processes and infrastructure further down the supply chain to make quality-assured health supplies consistently available at state and local levels. The importance and impact of these efforts are reflected by nurse and midwife Elizabeth Odo, whose state has already benefited from DRF implementation,

“With the DRF, in the event of emergency in the middle of night, there is no need to panic because the drugs are available. This helps increase patient trust and flow.”

The USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project recently partnered with Ebonyi State government to facilitate a series of pre-implementation activities for their DRF. The process kicked off with a workshop in November 2021, where GHSC-PSM convened state leaders to build consensus on the guiding principles of the Ebonyi DRF. 24 participants, including directors and representatives from the State Ministry of Health, State Ministry of Budget, State Central Medical Warehouse, primary and secondary health facilities, the National Council for Women Societies Nigeria, traditional leaders, and religious leaders met “to ensure there is representation in the inputs and to establish acceptable guidelines for a sustainable DRF in Ebonyi State,” said Dr. Mariya Saleh, GHSC-PSM Nigeria Director for Reproductive and Maternal, Newborn and Child Health (MNCH).

USAID Logistics and Commodities Program Manager, Health, Population and Nutrition Office, Emmanuel Ogwuche kicked off the workshop by emphasizing the Nigerian government’s role in leading DRF activities and GHSC-PSM’s supporting role, providing technical assistance that will allow the state to fully take over the management of its supply chain. He commended the strong community representation, including Ebonyi State President of the National Council for Women Societies Nigeria, Head of the Religious Leaders/Traditional Rulers, and Chairman of the Ward Development Committee.

The group used the workshop to share and review information—such as the State Drugs and Health Commodities Management Agency Law—deliberate, and finalize the Ebonyi Standard Operating Procedures (SOP), taking into account governing structures at both state and health facility levels as well as other elements of the DRF scheme. The group also discussed the structure of the DRF governing committee, which would be established later on in the DRF process. As was done in other Nigerian states supported by GHSC-PSM, the SOP developed during this phase will be used to establish DRF governing structures and guide training, warehouse and data system improvements, quantification processes, procurement and distribution of health supplies.

In Ebonyi, stakeholders left the planning workshop with a new sense of commitment and a better understanding of their roles and expectations in implementing activities for a successful DRF in their state. “As a women’s group leader, I know that the DRF initiative will give women and vulnerable groups more access to drugs and healthier living; women are known for moving things forward for the benefit of the society, and I am committed to playing my part," said Hon. Mrs. Theresa Osinachi Omoke, President National Council for Women Society, Ebonyi State Branch. This sentiment was buttressed by the State Director Pharmaceutical Services, Dr. Moses Okoro. “This workshop came at the right time; it became necessary to have broad participation to finalize the SOP and carry every relevant stakeholder along,” he said. He added that the workshop allowed stakeholders who had not been closely involved to appreciate the benefits of the DRF initiative.

According to Tukur Ibrahim, GHSC-PSM Senior DRF Manager, “the DRF model that the Ebonyi State stakeholders were able to achieve during the workshop is one of the best for now, and if implemented accordingly, Ebonyi will become a reference point for other states.” The model is aligned with the National Health Supply Chain Strategic Plan (2021-2025), with its vision to have a government-led sustainable system that is responsive, reliable, agile, and cost-friendly to run delivery services to the citizenry and achieve Universal Health Coverage.

Following the workshop, the project met with the Ebonyi State Commissioner for Health, Dr. Umezurike Howard Akuma Daniel (FWACS, FICS) and key members of his team. GHSC-PSM presented an overview of the Ebonyi State DRF model, including the SOP developed and agreed upon by Ebonyi stakeholders. The project also shared the criteria by which Ebonyi could receive MNCH and malaria seed stock and USAID technical assistance commitments. Dr. Umezurike shared that the state is committed to adopting the Pharma Grade Medical store as the only capital project in 2022—which would meet the readiness standards required by the DRF program to effectively store health commodities. The state also plans to create a more integrated supply chain distribution system for essential medicines by using coordinated wholesale centers.

According to the GHSC-PSM Nigeria Deputy Country Director Jiru Bako, “the presence of the Commissioner [at this meeting] shows that there is political backing and political will from the government to implement the DRF.”

Since the Ebonyi workshop and State Health Commissioner meeting, GHSC-PSM has helped the state conduct warehouse and organizational assessments, the government has inaugurated the Ebonyi State DRF committee—who will lead decision making for the initiative—and in January 2022, the project conducted quantification to determine the essential medicines needs of Ebonyi State. These steps in Ebonyi, and other DRF states, are the beginning of the journey to ensure quality health supplies are available to all Nigerian mothers and their families, for many years to come.