Reimagining the Supply Chain and Building Sustainable Solutions

Previously, the separate reagent items required for viral load testing were procured individually by the government from multiple suppliers, arriving on different days from different suppliers with different expiry dates. All these items had different handling and storage requirement conditions which were difficult to maintain as deliveries went first to the Zambia Medicines and Medical Supplies Agency (ZAMMSA) central warehouse, and then to each testing lab. Purchasing different items, sometimes as many as 11 components per test, from different suppliers with different expiry dates was difficult to track. This often led to frequent halts in testing while waiting for delivery of the missing reagent or consumable item.  

All 24 individual testing sites now have ownership for data and stock management which has minimized interruptions in testing due to expiries or stockouts. Reagents are now delivered directly to each testing lab as bundles (cocktails) based on each lab’s usage data. GHSC-PSM works with the Ministry of Health to centrally manage consumption data from each lab, and manage procurement of bundled reagents from the vendors. The replenishments for the inventory in the labs are centrally aggregated by the project with support from the MOH. This has reduced handling errors and ensured products do not expire on the shelves of the testing labs. 

There has also been a dramatic improvement in how testing labs are equipped and how these instruments are maintained. Prior to this arrangement, the government invested heavily in procuring this equipment, but without standardized maintenance contracts to ensure equipment functioned properly. This often led to lengthy periods where the machines were offline and unable to perform tests.  

Thanks to the restructured contracts with the help of GHSC-PSM, the cost and maintenance of lab equipment has now moved to the reagent vendors making the investment more cost effective for the host government. The vendor is now fully responsible for ensuring that the instrument is always functional, through scheduled preventive maintenance and responding to breakdowns, with the cost of the lease built into the price of each reagent.  

Both the project and government have benefited immensely from adjusting their relationships with commodity suppliers. Improved delivery methods such as cross-docking, the practice of unloading goods from inbound delivery vehicles and loading them directly onto outbound vehicles for immediate delivery to the labs, has minimized warehouse storage costs, space requirements and inventory handling.  

Direct delivery of the bundle commodities began in early 2020 at seven facilities. By October 2020, all 24 VL/EID testing sites had their commodities delivered directly to their facilities by the vendor. As a result of the reduced cost per test due to the reagent rental strategy, about $2.2m (~200,000 in additional tests) was realized in cost savings for Zambia by end of 2021. 

People living with HIV now benefit from having access to more effective and efficient testing facilities, in turn building further confidence in the treatment they are receiving. Waiting times have on average been reduced from 14 days to seven days. This partnership is reimagining the supply chain and building sustainable, long-term solutions that are a win-win-win for the government, for health facilities and, most importantly, for the people of Zambia.