ProjectsImproving Zambia healthcare services with a human-centred approach
A comprehensive analysis of medicines’ supply chain in Zambia healthcare system, to identify areas of intervention and a roadmap of private-public sector initiatives, coordinated by the Ministry of Health.
How could the Zambia government improve the delivery of care, even in the most remote rural areas? What are the major gaps along the existing supply chain and how could they be addressed through new initiatives and tech-based interventions?
We conducted an extensive field research study in various facilities and distribution areas in Zambia to understand the whole process of medicine delivery. The research focused both on mapping stakeholders, roles and platforms used throughout the supply chain, as well as understanding specific behaviours, mental models and blockers. The insights collected were then used to host a workshop involving all public and private sector actors involved in the supply chain, to discuss emerging findings, identify opportunities and collaboratively create a roadmap for future implementations.
A end-to-end map of medicines’ supply chain in Zambia healthcare system was created, describing the entire process and including the point of view of the final users (pharmacists, doctors and patients). The map is the collector of critical aspects and identified interventions, further detailed into a strategy document and roadmap - that aim at guiding stakeholder alignment around the implementation of a new tool for pharmacy supply chain management.
Zambia Ministry of Health (MoH) operates within a complex system of actors dedicated to enhancing healthcare access by providing medical commodities and related services. With more than 27 partners involved - including NGOs, foundations, public bodies and private organisations, each operating with their own platforms and tools - there is a lack of communication and systems’ interoperability, often leading to fragmented distribution. As a result, the much-needed resources often fail to reach the right people at the right time.
The lack of systemic vision and understanding of operational workflows - while making decisions related to supply management - had significantly impacted the work of its frontline users over the years. Pharmacists have often found themselves dealing with issues related to supplies stock-outs and scattered procurement process, made even worse by practical barriers such as lack of connectivity, power outages and adverse weather conditions.
In order for the MoH to develop an intervention plan and work on the improvement of the supply chain delivery system, it has become crucial to understand how the whole process performs from various perspectives - spanning from technical to economical and behavioural. This has meant listening to the final users needs and perspectives, and embed them into the strategic redesign approach.
As part of the research process, we engaged key stakeholders across Zambia (from supply chain experts to pharmacists, both in urban and rural areas) to have in-depth conversations about their activities, needs, blockers and enablers. During each of the field-visits to supply hubs, distribution centres and pharmacies, we observed operations, documented workarounds, analysed tools’ adoption and collected evidences of emerging problems and their direct or indirect consequences.
All the primary findings collected were then synthesised to provide a comprehensive overview of the end-to-end system and its key fragmentation areas. The overall system and process map, together with key fragmentation areas, have been then brought into a strategy workshop, providing the opportunity to all the stakeholders involved in the supply chain to develop a shared perspective, align on emerging gaps and coordinate on new initiatives and actions that could reduce fragmentation.
The goal of the workshop was to enable the Ministry of Health and all the existing partners to collectively set priorities and make strategic choices.
Obviously not all fragmentation areas and issues could be solved at once, so the first step was a collective agreement to prioritise the current blockers experienced by pharmacists - before starting to discuss new technical implementations and platforms. All the ideas and opportunities related to activating better workflows, enhancing data literacy and reinforcing feedback loops have been consolidated as initial steps of the strategic roadmap, clearly defining ownership and governance to coordinate and execute every intervention.
The following phases of the roadmap deal with the need of improving the supply management infrastructure in terms of roles and platforms - by reducing complexity and ensuring interoperability. Some of the interventions identified include the adoption of a new tool for supply management, a better integration of public and private sector distribution hubs, and reduced workload for the centralised operations.
