Health supply chains in the fight to end malaria

by | Apr 24, 2023

World Malaria Day, observed on April 25th every year, is a reminder of the ongoing fight against the deadly disease that claims many lives every year. 

Malaria is preventable and treatable, but it remains a significant public health issue, particularly in sub-Saharan Africa, where more than 90% of malaria and deaths occur. 

Health supply chains play an especially important role in the fight to end malaria. The availability of affordable, quality-assured Malaria Rapid Diagnostic Tests (MRDTs) and medical equipment used in microscopic examination or microscopy is critical for the early diagnosis and treatment of malaria. 

As a procurement services agent (PSA), The Partnership for Supply Chain Management (PFSCM) supports global donors with supply chain-, procurement- and health logistics services to reduce the burdens of epidemics like HIV, malaria, and tuberculosis (TB) in low- and middle-income countries.

Strategic sourcing, creating a diverse supplier base, quality assurance, and ethical procurement of medical products and equipment is essential in the fight against malaria, and PFSCM is at the forefront of this effort.

Since 2018, PFSCM has procured more than $432 million of malaria commodities such as MRDTs, antimalarials, and indoor residual spraying products; and delivered 403 shipments to 50 countries, making a significant contribution to fighting malaria.


Malaria Rapid Diagnostic Tests: an indispensable testing tool  

MRDTs are compact, easy-to-use tests that provide quick results, usually in less than 20 minutes Their efficacy and physical characteristics make them a cost-effective and practical way to diagnose malaria in resource-limited areas where laboratory-based diagnostic methods are unavailable.

PFSCM has always been supplying quality-assured MRDTs to various health programs. We have delivered more than 820 million individual malaria tests in the last five years alone.

Uganda, Tanzania, Congo DRC, Nigeria, and Zambia are the top countries for the number of MRDTs ordered. These countries have a high malaria burden, and MRDTs are critical for timely diagnosis and treatment. The high demand for MRDTs in these countries underscores the need for continued efforts to ensure their availability in areas with limited resources.

PFSCM’s efforts to procure and distribute MRDTs to these countries have played an essential role in the fight against malaria, improving access to essential medical products and reducing the burden of the disease.

Microscopy: relevant and effective

Apart from maintaining supply chains for the delivery of MRDTs to malaria-endemic countries, PFSCM also sources, procures, quality assures, and delivers laboratory equipment such as microscopes, staining and drying racks, and slides used in microscopy diagnosis of malaria. Despite the longer turnaround to producing patient results, microscopy is still one of the gold-standard malaria species identification techniques.

Moving MRDTs in a responsible way

Malaria products, especially MRDTs, are high-volume goods often shipped by container full. For this product category, plenty of initiatives are in place to reduce the logistics emissions associated with moving the goods. 

Firstly, the products are already shipped by ocean, which is far less polluting than by air.

Secondly, because of the sheer volume of goods shipped, other sustainability initiatives like Load Optimization are viable. 

PFSCM implements Load Optimization by actively identifying opportunities to improve pallet and container loading for high-volume and high-freight cost orders placed by its clients (principal recipients). This activity ensures that cartons, pallets, and shipping containers are packed optimally while meeting principal recipients’ receiving and warehousing requirements. Optimal packing means cartons, pallets, and containers are loaded in configurations that use the packing area entirely or with the least amount of unused space. This reduces shipping costs and lowers the logistics carbon footprint.

In 2021 and 2022, PFSCM worked with stakeholders, mainly large-volume suppliers, to optimize more than 1,000 ocean and charter flight shipments, saving $5 million. Freight savings for MRDT shipments alone amounted to almost $800,000. In total, 80% of products shipped by PFSCM qualify for Load Optimization; MRDTs being among those products. 

Thirdly, to ensure a sustainable supply chain and lower emissions, PFSCM implements the GLEC framework. This framework or method provides a common language and set of tools to drive logistics sustainability, reduce emissions and improve efficiency across the supply chain. By implementing the GLEC framework, PFSCM ensures that the supply of MRDTs and other critical health products is more sustainable, reducing emissions and creating a better future for the planet.

In conclusion, the availability of MRDTs is essential to the fight against malaria. By working together and implementing sustainable supply chains, we can progress toward a malaria-free world while preserving our planet for future generations.



Overcoming trade restrictions, production delays, and reefer shortages to deliver MRDTs to Pakistan

PFSCM has been serving Pakistan since 2010 on an ongoing basis. Every year since 2019, PFSCM has assisted the country with standard and emergency orders for malaria testing and treatment products.

In 2022 and 2023, despite Pakistan’s trade restrictions on imports from India, production delays, and reefer container shortages, PFSCM was able to assist the Directorate of Malaria Control (DOMC) in the country with large and urgent deliveries of malaria rapid diagnostic test kits (MRDTs).

In 2023, PFSCM delivered two large shipments of more than 5.3 million individual MRDTs to Pakistan. The recent shipments comprised nine reefer containers (more than 60 metric tons) worth more than $2 million. Another 16 reefers are due to be delivered to Pakistan by mid-2023.

Meanwhile, in 2022 overcame unique supply chain challenges to deliver several shipments of more than 11.4 million MRDTs worth more than $4 million to Pakistan. One notable and urgent shipment from last year consisted of 14 reefer containers, amounting to 95 metric tons, which were delivered by ocean and another 11 tons of MRDTs delivered as air cargo, bringing the total to 106 metric tons.

PFSCM Logistics Specialist Tassos Betzelos explains that expediting the procurement and shipping required extensive coordination with suppliers and 3PLs.

“Urgent orders require all hands on deck to advocate for shorter production and documentation approval lead times, as well as speedy delivery using the first and most suitable available freight options to prevent possible stockout situations for our clients.”

He adds that with many years of experience, PFSCM is well-positioned to negotiate and collaborate with suppliers and shippers.

“Last year, when we worked on these orders, COVID-19 still affected supply chains. Our stakeholders and we were still experiencing the knock-on effects of the pandemic. Despite those ongoing global issues, we worked closely with our supplier to prioritize production. The supplier reduced the lead time for the first urgent MRDT order to about 50 days. This is a 25 to 40-day improvement on the standard 75 to 90 days lead time usually offered.

Further, PFSCM collaborated closely with its 3PL partner Maersk to overcome some unique logistical barriers that were presented during the planning of ocean shipments.

“In 2022, urgent deliveries to Pakistan are not only complicated by the trade restriction imposed on imports from India but also by the global shortage of reefer containers.”

Betzelos notes that PFSCM recognized these issues in the early stages of supply chain planning and, before procurement and shipping, engaged all the stakeholders — Maersk, their legal team, the supplier, the donor, the PR, and the Pakistani authorities — to ensure that all the necessary exemptions were in place and that import waivers were pre-approved for accelerated delivery.

He explains that the exceptions are based on an Import Policy Order from 2016 (and a clause added in 2019) stating that “therapeutic products regulated by the Drug Regulatory Authority of Pakistan (DRAP)” are exempt from the trade restrictions.

“We are extremely pleased and grateful that the supplier and 3PL could accommodate these urgent orders despite ongoing supply chain challenges. The dedication and flexibility of our suppliers and 3PLs are testaments to our collective commitment to end serious epidemics like malaria, HIV, and tuberculosis,” concludes Betzelos.