How can people living with HIV/AIDS continue to get the life-saving medical supplies they need in a country undergoing political unrest? Thanks to the preparedness of the Supply Chain Management System (SCMS) and its partners in Burundi, operating under such unstable conditions barely affected the availability of and access to supplies for much-needed treatment.
Civil unrest erupted in Burundi on April 26, 2015, just before the elections, and political tensions continue to this day. Due to protests, as well as ambushes, assassinations, and a thwarted coup d’état, most parts of the city have been inaccessible.
The situation frightens us,” said Jean Claude Niyonizigiye, Supervisor at Zone Sud Health District in Bujumbura City. “Workers who need to pass through the difficult areas of Bujumbura, the capital, often proceed with hesitation and take many precautions to avoid being targeted. Other times, when things are especially tense, people avoid commuting to work. Health facilities face unstable employee attendance during the unrest. At times, it has been difficult for some health facilities to access the Central Medical Store, CAMEBU, to resupply needed HIV commodities. Health facilities, especially those in Bujumbura City, have been unable to access their own stores.”
To ensure the continuous flow of HIV supplies from the Central Medical Store (CMS) to health districts and the uninterrupted availability of such commodities in-country, SCMS continues to work closely with La Centrale d’Achats des Médicaments Essentiels, des Dispositifs Médicaux et des Produits et Matérials de Laboratoire du Burundi (CAMEBU), managers of district pharmacies, and FHI 360 (a PEPFAR implementing partner) to troubleshoot supply problems. The key to the continued supply of medications was proper planning.
Specifically, the team attributes its success to three factors:
1. Establishing a distribution calendar
Thanks to scheduling HIV commodity distribution in advance, we were able to assist CAMEBU in establishing a distribution calendar for health districts a week prior to the launch of the monthly requisition and reporting cycle. We worked hand-in-hand with the 25 health districts supported by PEPFAR in assessing and addressing resupply challenges at CAMEBU in anticipation of potential health supply delivery difficulties during the election.
2. Advance delivery of shipments
In anticipation of potential challenges, we managed to deliver over 90 percent of expected shipments before the crisis erupted. It is so gratifying to have the right quantities of HIV commodities, allowing for adequate supply to meet health district needs during a time of insecurity.
3. Flexibility and coordination
Achieving an uninterrupted flow of HIV commodities has required strong coordination and imagination to overcome challenges. The logistics manager, for example, was in constant communication with health district pharmacy managers to share information on the security situation, arrange meeting locations and bring all the necessary documents to ensure the resupply was approved.
Overcoming unique challenges
While there continue to be many challenges during the unrest, SCMS and its partners continue to find creative approaches to addressing potential obstacles. For example:
Challenge: No passage to the SCMS office.
Solution: When the SCMS office was inaccessible due to security threats, staff communicated via mobile phone with health districts to jointly identify secure meeting points to analyze and approve monthly distribution reports and requisitions. Staff convened to analyze and approve five reports and six requisitions from five health district pharmacies at locations other than the SCMS office.
Challenge: No access to health district stores
Solution: Temporary locales for HIV commodities distribution were identified based on SCMS recommendations.
Challenge: Barricaded/inaccessible roads.
Solution: Commodities were transported in district hospital ambulances that were allowed passage by people guarding the barricades.
Challenge: Transportation constraints.
Solution: SCMS collaborated with FHI 360 to help address product accessibility for PEPFAR-supported districts experiencing transportation constraints. Adopting a direct delivery mode, FHI 360 used a rented truck to deliver commodities and supplies to three health districts in less than two weeks.
Service delivery remains high
We are happy that health districts are able to resupply and bring lifesaving health products to service delivery points where patients can reach them. During the unrest:
- 92 of orders expected from sites were received by SCMS who then analyzed and processed them for procurement.
- Districts collected their HIV commodity orders for health facilities at a fill rate of 99.3 percent.
- CAMEBU filled health districts’ orders within an average time of 1.9 days after receiving their orders.
The crisis in Burundi is continues. to this day. SCMS staff, CAMEBU staff, district pharmacy managers, and FHI360 remain committed and proactive in ensuring lifesaving health commodities reach patients. Stakeholders continue to work as a team to find solutions to barriers. Good planning, effective communication and coordination drive this collaboration and play a significant role in maintaining the flow of HIV commodities throughout the health system.