Overcoming importation complexities in health supply chains

by | Jul 10, 2024

Public health supply chains in developing countries are critical in delivering lifesaving health products to patients, but these supply chains are often complex and fragmented. This complexity can lead to inefficiencies or bottlenecks, diffuse accountability, and silos of information, and it tends to affect a particular portion of the supply chain which is the importation activities.

The Partnership for Supply Chain Management (PFSCM), a nonprofit supply chain solutions provider and procurement services agent, has been serving low—and middle-income countries since its inception in 2005. 

Since 2020, PFSCM has procured more than $1.6 billion worth of health products for 111 countries and delivered more than 9,616 shipments, 6,923 of which were cold chain shipments. More than 90% of PFSCM’s product volumes are destined for African countries. 

One of PFSCM’s core services and capabilities is health and humanitarian logistics. PFSCM works closely with a network of reliable freight forwarders to ensure products are delivered on time and in full to some of the most challenging destinations on earth.

Along with its partners, PFSCM captures and analyzes a wide range of supply chain data. 

Information collected for shipment delays shows that importation processes such as export licences, tax and product registration waiver applications, and customs clearance are among the biggest causes of increased delivery lead times. Other typical issues include receiving, storage, and distribution bottlenecks where shipments are delayed or held up in ports because of a lack of downstream capacity and/or infrastructure.

With more than 15 years of experience, PFSCM is adept at managing importation challenges. PFSCM continues to evolve but always relies on people, processes, and technology or tools to reduce importation lead times and mitigate risk and unnecessary costs. 

In humanitarian and emergency settings, health supply networks and processes become complex once a shipment arrives at the port of entry. Unregistered products, inadequate documentation, and sudden changes in government regulations can cause inefficiencies and bottlenecks, delaying importation processes and increasing procurement lead times. With careful planning, many of these problems can be minimized or avoided,” – Reducing Procurement Lead Times with Streamlined
Importation Processes (JSI technical brief).

Examples of overcoming importation challenges

Throughout the years, PFSCM has collaborated closely with clients in-country to improve a multilateral understanding of issues impacting importation processes. PFSCM works with stakeholders to map importation processes, identify bottlenecks, and simplify the procedures to streamline delivery.

For importation specifically, PFSCM recently coordinated with supply chain stakeholders in the Dominican Republic (DR), Gambia, Sierra Leone, Guinea, Nigeria, Tanzania, Yemen, and Pakistan to help resolve and streamline importation processes that were causing delays. PFSCM also recently helped resolve downstream distribution challenges in Uganda by establishing a transit warehouse. 

Dominican Republic 

Late in 2023, the customs authority in the DR unexpectedly reclassified condoms. This change affected the importation regulations and unintentionally divested the goods from a blanket tax waiver, which it previously held to ensure the prompt clearance of goods.

This change happened just as PFSCM was about to deliver 7 million condoms, or three containers full, to the country. As the containers were offloaded, the reclassification quickly complicated the customs clearance process, initially leaving stakeholders with two costly and time-consuming options. The DR could pay the estimated $40,000 in import duties and taxes or apply for tax exemption only after the containers were discharged at the destination port. This tax waiver process could take up to eight weeks, for which port storage and demurrage and detention charges of about $6,000 would have been incurred.

Thanks to PFSCM’s deep understanding and experience of the importation process and its close collaboration with key stakeholders, PFSCM was able to identify a third option, which was to agree that the importation declaration for the condoms could be submitted under a category that already benefitted from a time-saving blanket waiver. 

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In July 2023, the Gambian Medicine Control Agency (MCA) ceased issuing waivers for product registration, with an official communication publicized a few days prior to the change taking effect. 

PFSCM’s Logistics team assumed full responsibility for orchestrating all the necessary meetings and information-sharing opportunities among suppliers, the MCA, and the recipient in the country. 

PFSCM helped prepare documents, checked the accuracy of the paperwork, and assisted suppliers in expediting the registration process. This collaborative effort with the stakeholders has minimized delays in the overall process, and all orders were successfully delivered with limited delay.

Sierra Leone

In September 2023, authorities in Sierra Leone abruptly revised the approval requirements for the waiver process concerning the importation of products into the country.

Owing to strong collaboration with its client in-country and freight forwarder, PFSCM navigated the new clearance and waiver processes seamlessly. PFSCM’s partnership with 3PL partner Logenix International’s clearance agents at the destination proved instrumental in ensuring a smooth transition. Despite the changes in the waiver process, there were no shipment delays, even for shipments already in transit or departing during the official change in the waiver process.


In 2022, PFSCM collaborated with a host of supply chain stakeholders to align Harmonized System (HS) codes, which caused a delay in the delivery of large orders of health products originating from Asia and destined for Guinea.

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Nigeria is PFSCM’s largest client, and the country’s complex logistics landscape, characterized by infrastructural, environmental, and socio-economic intricacies, has been a significant focus for PFSCM.

For several years, PFSCM has supported supply chain stakeholders in Nigeria in overcoming unique importation challenges. 

These challenges included: 

  • 2017: the superfluous completion of the e-Form M, which accounted for about eight weeks of the importation process. 
  • 2018: road congestion and infrastructure issues at the port of Apapa also resulted in trucks queuing for weeks to collect containers. 
  • 2019: industrial strikes and political unrest created disruptions preventing goods from being picked up at the port. 
  • 2020: COVID-19 caused severe logistics disruptions, and also in 2020, Nigeria also implemented an automated online import duty exemption certification system to replace the manual process, an initiative for the good that first had to go through some teething pains. 

Throughout the years, PFSCM collaborated with stakeholders to open channels for proactive communication, thereby improving the flow of information and empowering stakeholders to make sound decisions and solve problems. PFSM not only works closely with the recipients in-country but also offers dedicated support to suppliers, helping them navigate the many importation documents needed to import health products into Nigeria. 

Meanwhile, PFSCM has undertaken several initiatives to streamline importation processes in Nigeria, reducing procurement lead times. These include:

  • Process mapping: identifying key stakeholders and preparing detailed shipping instructions.
  • Checklists: ensuring all required shipping documents are in order.
  • Online tracker: monitoring paperwork and exemption certificates needed for importation.

These measures have enhanced transparency and efficiency, minimizing errors and reducing delays caused by incomplete importation documentation. 

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In 2019, when Tanzania made major changes to its importation process for health products, PFSCM mapped the new process to identify and reduce bottlenecks caused by the new procedures. 

PFSCM collaborated with various stakeholders and shared best practices with peers to help them navigate through the new importation environment. 

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Despite significant challenges since the onset of the Yemeni Civil War in 2015, PFSCM has consistently delivered health products to the country. PFSCM partnered with the World Food Program to ensure the delivery of health commodities. Strategies included consolidating shipments to reduce risk and expedite customs clearance, resulting in the successful delivery of essential products like malaria rapid diagnostic tests and antiretrovirals. 

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PFSCM has assisted Pakistan since 2010 in managing emergency orders for HIV and malaria testing and treatment products despite trade restrictions, production delays, and reefer container shortages. PFSCM coordinates extensively with suppliers and 3PLs to expedite procurement and shipping, overcoming trade restrictions and global supply chain disruptions. 

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The above are examples of complex importation issues unique to developing countries’ fast-changing and often unpredictable health supply chain and logistics environment. 

This complexity requires control, and PFSCM has learned that the only way to ensure controls are in place is by proactively communicating and coordinating with supply chain stakeholders so that each entity is empowered to excel and no party is causing another to fall behind. 


Lessons learned

  • Accurate data: ensure accurate and complete data expedites the approval of exemption certificates (product registration or tax waivers).
  • Understanding processes: supply chain stakeholders must know importation processes and requirements.
  • Triple-check information: verify information in importation documents to prevent delays.
  • Use automation: leverage electronic applications to accelerate importation and clearing processes.
  • Communication and collaboration: build relationships with all parties involved to ensure smooth operations.
  • Contingency planning: understand the processes and systems to allow for effective contingency planning.

While the challenges of importing health products to LMICs are significant, they are not insurmountable. Through collaborative efforts, strategic planning, and innovative use of technology and tools, supply chain stakeholders can overcome these barriers and ensure that all populations have access to the health products they need to live healthy, productive lives.



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