1. Supply Chain – Strengthening the
Foundation of Botswana’s
Healthcare System Link by Link
Peace Corps Volunteer Panel Discussion
June 16, 2015
1
2. Agenda
• Introduction of Panelists
• Country Context
• Supply Chain Successes
• Supply Chain Challenges
• PCV Interventions
• The Way Forward
2
3. PCV Panelist
3
• Name: Marcy Frank
• Site: Thamaga
• Placement: Thamaga Clinic
Thamaga Facts
• Population: 19,547
• Thamaga was named
after the color of a horse
THAMAGA
4. PCV Panelist
• Name: Camille “CJ” Jones
• Site: Mochudi
• Placement: Kgatleng DHMT
4
Mochudi Facts
• Population: 44,815
• Mochudi was created by
a South African tribe
escaping Boer
oppression
MOCHUDI
5. PCV Panelist
• Name: Tiphaine Monroe
• Site: Gobojango
• Placement: Gobojango Clinic
5
Gobojango Facts
• Population: 1,631
• A young entrepreneur
just started the
village’s first egg-
selling business
GOBOJANGO
6. PCV Panelist
• Name: Anna Payton
• Site: Tsabong
• Placement: Kgalagadi South
DHMT
6
Tsabong Facts
• Population: 8,939
• Tsabong has a camel
park; one of the camels
in this park was a gift
from Qaddafi
TSABONG
7. PCV Panelist
• Name: Marshall Washick
• Site: Shoshong
• Placement: Shoshong Clinic
7
Shoshong Facts
• Population: 7,490
• Shoshong had an estimated
population of 30,000 people
in 1866, which was about the
same as the Cape Town
population at that time
SHOSHONG
8. Country Context
8
In the past 10 years, the USG has assisted the GOB in
making incredible strides to strengthen its supply chain.
Nevertheless, recent
challenges stemming from
the MOH’s contract with
Botswana Couriers have
threatened the progress that
Botswana has made.
Additionally, the USG has decided to only continue funding
supply chain activities through TA for the time being.
It is expected that Botswana’s supply chain will continue to
worsen before the situation improves.
9. PCV & Supply Chain Survey
9
Clinic & Health
Team
13
Local
Government
Capacity
Building
7
Life Skills
6
NGO Capacity
Building
2
Assignment Areas of the “Botswana PCVs and
Supply Chain” Survey Participants
As the effects of the
supply chain are far-
reaching, many PCVs in
different assignment
areas often work to
support the supply chain
in various ways at their
sites.
Approximately 30 PCVs
are currently working in
this capacity – 28 of
which responded to a
survey about their
observations of
Botswana’s supply chain
and how they support the
supply chain at their
sites. Their responses
informed this
presentation.
11. Supply Chain Successes
11
13
12
3
0
2
4
6
8
10
12
14
Yes No Skipped
Number of PCVs who have observed positive aspects of
Botswana's supply chain at their sites (e.g., people get their
drugs on time, a health facility staff member is trained on
reporting, condom availability, limited number of expired
drugs, etc.)
12. Supply Chain Successes
12
• High levels of condom supply
and distribution
• Creative and discreet condom
distribution techniques
• People are able to acquire
ARVs most of the time
• Many pharmacists are
trained in supply chain
PCV Observation
“When there was a Condom Focal Person
at the DHMT in 2012-2013, we distributed
1.7 million condoms as a district.”
PCV Observation
“Access to ARVs is prioritized by healthcare
providers. Pharmacists and technicians
genuinely care about dispensing drugs to
HIV+ patients and monitoring the supply
of ARVs.”
15. Supply Chain Challenges
• Appropriate staffing to
demand is needed
• Many clinic staff are not
trained in supply chain
• Lack of ownership of supply
chain management
responsibilities
15
PCV Observation
“Most of what I've observed was
challenges with staff. Testing counselors
would not show up to work or not be
available to test people during office
hours. Doctors sometimes also don’t show
up.”
PCV Observation
“Nurses and staff usually don't have
channels to voice their complaints or issues.
Many times it is their superiors who are not
doing their jobs with the supply chain, so
they have no one to speak to and often don't
want to speak out, so no lasting changes are
made.”
16. Supply Chain Challenges
• Facilities often make up
inventory numbers or fail to
report
• Lack of empowerment among
health facility staff
• Unclear reporting expectations
16
PCV Observation
“A lot of facilities make up their inventory
numbers or refuse to report at all, rather than
reporting accurately because they feel that the
MOH and ‘higher ups’ are always handing
down new reporting methods and conflicting
expectations.”
17. Supply Chain Challenges
• Shortages of drugs
and commodities at
CMS
• Shortages of drugs
and HIV testing kits
at the clinic level
• Expired drugs and
commodities
17
PCV Observation
“We are constantly stocked out of things like basic antibiotics. Over the holidays, we were
stocked out of ARVs for a few weeks. For several weeks we were out of blood pressure medicines
as well, and we have had to admit several patients because of high blood pressure this month –
likely as a result. I would estimate from my recent physical count that we are stocked out of
about 20 different drugs. The drugs are generally not expired, but medical supplies that are not
used as frequently often are (the oldest was from 2010).”
18. Supply Chain Challenges
18
PCV Observation
“Often there are no condoms, HIV tests,
or basic medication to be provided to the
clinics. The vehicles break down and
can't transport medications/supplies.”
• Confusion as to where expired
drugs are taken to be
destroyed
• Delay in or absence of
transportation for drugs and
commodities
• Poor storage conditions for
drugs
PCV Observation
“I've noticed that testing kits that need to
be kept refrigerated or at a certain
temperature are left just on shelves. I am
uncertain as to whether tests are done to
ensure the viability of the batches of
testing kits.”
20. PCV Interventions
2020
• Create condom
distribution targets for
clinics to monitor supplies
• Teach IT skills to staff
• Encourage paper recording
and reporting at facilities
in addition to reporting
electronically
PCV Observation
“I have worked with the DHMT to
create targets for condom
distribution to individual facilities so
that supply can be more easily
monitored.”
PCV Observation
“I’ve begun encouraging paper
reporting so that all health facilities,
even those without electricity or
computers, can monitor supplies and
properly report.”
21. PCV Interventions
2121
• Work with the DMSAC to
resolve transportation issues
• Network with stakeholders
to find alternative
distribution routes
• Work with the DAC office to
use its supply of condoms to
supplement the DHMT’s
limited supply
PCV Observation
“I’ve offered to deliver condoms to outlying farms on my bicycle. It may not be a
sustainable intervention, but it can assist in getting condoms to rural areas while
the transport situation is being sorted.”
22. PCV Interventions
2222
• Mobilize staff to count
inventory and check for
expiries
• Train clinic staff on stock
card issues and storage
guidelines
• Implement additional
methods for stock card
tracking
• Create and modify
recording tools to be more
user-friendly for clinic
staff
• Facilitate on-the-job
trainings and refresher
courses on taking stock
each month
PCV Observation
“I work to ensure that we have a day at the
end of each month in order to do a physical
count and make sure drugs and
commodities aren't expired.”
23. PCV Interventions – Supply Chain
Training
• Supply Chain
Management Systems
(SCMS) trainings
– Training of Trainers
November 2014
• 3 PCVs
• 2 Counterparts
– Logistics Management
Training
February 2015
• 19 PCVs
• 2 Peace Corps Staff
23
PCV Observation
“I recently gave a short overview of the Supply Chain Management workshop I attended to the
nurses at my clinic. I also implemented more methods for drug stock tracking - monitoring
how many drugs are dispensed each month, how many are received, and what the current
stock is. I stress the importance of this, especially in regard to ARVs.”
24. PCV Interventions – SCMS
Committee
• SCMS Committee
– The first committee of its
kind in Peace Corps
worldwide
– Partner with MOH and
health facilities to
strengthen Botswana’s
supply chain
24
PCV Observation
“Through my work with Peace Corps and
supply chain management, I’m developing
an intervention for correct stock card usage
and easy-to-read storage guidelines. Next
week I’m going to the DHMT to address
more large scale problems there.”
26. Suggestions for PMT
26
• Support condom
distribution
• Address the inconsistent
and incorrect use of
reporting tools
• Promote transport
alternatives
• Strengthen and clarify
communication channels
between MOH, CMS,
DHMTs, warehouses, and
health facilities
• Support MOH’s
maintenance of the
Standard Operating
Procedures for Logistics
Management of Health
Commodities and Related
Supplies
• Address reporting of drug
availability
You, the members of PMT, have the ability to set the agenda and
influence outcomes. We suggest your engagement to address the
following:
Health Systems Strengthening
27. Suggestions for PMT
27
Human Resource Issues
• Train clinic-level staff on
supply chain, the
importance of reporting,
how to report, etc.
• Support the appointment of
a supply chain focal person
at health facilities
• Place a trained third-year
PCV in the Logistics
Management Unit
Infrastructure Issues
• Bring attention to
infrastructure needs, such
as the necessity of proper
storage for drugs and
testing kits
PCV Observation
“Not everybody has been trained, yet the MOH
seems to expect all clinics and health posts to be
on the same page. Really unrealistic
expectations, especially in light of storage
challenges and lack of real support from those
above.”
