Experience from MEDS, Kenya by Pascal Manyuru

Improving Supply Chain for Achieving Universal Health Coverage (UHC):

Experience from MEDS, Kenya

ACHAP 7TH

BIENNIAL CONFERENCE

Wednesday, 25th February 2015

Safari Park Hotel, Nairobi - Kenya

Paschal Manyuru, Managing Director, MEDS

A World Class Medical Supply Chain and Support Organization of Choice since 1986 ISO 9001:2008 CERTIFIED

1. Share MEDS Experience in Improving Supply Chain for Achieving UHC

2. Highlight Key Successes & Challenges in Supply Chain in Kenya

Session Objectives

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A World Class Medical Supply Chain and Support Organization of Choice since 1986 ISO 9001: 2008 CERTIFIED

1.0 BACKGROUND INFORMATION

Mission for Essential Drugs and Supplies (MEDS) is a Faith Based, not-for-profit Trust of CHAK & KCCB, established in 1986 due to:

Reduced Government support to Church Health Facilities in the 1980s => thus affecting the supply chain.

Church Health Facilities faced several problems => pharmaceutical supply chain & training of health workers.

Increased distribution & logistical costs => dealing with very many suppliers that have limited stocking holding/range

Poor prescribing & dispensing practices => poor patient care and un-assured quality of medicines

Challenges provide Opportunities

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MEDS Core functions

1. Supply chain: provision and distribution of reliable, quality and affordable Essential Medicines, medical/non-pharmaceuticals and clinical laboratory Supplies

2. Capacity Building & Client Support Services: to improve the quality of patient care through training, mentorship field visits, capacity building and professional assistance

3. Pharmaceutical Quality Control Laboratory services: QC Laboratory that ensures stringent quality assurance mechanism for quality products

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a) Supply Chain & Distribution

Private & Faith Based Organization (FBO) sector meet over 40% of Kenya’s health needs

MEDS serves over 2,000 corporate clients: Faith Based NGOs Government Private Others – CBO, L/Institutions

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Supply Chain & Distribution - 2

•MEDS clientele has grown beyond Kenyan borders to the Countries highlighted in the Map

•Regional supply chain hub for African Countries include: DRC, South Sudan, Ethiopia, Somalia, Malawi, Zimbabwe, Chad and Cameroon

Health Facilities Beyond Kenya

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Numbers per Facility Level in 2013 (n= 2,155)

18%

34%

48%

0% 10% 20% 30% 40% 50% 60%

Hospitals (Level 4, 5 & 6)

Health Centres (Level 3)

Dispensaries (Level 2 & 1)

7 A World Class Medical Supply Chain and Support Organization of Choice since 1986

ISO 9001: 2008 CERTIFIED

1,034 Dispensaries

733 Health Centers

388 hospitals


Over 28 years experience in health service delivery

MEDS stocks over 1,000 items – reviewed annually by a Formulary Committee => “PULL” System

Special shopping service for >3,000 non-stocked items

One-stop shop for:

o Medicines, vaccines, disinfectants, infusions

o Laboratory reagents, kits & supplies

o Medical & surgical supplies

o Special (designated) Projects

o Publications

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Fundamentals of MEDS Supply Chain


ISO 9001: 2008 CERTIFIED

Quantification: Formulary committee for selection; Medicines & Therapeutic committee for quantification

Procurement: Large quantities that attracts bulk discounts without Government subsidies

Storage capacity: High and well organized warehousing

Distribution: Centralized and effective (door-to-door delivery) = PULL

Quality Assurance: Good – backed with WHO pre-qualified QC laboratory

Strategic Information: Continuous feedback from clients and market players

Capacity Building and Client support – supply chain function is supported by capacity building programmes and field visits to clients

MEDS Experience: Evolution of MEDS Supply Chain

MEDS in the Past MEDS Today

Served FBOs only Serves over 2,000 health facilities in Kenya and Africa; Faith Based, NGOs, Government, Private, Community Based Organizations, Learning Institutions

Low forecasting accuracy High forecasting accuracy due to optimized and automated processes and systems

Limited stocking levels Demand driven, faster stock movement; Optimized stock levels that balance efficiency and customer service

Rented warehouse space 10,000 square meters warehouse

Basic QC Laboratory Supply chain backed by WHO prequalified QC Laboratory

<20 members of staff Over 120 employees, with major services being outsourced

Few partnerships Many Partnerships


MEDS State-of-the-art Warehouse Spacious (10,000 m2 with 9m height of racking) and professionally-run

Ensures good storage and efficiency in processing orders

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Officially opening of the MEDS Centre by His Excellency the President on 13th March 2012

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Efficiency, Reliability & Cost-effectiveness

Over the years, MEDS ensured:

100 % computerized stock holding Over 98% fill rates to health facilities orders

Online ordering

Maximum 3-5 working days turn-around time of clients’ orders

Doorstep delivery networks across the country at no extra cost to clients

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Efficiency, Reliability & Cost-effectiveness - 2

ISO 9001:2008 Certified with well functioning Quality Management System

US-OFDA pre-qualified distributor

Supplying to 35 County Governments to date; over USD 12m

Transparent, Accountable and Corrupt-free organization guided by Christian & Professional values

Partnership => the Government, Development Partners and Manufacturers to improve on UHC

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Efficiency, Reliability & Cost-effectiveness - 3

Clients have access to Customer Relationship Management (CRM) solution – an online platform that enables them to do the following:

Place orders by logging on to www.meds.or.ke and click on “Self Service”

Track the status of their orders

Be informed on out of stock situations

Access statements of accounts

Chat with a Customer Care staff

Provides real-time information to clients on their requests

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http://www.meds.or.ke/

b) Capacity Building & Client Support

Training Products: Annual training programme Facility-based trainings Consultancy services Technical Assistance & Mentorship

Health facilities support services Field visits to the sites by technical staff: > 1, 600 facilities are

visited annually Special projects to build capacities of health facilities Publications & pharmaceutical services

Partnerships with Public and other Stakeholder

Training frontline health workers => Public and Private

Consultancy services => other countries & health facilities

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Capacity Building Session

Training County Government Pharmacists


c) Pharmaceutical QC Laboratory Services

MEDS Quality Control Laboratory

Achieved WHO pre-qualification status on 30th March 2009 1st Faith based

laboratory worldwide

1st Non-public QC laboratory in Kenya

4th in Sub-Saharan Africa (2 in South Africa)

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MEDS Story: QC Laboratory services

• Partnership with African Countries to ensure quality of pharmaceuticals

Note: These African Countries have approached MEDS for services due to WHO pre-qualification status


ISO 9001:2008 CERTIFIED


MEDS Experience: Contributing to UHC

In summary, MEDS supply chain that has:

1. Reduced product costs => bulk procurement

2. Reduced ordering costs => One stop shop - Clients

3. Increased availability/access of medicines & medical supplies with a wide variety

4. Reduced prevalence of counterfeits

5. Promotion of rational use of medicines and reduced medication errors due to training initiatives


2.0 SUPPLY CHAIN IN KENYA


2nd August 2013: Launch of MEDS -

County Governments Partnership Initiative

Saw over 50% attendance by the

Counties - Ministers of Health/ CECs

a) Successes

Public-Private Partnership (PPP) initiatives

MEDS playing a complementary role to the government supply chain

Devolution of health services

EA Pooled Procurement Initiative

Partnership with County Governments:

August 2013: MEDS-County Governments Partnership Initiative => supporting devolved govt.

April 2014: Conducted County Pharmacists workshop => Health Commodity Management & Leadership

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b) Challenges (= Opportunities for FBO?)

Weak health systems and infrastructure

Health financing gaps => supply chain gaps

Affordability of Essential Medicines & Medical Supplies => the poor & marginalized communities

Human Resources Capacity gaps => at County & National Government levels

Limited Coordination & Consultations at County & National level


Challenges - 2

Unpredictable Purchasing Patterns & Suppliers’/ Manufacturers’ response capacity => Stock Outs

Free and liberal market => influx of sub-standard &

counterfeit products

Interpretation & Implementation of the Constitution => Confusion/inefficiency in the health sector

Debt Burden – Clients not paying => supply gaps

Politics at National & County Government level

Lack of Strategic Information => policy/decision-makers


Receive greetings from MEDS family


Please plan to visit MEDS while here! …….Welcome!

For more details please visit our website: www.meds.or.ke or email to

[email protected]

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Thank you

http://www.meds.or.ke/

mailto:[email protected]

Experience from MEDS, Kenya by Pascal Manyuru

Documents

support organization

map regional supply

meds experience

supplies meds

health centers

kenyas health needs

church health facilities

health centres level