WASHINGTON, April 21, 2010–A pilot project in Zambia has shown that strategic improvements in the supply chain for lifesaving drugs can have an immediate and dramatic impact on child mortality. Pediatric malaria drugs—so essential to save children’s lives—are now available in 88 percent of public health centers in trial districts, nearly double the 51 percent availability rate in control districts.
Scaled up nationwide, simple but smart steps, such as hiring a district-level planner to ensure smooth delivery of drugs to rural public health centers, could save as many as 27,000 children in Zambia between now and 2015. In fact, child mortality due to malaria could be cut by up to 37 percent with these changes.
The 16-district pilot project, which was evaluated using state-of-the-art methodology, takes on extraordinarily urgent significance in a context where only 7 percent of children in rural areas receive these medicines within 24 hours of developing fever (Zambia National Malaria Indicator Survey, 2008). Malaria is a leading cause of child mortality in Zambia, and access to effective treatment is a major challenge.
“The Zambian government has done very well with mass malaria prevention measures such as distributing treated bed nets and spraying houses, but malaria remains endemic and progress on access to treatment has been slower,” said Eva Jarawan, Sector Manager, Health, Nutrition and Population for the World Bank’s Africa Region. “We have found that strengthening drug supply chains can make a significant contribution toward extending treatment access and reaching the health MDGs.”
The potential benefits of stronger supply chains—in which orders based on actual needs pass quickly through district stores instead of lying there for weeks—extend well beyond pediatric malaria drugs. The same chains carry malaria preventives for pregnant women, antibiotics, and other critical supplies.
“Working with the Zambian government and our partners USAID and DfID, we have been able to get drugs off the shelves in district warehouses and into the villages, where their availability is often the difference between life and death,” said Monique Vledder, who oversaw the project for the World Bank. “I hope that our findings will help strengthen the public sector’s ability to provide lifesaving drugs to people—not only in Zambia, but also in other places across Africa.”
This supply chain project—called the Zambia Access to Artemisinin-Based Combination Therapy (ACT) Initiative—was jointly funded by the World Bank, USAID and the UK’s Department for International Development. The project was implemented by the Ministry of Health in Zambia with support from John Snow, Inc., and Crown Agents. The Massachusetts Institute of Technology (MIT) and the MIT-Zaragoza Logistics Program provided technical support to the design of the program.
“I am impressed by the project’s results because supply chain problems in public health systems are notoriously difficult to fix,” said Prof. Prashant Yadav, a global expert on supply chain management at MIT’s international logistics program in Zaragoza. “This project has created new knowledge on how to improve drug supply chain design in low-income countries.”
MORE KEY FACTS
- Approximately 77,000 children under five years of age die in Zambia every year. An estimated 20 percent of these deaths are caused by malaria.
- In the trial districts where supply chain improvements were introduced, pediatric malaria drugs are now available 345 days out of 365, with an average downtime of only 20 days a year. The availability in control districts was just 247 days.
- The availability of other drugs also increased in the pilot areas. Amoxicillin, a life-saving antibiotic that cures lower respiratory infections and other opportunistic infections caused by HIV/AIDS, was available 335 days of the year (92 percent of the time) in the districts with the enhanced supply chain, while it was only available 230 days in other districts (63% of the time).
- Similar improvements were observed for all essential drugs and supplies in the country, including malaria prophylaxis for pregnant women. The availability of Sulfadoxine-pyrimethamine increased to 84 percent in pilot areas, compared to 39 percent in control districts.