Zambia: Measuring New Ways Keep Rural Clinics Stocked with Essential Drugs

Published: November 2016


In Zambia, clinics frequently ran out of basic lifesaving drugs, such as antibiotics and anti-malarial drugs, leaving children and adults at risk of illness or death. The problem usually wasn’t availability, but getting the medicines from state warehouses to clinics that needed them the most. With support from SIEF, researchers tested two methods for ensuring that often remote clinics were able to maintain stocks of essential medicines. A rigorous impact evaluation found that shipping drugs directly to clinics, instead of to a holding facility, and having a dedicated staff member to facilitate and track orders reduced stock outs of drugs needed to save lives. Thanks to the impact evaluation evidence, the Government of Zambia began working with donors to expand the program nationwide.


Rural health clinics in remote parts of Zambia frequently reported that they had run out of ba­sic lifesaving drugs, such as antibiotics and anti-malaria pills. This was putting lives, especially of children, at risk. The Government of Zambia, which had sufficient stocks of drugs in central ware­houses, wanted to understand how to improve its drug distribution system to avoid shortages.


SIEF-funded researchers worked with the government to evaluate two alternative drug distribu­tion systems. The first relied on a district planner to collect prescription orders from rural clinics, buy in bulk, and distribute the medicine. The second allowed rural facilities to order directly from a central pharmacy, with the district office acting only as a point of transit for drug deliveries. In a 12-month pilot, the models were each implemented in eight districts randomly selected from 50 possible districts. Baseline and endline surveys collected information on the inventory and stockout rates of 15 drugs.


Allowing rural clinics to order directly from a central pharmacy helped them to maintain needed stocks of antimalarial medicines and other essential drugs. Researchers estimated that if imple­mented nationwide, malaria-related deaths could drop by more than 20 percent.


Clinics in the districts where the new models were piloted have switched over to direct order of essential medicines; in the rest of the country, the government is working on a plan to roll out the new system in the rest of the country.


" You can’t go wrong if you produce numbers proving that specific changes will get you better results. "

John Bosco Makumba

World Bank Operations Officer in Zambia