Drug Supply Systems of Missionary Organizations

Identifying Factors Affecting Expansion and Efficiency:
Case Studies from Uganda and Kenya.

 Report prepared for WHO/EDM

by

Eriko Kawasaki, MPH. and John P. Patten, MA, RD.

Boston University School of Public Health

 January 15, 2002

WHO #HQ/01191467

Executive Summary

In many developing countries, difficulties that governments face in drug supply systems have been addressed by many researchers. However, there are few detailed studies regarding efficient management of drug supply systems by mission organizations, despite their large contribution in many cases to the health care systems of developing countries. Existing literature has pointed out that efficiency of mission organizations and their high service quality are due to a high dependence on foreign donors. In fact, there are some mission drug supply systems that have become self-sustainable and have expanded their drug supply capacity to the public and private sectors.

In order to identify the key factors for success and obstacles facing mission run drug store systems, this work is a detailed qualitative and quantitative study on the drug management systems of the Mission for Essential Drugs and Supplies (MEDS) in Kenya and the Joint Medical Store (JMS) in Uganda. The methods of this study, using in-depth interviews and analysis of data given by the organizations, have produced a comprehensive overview of both organizations, and have drawn lessons regarding sustainability and expansion.

Both MEDS and JMS have grown progressively over the past five years. MEDS is now a self-sustaining organization, as is JMS, however two key management positions at JMS are supported by outside donor funding. MEDS procures mostly from local suppliers, while JMS relies to a larger degree on international procurement. MEDS is invested heavily in in-house Quality Assurance and training for staff and customers, and works closely with the Ecumenical Pharmaceutical Network (EPN) in training of pharmacy assistants to address the shortage of pharmaceutical personnel in the region. In addition, their efficient managements reflect their low operational expenditures; with both organizations spending about 10% of the total expenditure on operational costs. About 60% of these operational cost are allocated for staffing costs.

While both organizations exist in similar environments (with distinct differences), MEDS provides a smaller number of items (508) while JMS has 1408 items on their stock list. MEDS provides training for their clients while JMS has recently emphasized equipment supply and support. JMS caters predominantly to NGOs, which comprise 70% of their current clientele. Mission units are 30% of their current customer base. The customer base at MEDS is exactly the opposite, with 70% of customers mission units and 30% NGOs. JMS uses a cash and carry system, while MEDS extends credit and provides delivery services.

The prices charged by the two organizations are very competitive internationally. For a "basket" of indicator drugs MEDS was 1% above the MSH Drug Price indicator guide prices. For the same basket JMS was 13.3% above the same index. MEDS procures almost entirely (95%) through local suppliers and local agents. JMS on the other hand procures 50% directly from international suppliers with the remainder coming from African suppliers or agents. Stock availability in both organizations is good with rates of about 90% availability.

JMS and MEDS uses different approaches because of the different economic environments, however the most important point is that both organizations maintain high staff motivation levels, and provide a reliable drug supply systems for their customers. Both organizations voice a strong commitment to serving the poor in their respective countries, and achieve this goal through efficiency and maintaining their purpose. Both organizations are beginning to supply significant amounts of products to organizations in neighboring countries.

MEDS and JMS are vibrant, self-sustaining organizations, which fulfill a need within their two countries. Governments might consider exploring areas for linkages and utilizing drug supply infrastructures of mission organizations. In other Central African countries, support for similar organizations is worth exploring. Direct support from international donors in training and computerized operating systems can contribute to self-sustainability of other mission organizations.

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