Africa Institute for Health Policy, P.O. Box 57266-00200, Nairobi, Kenya.
Department of Health Sciences & Department of Global Health, Boston University, Boston, U.S.A.
BMC Health Serv Res. 2024 May 1;24(1):557. doi: 10.1186/s12913-024-11028-6.
The Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic investments that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. This assessment sought to determine the effects of the project on the health system.
This study employed a mixed methods design combining quantitative and qualitative research methods. The quantitative part entailed a descriptive analysis of procurement and supply chain data from the Zimbabwe healthcare system covering 2018 - 2021. The qualitative part comprised key informant interviews using a structured interview guide. Informants included health system stakeholders privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis.
Approximately 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfillment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period. Majority of the system stakeholders interviewed agreed that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas include improved infrastructure and equipment, data and information systems, health workforce and financing. Many of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices.
It is imperative for governments and donors keen to strengthen health systems to pay close attention to the procurement and distribution of medicines and health commodities. There is need to collaborate through joint planning and implementation to optimize the available resources. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.
全球基金与津巴布韦政府合作，为加强卫生系统的采购和供应链提供端到端支持。这是通过一系列战略投资实现的，包括基础设施和车队改善、人员培训、购置现代化设备和优化仓库。本评估旨在确定该项目对卫生系统的影响。
本研究采用混合方法设计，结合定量和定性研究方法。定量部分包括对 2018-2021 年津巴布韦医疗保健系统采购和供应链数据的描述性分析。定性部分包括使用结构化访谈指南对全球基金在津巴布韦支持的举措知情的卫生系统利益相关者进行关键知情人访谈。收集的访谈数据全部转录，并进行主题内容分析。
约 90%的公共卫生机构被纳入采购和配送系统。在实施的 4 年期间，设施层面订单履行的及时性（在 90 天内）从平均 42%提高到 90%以上。艾滋病毒药物和检测试剂盒的缺货率分别下降了 14%和 49%。尽管艾滋病毒感染者的比例不断增加，但艾滋病毒成人和儿童治疗的人口覆盖率仍保持较高水平。在 4 年期间，过期商品的价值减少了 93%。接受采访的大多数系统利益攸关方都认为，全球基金的支持对于提高该国的采购和供应链能力至关重要。关键领域包括改善基础设施和设备、数据和信息系统、卫生工作队伍和供资。许多参与者还提到，全球基金支持的仓库优化对于改善库存管理做法至关重要。
政府和热心加强卫生系统的捐助者必须密切关注药品和卫生商品的采购和分发。需要通过联合规划和实施进行协作，以优化现有资源。组织自主权和分享管理最佳实践，同时加强问责制，对于建立机构能力的努力至关重要。
