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
2
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
3

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
4

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
5

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
6

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)
7A World Class Medical Supply Chain and Support Organization of Choice since 1986
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
8

Fundamentals of MEDS Supply Chain
 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
11

Officially opening of
the MEDS Centre
by His Excellency
the President on
13th March 2012
12

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
13

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
14

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
15

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
16

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)
18

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
22

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
sahibu@africaonline.co.ke
26
Thank you

Experience from MEDS, Kenya by Pascal Manyuru

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