Sila Mwanzia�Bpharm,Bsc.Microbiology�Pharmacist-MoH Kenya

Strengthening inventory management and stock visibility of HIV supply at the last mile: achievements, challenges, and lessons from Makueni County, Kenya

Background: Map of Makueni County

Key statistics

Population; 949,298 (KNBS,2019)

Size; 8,000Km²

PLHIV; 24,176

AYP (15-24yrs); 179,381 (Account for 42% of new infections)

Adult HIV prevalence: 3.2%

Key Populations

• Female sex workers (FSW); 2,743
• MSM : 2177

No of health facilities; 236

ART Sites; 73 (KHIS, 2019)

Background: Situation analysis

Past challenges in supply chain management of ARVs and program items in Makueni County included:

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• Lack of end-to-end supply chain visibility
• Poor forecasting and quantification
• Poor utilization of stock management tools
• Poor reporting rates and delayed reports.
• Expiries of vital commodities

Strategy/Methodology: Piloting a Stock Visibility System (SvS)

In April 2022, the Afya Ugavi Activity, a USAID implementing partner providing health supply chain systems strengthening support in Kenya, partnered with the Department of Health, County government of Makueni, to pilot an outsourced last mile distribution and stock visibility system dubbed- SVS (Stock visibility System).

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A one week data collection exercise was conducted between 24th -28th April 2022 in 120 facilities within Makueni county to pick out the main supply chain challenges experienced at the different levels of care.

Stock verification and onboarding of 22 facilities

Methodology: Key Findings during Onboarding Process

• Un-updated stock cards
• Unusable commodities i.e. damaged, expired, phased out regimens
• Large quantities of commodities with near 6 months to expiry
• Discrepancies between physical stock and bin card quantities
• Lack of verification of received commodities
• Overstocked, understocked and stocked out commodities
• Poor documentation-documentation on requisition and issue vouchers (S11 forms).

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Key Supply Chain Indicators to be addressed

• Central warehouse availability
• Adoption rate
• Anomalies rate
• Verified facility stock rate
• Stock delivered
• Products at risk
• Stock in transit
• Stocks expiring in 6 months

SvS Journey Experience: screenshots

1. Application Home screen

2. Facility Stock Verification menu

3. Select stock item

4. Select stock update method

SvS Journey Experience: screenshots

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5. Capture stock update

6. Record Anomalies

7. Record Anomalies

8. Record transactional stock

SvS Journey Experience: screenshots

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9. Verify deliveries & receipts

Tableau – E2E Dashboard

Title ; SvS Dashboard

Tableau – Facilities

SvS™ Impact on the supply chain

1. Impact on forecasting and ordering of ARVs

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The county was able to plan better and only order what was needed since there was end-to-end visibility of available commodities in all pilot sites.

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SCPs were able to mop up excess commodities identified during the mapping phase and re-distribute to facilities that lacked or had higher volumes.

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Subsequently ordering was purely based on the forecasting reports

SvS™ Impact on the supply chain

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2. Impact on reduction of expiries

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Prior to the rollout of the app, there were rampant expiries, especially on the HIV rapid test kits (RTKs).

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After the rollout, a drastic drop in expiries was reported, up to 50%

SvS™ Impact on the supply chain

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3. Stockouts

There was a remarkable reduction in the stock-out rates of tracer commodities.

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TLD stock out rates decreased from 24% to 3%, HIV RTKs decreased from 53% to 48% as attributed to the enhanced efficiency.

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The commodity manager was empowered by reliable consumption data while making allocations hence ease in rationalising orders based on consumption and stocks on hand

SvS™ Impact on the supply chain

4. Reporting rates and utilisation of reporting tools

There was a remarkable increase in reporting rates on the Ministry of Health’s Facility Consumption Data Report, from 95.9% to 98.6% due to ease of reporting.

Bi-monthly stock verification meant that on the 15th and the last day of the month HIV commodity data was readily available on the app for reporting eliminating the need for manual paperwork.

This makes it a ‘ top of mind’ report as it is by far the easiest report to generate for a healthcare worker who is supposed to prepare upwards of ten reports by the 5th day of each month.

Source: Dhis 2019

Facility Monthly ARV Patient Summary

(MoH 729B F-MAPS)-Service data

Facility Consumption Data Report& Request (MoH 730B)

Title: Impact on Supply Chain

• Overall impact on community health strengthening

The app impacted positively on diagnosis with provision of test kits and significant reduction in the expiries of test kits. patient retention due to better fill rates, patient stratification to care- differentiated and non- differentiated was smooth due to better forecasting based on consumption data and a streamlined supply chain. Suppression was better achieved with better compliance and adherence . All these leading to improved health outcomes and progress on reaching 95-95-95.

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Challenges

1. Lack of stable internet connectivity in some facilities – making real-time reporting a challenge
2. Difficult terrain hindering distribution to some facilities especially during the rainy season
3. Staff turnover especially in the dispensaries

Lessons Learned

• The SVS app and dashboard is a useful tool that assists with end-to-end stock visibility, quick analysis, and assisting in making informed decisions to manage ARVs and other program commodities at all levels of care
• The dashboard provided an easy way to calculate the commodity fill rates after a given supply cycle, the stocking levels for various commodities, the expiry dates, and the inventory costs can be calculated if need be
• A robust supply chain system is key in ensuring continuity of care and ensuring better clinical outcomes. With the pilot period coming to an end in June, the key take home is the stock visibility system is a cost effective and sustainable way of enhancing end to end visibility in the HIV supply chain
• Buy-in from the top leadership is essential for ownership and sustainability

Areas for future improvement

1. Interoperability with existing HMIS e.g. Kenya EMR, Web ADT for ease of patient care and monitoring
2. Create an application compatible with iOS and a web version of the app
3. Improve dashboard to enable to enable data visualization in graphical form, besides percentages to easily visualize trends

Thank You