Sierra Leone Enhances Malaria Supply Chain Strategy with Improved Data

“We had little or no capacity building for supply chain staff, especially at the district level,” explains Samuel Hassan Serry, Head of Access and Availability at the Directorate of Pharmaceutical Services (DPS). “Supply chain managers did not have a routine supply planning system to guide procurement decisions, and they used Excel spreadsheets that were not standardized to track shipments.”

Major supply chain activities and decisions, such as forecasting and supply planning, were conducted only at the central level and not routinely; forecast results were not validated; and these activities relied heavily on donor support.

Compounding these challenges, health facility reporting on malaria commodities with the existing logistics management information system (LMIS) CHANNEL, was irregular. Reporting rates ranged from 19 percent to 40 percent, and key data elements were not available.

Accessing facility-level data was also challenging: Ministry of Health (MOH) staff first needed to ask districts to email facility data from CHANNEL, and then they conducted time-consuming discussions with districts to clean the data.

These data challenges led the government to largely rely on demographic data for forecasting rather than actual logistics data resulting in inefficient commodities distribution. For example, Serry explains, “the same quantities of malaria commodities were distributed to facilities of the same type, rather than by need.”

To improve forecasting and supply planning for malaria commodities, USAID’s Global Health Supply Chain-Procurement and Supply Management (GHSC-PSM) project — through PMI funding — conducted the following activities:

Established monthly LMIS data review meetings to improve facility-level reporting. In 2018, the government’s supply chain technical working group (TWG) began reviewing facility-level malaria commodities data each month and sending feedback to districts, enabling the TWG to continuously resolve reporting challenges.

Implemented a new LMIS to improve visibility and reporting. In 2019, the MOH, GHSC-PSM, and global malaria partners developed and implemented a new, more robust, and user-friendly LMIS module for malaria commodities in the open-source District Health Information Software 2 (DHIS-2) system and phased out CHANNEL and the Sierra Leone Pharmaceutical Dashboard, which consolidated all malaria commodities data in one place to improve visibility. Facility-level reporting to the new LMIS increased from the 19–40 percent range during 2017/2018 to 80 percent during 2019/2020.

Provided training and tools to build MQ-TWG leadership. From 2018 through 2021, GHSC-PSM strengthened the Malaria Quantification TWG’s (MQ-TWG’s) capacity to lead forecasting and supply planning; implemented GHSC-PSM’s web-based supply planning tool, the Quantification Analytics Tool (QAT); and developed standard operating procedures (SOPs) for malaria commodity quantification, a user guide for forecasting, and a quantification report-writing template.

Decentralized forecasting to the district level. The MQ-TWG and GHSC-PSM worked through the National Quantification Committee (NQC) to decentralize forecasting to the district level by establishing a District Forecast and Distribution TWG (DFD-TWG) in all 16 districts of the country and strengthening their forecasting capacity. The DFD-TWGs integrate all health programs.

Began integration of the LMIS and mSupply. The MOH, GHSC-PSM, and other supply chain actors have started the preliminary work to integrate the improved LMIS with mSupply — the country’s inventory management system for health commodities — by the end of 2024 to enable even better visibility of all malaria commodities consumption and inventory data in one place.

“With technical support from GHSC-PSM, the capacities of the MQ-TWG and DFD-TWGs were developed, setting the stage for routine TWG meetings to review facility data, identify and support poor-performing facilities, conduct forecasting for malaria commodities at the district level, and extract and analyze facility data to inform supply planning,” says DPS’s Serry.

In 2020, the MQ-TWG conducted its first quantification without external technical assistance support. Since then, the MQ-TWG and DFD-TWGs have led the more robust and routine forecasting and supply planning processes with financial support from GHSC-PSM:

• DFD-TWGs lead forecasting for each district, which now utilizes a variety of data sources and methods in addition to demographic data — such as consumption and morbidity data — to ensure accuracy.
• The MQ-TWG, along with the MOH and partners, conducts a national consolidation and validation of district forecast results.
• The MQ-TWG develops a national supply plan using QAT and a national quantification report.
• The MQ-TWG leads quarterly reviews of the supply plan and submits findings to GHSC-PSM and the Global Fund for procurement decisions.

Additionally, the NQC now conducts an annual forecasting and supply planning workshop, attended by the MOH, all health programs, hospitals, district health management teams, partners, and donors. Participants discuss forecast results, the supply plan, gaps, and recommended actions from the TWGs, then develop resolutions for implementation.

“GHSC-PSM’s technical support has not only enhanced our efficiency but also fortified the supply chain’s overall resilience and placed us in a comfortable position to conduct annual quantification exercises, quarterly meetings, and supply plan development with little or no support from the project,” remarked Brenda Stafford, MQ-TWG Secretary and Procurement and Supply Management Lead for the National Malaria Control Program (NMCP).

“This knowledge has also helped in improving product availability through effective supply planning and procurement processes, as well as reducing stockout of commodities, especially to the last mile,” she added. Through GHSC-PSM’s support, the facility’s average stockout rate for malaria treatment (artemether-lumefantrine) dropped from about 16 percent (2018) to 3 percent (2022).

The government also institutionalized its quantification processes, clearly assigning responsibilities to the DFD-TWGs and MQ-TWG and including forecasting and supply planning in the NMCP’s workplan, budget, and timeline.

DPS’s Serry noted the government’s appreciation for “GHSC-PSM’s support in the formation of the TWGs and institutionalization of forecasting at central and district levels and supply planning at central level.” NMCP’s Stafford added, “We look forward to continuing this impactful collaboration and achieving even greater milestones in the fight against malaria in Sierra Leone.”