Technical Assistance (South Africa)

The USAID Global Health Supply Chain – Technical Assistance, South Africa (GHSC-TA-SA) was launched in September 2016. The Program provides technical assistance to the South African government to strengthen public health systems and supply chains in order to advance an AIDS-free generation and contribute toward the achievement of universal health coverage.  

Program Objectives:

  • The aim of GHSC is to improve medicine availability across all levels of care in the country
  • The program spans the entire medicine supply value chain beginning with the selection of medicines and the application of health technology assessments (HTA), through to contracting and contract management, supply chain management, and ultimately rational medicine use (RMU)

Country Context:

South Africa has the world’s largest population living with HIV, with 7.1 [6.6-7.9] million HIV positive people, (STATS SA, 2017), 4.4 million of whom are currently receiving antiretroviral treatment (UNAIDS, 2017). The government’s commitment to the 90:90:90 targets, introduction of Universal Test and Treat (UTT), and the pledge by the President to add 2 million patients on ART by 2019, necessitate a robust yet flexible supply chain.  As patients living with HIV present with comorbidities, exacerbated with age, the supply chain for essential medicines and related health commodities must be strengthened to in order to improve health outcomes for South African citizens.

 

Diagram of Medicine Value Chain

Project Accomplishments:

  • Health Technology Assessment (HTA):  Updated medicine selection process guides including the Standard Treatment Guidelines (STG) Reviewer’s Manual and co-developed a new process for analyzing medicine effectiveness including improved use of financial considerations.  Developing the knowledge and skills of medicine selection expert review committee members as part of a strategy to increase the capacity of Hospital Adult and Tertiary Expert Review Committees.  
     
  • Supply Chain Strengthening:  Developed new processes for Demand and Supply Planning transforming how Affordable Medicines Directorate (AMD) within the National Department of Health (NDOH) model future medicine demand and generate recommended medicine orders based on current stock levels and historical demand trends.  Planning implementation of new network design and distribution operations in the North West Province including optimized scheduling, routing, and increasing supplier direct delivery that will improve velocity, reduce costs, and improve medicine availability.
     
  • Visibility Analytics Network (VAN):  Established a results framework to improve medicine selection, supply chain, supplier performance management and rational medicine use.  Developed more than 100 individual dashboards allowing users to drill down from national to healthcare facility level views of medicine availability and other Key Performance Indicators (KPIs).
     
  • Provincial Procurement Units:  Developed training materials and tools for new Provincial supply chain processes detailing roles, responsibilities, and performance measures.  Supported rollout of a Warehouse Management System that transforms ordering and replenishment via electronic work flows, approvals, and right-sizing of inventory levels.
     
  • Rational Medicine Use (RMU):  Supported requirements, testing and evaluation of the application governing medicine selection, Standard Treatment Guides, and the Essential Medicines List (EML).  Developed the new Formulary Guidelines to define and standardize development, maintenance and formulary use across all levels of care and health facility types along with a master data dictionary that standardizes data elements across AMD IT systems and supports developing provincial, district, and healthcare facility formularies based on the EML.  
     
  • Enabling Environment:  Developed new job profiles, performance agreements and measures for AMD and select provincial staff to support workforce development.  Completed an organizational redesign of Contract Management Unit to facilitate improved supplier relationship management and monitoring supplier performance.

Key Partners:

Principal stakeholders include the Affordable Medicines Directorate (AMD) within the National Department of Health (NDOH), Provincial Departments of Health, District Pharmacists, and healthcare facility level pharmacy personnel.

Geography:

GHSC TA-SA operates and has staff across all South African provinces.