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. 2024 May 1;24(1):557.
doi: 10.1186/s12913-024-11028-6.

Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study

Abaleng Lesego  1 , Lawrence P O Were  1   2 , Tsion Tsegaye  1 , Rafiu Idris  3 , Linden Morrison  3 , Tatjana Peterson  3 , Sheza Elhussein  3 , Esther Antonio  4 , Godfrey Magwindiri  4 , Ivan Dumba  5 , Cleyland Mtambirwa  5 , Newman Madzikwa  5 , Raiva Simbi  5 , Misheck Ndlovu  6 , Tom Achoki  7
Affiliations

Health system lessons from the global fund-supported procurement and supply chain investments in Zimbabwe: a mixed methods study

Abaleng Lesego et al. BMC Health Serv Res. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Development assistance for health; Donor funded programs; Global fund; Health systems; Health systems strengthening; Procurement and supply chain management.

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Conflict of interest statement

RI, LM, TP and SE declare that they are fulltime employees at the Global Fund to Fight AIDs, Tuberculosis and Malaria. EA and GM declare that they are fulltime employees at PricewaterhouseCoopers. ID, CM, NM and RS are fulltime employees at National Pharmaceutical Company of Zimbabwe. The rest of the authors declare that they have no competing interests.

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Convergent mixed methods design
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Analytic framework
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Adult and paediatric HIV treatment population coverage
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Percentage value of expired stock
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Stock-taking variance
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Duration to resolve stock variance
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References

    1. UNDP. Healthy systems for healthy people: UNDP and Global Fund support to strengthen financial and risk management for the delivery of health services in Zimbabwe. New York: United Nations Development Programme; 2020.
    1. UNDP. Healthy systems for healthy people: UNDP and Global Fund support to strengthen the national health management information system. New York: United Nations Development Programme; 2020.
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    1. MOHCC. National health strategy 2021–2025. Harare: Ministry of Health and Child Care; 2020.
    1. WHO . Everybody business: strengthening health systems to improve health outcomes: WHO’s framework. Geneva: WHO; 2007.

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