Supply chain management and health system complexity

When watching this video you may be struck by the fact that the government of Uganda and each of the different donors were all working to achieve a similar goal. Everyone wanted to increase the proportion of people having access to anti-retroviral therapy (ART). Everyone wanted to reduce the burden of HIV in Uganda. So, what went so terribly wrong with the supply of ART, given that everyone was working to the same purpose? One aspect that is not captured in the video is the fact that each stakeholder was working to their own targets and milestones for rolling out ART. Yet these targets were dependent on weak systems in the country.

The stakeholders faced a difficult choice. They could either meet their donor targets for ART roll-out by developing their own independent strategies to overcome the system weaknesses, (and not worry about any of the unintended consequences) OR they could decide to try and improve the health system, and as a result risk not complying with donor requirements, and perhaps losing their funding.

It is striking, but not that surprising, that the response of most stakeholders was to create their own workarounds, which in turn led to the duplication and the knock-on effects described in the case study.

Put yourself in the position of an implementing agency fulfilling a global donor’s commitment to ART delivery – reflect on what your response would be.