MSD Direct Delivery Tanga Pilot

This section describes roll out of direct delivery in Tanzania, beginning with a pilot in Tanga, which further enabled Project Last Mile partners to identify concrete opportunities for supply chain improvements at MSD.

Responding to an outcry of delay in delivery of medicines to health facilities and stock expiries, and widespread stock outs, the Ministry of Health and Social Welfare (MOHSW) in Tanzania instructed the MSD to undertake a pilot study to investigate the delivery of medicines and medical supplies directly to the health facilities instead of going through the District Medical Offices (DMOs). Within one month of the mandate from the MOHSW, MSD began its “direct delivery” pilot in Tanga Zone for medicines and supplies on the Integrated Logistic System (ILS). Tanga was selected because it has a varied geography from coastal plains to mountainous roads as well as urban and rural populations, resulting in a mix of facilities and road conditions that were believed to be representative of Tanzania as a whole.

Using district pharmacists to guide them to the primary health facilities, MSD officials from the Tanga zonal office delivered medical supplies to the facilities directly, instead of relying on the district office. A number of lessons were learned during the direct delivery pilot including:

MSD was able to deliver to end users: MSD increased the number of deliveries from the regular eight districts in Tanga zone to 234 primary health facilities. In order to make these deliveries, additional resources, including vehicles and delivery staff, were needed by MSD.

Non-operational facilities were receiving funding for medicines and supplies: Traditionally, MSD’s responsibilities have been limited to fulfilling orders. Once MSD had to deliver to its end user, it found that it had been fulfilling orders for facilities that were not operational (some were built but not staffed, others were not completed). Through this physical verification of facilities, the zonal office noted that 45 of the 234 were non-operational. Since 2002, the ministry had disbursed 271,585,632 Tanzanian Shillings (TSh) to the non-operational facilities accounts and 105,980,400 TSh had been spent.1

Service population numbers ranged greatly from facility to facility: There is a large range in the catchment areas for each facility in the Tanga Zone. Health centers serve communities whose populations range from 4,050 up to 66,130. 2 Despite these differences, each health center had been receiving a standard budget allocation per quarter for medicines and supplies. 

MSD was able to fulfill only 65% of the orders during the direct delivery pilot: MSD noted it had a 65% fill rate during the Tanga pilot from February to April 2010. During the pilot program, the Tanga Zonal store was out of stock of fifteen commonly used items, including various antibiotics and oxytocin for treatment of hemorrhaging after childbirth. 3

Ownership and accountability improved under direct delivery: MSD's visibility to the community increased as fleets of MSD trucks were seen at the villages, providing important opportunities for MSD to directly connect to their customers. MSD also became accountable for the delivery of items throughout the entire supply chain – from central warehouse to the health facility, eliminating misunderstandings among the facilities, district offices and MSD itself. In addition to promoting transparency and accountability, this practice fostered a stronger sense of ownership as the community became more engaged in terms of checking supplies and reporting discrepancies. 

Remaining Challenges

"Drug management seems to pose a serious challenge in the Region, despite the fact that the Ministry of Health and Social Welfare and other partners are supporting direct supply of medicines from MSD to health facility level." Excerpt from the Tanzanian German Programme to Support Health (TGPSH) study, conducted from November to December 2011. 4

Although interviews, health facilities’ ledgers, and visitor books in Tanga Region led the Yale GHLI team to observe a possible slight improvement in delivery times (approximately one week faster) during August 2011 as a result of the change to direct delivery, some facilities reported longer delivery times under this new mandate. Health facilities also reported that MSD’s shutdown for stock counting in June adversely affected their deliveries. It was also noted that direct delivery has its limitation in changing stock out rates at the facility level. For example, the quantity a health facility requested in the order form is sometimes changed at the level of the district medical officer and/or zonal MSD, according to the available budget and stock on hand at the MSD warehouse. Health facilities often compain of receiving  items they did not order and items delivered in quantities below their request. They are forced to receive and pay for the deliveries regardless of whether the contents of the boxes actually match what was ordered. 

Factors outside of MSD also contribute to problems with stock outs, include standard budget allocation regardless of catchment size of the facility and Tanzania’s health care provider crisis. Scarcity of human resources remains a problem at all levels within the supply chain, particularly in most health dispensaries. Without an adequate and stable personnel base, it is difficult to establish or maintain consistent work processes for supply chain management.

Roll out of Direct Delivery
Despite these challenges, direct delivery remains a highly visual political device for driving accountability in the medical supply system in Tanzania. The MSD report on the direct delivery pilot was positive, pointing out, “Generally the exercise is very positive as from a public point of view it shows that the availability of medicines and medical supplies has improved in the piloted region.” Following the pilot, roll out of direct delivery in targeted regions across the country was planned, at an estimated cost of TSh 3.127 billion. The USAID report released September 2011 predicted direct delivery would cost between $23 and $26 million USD in 2020 with a 60% MSD fill rate. Please refer to the full report for further details on the costs and scheduling of the roll out.

 

  • 1.  Medical Stores Department. "Pilot Study for Delivering Direct to Health Facilities and Rollout to Other Regions". June 10, 2010.
  • 2.  Medical Stores Department. "Pilot Study for Delivering Direct to Health Facilities and Rollout to Other Regions". June 10, 2010 
  • 3.  Medical Stores Department. "Pilot Study for Delivering Direct to Health Facilities and Rollout to Other Regions". June 10, 2010.
  • 4. Tanzanian German Programme to Support Health (TGPSH). Availability and Management of Medicines and Medical Supplies: Findings from an Assessment of 87 Health Facilities in Four Regions in Tanzania. November 2011 http://www.tgpsh.or.tz/fileadmin/documents/SHI_2/GIZ_Medicines_Management_Assessment_2011_final.pdf


 Background Resources

Final Report on “Pilot Study for Delivering Direct to Health Facilities and Rollout to Other Regions” by MSD, June 10, 2010. Read about the findings of the Tanga direct delivery pilot.

The Roll Out of Direct Delivery to Public Primary Health Facilities in Tanzania by MSD, October 2010. Read about the increased cost to initiate direct delivery for selected districts in Tanzania.

2020 Supply Chain Modeling by USAID, September 2011. Read about the increased MSD funding needed to implement direct delivery to all facilities in Tanzania.

Availability and Management of Medicines and Medical Supplies by Tanzanian German Programme to Support Health, November 2011. Read the section on management and order fill rates in Tanga after direct delivery.

Direct Delivery 

 Partners' Perspectives

"It was good, also, to interact with each other between MSD and the facilities. Now even our communication is coming closer. We can contact direct to them. Before we had to contact the DMO office, and then DMO give us information on that. Also, it took time to get information on the facility through DMO, but for this we can get information anytime because we have the communicationMSD Supply Chain Personnel

MSD announces new MSD vehicles on February 10, 2012.  See announcement.