MAUL Bulletin, We Share with You a Detailed

MAUL July 2020 BULLETIN Volume 3 Issue 2

INSIDE THIS ISSUE Hello,

• Support to National Response and Relief Ef- forts in Combating COVID-19 Enhancing human health involves the use of innovative ap- • Emergency Delivery of Medicines to Kilembe proaches and best practices to procure and deliver medi- Mines Hospital Amid Flash Floods cines and health commodities to patients when and where • Logistics Team in Action During the COVID- they need them the most. However, with the emergence of 19 Pandemic the COVID-19 pandemic, we have had to find new and in- • Procurement Agency: Mitigating Sourcing Risk During COVID-19 novative ways to ensure an uninterrupted supply of medi- • CDC & Implementing Partner Communica- cines to over 240,000 people. We implemented a business tors’ Meeting continuity plan that aimed at keeping staff safe while ensur- • Working From Home: Joseph’s Experience ing continuity of procurement, supply chain and health sys- • COVID-19 Pandemic: Our Response & Inno- tems strengthening operations to avert treatment interrup- vation tions for the people that need the medicines the most. • COVID-19 Training: Infection Prevention and Use of Virtual Working Applications Through the MAUL bulletin, we share with you a detailed

insight into how we have been able to continue our opera- EDITORIAL TEAM tions running sustainably, keeping our staff and the wider • Arthur Muwanga community safe while delivering on our commitment of en- • Sheba Nakimera suring access to life-saving medicines to all that need them. • Josephine Tamale

• EmmaLinda Nassali Cheers!

SUPPORT TO THE NATIONAL RESPONSE & RELIEF EFFORTS IN COMBATING COVID-19 Medical Access Uganda Limited (MAUL) donated managing the current COVID-19 crisis. The PPE personal protection equipment (PPE) worth UGX materials shall facilitate frontline health workers in 11Million to frontline health workers in the fight the on-going effort to trace and test all suspected against the global COVID-19 pandemic in Ugan- patients and their patient management efforts,” da. The PPE materials comprising surgical masks said Dr. Settaala “ As an organisation, we remain and disposable gloves were handed over to the committed to ensuring the safety of our staff while State Minister of Health for General Duties, Hon. giving back to the communities in which we oper- Robinah Nabbanja at the Ministry of Health ate as we stand together with the Government of Headquarters in Kampala. MAUL also contribut- Uganda to fight against the COVID-19 pandem- ed 175 litres of hand sanitizer to bolster sanitation ic.” hygiene efforts in-line with COVID-19 interven- tions. This donation is in line with MAUL’s Restoring Hope Initiative, our corporate social responsibility Speaking during the handover, MAUL’s Director program aimed at fostering a strong foundation of Programs, Dr. Rashid Settaala applauded the for sustainable healthcare delivery in the commu- Government’s efforts in managing the crisis and nities in which we operate through annual staff curbing the COVID-19 pandemic. “I would like to contributions towards public health issues com- appreciate the Government of Uganda and Minis- munity organizations. try of Health’s exceptional efforts of leading and

EMERGENCY DELIVERY OF MEDICINES TO KILEMBE MINES HOSPITAL AMID FLASH FLOODS

Kasese district was hit by flash floods when river Nyamugasani, Mubuku and Nyamwamba burst their banks. Huge volumes of water washed Kilembe Mines Hospital destroying the hospital infrastructure in its path. Calamities like these usually disrupt health systems and thus reduce uninterrupted patient access to health services and life-saving medicines. Muhammed Lugolobi, a Last Mile Executive who delivered emergency medicines supplies narrated, “the whole facility was filled with dark soils and water that the locals called minerals that had flowed down from the hills. There were large rocks everywhere and the medicines stores was completely destroyed, and all medicines lost since it was among the struc- tures closest to the banks of river Nyamwamba.”

The destruction of the medicine stores largely meant that hundreds of people living with HIV (PLHIV) under their care wouldn’t be able to re- ceive their medications where and when they Rocks and other debris left behind in the needed it. For PLHIV, antiretroviral therapy un- wake of floods destroying Kilembe Mines Hospital infrastructure questionably represents the best opportunity to achieve viral suppression, recover immune func- of the nationwide curfew imposed to prevent the tion and prevent HIV-related diseases. Thus, an spread of COVID-19. interruption is detrimental to their lives, causes resistance to ART and a reversal to gains made In addition, “the hospital also had no pallets and nationally on the path to epidemic control. thus we had to improvise with benches as pallets to ensure that the drugs are appropriately stored However, even with a readiness to respond to in the new structure housing the ART clinic. Fur- emergency needs for medicines to ensure PLHIV thermore, I had to carry all the medicines stocks remain on treatment, Muhammed still couldn’t myself from the vehicle to the new medicine store hand over the commodities as health workers to ensure I protect myself from COVID-19 infec- were in a rush to get back to their homes in honor tion as per the trainings we had been taken through”.

EMERGENCY DELIVERY OF MEDICINES TO KILEMBE MINES HOSPITAL AMID FLASH FLOODS (CONT’D)

“We are very thankful and were always sure that Medical Access would assist us in this time of need,” the hospital administrators told Mu- hammed on finishing the stacking and organization of the medicines in the stores. As a Last Mile Executive, Muhammed is a critical link in ensuring that these medicines and essential healthcare commodities reach more than 240,000 patients on antiretroviral therapy at over 250 health facilities under the Health Supply Chain Improvement Project (HSIP) wherever they may be and always with a smile. “Each time I make a delivery, I get compliments from staff and patients. To me, this is enough motivation for the work I do,” said Mu- hammed.

Medicines stocked on benches in the absence of pallets

While the new ART clinic store could store medicines under normal room temperature levels, it couldn’t handle thermolabile products such as Lopinavir/Ritonavir and thus the hospital administrators sought the help of St. Paul Health Centre IV, a neighboring health site to adequately store these cold chain products for the time being as the hospital shifted its operations to St. Micheal Kindergarten and Day Care School temporarily. The temporary hospital site

“The Distribution team ensured 100% order fulfilment and on-time delivery for all health commodities required by CDC-supported health facilities during the COVID- 19 pandemic situation alongside ensuring adherence to COVID-19 infection and prevention control practices. At the end of the distribution cycle, no MA staff had been diagnosed with COVID-19. However, the team still navigated through poor ter- rain, flooded roads and spent nights in the delivery trucks with a core objective to ensuring patient access to life-saving medicines against all odds”

PROCUREMENT: MITIGATING SOURCING RISK DURING COVID-19 The COVID-19 pandemic is currently affecting over 200 countries globally including those from which Medical Ac- cess procures life- saving HIV medicines and vital health commodities needed for care and treatment of people living with HIV in Uganda. MA split orders amongst prequalified suppliers to The pandemic has applied significant pressure on ensure on-time delivery and reduce the risk of global manufacturer production capacities, suppli- increased lead times especially for HIV medicines er availability and logistics. This has in turn risked that had been caused by the scarcity of active the continuation of an uninterrupted supply of pharmaceutical ingredients (APIs) that had result- medicines to PLHIV in Uganda due to lockdowns ed from the shutdown of major manufacturers in and other measures undertaken to contain the China. spread of the virus, which also has an impact on supply. Medical Access is in on-going dialogue Furthermore, MA has reduced the issuance of with suppliers to assess risk of commodity availa- requests for quotations to avert unnecessary bility and accessibility and undertaking mitigating price increments from suppliers while ensuring measures to avert interruptions in antiretroviral routing follow-up on pending shipments for com- therapy for more than 240,000 PLHIV. modities to ensure timeliness of delivery. In order to further ensure zero disruptions in HIV treat- Through supplier relationship management ef- ment efforts, MA has opted for mulit-month dis- forts, MA has engaged suppliers prior to award to pensing packs for antiretroviral therapy to ensure confirm availability of commodities and price va- PLHIV have constant access to treatment while lidity, negotiations with suppliers to maintain pric- staying away from health facilities for longer peri- es for pipeline orders while reaching out to local ods of time to protect themselves from contract- suppliers to secure enough stock of commodities ing COVID-19 from previously recommended reg- before major global lockdowns had escalated. To ular health visits. mitigate instances of supplier failure to deliver,

CDC & IMPLEMENTING PARTNER COMMUNICATORS’ MEETINGS

The U.S Centers for Disease Control (CDC) held their Implementing Partners (IPs) communicators’ roundtable meetings via the Zoom platform with a focus on strategies and innovations adopted by Implementing Partners in HIV programming and continuity of service delivery to people living with HIV while ensuring COVID-19 infection and prevention control. The meetings also highlighted CDC’s role in COVID-19 communications efforts as well as the pandemic’s situation in Uganda while taking note of Ips’ best practices of HIV programming innovations amid the pandemic.

The IPs Communicators’ meetings aim at clearly communicating the rationale and practical implementation of CDC’s high impact, data driven approach to strengthening partner government ministries of Health response towards to HIV and other global health threats; communicating CDC’s work as a powerful investment of American tax- payer money and build support for ongoing investments; increase awareness of ongoing efforts to fight HIV/AIDS and TB as well as showcase CDC’s amplified efforts to fight and eventually eliminate such health threats; highlight CDC’s unique role in creating sus- tainability within countries at the epicenter of these epidemics and lastly, to improve communications between CDC and partners, with a focus of increasing partner under- standing of CDC’s work and priorities in country and their roles in achieving them.

WORKING FROM HOME: JOSEPH’S EXPERIENCE

Due to the coronavirus pandemic, working from and Implementing Partners (IPs) on ground to home has become increasingly inevitable for ma- ensure quick response to needs of health facili- jority of the Medical Access staff. For several em- ties such as redistributions and commodity avail- ployees, the experience is not only new, but a ability, “he added pointing to the ways that collab- few also dreaded it. It’s not the logistics that are oration between Medical Access and Implement- the tough part. It’s the day-to-day working life. ing Partners has ensured an uninterrupted supply Having to adjust to spending a large part of your of HIV medicines to patients during the COVID- day alone in your house or under the constant 19 period. To further build sustainable relation- distractions from children instead of around your ships with frontline health workers, Joseph says co-workers in an office. “My first few days of that his phone is always on and ready to provide working remotely were a pain as I started mixing logistical assistance to frontline health workers at my home and office routine. Social distancing is any time of the day so that they in turn can ably tough and I’m missing my work friends and the serve patients and their respective needs ade- human connection,” highlighted Joseph Emiku, quately. Supply Chain Technical Officer as he narrated his start to remote working. “Additionally, the intermit- tent power supply and internet connection push me to working more than the eight hours I was accustomed to so that I can get my work priorities accomplished,” he added. However, working from home has equally been productive since Joseph says he saves time spent commuting to and from work that he now spends getting more work done. Joseph further pointed to the creativity and ingenuity skills that he has developed during this period especially while interacting with health workers who were used to physically seeing him on a weekly basis. “We have had to offer support supervision remotely using the abridged SPARs tool coupled with phone calls and WhatsApp chats to ensure that health workers can comfortably continue with their primary work of logistics management of health commodities,” Joseph noted. “We have Joseph currently at his remote created WhatsApp groups with health workers work station

COVID-19 PANDEMIC: OUR RESPONSE & INNOVATION COVID-19 is spreading across countries and re- leveraging MA’s online supply chain training plat- gions at a rapid pace. Lockdowns, border clo- form with a supply chain management course sures and restrictions on movement of people used to train, mentor and support health facilities and commodities have caused a huge impact on in ensuring proper management of health com- the global supply chain of production and a dis- modities. With health workers able to experience ruption to health services and supplies to patients self-paced learning, the platform will serve as a who need them the most. In order to ensure an gateway of Realtime mentorship from MA tutors uninterrupted supply of HIV medicines and vital to ensure upskilling of health workers with neces- healthcare commodities, MA developed risk miti- sary knowledge and practical skills during this gation strategies to ensure staff safety along all crisis period. points of the health supply chain while ensuring full order fulfilment and delivery timeliness of medicines to health facilities to avert interruptions of HIV medicines that would endanger millions of patients and additional HIV-related deaths.

To maintain safety of logistics staff during last mile delivery, delivery trucks were parked in des- ignated spots away from regular truck drivers in a “bumper to bumper” style to reduce exposure to possible COVID-19 infected individuals en-route as well as ensure commodity security during the distribution cycle. Furthermore, staff were provid- ed with adequate personal protection equipment comprising overalls, gloves and googles plus pro- tein bars meant to sustain them for the long drives in the event they could not access a meal given the national guidelines on the on COVID-19 infection and prevention control. Additionally, des- ignated drop-off zones were identified where health commodities would be dropped and recipi- ent health sites take over delivery to their storage areas to ensure limited interaction between staff and frontline health workers. MA Distribution team with PPE, bumper to bumper to secure commodities and Maintaining sustained achievements in capacity resting inside truck to avoid contact building efforts amongst health workers involved with people while on the road

COVID-19 STAFF TRAINING: INFECTION PREVENTION & VIRTUAL WORKING APPS Protecting staff from the COVID-19 pandemic is advised to continue working from home full-time paramount to ensuring business continuity of and avoid contact with dead animals. The MAUL Medical Access’ supply chain operations regard- COVID-19 taskforce operational guidelines to ing ensuring an uninterrupted access to life- staff which included receipt of staff and visitors at saving HIV medicines to over 240,000 people MAUL premises; utilization of personal protective living with HIV. In that regard, all staff were taken ware and equipment; appropriate information flow into refresher trainings through virtual meeting and decision making; hygiene, sanitation and applications on COVID-19 transmission, symp- housekeeping; food handling and serving; deliv- toms and prevention meth- ery of outbound shipments; field ods as well as current stra- accommodation practices; infec- tegic operations procedures tion prevention and control. (SOPs) and social and be- havioral change materials MA staff working remotely were to support the adoption of taken through a virtual training on COVID-19 prevention be- the appropriate use of Zoom as a haviors. virtual working application. The Communication to staff fo- training aimed at updating staff on cused on the global impact the vast array of options available of the coronavirus and its on using the application such as mortality rate, it’s mode of user security improvements, crea- transmission and the re- tion of break-out rooms and wait- spective symptoms as well ing rooms plus the need to lock as the effect of the pandem- meetings to ensure only invited ic on the organization oper- guests can join the meeting. The ations based on the out- virtual working applications training break and guidance from was in line with on-going business the national guidelines and continuity management plan set up pandemic control strategies. Furthermore, staff to steer the organization operations through the were trained on precautionary measures to pre- COVID-19 pandemic. vent transmission such as appropriate use of personal protection equipment, social distancing and The refresher trainings are part of MA’s business specific workplace preventions. Staff were also continuity management (BCM) plan aimed at en- advised to ensure they increase uptake of suring service resilience, operational stability and fruits and vegetables while increasing uptake of utmost importance on the management of the water to. Staff with pre-existing conditions were health and safety of staff and wider community.

20 Years delivering life-saving medicines

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