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Logistics Systems and Management Assessment in Sofala, Manica, and Tete Provinces: Results of an Independent Consultancy for CHASS-SMT

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Logistics Systems and Management Assessment in Sofala, Manica, and Tete Provinces: Results of an Independent Consultancy for CHASS-SMT Logistics Systems and Management Assessment in Sofala, Manica, and Tete Provinces: Results of an Independent Consultancy for CHASS-SMT Consultancy by: VillageReach 2900 Eastlake Ave., E., Suite 230 Seattle, WA 98102 USA Tel. +1 206 512 1533 Fax +1 206 860 6972 Consultants: Leah Hasselback and Evy van Weezendonk Submission Date: March 28, 2012 Submitted Under: CHASS-SMT Cooperative Agreement No.: 656-A-00-11-0021-00 RFP Number: CHASS-SMT-2012-01 1 Table of Contents 1 Executive Summary ...................................................................................................................................................... 4 2 Introduction ..................................................................................................................................................................... 7 2.1 Methodology ........................................................................................................................................................... 7 2.2 Limitations .............................................................................................................................................................. 8 3 Assessment Results – National Level ................................................................................................................... 10 3.1 Central Level Key Informant Interviews .................................................................................................. 10 3.1.1 The Landscape of Logistics Systems Strengthening in Mozambique .................................. 10 3.1.2 Key Informant Rankings of Problems and Solutions ................................................................. 11 3.1.3 Other Results from Key Informant Interviews ............................................................................. 13 4 Assessment Results – Provincial Level ............................................................................................................... 15 4.1 Tete .......................................................................................................................................................................... 15 4.1.1 Logistics Network Strengths and Weaknesses ............................................................................. 15 4.1.2 Logistics System Design for Medicines ............................................................................................ 16 4.1.3 Storage Conditions ................................................................................................................................... 18 4.1.4 Transport Availability ............................................................................................................................. 18 4.1.5 Tracer Commodities Analysis .............................................................................................................. 19 4.1.6 Requisitions Analysis .............................................................................................................................. 21 4.1.7 CD4 Sample and Results Logistic System ....................................................................................... 26 4.1.8 DPS Discussion of Results ..................................................................................................................... 27 4.2 Manica ..................................................................................................................................................................... 28 4.2.1 Logistics Network Strengths and Weaknesses ............................................................................. 28 4.2.2 Logistics System Design for Medicines ............................................................................................ 29 4.2.3 Storage Conditions ................................................................................................................................... 32 4.2.4 Transport Availability ............................................................................................................................. 32 4.2.5 Tracer Commodities Analysis .............................................................................................................. 33 4.2.6 Requisitions Analysis .............................................................................................................................. 35 4.2.7 CD4 Sample and Results Logistic System ....................................................................................... 39 4.2.8 DPS Discussion of Results ..................................................................................................................... 40 4.3 Sofala ....................................................................................................................................................................... 42 4.3.1 Logistics Network Strengths and Weaknesses ............................................................................. 42 4.3.2 Logistics System Design for Medicines and Consumables ...................................................... 43 4.3.3 Storage Conditions ................................................................................................................................... 45 2 4.3.4 Transport Availability ............................................................................................................................. 45 4.3.5 Tracer Commodities Analysis .............................................................................................................. 45 4.3.6 Requisitions Analysis .............................................................................................................................. 48 4.3.7 CD4 Sample and Results Logistic System ....................................................................................... 53 4.3.8 DPS Discussion of Results ..................................................................................................................... 53 5 Recommendations ....................................................................................................................................................... 54 5.1 Examples of Best Practices in the Provinces ........................................................................................... 54 5.2 Short-Term Recommendations .................................................................................................................... 55 5.3 Medium-Long Term Recommendations ................................................................................................... 60 5.4 Province-Specific Recommendations ........................................................................................................ 63 5.5 Recommendations Analysis ........................................................................................................................... 65 5.5.1 Logistics System Focus ........................................................................................................................... 66 5.5.2 Logistics Systems Performance Area ............................................................................................... 66 5.5.3 Solution Characteristics Priorities ..................................................................................................... 70 6 Conclusion ....................................................................................................................................................................... 73 Annex 1: List of Key Informant Interviews at the Central Level ........................................................................ 74 3 1 Executive Summary The Clinical HIV/AIDS Services Strengthening (CHASS-SMT) project is a USAID-funded health systems strengthening and HIV care and treatment project in Mozambique’s Sofala, Manica and Tete (SMT) provinces. CHASS-SMT provides direct support to 160 health facilities and identified very weak logistics management in the three provinces that resulted in frequent shortages and stock outs of essential commodities and interruptions in patient monitoring. This report provides findings and recommendations from a consultancy for CHASS-SMT to improve logistics capacity and performance in the provinces. The consulting team started the assessment with a desk review of relevant documents and reports followed by interviewing key stakeholders in Maputo including CHASS-SMT staff and other health logistics professionals. The interviews resulted in a general consensus that the logistics systems problems are complicated and interrelated, which is also the opinion of the consultants. Between the two stakeholder groups, there was not consensus on the biggest problems. CHASS-SMT identified planning and coordinating in the logistics system and the other logistics professionals identified human resources for logistics activities as the biggest problem. However, the two groups did agree that maximizing sustainability is a top priority for a solution and minimal cost was regarded as the lowest priority. The central-level key informant interviews also resulted in four areas of need in the logistics system: improving information, building capacity throughout the system, standardizing logistics practices and activities, and integrating activities. Finally, the interviews revealed a lot of interest in outsourcing transport. After the central level portion of the assessment, the consultants traveled to each province to complete the assessment
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