3 Questions with Dr. Theo Faruna on Ensuring Access to HIV Commodities in Nigeria

GHSC-PSM Nigeria envisions an optimized supply chain management system led by the government of Nigeria. This vision aims to ensure that activities are focused on providing lifesaving medicines and health commodities while establishing efficient, reliable, and cost-effective supply chains for delivering these drugs and commodities to patients and other clients across the country. The strategic goal of GHSC-PSM is for Nigeria to have a locally led health supply chain that is integrated, optimized, accountable, agile, lean, and capable of sustainably providing quality products to all citizens.

To ensure the delivery of HIV/AIDS commodities to hard-to-reach communities, GHSC-PSM has provided technical support with mentoring to major warehouses, including receiving, storing, pick and pack operations, engaging vendors for last mile delivery to facilities, and maintaining transaction records for reporting to funders. GHSC-PSM has started mentoring subnational entities to enable state-led last mile distribution, including training government staff to lead the conduct of assumption building workshop, quantification, and supply plan exercises. The aim is for state governments to take the lead in making commodities available to all facilities. The GHSC-PSM project is still supporting the Procurement and Supply Management Technical Working Group to facilitate discussions that contribute to the availability of commodities nationwide through the national quarterly meeting. 

One of the key pillars of the Nigeria HIV Program is the attainment of the UNAIDS 95-95-95 strategy. GHSC-PSM, with funding from USAID, oversees the integrated samples referral network, which plays a crucial role in achieving the third 95 (viral suppression) by monitoring the viral load suppression rate among individuals on antiretroviral therapy. Worthy of mention is the funding to support the training in and use of the Quantification Analytics Tool (QAT). This modernized solution replaces legacy forecasting and supply planning tools such as PipeLine and Quantimed. The QAT is empowering Nigeria to conduct its own supply planning and forecasting.

 3. What recommendations do you have to sustain these improvements to the Nigerian supply chain system in the future?

To sustain the gains achieved so far, the Government of Nigeria, through NASCP and the National Agency for the Control of AIDS should continue to build on the existing framework that incorporates essential skills for forecasting and supply planning activities into the staff orientation program. 

The federal Ministry of Health should take deliberate actions to maintain the continuous delivery of commodities from warehouses to healthcare facilities. This will ensure that the facilities always have access to commodities and minimize the occurrences of stockouts or expirations. The state-led last mile distribution should be expanded to all the subnational governments for sustainability. Additionally, government officials have already taken proactive measures in assumption-building, forecasting, and reviewing supply plans through the knowledge acquired from QAT training. It is crucial to consolidate and expand upon this progress. However, there is still much work to be done in transitioning from the conventional government procurement bureaucracy to a streamlined procurement and pipeline monitoring system for HIV commodities and laboratory reagents and consumables. That requires a government–dedicated budget line for HIV commodity security that is not susceptible to manipulation.

To ensure the continuous supply of commodities, the government should continue to provide waivers and address bottlenecks in importing necessary reagents and consumables that are not produced locally. There should also be an appropriate government agency to establish robust memorandums of understanding between funders and state ministries of health to clearly define service levels and accountability frameworks for the drug management agencies/drug revolving funds. These frameworks should include co-financing schemes involving donors, the national health insurance scheme, and community insurance with termination conditions. The government should also sustain the progress achieved by the national integrated specimen referral network, which has facilitated the desired viral load monitoring for individuals undergoing treatment, and early infant diagnosis testing for babies exposed to HIV.