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[e-drug] Logistics systems in the less developed world (7)

E-DRUG: Logistics systems in the less developed world (7)

As a professional logistician myself, I agree with the main points of
Paul Dowling and Beverley Snell.

However, even in many developing countries where these points have
been addressed with extensive programs, we see such programs fail
miserably a few years after  donor funding has dried up.

Recently I had the pleasure of being able to take a detailed look at
the supply chain of the Health system in Cuba. I say pleasure, because it was 
the first time ever I have seen a pharmaceutical supply chain being operated, 
as by the book.

Practically all good practices that are being preached by us were in
place and being used. It struck me that at each level (central,
regional, field) we met with complete teams who were motivated, well
educated, enjoyed their work and had sufficient time to do it. I asked
myself, why did this system work there, and not in so many developing

I believe the main differences were: sufficient funds, sufficient well
educated staff, a drive to work for the community and a dose of strict
discipline in case SOP's & reporting rules were not followed timely.
High staff attrition rates are one of the main reasons well designed
pharmaceutical supply chains often collapse after a while in
developing countries. This does not seem to be an issue in Cuba,
because staff mobility is somewhat limited and people cannot easily
travel outside the country.

Basically I think the principles of a good public health system, that
we try to promote in developing countries, do not comply with the
principles of a free open market economy. You can't really blame the
nurse at the health center for not filling in her weekly report with
50+ indicators for TB, HIV, malaria and logistics combined, while her
pharmacist ran off to Europe for a better paying job. We can set up
all the systems we want, but if the money is not there nor the people
to run them, sadly, they will not work.

[The moderator agrees!]

Jurgen Hulst
Consultant Pharmaceutical supply chain management
Kathmandu, Nepal

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