Building local capacity to improve availability of medicines for the people of Southern Sudan

A lone health worker, Goodwing, does his best to provide basic health care to his community. The drugs shown here were his entire drug supply for the month.
When individuals are ill in Tambura County, Southern Sudan, they are lucky if they have a health facility where they can go for care. The civil war between north and south Sudan that has marked much of Sudan's 52 years of independence has severely stunted the growth of Southern Sudan's health system, and as a result, up to 75% of the population is estimated to have no access to a health care center or unit. In the event that a health facility is accessible, patients still may not receive quality services. Most facilities are staffed by a community health worker and/or a nurse with only basic health knowledge. Even when health workers have the technical capacity to care for their patients, a larger obstacle to addressing a patient's health condition may present itself: the right drug for the treatment is not available and staff do not know when, or even if, more will arrive. For patients, this means going without treatment, sometimes leading to serious consequences or death. Fewer people are willing to go to health facilities knowing that drugs may not be there to treat them even if a diagnosis is made.

Getting essential medicines to health facilities in Tambura County or anywhere in Southern Sudan is not an easy task. Many roads are in poor condition, particularly during the rainy season when areas become inaccessible for months at a time. Large trucks, while able to carry adequate quantities of medicines, are more likely to get stuck along the way; however, using smaller trucks requires more frequent trips. The government, dedicated to rebuilding the health system but facing resource constraints, cannot always transport the drugs themselves or use hired transporters, and international nongovernmental organizations frequently end up making deliveries or even procuring drugs with their own funds. None of this is well coordinated or done according to a schedule. Compounding the problem of irregular transportation for deliveries is a lack of information in Juba or even in Tambura, on the quantities of each drug that a facility uses, needs, or even how much they currently have in their storeroom to meet patient needs.

A health worker in a SHTP health facility provides medicine to the mother of a sick child
Very few personnel working in health facilities and storerooms, either in rural or urban areas, have a comprehensive enough knowledge of logistics to e nsure that health facilities do not run out of the essential drugs they need. To begin to address this gap, the Sudan Health Transformation Project (SHTP), a USAID supported program implemented by JSI Research & Training Institute, Inc., successfully conducted a workshop, "Improving Logistics Capacity," in July 2008 in Juba, the capital of Southern Sudan. Since the 20 participants represented the Government of Southern Sudan's Ministry of Health, state-level ministries of health, county health departments, and several of SHTP's partner organizations (International Medical Corps, World Vision International, Tear Fund, Action Africa Help, and Sudan Inland Development Foundation), all were familiar and experienced with the lack of supplies in health centers and units.

Over the four-day workshop, participants mastered basic health commodity logistics concepts, such as the purpose of a logistics system, what essential information must be collected in order to make good logistics decisions, how such information moves within a logistics system, how to assess stock levels, and when to take action to prevent an overstock or a stock out. Thirsty for such knowledge, one participant even commented that the "workshop has acted to me as an eye opener. It has prepared me to handle the logistics department with confidence. From today, I am going to be a decision maker."

Plans and strategies developed by participants during the workshop are beginning to be used in the counties where SHTP is currently working. Their efforts, ideas, and experiences can someday inform the government's efforts to build its own national logistics system in the future.