Management Sciences for Health, with funding from USAID and in cooperation with multiple private and public entities in Ukraine, launches a successful pilot to improve that country’s healthcare delivery supply chain.

The availability of safe and affordable medicines for battling HIV and other chronic diseases is anything but equal among countries. But an innovative public-private partnership launched in Ukraine has gone a long way toward improving access to critical healthcare in that country.

The effort involved coordination among multiple groups and agencies, led by Management Sciences for Health (MSH), a global nonprofit that advises on setting up health-management systems in the poorest countries and communities. In Ukraine, its focus was on the one element that frustrates so many attempts to deliver quality healthcare to people around the world: logistics.

Ukraine contains one of the largest HIV-positive populations in Europe. At the beginning of 2018, it counted 244,000 people living with HIV in the country. Most rely on a steady supply of antiretrovirals (ARVS) to suppress the virus and halt the progression of AIDS. Ukraine’s government has announced a commitment to providing ARVs to those individuals free of charge, primarily through use of public funds. It has also targeted sufferers of tuberculosis.

All well and good, but executing on that promise means navigating a complex bureaucracy involving multiple public and private stakeholders, as well as the natural obstacles that are bound to occur in any extended logistics network. Drugs for treating HIV/AIDS are purchased through a central procurement program maintained by Ukraine’s Ministry of Health (MOH), then delivered to major regions of the country. But further distribution to sub-regional healthcare facilities requires separate management, involving outdated and redundant processes that can lead to serious delays in delivery and compromised quality of medicines.

A Lack of Certification

Two of Ukraine’s state-owned enterprises responsible for customs clearance, warehousing and distribution lack Good Distribution Practices (GDP) certificates, which recognize minimum distribution standards for ensuring the integrity of medicines throughout the supply chain. According to MSH, there was no systematic approach within the public sector for regional last-mile distribution. Transportation was without temperature-controlled vehicles, and warehousing lacked qualified personnel for handling the sensitive medicines.

Various private companies were, however, available in Ukraine to provide distribution, warehousing and inventory management in accordance with international best practices. So MSH, with funding from the U.S. Agency for International Development (USAID), set out to implement an innovative program dubbed Safe, Affordable and Effective Medicines for Ukrainians (SAFEMed), drawing on both public and private resources in a logistics pilot launched in the Odesa region in 2019.

In addition to MSH and the MOH, the effort involved collaboration with Ukraine’s National Health Service, Central Procurement Agency, Center for Public Health and State Export Center. The idea was to engage private entities, which could maintain the necessary level of quality for delivering the medicines, to provide specialized logistics to the public sector.

In the process, the pilot was able to ensure full compliance with temperature and cold-chain requirements, as well as adherence to GDP, all the way to final point of consumption at 39 facilities in the region. It also resulted in improved frequency of delivery and dispensing of the medicines, while leading to creation of a “feasible costing” model to guide future logistics efforts by Ukraine’s state agencies.

The Winning Bid

SAFEMed undertook a competitive tender for private logistics providers. The winner was a local company called Farmasoft, which met all technical specifications and held a valid GDP certificate. The Odesa Regional AIDS Center managed stock levels at the regional level, and provided Farmasoft with delivery details and required documents.

The first delivery by Farmasoft, in December of 2019, involved two trucks and a five-day transit over a total of 6,000 kilometers (around 3,700 miles). The average monthly cost per site was around $100, according to MSH.

Additional benefits of the pilot included achievement of standardized delivery frequency to targeted healthcare sites within the region, improved quality of transportation, optimization of stock levels at both regional and sub-regional locations, and reduction in the time that healthcare specialists spend on logistics-related issues.

A subsequent one-page survey of healthcare facilities in the Odesa region by SAFEMed and the local AIDS center yielded a high level of satisfaction with the pilot. One hundred percent of respondents chose “it got better” when comparing results with previous arrangements.

After 11 months of running the pilot, participants emerged with a number of recommendations for extending the effort in Ukraine and beyond. They called for the bundling of TB and HIV last-mile deliveries with other medicinal products, including vaccines and lab commodities, procured centrally with public MOH funds. They said private-sector delivery trucks should be repurposed to bring back lab samples to the Odesa Regional AIDS Center in order to speed up HIV and TB testing services. And they urged spreading the pilot to other regions.

In November, 2020, MOH elected to extend the arrangement to all 25 regions of Ukraine, to ensure quality last-mile transportation throughout the country. The action is expected to become the basis “for the development of the national strategy for institutionalization of results, by including logistics services in centralized budgets and packages of services financed by the National Service of Ukraine,” MSH said.

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