1. BY MOSES TIEL EXECUTIVE DIRECTOR OF CENTRAL MEDICAL SUPPLIES MINISTRY OF HEALTH REPUBLIC OF SOUTH SUDAN GENEVA 06.11.2014 CHALLENGES FACING CENTRAL MEDICAL SUPPLIES

2. OUTLINE Country Profile Challenges facing central Medical Stores Little Progress in Central Medical Stores The Way Forward (in the near future)

3. Country Profile

5. THE REPUBLIC OF SOUTH SUDAN It was part of old Republic of Sudan until it became an independent country on July, 9 th 2011 Area: 644,775.43 sq. km Population: approximately 11,090.104 Languages : English, Arabic, Dinka, Nuer, Shiluk, Bari etc. Currency: South Sudanese pound (SSP)  1 USD = 2.970 SSP Capital city : Juba

6. Challenges Facing Central Medical Stores 1. Trained Health Personnel 2. Warehousing and Storage facilities 3. Funding Agents & their Coordination 4. Procurement 5. Quantification 6. Inventory control of stock 7. Transportation and Distribution 8. Product Use 9. No National Laboratory for Quality Control

7. 1. LACK OF SKILLED HEALTH PERSONNEL There is acute shortage of of health professionals  Approximately 1500 nurses and midwives  500 medical officers  45 specialists  20 dentists  120 pharmacy personnel (pharmacists & technicians) A good number of health personnel are not practicing their professions Many are employed by NGOs

8. 2. Warehousing and Storage Inadequate storage facilities at all levels  Only two warehouses available in CMS in Juba  One warehouse of 600 m 2 (built in 2007)  Another warehouse of 320 m 2 (built in 1963)  No regional stores (only one in Juba belonging to Central Equatoria State) Irrational use of the few storage spaces available Renting of private warehouses by the government and partners, leading to diversion of funds

9. 2. Warehousing and Storage (cont’d) Very little communication between CMS and other regional stores (if existent) No shared inventory of health commodities between ministry of health and other partners such as MSF, UNICEF, GOLBAL FUND, MALARIA, TB and HIV programmes Very poor inventory control procedures No efficient policy of disposal of unusable health commodities

10. 2. Warehousing & Storage

12. 3. Funding of Health Commodities Insufficient resource allocation for health commodities Delay in release of funds to the suppliers of health commodities Existence of parallel programmes Multiplicity of funding agents without coordination Inadequate and inconsistent nature of funding Weak government ownership and coordination Lack of accountability

13. 4. Procurement Challenges Inadequate and inconsistent government funding for procurement of health commodities Lack of trained procurement officers Lack of transparency in the procurement processes Lack of long-term procurement plans Lack of SOPs for key procurement activities Procurement decisions not based on quantification

14. 4. Procurement Challenges (cont’d) Lack of performance standards for procurement services (government or outsourced) No involvement of technical experts and relevant stakeholders in the procurement and tender boards Ineffective national policies of procurement Government policies change frequently with the change of governments or ministers Absence of National Drug Procurement Agency

15. 5. Quantification Challenges No data on morbidity and consumption of health commodities Lack of dedicated staff Weak infrastructure to support an automated or computerized quantification processes Lack of training on quantification of health commodities

16. 6. Inventory Control Procedures Challenges Lack of or no trained personnel Lack of inventory management standard operating procedures (SOPs) Poor and inefficient reporting system from and to health facilities Lack of data use culture Lack of adequate storage spaces in the CMS and in the health facilities Untimely arrival of commodities into the country and their distribution to the health facilities

17. 7.Transportation & Distribution Challenges The road transportation system in the whole country is a nightmare Many parts of the country are inaccessible by road, especially in the rainy season (June – November) The river transport is not well developed, but could provide a very important alternative method of transport Some roads are relatively passable during the dry season(December – April) other parts of the country could only be reached by air

18. 7. Transportation & Distribution Challenges (cont’d) Lack of delivery vehicles (only 2 in CMS) No vehicles with cold-chain system Insufficient capacity of transportation and distribution vendors in the private sector Poor monitoring of outsourced services, such as transportation and storage Lack of integrated distribution systems (ARVs, TB and antimalarial drugs and other parallel programmes

19. 7. Transportation & Distribution Challenges (cont’d) Ineffective flow of information from requisitioning health facilities to central medical stores No computerized data management system to coordinate all the activities involved in the distribution processes

20. 7. Transportation & Distribution Challenges (cont’d)

25. 8. Product Use Challenges Acute shortage of skilled health personnel (clinicians, nurses, pharmacists, technicians) who can use health products properly Lack of knowledge of product use Non-availability and inconsistent use of STGs in all health facilities, especially in rural areas Lack of easy access to health products due to cost, availability, distance, geography and transport Lack of reliable record-keeping and data collection Reluctance of patients to come to a health facility

26. Progress in Central Medical Stores Racking materials have been erected in two stores in Juba Air-conditioners have been installed in the 2 stores On-going training of the staff in the management of warehouse operations i.e. use of forklifts and other basic handling machines Cold room building construction completed

27. Progress in the Central Medical Stores

32. The Improvement of Central Medical Stores in the Near Future Recruitment of trainable staff in CMS Construction of regional medical stores Formation and strengthening of drug and food control authority (DFCA) of South Sudan Formation of health professionals council CMS as a semi-autonomous body (Bill in SSLA) Opening of 4 more training institutes for mid-level cadres such as nurses, pharmacy technicians, medical officers and community health educators

33. THANK YOU VERY MUCH Moses Tiel Executive Director of Central Medical Supplies moses_tiell@yahoo.com Tel No. +211-955009493