Today is clinic day at Bechem Hospital in the Ahafo Region, for persons with HIV. Pharmacist Philip Opoku usually enjoys making sure his clients get their antiretroviral medications, especially since many travel long distances. But today he was almost out of medications and worried about telling his clients. How would he explain that the pharmacy’s medications would not be enough for their regular three-month supply?
He had to reduce their supply to one month and explain the shortage. This disappointed many, especially those who traveled far, as they would need to return in a month, increasing their costs and burdens. Some clients, worried, asked if the free HIV treatment might stop altogether.
In Ghana, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports the government to control the HIV epidemic. USAID focuses on service delivery in three regions: Western, Western North, and Ahafo. PEPFAR supports these regions with the procurement and distribution of antiretrovirals and laboratory commodities, as well as strengthening the HIV commodity supply chain. Despite monthly reports, stock visibility issues lead to frequent shortages, affecting patients like those at Bechem Hospital.
Investigations showed a one-month delay in monthly reports, due to the manual process of collecting and reconciling data at the end of each month. This delay made it hard to make timely supply chain decisions, leading to medication shortages and affecting the care health workers like Philip could provide. Some managers also struggled with inventory management, ordering too much or too little, causing shortages or excess stock. The lack of real-time stock visibility and gaps in human resources affected the availability of HIV medications.
Pharmacist Philip dispensing antiretroviral medicines
To address this, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project hired officers to help the PEPFAR-supported regions. They collected weekly reports on stock levels of key HIV items like first-line medications and rapid test kits, prevented stockouts by redistributing supplies through coordination with facilities, advised on the right quantities to order from the Regional Medical Stores (RMS), helped with item codes and reminded facilities to check expiry dates. This support was crucial for Philip in maintaining stock levels and reducing his anxiety about medication shortages.
The project also analyzes monthly logistics reports, regional warehouse stock reports, and HIV supportive supervision data, integrating weekly stock reports for near real-time visibility. For Philip and his colleagues, this was a game-changer, allowing them to anticipate shortages and adjust before they became critical issues for their patients. With better inventory management, he could ensure his patients consistently received the medications they needed.
These interventions have resulted in remarkable progress in the availability of the most used antiretrovirals. From June 2020 to June 2021, the availability of Tenofovir, Lamivudine, and Dolutegravir (the most used adult ARV) increased from 84 percent to 100 percent and has remained high, between 98 percent and 100 percent, ever since. In addition, the availability of tracer pediatric ARVs – nevirapine suspension and zidovudine syrup increased from 18 percent and 56 percent in June 2021 to 86 percent and 81 percent in December 2023 respectively. This advancement has brought Philip and his clients a greater sense of security and trust in the healthcare system.
"Now, with near real-time data, we can anticipate shortages and adjust our supplies before it becomes a crisis," says pharmacist Philip with a smile. "Our patients no longer have to worry about missing their medications."
