Supporting the Ministry of Health in Tanzania to improve commodity availability through bottom-up quantification

Over the years, the Government of Tanzania through the Ministry of Health has been implementing strategic interventions to strengthen the health supply chain systems in the country to align with increasing demand in health services delivery. In collaboration with different supply chain stakeholders, the government conducted a strategic review of Medical Stores Department (MSD) in 2015, and later in 2017, it conducted a Holistic Supply Chain Review (HSCR) of the entire health supply chain system to identify technical and operational gaps. This informed priority areas that needed improvements.

Following the findings and recommendations of the HSCR in 2017, the Ministry of Health, in collaboration with the President’s Office – Regional Administration and Local Government (PO-RALG), Medical Stores Department (MSD), and with the support of the relevant stakeholders, instituted reforms in quantification systems for essential health commodities. These reforms included the change from the traditional top-down approach (whereby the central level conducts a national demand forecast on behalf of facilities using data generated by facilities) to the bottom-up approach, implemented in August 2019. In this approach, health facilities conduct their own demand forecasts while the central level aggregates individual facilities’ demand forecasts to get the national demand forecast, used to inform MSD supply planning.

The Bottom-Up Quantification (BUQ) approach for essential health commodities has demonstrated the potential to facilitate health facility accountability and ownership of the demand forecasts, leading to increasing interest in adopting the approach for vertical program commodities. However, due to the complexities of the quantification of vertical program commodities (as is done by Programs currently using the traditional top-down approach), the BUQ process needs further strengthening and customization to be used as a sole source of vertical program commodities demand forecasts. Currently, the BUQ approach results for vertical program commodities are used mostly for comparison and pipeline monitoring purposes only.

To this end, Results for Development through the GiveWell-funded Pneumonia Program supported the development of a transition roadmap for adopting the BUQ approach for vertical program commodities. This transition roadmap is essential considering the programmatic gains attained with vertical program commodities, complex nature of the commodities (e.g. laboratory commodities), data quality, multi-year requirement for donor funded support and the difference between fiscal years of the Government and the development partners among other factors.

This activity was conducted through a facilitated workshop in Arusha, Tanzania, in November 2022. The activity brought together technical staff from four major vertical programs including the National AIDS, STIs and Hepatitis Control Program; National TB & Leprosy Control Program; National Malaria Control Program and the Division of Reproductive, Maternal & Child Health; development partners such as USAID and the Centers for Disease Control; and technical supply chain partners such as Global Health Supply Chain – Technical Assistance. Representatives from PO-RALG and MSD were also a part of the workshop. The Pharmaceutical Services Unit team led the workshop, whose attendees included the Chief Pharmacist.

In line with Results for Development’s core principles of co-creation, the workshop facilitation team developed the agenda to include various presentations from different participants, brainstorming exercises (using sticky notes to add color and facilitate idea development), breakout sessions for specific programs to think about their processes, and facilitated synthesis sessions where the ideas could be brought together as a team to develop consensus and chart clear inputs for the roadmap being developed.

Keeping in mind the needs and complexities of different vertical programs, discussions also included the use of emerging technologies such as artificial intelligence to improve the quantification processes (with a very interesting presentation from Afya Intelligence), technological requirements for the systems that will be enhanced to align with these processes and the involved risks. Criteria for transition and transition readiness across all the different programs were essential discussion points.

The transition roadmap outlines a phased approach for the re-alignment of vertical program commodities to the BUQ approach. It considers the transition readiness of the different programs and the special needs (if any) for any single commodity or category of commodities within the programs — all to ensure uninterrupted availability at the last mile and reduced wastage at all levels of the supply chain.

Key steps outlined in the transition included:

• Conducting commodity-by-commodity analysis of key assumptions related to the quantification process for each of the programs.
• Drafting technical requirements to integrate methods and assumptions into the existing bottom-up quantification tool and updating of the tool.
• Discussions with different donors to achieve consensus on timelines and other aspects.
• Development of guidance, training and implementation.

The roadmap considers these steps in accordance with the fact that different programs have their own programmatic interventions and targets along with accountability to different development partners supporting these programs.

The transition roadmap was submitted to the Chief Pharmacist and his team in April 2024 and is in the process of resource mobilization and implementation as a continuous aspect of improving health supply chain systems in Tanzania.

The process used to develop this transition roadmap is a strong example of the approaches implemented by Results for Development in different country programs, working closely with the government and different agencies as local change agents to co-create a vision, objectives and strategies for the health sector.