Transforming Cold Chain Distribution in Developing Countries

Published by Leo Almonte on

delivery of vaccines to far flung areas

Poor Countries = Weak Pharma Cold Chain

Effective storage, transport, and distribution of vaccines and health products depend on a well-functioning pharma cold chain.   Public health logistics are critical in disease prevention and medical programs all over the world. This is why transforming the Cold Chain distribution in developing countries is essential.

Unfortunately, the pharma cold chain in developing countries suffers from various deficiencies due to government neglect, weak regulations, insufficient funding, lack of equipment and incompetent human resources. The geographical locations of countries without roads and reliable transport also contribute to weak cold chains.

Consequently, mediocre medical logistics affect the implementation of health programs, particularly in distributing vaccines and other life-saving medicines.

A well-functioning health logistic system includes refrigerated transport vehicles, storage with thermal controls, and compliant systems managed by certified administrators. It ensures the constant availability of medical products and their timely distribution.

Cutting-edge pharma cold chain requires constant data monitoring and real-time transfer of information. Operators have to be trained and certified to expertly operate the supply management of medical drugs. State of the art logistics translates to added capital expenses and maintenance costs. Expectedly, poor and developing countries lack systems to store and transport medicines and vaccines efficiently.  Their governments are shorthanded and they prioritize basic necessities. Cold medical logistics falls on the bottom list of priorities and jeopardizes effective medical products management. Low-income countries prioritize investment in food, shelter, and utilities rather than improve their healthcare logistics.

Conceptual framework of the interaction between supply chain and different elements of the health system (Prashant Yadav)

Using the matrix above as the basis for developing countries’ assessment regarding their pharma cold chain systems, we can ask questions to draw out the root causes of challenges.

Assessment Questionnaire
Health System Governance: What are the laws, policies and guidelines of developing countries related to medical drug distribution?
Health Care Workforce: Are the workforce sufficiently trained and given continuous learning to stay current with industry innovations?
Health Financing: Is the budget sufficient to build and maintain a well-functioning pharma cold chain?
Health Information System: What is the efficiency level of data monitoring and transfer? Is the supply chain equipped with the appropriate technological system?
Health Product Supply Chain: Are the current storage and transport logistics sufficient to prevent wastage and to assure timely delivery?
Coverage: What is the reach of supply logistics? What percentage of the country population can it cover?

Ironically, the support that developing countries receive from international health organizations and institutions causes problems. The mediocre medical logistics, clogged with multiple hitches, hampers the influx of vaccines and life-saving drugs.

Since developing countries have limited means to store vaccines,  the result is wastage. Medicines require specific temperatures to preserve their composition, while the slightest change in temperature can quickly corrupt the vaccines. 

Vaccines for malaria, flu, tuberculosis, and other diseases get stuck in the cold chain due to bottlenecks and system breakdowns. Delays and uncontrolled system put countless lives in danger simply because vaccines are not safely stored and delivered. The lack of effective pharmaceutical logistics has become a significant issue among health advocates and medical supply chain managers.

The flow of Cold Pharma Supply Chain

According to a study done by Yadav and Smith in 2012, the drug distribution system in low-and middle-income countries has the same necessary steps as for high-income countries, but with more intermediaries between the manufacturer and patient. As indicated by the chart below, there are several small chains involving small companies at every step, instead of having a single distribution chain that reaches the entire country.

Comparative structure of health product supply chain for private and public sectors  (Prashant Yadav)

Pharma Market Structure:  

A Contrast Between Developed and Developing Countries

By noting contrasts between the pharma markets of developed and developing countries, we can pinpoint weaknesses in the latter’s supply chain

Differences in Overall Structure of the Pharmaceutical Market in Developed and Developing Countries. Source, Yadav and Smith, 2012.

The regulatory structure is one of the starkest contrasts between developed and developing countries. It affects the efficiency of the operations, quality of delivery and coverage of the pharma cold chain. Without strong laws, regulations and policy, private and public sectors operate on a fragmented structure—entities involved in the supply chain may work differently, without standards.

Payment or reimbursement methods are a critical outside factor that influence the cold chain.  Financially capable consumers can buy medical drugs, through out of pocket payments or through medical insurance, which may help unclog the supply chain.   

The sooner pharmaceuticals reach consumers, the better it is for the supply chain, since it allows manufacturers to replenish old stocks on a timely basis. Manufacturers invest more capital, technology, and human resources in countries where there is a high volume of consumers with buying capacity.

Problems and Challenges in Public / Private Sector of Medicine Supply Chains

Several factors contribute to the underperformance of medical supply chains in developing countries. The confluence of these circumstances creates complex problems that are not easy to solve. Solving the problem may require a significant overhaul from top to bottom, starting from government regulations down to the distribution level.

Appropriation of  Shared Accountability

The multi-tiered supply chain in developing countries causes problems in accountability. A blame game among departments, agencies, and entities involved in the supply chain tend to transpire due to an overlap of roles. When there are breakdowns in procurement, forecasting or requisition, each of the intermediary elements readily ascribes the fault to other stakeholders. 

Unstable Financing

Disbursement of government funds affects the procurement cycle and distribution. Storage and transport of pharmaceuticals become less predictable due to a lack of funds, making them more difficult to manage.

Complex Decision Making

Since developing countries lack centralized control and follow a multi-tiered structure in the downline, decision making is slow and complicated. Discrepancies and differences of approaches delay the processes and put the integrity of the vaccines at risk. Medical drugs may be either stored longer inside defective cooling systems, or lose their potency when kept beyond the recommended shelf life.

Lack of Logistic Planning and Data

Feedback and data are essential in creating effective long-term planning. Governments in the developing world, however, fail in gathering data from key agencies in different tiers.  Personnel overlook mistakes and oversight errors when the cold chain doesn’t have advanced monitoring systems. Plans don’t work when managers base them on inaccurate and obsolete data.

Lack of competent cold chain personnel

In most cases, there is a mismatch between skills and system design. Human-error in operating cold chain systems are bound to happen because of incompetence and lack of personnel training. 

Proposed Solutions and Agenda

Solutions to improvement for the pharma cold chain must come both from the government and private sectors. To hurdle the industry’s challenges, the best practices in public management and corporate leadership must fuse with appropriate funding and system improvement financing.

Reduction of Tiers in the System

Reducing the number of tiers in a system simplifies the storage, transport and distribution of pharmaceuticals. It can accelerate the process, decrease wastage and improve accountability. People in critical positions have fewer excuses due to more transparent workflows.

Quicken the Replenishment of Supplies

Reducing suppliers’ lead time and increasing the frequency of replenishment is a critical improvement in the supply chain. It assures the continuous flow of medical products from manufacturers to end-users.

 Better Communication and Information Flow

The cold chain pharma has significant variable data that stakeholders in the different tiers need to know in real-time. Managers from top to bottom make decisions based on data related to stocks, inventory, consumption, shipment status, wastage and onsite issues, among many others. 

Improving communication, data transfer and information flow results in better decision making among cold chain managers and administrators.

Standardization of  Performance Indicators

Poor standardization of systems, processes and management deliverables happen due to lack of transparency and best practices. Discrepancies and confusion occur when players in each tier perform their duties based on unstable standards. There should be a centralized and accepted standard at each step of the entire cold chain system.

The hiring of Top Talents and Training

Offering attractive incentives and pay can attract top talents to the cold chain industry. Hiring highly-trained leaders who are experts in the field will result in efficient implementation of strategies and better operations management.

Conclusion

Developing countries need and deserve better healthcare systems. Their accessibility to medicines, vaccines and medical drugs is paramount to preserving their population. They need a responsive medical storage, transport, and distribution systems to achieve their public health targets.

So much is at stake in the pharma cold chain that both governments and the public sectors must act to solve the problems and prevalent issues.


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