How WHO Africa cut down its emergency deliveries from 45 days to just 3

A little over a year ago the World Health Organization’s regional office for Africa launched its warehouse in Nairobi where it houses medical supplies to help the continent respond to health emergencies faster. Before this, WHO AFRO’s operations relied on the agency’s global warehouse in Dubai as well as a warehouse in Accra, Ghana, which the UN World Food Programme manages. It previously took WHO about 45 days to deliver medical supplies to an African country experiencing a health emergency — but now the Nairobi hub can ship supplies in only 72 hours, said Thiam Adama, head of emergency operations and logistics support for WHO in the Africa region, known as WHO AFRO, during a webinar last week. And now the agency is encouraging African countries to make greater use of the hub — with a primary selling point that it helps them to reduce wastage — both in expired medical supplies and funding that has time limits. The warehouse focuses on stockpiling and pre-positioning — which are crucial to do in advance of a crisis. When an emergency strikes, resources are stretched thin and there are a lot of competing priorities that can lead to supply chain disruptions. “Healthcare supply chain is very complex, and trying to manage it during a crisis just makes the complexity even more compounded,” said Dr. Lyndah Makayoto, team leader for health emergencies at WHO Rwanda. A ‘pull’ approach In the wake of the supply chain disruptions that occurred during the COVID-19 pandemic, WHO is working to rewrite its global supply chain strategy — and the launch of the Nairobi warehouse, where products are brought closer to countries in need, is a crucial element of this new approach. “Pre-positioning is actually a revolution,” Adama said. The warehouse currently houses 3.4 million of 317 distinct types of items valued at $9.8 million. And over the past year of operations, the Nairobi warehouse and warehouse in Ghana have sent out 204 shipments to 44 African countries valued at $13 million, said Fatima Isa Tafida, regional supply chain lead for emergencies at WHO’s African office. Tafida recently gave Devex a tour of the Nairobi warehouse. WHO plans to launch another warehouse in Dakar in December — and will shift their supplies from the Ghana warehouse to this warehouse. Operation support and logistics amounts to over 70% of all emergency health response operations, she said. “No matter how gifted a doctor is, without the right tools, they cannot do their work,” Tafida said. But WHO AFRO won’t just send supplies to countries without a request. They use a “pull” model — where countries forecast and quantify their own needs in an emergency, or ahead of an emergency, and put in a request to WHO. A country’s ministry of health requests supplies to its WHO country office, which then makes the request to the Nairobi hub. Tafida said this is a change for a continent that has historically often had supplies dumped on it that it doesn’t need. These requests involve a bit of pre-positioning of supplies depending on a country’s risk profile. For example, in Kenya, WHO has pre-positioned supplies in anticipation of the health impacts of the heavy rains expected with El Niño. “If you wait for the event, you missed the event. Pre-positioning is all about planning based on trend analysis and risk profiling,” Tafida said. Maureen Kamene Kimenye, acting director of public health and sanitation in Kenya’s Ministry of Health in the State Department of Public Health and Professional Standards, said the country is “learning from WHO on how to prepare in advance.” “We do not have any stocks as a country for emergency stockpile — and we have realized that we are rarely ready whenever an emergency comes to handle any outbreaks,” she said. She said that one of the key areas is diagnostics. “In our last cholera outbreak, we’re only able to confirm 5% of the cases, because of our lab capacity, lack of reagents — meaning we’re not ready,” Kimenye said. It also involves requests that are in response to unexpected health emergencies. WHO has offered countries the use of its own forecasting and quantification experts to develop a stockpiling plan. Part of the preparation also includes streamlining in-country customs procedures to ensure expedited clearance of supplies during an emergency. “You do not wait until you need to bring in morphine to start telling your regulatory bodies: ‘I'm bringing in morphine’ — which is a narcotic in any country,” Tafida said. When WHO packs together a shipment from its Nairobi warehouse, it must also wait for a country to allow the shipment in. More than 20 countries have a ‘green light’ procedure meaning they must wait for regulatory body approval before the shipment can enter the country, Tafida said. ‘UN Amazon’ The Nairobi warehouse has a rolling stock. A country can give WHO a chunk of money to buy supplies, but those supplies won’t just sit on a shelf waiting for that country to experience a health emergency. In the meantime, the warehouse will send out supplies to other countries that need them, and then restock those supplies. Whenever a country that has given the funds needs those supplies, WHO will then send them as part of an emergency response. This allows countries to spend funding within the required time frames, which may be before they experience a health emergency, Adama said. Alex Yao Sokemawu Freeman, health logistics officer at WHO AFRO, added that some procurement processes also will not allow approval for the procurement of medical supplies when funds are about to expire. It also helps countries that don’t have the capacity to store and maintain supplies, or just want to save on the holding costs of a warehouse. “Let us do it for you: We’ll buy the supplies and we guarantee you nonexpiry,” Adama said. Tafida said that with this setup, countries don’t have to worry about the end of the financial year or biennium. “Your money is with us — and we give you the equivalent … in stocks when you need them,” Tafida said. Because of this, the Nairobi hub must be cognisant of the items with short shelves — and calculate how many of these items to keep on its shelves. “Supply chain is all about data management,” Tafida said. The hub also allows for an opportunity to take advantage of economies of scale — vendors are more responsive to large orders than smaller orders from an individual country, Tafida said. “We are there for you like U.N. Amazon,” she said, adding that countries must come to them when they’ve secured funding. “You don’t go to Amazon when you are broke. You go when you’ve been paid your salary.”