Abstract
Background: The Government of Cameroon and its partners have made major investments in the last decade in prevention, treatment, and care of HIV-infected patients. However, unmet need for antiretroviral therapy (ART) among HIV-positive pregnant women remains high at 66%. Critical to satisfying this need is ensuring adequate availability of prevention of mother-to-child transmission (PMTCT) commodities for rollout of new Option B+ guidelines. The Cameroon supply system consists of a cost recovery system for essential medicines and other health commodities and a free-of-charge system for priority commodities including those for PMTCT and ART. This study examines options for improving the supply and availability of these commodities. Method: Supply chain (SC) operational data was collected in July 2014 from central (CENAME) and 4 regional warehouses (CAPRs); 10 district stores; and 30 service delivery points (SDPs), including ART and PMTCT sites. The study also included seven central private-sector logistics firms. In addition, SC cost data was obtained from CENAME and CAPRs financial statements audited in 2013. Data collected served for analysis of three options to improve effectiveness of delivering PMTCT commodities, based on the four variables detailed in Figure 2.4.1. Results: Asset utilization within the cost recovery system ranged between 73% and 89% while inventory turnover was at 1.5. Therefore, a reliable supply of medicines to SDPs is ensured. However, for PMTCT and ART commodities, distribution to the SDPs was unreliable (in 2013, 40% of prescriptions remained unfilled). Meanwhile, results of the options analysis indicated that the model of CAPRs delivering PMTCT commodities to SDPs was the most desirable. Although the distance traveled was higher, the need for network storage space was minimal. Moreover, its total cost and human resource requirements were more favorable. Conclusion: As a result of disseminating the findings, the Ministry of Health adopted Option 2. PMTCT free-of-charge commodities are also amenable to being managed within the existing effective cost recovery system.
Highlights
HIV, malaria, and unintended fertility constitute barriers to the achievement of Millennium Development Goals 4, 5, and 6 in Cameroon.[1][2] The national health sector strategy 2011–2015 describes control targets for these diseases, for example, elimination of mother-to-child transmission of HIV by 2015
The national strategy to scale up prevention of mother-to-child transmission (PMTCT) Option B+ includes plan to move from 22 pilot sites in two out of ten regions to 3000 sites nationwide.[3][4]
The standard practice for supply of PMTCT commodities is through requisitions, but owing to stock shortages, resupply is by allocation based on quantities of commodities that have been collected from CAPRs
Summary
HIV, malaria, and unintended fertility constitute barriers to the achievement of Millennium Development Goals 4, 5, and 6 in Cameroon.[1][2] The national health sector strategy 2011–2015 describes control targets for these diseases, for example, elimination of mother-to-child transmission of HIV by 2015. As a consequence of shortage of ARVs during the last couple of years, the NACC has rationed PMTCT and ART commodities to SDPs based solely on quantities that could be procured with insufficient funding This push model currently used for PMTCT and ART commodity supply includes transportation by CENAME to CAPRs and collection of commodities from CAPRs by either district health service staff for PMTCT or ART dispensing site staff for ART commodities. The standard practice for supply of PMTCT commodities is through requisitions, but owing to stock shortages, resupply is by allocation based on quantities of commodities that have been collected from CAPRs. Logistics capacity is generally lacking at the district health service level. In some of the districts, staff members use their personal vehicles to transport PMTCT and ART commodities between CAPRs and treatment sites
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