Strengthening logistic support for better service delivery of health commodities

Jan Debyser, UNICEF | 09 September 2009 | 0 comments

© UNICEF/MLIA2012-00861/Bindra

This was originally published as an internal lessons learned document by Jan Debyser, Logistics Specialist, UNICEF Ethiopia


For a Health Sector Development Plan to effectively reduce child and maternal mortality, all fundamental elements need to be in place at the sub-district level; namely, trained and supervised Health Extension Workers (HEWs), Health Posts, sensitised communities, equipment and health commodities. If one element is missing, the achievements of the Health Extension Programme (HEP) are in jeopardy.

Health Post (HP) kits are essential to the effective functioning of the HEP since they contain basic equipment and commodities, such as a delivery bed, fridge, and other items for antenatal care, Expanded Programme on Immunization (EPI), growth monitoring, infection prevention and treatment of diarrhoea and malaria. Prior to 2007, HP kit delivery was handled through the Government of Ethiopia (GoE) distribution system. Monitoring and evaluation (M&E) findings demonstrated that HP kit distribution was seriously delayed, with only 50 per cent of kits reaching their intended HPs. In agreement with the Ministry of health (MoH), UNICEF became involved in the distribution of UNICEF-procured HP kits.

Between September 2007 and March 2009, UNICEF delivered 6,070 HP kits down to district and sub-district levels benefiting over 30 million people. All associated costs were covered by programme funds. Without a solid supply chain to deliver equipment and basic supplies, HPs would not be able to function. Without extra effort from UNICEF, the capacity of HEWs to tackle child and maternal mortality would be insufficient. 

It is UNICEF’s responsibility to ensure that all essential elements are in place and that our programmes are implemented effectively in order to achieve set targets, especially to reduce child and maternal mortality.

Lesson Learned: 

Wherever UNICEF is providing substantial procurement services but Government lacks the necessary logistical capacity, UNICEF should go the extra mile to ensure that goods reach their final destination and that the end user is fully trained in the use and maintenance of the equipment. In this case, the extra cost of delivering the kit to the HP (an average of USD 128 in variable costs per kit) is minor when compared to the initial investment by the MoH (ranging from USD 2,000 to 4,000 per kit) and the effort put into procuring, shipping, clearing and storing the kits. In addition, the results are immediate and lasting. 

When assisting in equipping health facilities, UNICEF should work simultaneously to support the establishment of a robust and efficient system for the procurement and distribution of essential health commodities for the public health sector.


Between December 2006 and January 2007, UNICEF Ethiopia evaluated the distribution and use of 2,346 HP kits that had been procured and distributed to four major regions in the course of 2005. M&E findings showed that, 10 months after distribution, on average only 50 per cent of the kits had reached their intended HPs. In some cases kits had been dismantled with some parts being sent to Health Centres (HCs) and Hospitals. The most common reason mentioned for not delivering kits on time was the lack of transportation and of communication between the different levels of the health system. 

Strategy and application: 

As of September 2007, UNICEF took up the storage and distribution of HP kits and health commodities, procured by UNICEF on behalf of the MoH. UNICEF also distributed kits of consumables to replenish HPs after one year. This activity will continue until all 9,651 kits have been delivered to the HPs. In the meantime the MoH, through its Pharmaceutical Fund and Supply Agency (PFSA) is receiving an additional 7,000 HP kits, procured with World Bank Protection of Basic Services (PBS) funds. 

Together with 2,399 HC kits (1,999 PBS and 300 GAVI) plus an important order of essential health commodities, a total of 1,711 TEU (20’ containers) is expected to arrive in country during the next 6 months. UNICEF is available to provide capacity building and technical support as per the request of PFSA in the areas of planning, storage, kit- and re-packing, distribution. 

Over the past 15 months, much effort has gone into improving the quality and effectiveness of the process. Initially, the contracting of commercial transporters proved to be ineffective since quite often equipment was left at districts rather than being delivered to HPs. When kits did reach their intended users, HEWs often did not understand the content of the kits, hence equipment was not always being assembled properly or used. Since February 2008, commercial transporters only pre-positioned kits at district level, while micro-distribution to HPs was conducted by UNICEF trucks. 

UNICEF drivers were trained to explain the content of the kits and on kit assembly. To further expand distribution capacity, UNICEF engaged Population Services International (PSI) as an implementing partner as of June 2008. PSI trainers travelled with trucks and pick-ups to ensure that kits were delivered, correctly assembled and properly used. Local means of transport (mule, donkey, camel) were often used to reach the most remote HPs. 

Progress and Results: 

Since 2008, in collaboration with PSI, UNICEF delivered 4,243 HP kits to districts and sub-districts. ‘Delivery’ includes an explanation on the contents of the kit and training on the assembly of the delivery bed and other pieces of equipment. At least 92 per cent of kits have been successfully delivered. As proof of delivery, drivers and trainers brought back Global Positioning System (GPS) readings of the location of the HP and digital pictures showing the kit assembled inside the HP. Output indicators (number of HPs equipped per month and percentage of dispatched kits reaching HPs) show constant improvement. Information on outcome indicators (how well equipment is being used for its intended purpose) has not yet been collected.

Kits which could not be delivered to HPs due to inaccessibility (security concerns or rain) were left at district health offices, or at a nearby health facility. UNICEF drivers are now returning to locations accessible in the dry season to complete the job, thereby gradually increasing the delivery rate to 90-95 per cent.

Next steps: 

UNICEF will continue to provide full service delivery until all existing HPs are reached. More vehicles have been deployed to accelerate distribution, and to provide additional capacity to the GoE for the distribution of the 7,000 HP and 2,399 HC kits. As a follow-up to the initial training during the delivery of the kits, PSI trainers are now visiting HPs again together with MoH supervisors to carry out further training and supportive supervision on the use and the maintenance of the equipment.

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