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Feb 16, 2023   |   Blog Post

Making Space: Solving Supply Chain Challenges in Liberia

Youjay Clinton (right) checks storeroom stock levels at a storeroom in Grand Bassa County, Liberia. Photo credit: Benjamin Killen

By Lusubiro Mwamsamali and Benjamin Killen

The Grand Bassa county health team manages medical drugs and supplies through the county supply chain unit, headed by the county pharmacist. Youjay Clinton is the pharmacist assigned in Grand Bassa to head and manage the medical supply chain unit. Prior to Clinton’s transition to the role of county pharmacist, he had worked at the Grand Bassa Liberia Government hospital in the position of hospital pharmacist for six years. When Youjay Clinton first took his position in 2020, the storage space for health products was small and disorganized. This meant keeping track of available essential medicines was a challenge – hindering his ability to get quality products to people.

When Clinton was asked what challenge he would want to address to improve the drugs and medical supplies system in Grand Bassa county, his answer was certain. “Storage is one of the key components of the supply chain,” he said. “If you have a better storeroom, you can better arrange your products by expiration date, first to expire/first out. With small storage space, you are more likely to mix up [products] during inventory, which makes a pharmacist’s job very difficult.”

Grand Bassa County is among the most populated counties in Liberia. Subdivided into eight health districts, it is served by 34 health facilities. Since 2019, VillageReach has been working with the Liberian Ministry of Health and Last Mile Health to integrate community health workers (known as community health assistants, or CHAs, in Liberia) to the country’s public health supply chain. However, integrating CHAs into the public health supply chain requires strengthening key areas of the supply chain – including proper storage management of health products. An adequate drug storage facility is also critical to ensuring a one-supply chain unit where both community and health facilities products are managed.  This helps promote transparency and shared accountability of product management.

Taking a closer look

In 2019, the government asked VillageReach and Last Mile Health to assist with county-level supply chain assessments. This presented the perfect opportunity for us to learn about immediate supply chain challenges and develop specific interventions to address them. To identify these immediate challenges, Last Mile Health and VillageReach jointly conducted the county supply chain capacity assessment in 2019 and shared findings with Youjay Clinton, his team, and the county health team. Notably, adequate storage facilities to promote proper management of supplies were a cross cutting gap revealed by the assessment.

And unsurprisingly to Clinton, the assessment findings outlined many of the challenges he faced in his day-to-day work. With such a small space for storage, he had to sort through deliveries outside where products could be damaged by rain or bad weather. Additionally, securing products outside was difficult putting them at higher risk of theft or misplacement.

“As a county pharmacist, I supervise the entire supply chain of the county in terms of receiving [products] from the central medicine stores, and then making sure that [they] are timely delivered to [each] health facility,” Clinton said. “I also monitor the quality of products to ensure that they meet the standard for end users.”

This is a responsibility Clinton takes seriously: it is up to him and his colleagues to make sure health facilities and CHAs in Grand Bassa have the products they need to provide quality health care. Something that is challenging with the space to properly manage and receive health products.

Turning problems into solutions

A storeroom in Grand Bassa County, where Youjay Clinton works. Photo credit: Benjamin Killen

Using the assessment findings, VillageReach and Last Mile Health worked with the government to provide on-job coaching and mentorship to county, health facility and CHAs on good storage practices in three counties, including Grand Bassa, while simultaneously advocating for renovations to improve storage facilities. Clinton said the mentorship helped him a lot. And when advocacy efforts for a new storage space paid off, with Last Mile Health securing funding to renovate Grand Bassa county’s medical storage rooms (including new shelves, air conditioners for cold storage of medicines, and upgraded electricity and security), Clinton was armed with both knowledge and improved working conditions

“Now we have nine rooms for storage of [products],” Clinton said. “We have a bigger space that allows us to effectively manage [products]…. and it helps us to not mix up our [products] during inventory.”

Clinton said before the mentorship and a new storage facility, it would sometimes take two weeks after receiving health products to repack them for health facilities and CHAs. Now products can be stored at the county depot within 72 hours, and last mile distribution is completed in less than 10 days – with the new storage facility and more space and better organization, goods reception and put away are completed in less than 72 hours while last mile distribution to health facilities is completed in less than 10 days – this means people are getting access to the quality health products they need more quickly.

Scaling Impact

With the initial success of storage room improvements in three Liberian counties, VillageReach is extending this work to two new counties as part of a new project. A long-term goal is to scale our supply chain strengthening work to all counties in Liberia, not just at the county level but all the way down to the health facility and individual CHA.

Clinton agrees more work needs to be done.

“While it is true, we are satisfied that the county depot is much improved, we also think that the supply chain does not end at the county depot,” Clinton said. “It goes beyond the county depot to the health facility – to the last mile.”

As VillageReach continues to achieve our mission to transform health care delivery to reach everyone, we hope to help a lot more people like Clinton along the way.

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