Products to People: Episode 4 – Supply Chain Workforce Professionalization

TRANSCRIPT

Tiwonge Mkandawire: You’re listening to Products to People, an integrated public health supply chain. I’m your host, Tiwonge Mkandawire, bringing you guests from the global health sector to discuss the importance of integration for building equitable, people-centered, resilient, and sustainable public health supply chains. Now, the glue that makes sure that we get the fully integrated public health supply chains that we want are the people, the people that are working in the system, managing the system. We need to make sure that the skills that we need are available in the right places, deployed at the right level, and have the right level of competency.

So today, during this episode, we’re going to talk about professionalization; how do we go about creating a pipeline of adequately and locally trained supply chain workers? The reality is we’re going to need to do this using different ways. The one approach could be to develop a whole new supply chain workforce where we have councils and bodies registering supply chain specialists. The other approach is a hybrid model, which might be quite unique and relevant for the public health supply chain specifically. This means using the existing skills that we have in the pharmacists, pharmacy technicians, logisticians who are already working in the supply chain space and bringing them up to speed with the additional competencies, additional skills needed for new job roles. As a part of that, there needs to be a clear pathway for how to get that done, a clear pathway for coordinating the stakeholders that are going to do this work, a clear pathway for doing pre-service training as well as the final workforce support.

So I am really excited to be having this conversation today. So we have joining us Dr. Lloyd Matowe, who has been working in this space for a long time. Lloyd, welcome. Please tell us a little bit about yourself.

Dr. Lloyd Matowe: Thank you, Tiwonge. I’m delighted to be here. So, as a way of introduction, I am the executive director of the organization Pharmaceutical Systems Africa. I also serve as a director for another agency, PICMA Africa Limited. I am a pharmacist by training, and I was born and grew up in Zimbabwe. I did my first degree in pharmacy at the University of Zimbabwe in Harare. After that, my journey took me up to Scotland, where I did a Master’s in Medicine and Therapeutics, and then onward to do my PhD in Health Policy, Research, and Systems. After that, I entered into academia, where I taught in different medical schools. I then moved to the Middle East, where I founded a new school of pharmacy in Kuwait. And then, I moved on to the US, where I joined the international development world with Management Sciences for Health. Then my journey took me from the US into Geneva, where I worked for the Global Fund.

Fast forward, I came back home to Africa; I thought I had something to give to the space where I grew up and founded Pharmaceutical Systems. The mandate is to provide capacity development in supply chain and pharmaceutical management in Africa and other low-income countries. I also founded the new School of Pharmacy here in Zambia; I’m the dean and director of the school. Apart from this, I sit on a number of boards and committees, including currently chairing the People That Deliver Coalition. In brief, that’s me. Thank you.

Tiwonge Mkandawire: Thanks, Lloyd. I have to say it just goes to show that you are the right person for us to be talking to about supply chain professionalization, particularly in the public health space. When you think about the state of supply chain professionalization, where are we in the whole spectrum of professionalizing the supply chain for the public health space across Africa?

Dr. Lloyd Matowe: Thank you, Tiwonge. I would say we are 20% to 30% on the way. We still have 70% to cover in other ways. We are very far away from where we want to get to. And where we want to get to is where supply chain is recognized as a profession in its own right. So far, it’s disjointed pieces of personnel with different backgrounds that purport and call themselves supply chain professionals. Anybody who has got a role to play in the supply of medicines and commodities they do it for a couple of days or a couple of weeks, and they call themselves supply chain professionals. So in a way, I think the initiative to get this right means people have done their homework and realized that this was a gap that needed to be solved, a gap that needed to be closed. But the answer to your question is we are far off from the goal. So, in a nutshell, we still have 70% to go.

Tiwonge Mkandawire: We still have 70% to go to get to where we need to be, where we want to be. Can you paint a picture for me when you think of a fully professionalized workforce working in the public health space? What do you see?

Dr. Lloyd Matowe: I’ll use Zambia as an example. Currently, pharmacists have always seen and continue to see any function related to the distribution, dispensing, and use of medicines as their niche. This is an area which is protected for pharmacists. And when other cadres, and for example, supply chain people, train adequately on managing the supply, they come onto deter. Now, the question is, are pharmacists appropriately trained to manage the supply chain? And the answer is, in our curriculum, it’s close to zero or very little in terms of training supply chain cadres.

In my curriculum, at my university, at a university in Zambia, we have supply chain modules, and they cover three months of the fourth year of study. And then, when these students graduate, we expect them to comprehend in full how procurement of medicines is done, how the medicines are packed and depart of entry, how customs are dealt with, how are they received when they reach the central works, and how are they stored and distributed, and how do they get to the last mile? So it becomes completely new endeavor for the students that we graduate. We focus more on the science, we spend 80% of our teaching on lab science, which is needed, but ultimately we end up with supply chain cadres that have spent 20% of their five years in school doing supply chain. So this is where the challenge is, that we have people who are supply chain professionals by designation and not by training and competence.

Tiwonge Mkandawire: Your comments just now have just reminded me of a number of conversations that I’ve had with people over the years about the role of pharmacists and supply chain professionals in this space. One of the things that keeps coming up in those conversations is in most countries; the law supports the pharmacist as being the main custodian, particularly for medicines. And so the argument is usually, “Oh, no,” but legally it’s my right and responsibility as a pharmacist to be in this function, not these supply chain people. What would you say to that?

Dr. Lloyd Matowe: So that’s the challenge we get, Tiwonge. That’s where the VillageReach model for professionalization gets it right. The VillageReach model starts with engage, which is the coordination piece. It is really, really important to engage with policymakers, with opinion leaders, including pharmacists, chief pharmacists in the Ministry of Health, director of Pharmaceutical services, and make it clear that getting the supply chain right is not a threat. Professional pharmacy, not by any means, is in effect if the supply chain is performing, if the supply chain is waiting, credit is given to the policymakers, to the pharmacist in charge, to the people who are in charge of the medicines. At a policy level, we should make it clear to the policymakers that it’s good for people who need the service when VillageReach is struggling with getting the last mile right.

Coca-Cola is not struggling to get Coke to every little corner across Africa. So Coca-Cola somehow has gotten the last mile right when we are struggling to get paracetamol to the pregnant woman who is down in the village in the corner of Mozambique or across the east part of Zimbabwe, and so on. We really do need to break it down to the bare basics so that supply chain professionalization is not a threat. If we have supply chain at the core as a profession in its own right, somebody with a mandate to get paracetamol to a pregnant woman in northern Zambia, then we will get the people with the skills to get it to the person. It’s more simple than we thought, but it’s still a skill; it’s still a profession that somebody needs to see, appreciate, and then be able to implement.

Tiwonge Mkandawire: You know, Lloyd, I think you really brought up a very important point, which is getting it right means someone at the end of the supply chain either gets their medicine or they don’t. So it’s about the people at the end of the value chain. They are the ones that we are serving, and we should be doing whatever we need to to get it right.

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Tiwonge Mkandawire: So you mentioned the village reach pathway for professionalization. I know that there are also some other bodies of work that provide guidance on how countries can actually move from where we are now to this ideal state. What are some of the hurdles that you think we need to overcome to actually get that journey to work?

Dr. Lloyd Matowe: So, I will spell out two specific hurdles. Number one is attitudes and exceptions. When we talk about supply chain professionalization, a number of people in the system, they see supply chain fraternity as encroaching traditional roles of pharmacists, medical doctors, and other cadres in the system. So it is by debunking this myth that supply chain professionals are there to create a niche for a new cadre and that is really, really important. Number two is probably more important. People rarely see supply chain as a profession in its own right, in its entirety. A nurse at a hospital, a pharmacy assistant, a medical doctor, a pharmacist—everybody who carries a box of medicine and ends up giving it to a patient sees themselves as a supply chain professional.

So to try and articulate the concept of professionalizing the supply chain, it’s harder than actually implementing it. So we do need to articulate what it means to professionalize the supply chain, but that alone is not good enough. We need to go beyond articulating it and bringing out the benefits of a properly functioning supply chain—a medical doctor would never understand. When you talk of efficiency, if you don’t ultimately end up with talking about the patient and what the patient may lose and those in management positions, the ministries of health, understand the numbers. So if we are able to say, look, if we got these medicines with enough time to expiry, if we shipped it on time, if we negotiated our prices, and if we distributed it on time, we would have saved so much money because we had competent people.

Now we are talking the money, the figures. Policymakers are able to appreciate the importance of supply chain in a professionalized service. For example, we can look at the developed world or in the western countries. Supply chain is purely different to a pharmacist who is doing clinical services. So I am not saying we should follow the western model. I’m saying if, in our setting, we think and feel pharmacists or pharmacy technologies can do supply chain functions, then let them be trained appropriately in those roles, and they can become professionals in their own right in supply chain. We are saying a pharmacy degree is not supply chain. And the five-year pharmacy training at any university across Africa does not accord anybody the status of being a supply chain professional.

Tiwonge Mkandawire: I like that. The pharmacy degree, no matter how long, does not make you a supply chain professional. And I can’t agree with you more. A long time ago, I used to be a pharmacist. I call myself a recovering pharmacist because I think for a lot of us getting to that point where we not only acknowledge that yes, we have a certain very specific set of skills. However, it is not the supply chain management skill set that’s needed, or at least not all of it.

So you’ve mentioned quite a number of things about the importance of changing mindsets. Have you seen where there’s good progress where we can learn some lessons that can be applied, perhaps in other geographies when it comes to this professionalization journey?

Dr. Lloyd Matowe: VillageReach went into Malawi, and there was paucity of cadres to manage medicines. So it wasn’t just competency in Malawi; it was also quantitatively. There were now not enough human resources. So they came with the pharmacy assistant program, which I recall the curriculum well, was 40%-50% supply chain. Now, that’s a cadre that comes into the system, albeit at a different level. It’s already accepted by the policymakers. People recognize them as a card and they provide the services that’s needed. We might not call them supply chain at that point, but if the curriculum has 50% content of supply chain, then we are going in on the right track. Now, where is it that we are not getting right? Where are we missing it? We are all missing it because we think professionalizing it is divorcing ourselves from pharmacy and health.

If you go into a business school and train a cadre in the supply chain, pure supply chain, they’ll never get a position in the Ministry of Health, ever. We did that in Botswana, working with the SCMS program. We went there, and the endpoints we trained about 24 young IT graduates,  pure IT,  put them in supply chain skills, and then we then sent them to health facilities. And it’s really difficult because the nurse, the doctors, the pharmacists see them as they are out of place. We have found it difficult. All of us have been scratching our heads on how to get it right, Tiwonge, including people that deliver. That I share. We have a very, very good competence framework, but nobody has a model that can say, “Look, I credit from Nigeria to South Africa. It’s a process.”

We have a pharmaceutical technician who focuses on clinical care, so why not have one that focuses on supply chain and that can work at the central medical stores? Because right now, we are all Jack of all trades. So we get it wrong because often, we think a professional supply chain cadre is somebody that’s completely divorced from the system, but we need it embedded in the current system. There are people and cadres who are doing it. They’re just not trained. But you don’t go to the ministry and say, “Look, I want seven supply chain professionals,” or in the Ministry of Health, the minister will look at you and say, “What are you talking about?” But you say, “I want seven more pharmacists.” And then you’re speaking to someone. Eventually, you will get that all.

Tiwonge Mkandawire: Thanks so much, Lloyd. It’s so very true that the supply chain profession is a relatively new field. So I hear you going to the minister and asking for a supply chain a professional. They will look at me blankly, but if, for instance, we’re asking for maybe a couple of more pharmacists who have certain certifications, we can talk about a supply chain pharmacist. For instance, I’m talking to you from South Africa, and here they do have the different cadres you mentioned, so why not a supply chain pharmacist? This cadre of people is not divorced from the system. They have to be part of the system, which means job descriptions might need to change to not only make it clear what’s expected of this new pharmacist but also creating space for complementary roles that might be filled by data analysts or the IT professionals that you mentioned, but be suitably embedded into the supply chain. So thank you so much. Are there any additional thoughts that you had that you wanted to share with our listeners?

Dr. Lloyd Matowe: Ultimately, who is the beneficiary of professionalizing a supply chain? It is the little child who is up in Liberia with malaria and 30 kilometers from the next hospital. This is the pregnant woman who needs malaria prophylaxis and can’t go to a natal clinic, or they can go, and there’s no supply. Not because the world has run out of anti-malarial not because they’ve run out of money, but because either the supplies were not adequate, somebody didn’t do it properly, or the planning to distribute was so poor that it takes such a long time to get this life-saving medicine to that woman. Whether they are up in northern Uganda or down in Namibia, the story is the same. So it is good to get it right.

Commodities and medicines are money. If somebody throws away a coin, a penny, a dollar, they’ll spend several hours looking for that dollar, that coin. Somebody wasted seven boxes, 20 boxes of anti-malarial, which cost thousands of dollars. Nobody sees it as lost money, but it is indeed money. Somebody else is putting money into those commodities so that wherever we are in low and middle-income countries, someone’s life can be saved.

So, in summary, simply by getting it right, people can then realize that we’re doing it wrong when things go wrong. We have grown up in a system that works the way it does, and nobody realizes that it’s not working because we haven’t been exposed to the standard to do the right thing. It’s only when the right thing is taken away from you that we realize that something is amiss. So it is the right thing. Professionalize. Because another way of looking at it is getting it right. Thank you.

Tiwonge Mkandawire: Thank you so much, Dr. Lloyd Matowe. Not much else I can add to that. Getting it right means we save money on the commodities, the meds. Commodities that are needed to save lives. So getting it right ultimately means getting products to the people and giving them a chance to have a healthier life.

Dr. Lloyd Matowe, thank you so much for your time. I really, really appreciate it. And I’m looking forward to continuing in our journey together as we seek to get our supply chains professionalized. Thanks.

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