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In low- and middle-income countries, weak supply chains are a major contributor to underperforming health
systems. Although great strides have been made to improve commodity availability upstream at lower prices,
issues with in-country supply chains are resulting in high stock outs and wastages at facilities. This in turn
reduces the availability of medicines at the point and time of need.

Health Emergencies like COVID-19 have emphasized the need for agile supply chains that can rapidly adapt in
capacity and coverage to respond to unexpected needs and irregular supply of health products.

Outsourcing is well established in high- and middle-income countries yet remains an emerging trend in low income countries due to numerous obstacles, including capacity issues both in the private sector and in
government.

A few countries in Sub-Saharan Africa have implemented outsourcing. Mozambique is one of the few that has
a nation-wide outsourcing of health commodity transportation, from national to provincial level and from
provincial level to all health facilities