Following the Ebola epidemics in Liberia and Sierra Leone, the capacity of their national healthcare supply chain agencies was devastated. Project Last Mile was invited by USAID and the ministries of health in both countries to provide technical assistance and capacity-building support for last mile delivery of lifesaving medicines and commodities.

In Liberia, the Project Last Mile team works directly with the Central Medical Stores (CMS) to redesign the supply chain and in Sierra Leone, we work with the National Medical Supplies Agency under the Directorate of Drug and Medical Supplies.

Our work in Sierra Leone and Liberia has involved a redesign of the last mile supply chain to optimize distribution. To do this, we’ve focused on demand planning, evidence-based forecasting, accurate data collection, dedicated delivery teams on fixed routes, and systematic ordering processes. Project Last Mile is supporting the Liberia CMS with technical advice for creating an effective and efficient distribution system by redesigning the supply chain using last mile delivery strategies from The Coca-Cola Company.

The Project Last Mile team and its partners successfully completed a pilot in Margibi County in Liberia. There are two main hospitals, 10 health centers and 39 clinics, making a total of 51 facilities served by the CMS. Twenty-seven of these facilities are public, and the rest are private.

In Sierra Leone, Project Last Mile launched the redesigned supply chain model for 23 health facilities in Makeni Town.

Through the pilots, a product list of over 350 commodities was compiled to understand which should be stocked at each facility. Routes to participating facilities were designed to improve efficiency and accountable delivery of commodities.

A PreSell model used by The Coca-Cola Company was chosen as the best option for assessing stock levels and demand at health facilities and creating a process for reordering stock so that medicine delivery can be optimally planned and executed. In this model:

1. A service technician first visits the health facilities following a pre-planned route.
2. The technician visits three to five health facilities a day. All health facilities in the county/district are visited on a four-week cycle.
3. The technician coaches the health facility staff to complete logistic management information system routines and prepare an order based on stock levels. Technicians spend an average of one hour at each facility.
4. The service technician returns to the depot, where the data is submitted, an order placed and a waybill is raised and approved.
5. On the following working day, the order is picked and packed and distributed to the health facilities (in Liberia) or delivered the next week (in Sierra Leone).

This project has achieved:

Data Visibility – Clear information about stock levels allows the right amount of stock to be made available to avoid stock shortages or medicine expiring.

Accurate Forecasting and Demand Planning – correct quantities of stock are ordered to avoid shortages; increase availability of medicines as needed by patients; and guide accurate stock volume orders on a national level.

Improved Expectations and Coordination – Because the service visits and deliveries are done on a fixed routine, health facilities know when they will happen and can be prepared to receive the technicians and stock.

In Liberia, the availability of essential medicines stocked at each health facility improved by over 43%, and in Sierra Leone, shortages of essential medicines reduced from 93% to 74% (a 20% improvement).