Lessons learned from redesigning public health medicines supply chain model in Uttar

Vasanthakumar Namasivayam^1*Manuj Purwar^2,3Sushant Jain²Shivalingappa Halli²Jagdeesh Kumar⁴Vikas Gothalwal²Marissa Becker²James Blanchard²Ties Boerma²Ravi Prakash²

• ¹Government of India, Union Territory of Ladakh, Leh, India
• ²University of Manitoba, Winnipeg, Manitoba, Canada
• ³India Health Action Trust, Lucknow, India
• ⁴Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India

Uttar Pradesh (UP), the most populous state of India, with 238 million people, has 30,000+ public health facilities. Ensuring continuous availability of essential medicines in all these facilities is a significant challenge. An audit conducted in 2017 indicated large gaps in essential medicines availability in public health facilities. This manuscript describes the lessons from Tamil Nadu’s Medical Supplies Corporation (TNMSC) adapted to inform Uttar Pradesh’s Medical Supplies Corporation’s (UPMSC) model and processes redesign. We identified seven essential pillars for a successful public health supply chain system through desk review and learnings from TNMSC. This included stable list of essential medicines, warehouses, centralized procurement, passbook system, quality control, centralized payment, and digital e-tracking enabling real-time inventory and procurement decisions. The system design established clear responsibility matrix. UPMSC is responsible for availability of all essential medicines in the district warehouses at all times. The facility in-charge is responsible for the required drugs at the facility. The facilities are notionally allotted budget and have complete freedom to pickup medicines needed from the warehouse within the budget available. Under these seven essential pillars, some key processes were undertaken to improve vendor participation, reduce vendor dependency, synchronize tender for all essential drugs and roster for facilities to pick up drugs from warehouse. These efforts lead to improvement in the availability of essential medicines from ~40% to ~100% and average availability of 275 medicines out of 287 per warehouse. The supply orders increased from $58M to $112M and facilities consumption value from $38M to $90M by April 2024. The challenges of last-mile delivery and prompt payment to vendors remain. The paper underscores the importance of system design in public health supply chain and will be useful for other Indian states, Low and Low Middle Income Countries (LMICs) with similar context.