As countries around the world grapple with infectious disease outbreaks, one USAID project in Kenya has adopted a new framework to ensure the health commodity supply chain for responding to public health emergencies is strong and sustainable when needed most.

Following the outbreak of Ebola in West Africa in 2014, the World Health Organization (WHO) classified Kenya as a “high-risk” country for the spread of the deadly virus. Being a major transport hub, with many flights to and from West Africa and major cities around the world, makes Kenya especially vulnerable. In recent years, the country has also experienced isolated outbreaks of uncommon but highly infectious diseases such as anthrax, Rift Valley fever, and cholera. These infectious diseases not only affect the health and well-being of populations and wildlife but also put a strain on the entire health system and, subsequently, the country’s economy. The responses to these outbreaks were uncoordinated and costly because there were no protocols in place to guide them. For example, after the Ebola outbreak in West Africa, Kenya quickly purchased protective equipment and medical supplies. Some of these have since expired while sitting in a warehouse, and others cannot be accounted for because there was no stockpiling policy in place.

Kenya’s Response

To reduce the risk of, manage, and mitigate the effects of such emergencies, the Kenyan government created various disaster management units to effectively manage and respond to such occurrences. In addition, policies aligned to global disaster risk management (DRM) guidelines to plan for effective response and build resilience for the health sector, such as the National Disaster Response Plan (2014) and the Kenya Health Sector DRM Capacity Assessment Report (2013), have also been developed, and implementation is ongoing. Kenya also developed its own National Action Plan for Health Security that defines the strategies for response to infectious disease emergencies.

But there were still gaps in the country’s ability to respond during emergencies and disasters that impact the health sector. A 2017 WHO assessment of Kenya’s capacity to prevent, detect, and rapidly respond to public health threats revealed that on the core capacity of the deployment of medical countermeasures, which are government-regulated products (biologics, drugs, devices) that may be used in the event of a potential public health emergency, Kenya scored one — the lowest score out of five.

In 2018, the USAID Afya Ugavi Activity, in partnership with USAID’s Global Health Security team, assisted Kenya to adapt Cameroon’s Emergency Supply Chain (ESC) framework using a “One Health” approach. An ESC is a system established in preparedness for managing all the commodities necessary to respond to an outbreak, ensuring they get to the site of the emergency efficiently. The One Health approach that was used emphasizes multi-sectoral prediction, detection, and response to infectious diseases with a zoonotic origin. The Kenya ESC framework is a response to these gaps and is intended to guide the design and establishment of a system that has a unified approach to building capabilities among key governmental and nongovernmental stakeholders in supply chain preparedness for increased efficiencies during response. Though it focuses on emergencies caused by infectious human and animal diseases, the ESC framework can complement response to all hazards that impact public health, including those caused by violence, civil unrest, and other human-created emergencies.

Three Components of the ESC Framework

(USAID | Global Health Supply Chain/Chemonics/McKinsey, 2018)

The purpose of the ESC framework is to outline the guiding principles and key structural elements needed to increase capacity for sending and receiving medical countermeasures. Emergencies present unique challenges to routine health supply chains due to several factors, such as demand — which is unpredictable during an emergency — and consistently timely delivery of commodities, which is required if lives are to be saved. Additionally, emergencies put a strain on existing logistics systems. For example, if vaccines are “borrowed” from the National Vaccines and Immunization Program, routine vaccination could be compromised. Also, the cost of emergency response is usually higher because teams will ignore procurement best practices to speed up the purchase process. Finally, delays in payments may cause the suppliers to inflate prices.

The ESC framework being used in Kenya — and previously developed for Cameroon — is divided into three critical components:

1. People and Processes. This component focuses on governance issues and sets up the organizational structures that will facilitate coordination of the many actors during emergency response. In the case of Kenya, this involved the creation of the ESC core team, which was comprised of representatives from several different ministries in the government of Kenya, with advisory support from USAID and its implementing partners, such as Chemonics. The core team is responsible for mapping out key players (state and non-state actors), identifying critical infectious disease hazards for the country, and prioritizing responses based on the likelihood to occur and severity of the hazards identified. The team created an estimated budget for procurement and maintenance and identified partners and the resources they have to offer. Data visibility for planning procurement, prepositioning, and maintaining commodities in a viable state was also addressed.

2. Commodity Planning. Based on the hazards that were selected, the core team then identified, quantified, and costed which commodities would be required to adequately respond to these health hazards. The relevant suppliers were identified and their capacity to respond was also assessed. Negotiation checklists to inform drawing up of contractual agreements with suppliers are included in the ESC framework’s toolkit.

3. Logistics and Transport. Simultaneously with commodity planning, the team did a similar exercise for logistics and transport. Warehouses, storage facilities, and transport routes and providers were mapped out and their capacities determined. Waste disposal during outbreak of disease is a great concern and several options to address this were also part of the decision-making process.

A Promising Future

Based on the results of simulation exercises conducted with the new ESC framework and tools, Kenya’s revised score on the core capacity of deployment of medical countermeasures is expected to progressively improve from one (no capacity) to three (developed capacity). Implementation of the ESC framework will address the unique supply chain challenges posed by emergencies while the focused investments will pay off in increased cost-effectiveness and improved speed of response during disasters, saving lives. Research has shown that money invested in advance of emergencies reduces the amount of response funds by half and allows for a quick response to control, contain, and, hopefully, stop the disease before it spreads.