Shoeshoe Mokotla, Lefa Maseba, Palesa Pitso, and Tumelo Mothebe pose for a picture. (Photo Credit: Litsoanelo Lesenya for Open Development)
Source: Epic Project
Kate Steger, Communications Specialist, Open Development, Palesa Pitso, Senior HRH Technical Advisor, Open Development, Annick Ranirisoa, Health Policy Advisor, Open Development
In 2019, supply chain activities such as logistics, warehousing, and procurement were all managed within the Pharmacy Directorate and Laboratory Services of Lesotho’s Ministry of Health (MOH). But the system was fragmented as different departments were responsible for their own supply chain functionalities through embedded staff from the Pharmacy Directorate. At this time, Shoeshoe Mokotla, Health Systems Strengthening Specialist, started managing the Lesotho health portfolio at the United States Agency for International Development (USAID).
Mokotla noticed that as a result of this fragmented system, commodities were stored haphazardly, delivered in different ways, and inventoried separately. This led to stock-outs, insecure commodities, and wastage, while the delivery of drugs from warehouses to points of use, especially in hard-to-reach areas, was riddled with obstacles, making it difficult for patients to have access to the medicines they needed. Mokotla was eager to support the MOH’s efforts to institutionalize supply chain management as a standalone department answerable to the Principal Secretary. “We wanted a unified, coordinated approach to our supply chain system,” says Mokotla.
While the MOH had established the Supply Chain Coordinating Unit to manage health commodities using embedded staff members as well as some staff from the districts, the setup was temporary as the structure and positions were not created through the Ministry of Public Service and many crucial supply chain positions were still funded from different departments or from donor funding streams. Long-term changes to government financing of the health care workforce, including sustainable salaries for supply chain management and staff, were needed to fully stabilize the system and achieve the Ministry’s vision of a standalone department.
Collaborative efforts toward this vision, supported by the USAID- and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project and the Procurement and Supply Management Project (GHSC-PSM), are finally bearing fruit. In 2020, the department was formally established through the Ministry of Public Service. Now, in 2024, the MOH is ready to hire five new permanent, publicly financed senior managers to run Lesotho’s restructured supply chain system and the new department. These positions are the first of many needed to fully staff a sustainable, unified, government-funded supply chain system for the country. The road to this milestone achievement took determination, hard work, and years of strategic planning.
Years of Effort
Lefa Mabesa remembers the arduous process well. Mabesa is a Health System Strengthening Advisor working on GHSC-PSM, implemented in Lesotho by Chemonics International as part of USAID’s Global Health Supply Chain Program. He began working with the Lesotho MOH to restructure their supply chain in 2016. Acting on recommendations from the Global Fund to centralize Lesotho’s supply chain management, the directors of various departments holding supply chain functions seconded pharmacy staff to work with Mabesa. Together, one of their tasks was to map out a long-term staffing structure for the proposed supply chain system including governance policies, professional competencies, reporting lines, and job descriptions for every supply chain position needed at the national, district, and facility levels.
Along the way, they encountered a difficult challenge: many stakeholders, who were handling programs’ health commodities—including some pharmacists and laboratory technicians—were conflating their roles with those of supply chain logisticians. “This was one of the most difficult transitions we faced,“ says Mabesa, “because they wanted to claim that supply chain [staff were] going to take their jobs.” Tumelo Mothebe agrees.
Mothebe, now Interim Director of the Supply Chain Management Department, worked closely with Mabesa during the restructuring process to build a clear understanding of the two distinct roles. “Pharmacists focus on the clinical part, on the pharmaceutics and things like that, but when you come to supply chain, we only focus on commodities and their movements,” explains Mothebe. Mabesa adds that health professionals need to understand that pharmaceutical stock is an asset governed by financial principles. “Stock is money,” he says, “supply chain is a business.”
Mothebe and Mabesa had help generating consensus on these two distinct functionalities and advocating within the halls of government for the overhaul of the supply chain management system. Within these halls sits Palesa Pitso, Senior Human Resources for Health (HRH) Advisor, hired by Open Development as part of the USAID EpiC project. She is in the Human Resources (HR) Department at the MOH where she has worked tirelessly to advocate for the health workforce needed to implement the new system. “The country’s battling an issue of inadequate staffing,” Pitso says. In the past, donors have supported staff in health facilities, especially in supply chain roles. Two years ago, in response to PEPFAR’s strategic focus on long-term sustainability, the MOH decided to take on some of this staffing. For Pitso and her colleagues in HR, this involved engaging two completely different ministries within the government: Ministry of Public Service and Ministry of Finance.
In Lesotho, the MOH must gain approval from the Ministry of Public Service before creating new government positions. Once Public Service approves the positions, the Ministry of Finance must guarantee that funds will be allocated to cover the cost. “We had to attend lots of meetings,” Pitso remembers, “to explain why these supply chain positions needed to be created.” Grace Mapaballo Mohololi recently transitioned to Ministry of Health Director of HR from the Ministry of Public Service. While she was there, she worked with Pitso and other MOH staff to help justify the staffing needed to create this department. “You have to understand why they want those people,” she says, “and how that will help them achieve the bigger mandate of the Ministry.” She adds that “understanding the functions of the department, the supply of medicines, commodities, and all that; it’s important to the end users. At the end of the day, [the patient] needs these services.”
Mothebe and Mabesa agree that this work holds important benefits for both staff and patients. Remembering his early career as a hospital pharmacist, Mothebe describes stepping out of the pharmacy storeroom, noting the time, and seeing a long line of patients needing clinical attention. “You need someone who is specifically dealing with logistics,” he says, so that pharmacists can address patient needs. Mabesa adds that, under the new system, “patients will be given different options in terms of where they can purchase medicines. No more going to the dispensary and queuing there for the whole day, waiting.”
At the Ministry and district management levels, staffing a standalone department also improves job satisfaction. Borrowing staff from the Pharmacy Department to build the Supply Chain Management Department has created headaches and logjams across both departments. Workloads have been heavy, and Mohololi says it is critical for each department to have its own established positions. “Officers who are in the Pharmacy Department can remain in the Pharmacy Department, and those in Supply Chain can be in Supply Chain, so that everyone can undertake their duties as required,” she says. This policy will prevent anger and competition, ensure staff are trained appropriately for the posts they hold, and will be followed for employees hired for the five new supply chain management positions.
Collaboration and Commitment
What did it take to get to this point? Mothebe says, “All the stakeholders were [of] one mind and understanding and wished to make sure that this became a reality.” Mohololi gives credit to “determination and constant follow-up on your responsibilities; that’s all.” Collaboration and resolve led to this achievement notes Mokotla, who adds “the commitment of the government and willingness to change is the one enabling factor in this whole thing.”
Securing government funding to fully staff the entire supply chain system will be a gradual process requiring continued effort over the coming years, but the commitment of the Government of Lesotho to a long-term sustainability plan is the change that Mokotla most appreciates. Other cadres within the Ministry will also need to go through this process and other countries are facing similar transitions. “What I can say to other countries,” Mabesa says, “is that the collaborative way of working is the only way that they can succeed.” In the end, the restructured supply chain has a potential double benefit: increase the efficiency and motivation of the health workforce, and increase access and decrease wait times for patients.