Transforming Supply Logistics for Health Commodity Security in Africa

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FIGURE 1
Transactions of Health Commodities Between Short-Line Subnational Private Wholesalers Operating Within Regions of a Given Low- and Middle-Income Country in Africa^a
Source: Author; Yadav et al.,⁵ Palafox et al.,²⁶ Rosen et al.,²⁷ McCabe et al.²⁷
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FIGURE 2
Transformation of the Multiplicity of Short-Line Subnational Private Wholesalers to Form Multiple Competing Full-Line National Logistics Units in a Low- and Middle-Income Country in Africa

TABLE.

Configuration of Multitiered Public-Sector Health Supply Logistics Systems in Selected African Countries^a,b

Design	Country	Central Medical Stores	Regional Medical Stores	District Medical Stores
3-tier	Benin^c	1	8	80
	Burkina Faso	1	7	63
	Democratic Republic of the Congo	2	15	228
	Guinea	1	8	38
	Madagascar	1	22	114
	Mali	1	5	49
	Mozambique^d	2	11	148
	Niger	1	8	72
	Nigeria^e	7	36	774
	Senegal	1	11	63
2-tier	Burundi	1	17	–
	Cameroon	1	10	–
	Chad	1	22	–
	Ghana	1	5	–
	Tanzania	1	8	–
	Republic of the Congo	1	–	41
	Rwanda	1	–	30
	Uganda	1	–	112
	Zambia	1	–	72
1-tier	Kenya	1	–	–
1-tier	Morocco^f	1	–	–

a Data from: Yadav, et al.,⁵ Prosser et al.,⁶ Prosser et al.,⁷ Sarley et al.,⁸ Wright et al.,⁹ Yadav,¹⁰ El Mokrini et al.,¹¹ Gavi, the Vaccine Alliance.¹²
b For each country, the number of central medical stores (CMSs), regional medical stores (RMSs), and district medical stores (DMSs) does not include health facilities as a tier or secondary (product-specific) warehouses set up for vertical health programs. The current situation in the countries listed may be different and sometimes, conflicting evidence is reported in the literature.
c In Benin, the number of RMSs refers to 7 department stores and 1 “regional” store; the number of DMSs refers to subdistrict (commune) stores.
d The description of the situation in Mozambique by Wright et al.⁹ differs from Prosser et al.,⁷ who report 1 national warehouse, 9 provincial medical stores, and 128 district stores.
e The CMS tier in Nigeria has 1 national store in Abuja and 6 zonal stores, 1 in each of its 6 geopolitical zones.
f From El Mokrini et al.,¹¹ it is unclear whether Morocco has 1 CMS plus 3 secondary warehouses or 2 CMSs plus 2 secondary warehouses.