Examining Public Sector Availability and Supply Chain Management Practices for Malaria Commodities: Findings From Northern Nigeria

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FIGURE 1
Conceptual Framework Showing Factors Influencing the Availability of Health Commodities Examined in the Study
Abbreviations: LMIS, logistics management information system; SCM, supply chain management; SOP, standard operating procedure.
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FIGURE 2
Percentage of Health Facilities Stocked Out of Malaria Rapid Diagnostic Tests, by State, Nigeria
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FIGURE 3
Percentage of Health Facilities Stocked Out of Artemisinin-Based Combination Therapies, by State, Nigeria
Abbreviations: AL1, artemether 20 mg + lumefantrine 120 mg; AL2, artemether 20 mg + lumefantrine 120 mg; AA1, artesunate 25 mg + amodiaquine 67.5 mg; AA2, artesunate 50 mg + amodiaquine 135 mg.
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FIGURE 4
Means of Resupply of Health Facilities, by State, Nigeria
Abbreviations: 3PL, third-party logistics; LGA, local government area; Nass, Nasarawa State

TABLE 2.

Organizational SCM Capacity and Workforce

	No. (%)
	Bauchi	Borno	Kebbi	Kogi	Plateau	Nasarawa	Sokoto
Health workers trained in SCM	312 (93)	164 (82)	266 (90)	158 (91)	241 (83)	221 (88)	279 (93)
SOPs available	215 (64)	166 (83)	211 (71)	114 (66)	175 (61)	164 (65)	239 (80)
Staff trained to use SOPs	292 (87)	144 (72)	275 (93)	142 (82)	236 (82)	218 (87)	274 (92)

Abbreviations: SCM, supply chain management; SOP, standard operating procedures.

TABLE 3.

LMCU Situational Assessment, by State, Nigeria

	Bauchi	Borno	Kebbi	Kogi	Plateau	Nasarawa	Sokoto
Presence of functional LMCU
State	Yes	Yes	Yes	Yes	Yes	Yes	Yes
LGA	Yes	Yes	Yes	Yes	Yes	Yes	Yes
No. LMCU staff	9	7	7	6	10	8	6
Public health commodities procurement
Through SMOH, spearheaded by budget, planning, and public procurement	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Drug revolving fund system	Yes	Yes	No	No	No	No	No
Logistics systems financing
Mostly donor support	Yes	Yes	Yes	Yes	Yes	Yes	Yes
State budget	None	None	None	None	None	None	None
Push and pull distribution model, including redistribution between health facilities	Yes	Yes	Yes	Yes	Yes	Yes	Yes
NHLMIS platform and paper reporting	Yes	Yes	Yes	Yes	Yes	Yes	Yes

Abbreviations: LGA, local government area; LMCU, logistics management coordinative unit; NHLMIS, national health logistics management information system; SMOH, State Ministry of Health.

TABLE 4.

Feedback Mechanism on the Management of Malaria Commodities and Logistics Challenges

	Bauchi	Borno	Kebbi	Kogi	Plateau	Nasarawa	Sokoto
State
Coordination/review/data validation meetings	No	No	No	Yes	Yes	No	No
IMSSVs	No	No	No	Yes	Yes	No	Yes
Phone call	No	Yes	Yes	No	No	Yes	Yes
WhatsApp platform	No	Yes	No	No	No	No	Yes
Written communication	No	No	No	No	No	No	Yes
Validated report	No	No	No	No	No	No	Yes
Stock/commodity tracker	Yes	No	No	No	No	No	No
Step down training	No	No	No	Yes	No	No	No
LGA
Coordination/review/data validation meetings	Yes	Yes	No	Yes	Yes	No	No
IMSSVs	Yes	Yes	No	Yes	No	No	No
Phone call	Yes	No	No	No	Yes	No	No
WhatsApp platform	Yes	No	No	No	Yes	No	No
Step down training	No	No	No	Yes	No	No	No
Logistics challenges
Labor disputes	No	No	No	No	Yes	Yes	No
Insecurity	No	Yes	Yes	Yes	Yes	No	Yes
Inadequate funding	Yes	No	Yes	Yes	No	No	Yes
Cultural festivals	No	No	No	Yes	No	No	No
Parallel operations	Yes	No	No	Yes	No	No	No
Territorial struggle	No	No	No	Yes	No	No	No

Abbreviations: IMSSV, integrated monitoring and supportive supervisory visits; LGA, local government area.

TABLE 5.

LMIS Reporting Frequency Across Assessed Facilities, by State, Nigeria

Abbreviation: LMIS, logistics management information system.
↵^a Health facility has never reported or the respondent was not aware of the health facility ever submitting LMIS reports.

TABLE 6.

Commodity Inventory Management by State, Nigeria

	%
	Bauchi	Borno	Kebbi	Kogi	Plateau	Nasarawa	Sokoto
Awareness of commodity ordering process and medium
Through BFSR	57	73	69	69	72	87.4	86
Other means	29	19	15	15	15	6.3	4.0
Don’t know	14	8	16	16	13	6.3	10
Emergency ordering frequency
Not placed in ≥ than 3 months	12.50	69	12	12	N/A	N/A	–
More than thrice in 3 months	–	3	–	–	N/A	N/A	–
Thrice in 3 months	–	7	–	–	N/A	N/A	–
Twice in 3 months		7	–	–	N/A	N/A	–
Once in 3 months		16	–	–	N/A	N/A	9

TABLE 7.

Percentage of Health Facilities Resupplied Through 3PL and With Stock-Out of Malaria Commodities

Abbreviations: AL1, artemether 20 mg + lumefantrine 120 mg; AL2, artemether 20 mg + lumefantrine 120 mg; AA1, artesunate 25 mg + amodiaquine 67.5 mg; AA2, artesunate 50 mg + amodiaquine 135 mg.