Posted by Duncan Maru
Here’s the challenge. In order to have continuous services running in a highly isolated and rural area, we need to develop a reliable and affordable means of transporting supplies across an over two-day journey across the country along challenging roads that additionally suffer from frequent bandhs (political strikes). This system therefore needs to be capable of accurately predicting our usage, preferably in three-to-six month intervals, to bring sufficient supplies for clinical use. To cut down on transit costs (as high as $800 per truckload), we need to minimize the number of trips without ordering medicines destined to expire. We also need to have some forecasting foresight, given that for processing and transit at least three weeks must be allocated to ensure the timely arrival essential supplies.
The wonderful thing about Nepal (and most so-called developing countries) is that if you look hard enough you will find that other people more experienced than you have already created the solutions locally. For example, our software solution did not come from USAID’s supply chain management strategy (which by the way is impressive) but rather from a local Nepali organization, Sustainable Solutions. Originally started by a Missionary pharmacist who wanted to improve the efficiency of his procurement organization, Sustainable Solutions has developed into a small but important player in providing supply chain management software. We found them first at the telemedicine conference and then through our pharmaceutical supplier (they used their software). The software, called mSupply, is completely free in a fully functional version to small single users like ourselves. They make money off of the bigger users (great business model of universal access plus economic sustainability).
After searching around some for the optimal suppliers, we decided upon the Medical Supplies Management Trust, a pharmaceutical house which supplies most of the mission hospitals in KTM. They are reliable and are honest about their costs. For surgical and laboratory supplies, we went with Bikash Surgical Concern, which has an excellent reputation for speed and integrity.
With some amount of forecasting from the available epidemiological data and a whole lot of common sense, we arrived at our initial order. We will use mSupply to monitor usage. It is quite likely that for the beginning we will have to make at least a few orders monthly. Over time, we hope to become better at forecasting usage and can decrease the extra transit costs.
