Unreliable transport for pharmaceutical supplies is a major problem in many health care programs. Good transport practice demands reliability, efficiency, safety, accountability, timeliness, affordability, and sustainability. Transport is difficult to plan and manage well. Politicians and senior program managers generally assign greater priority to other, more visible, aspects of health care delivery. However, policy makers and administrators need to appreciate that effective and responsive health service depends on always having medicines available when and where they are needed, which requires the secure and proper transport of pharmaceuticals and medical supplies. If the pharmaceutical sector has to compete with other services for planned and emergency logistics, the consequences may be critical to public health.
Transport is provided for pharmaceuticals and related supplies either by the subject facility, by the supplier, or by an outsourced transport service. The type, volume, frequency, and duration of transport services required are determined by the nature of the health service. For practical purposes, main stores or central medical stores require major transport when moving pharmaceuticals from port to warehouse. If the store has branches in different parts of the country, it will need to transport the supplies to the branches. Facility-level transport requires a sophisticated transport network, involving in-house vehicles, rental services, or supplier delivery.
When planning transport system improvements, managers must -
- Thoroughly review and understand the existing transport system
- Select suitable vehicles
- Ensure adherence to standard operating procedures
- Ensure that vehicles are used for their intended purpose
- Maintain vehicles properly
- Replace vehicles before they wear out or become too expensive to operate
- Provide funds for vehicle maintenance and replacement
- Consider the formation of a vehicle pool system
- Consider alternatives, such as third-party and private-sector contracts
Major determinants of the transport system, which require special attention, are the vehicles and their operation and management. The costs of purchasing, running, and maintaining vehicles are high. If funding is inadequate, transport services will not be sustainable.
Transport services require effective management, which is particularly difficult to achieve in countries where transport is challenging and the pool of qualified managers is relatively small. When a shortage of transport exists, health service vehicles are frequently misused for the personal benefit of health service staff. Strong management is necessary to eliminate abuses and to ensure that vehicles are used appropriately. Although cost is a limiting factor, the logistics needs of the pharmaceutical sector can be adequately met if vehicle costs are shared with other services.
In many countries, the burden of managing transport and transport maintenance services can be reduced by contracting out these services to private or parastatal companies that specialize in such operations and are able to provide competitive rates. Before taking such action, the private or parastatal sector must be assessed based on its capacity and past performance, and existing operating costs must be accurately assessed so that a realistic cost comparison can be made. Transport contractors should then be carefully selected and monitored, and contract terms should be clearly drawn up and enforced. These measures also make monitoring transport costs easier.
Contracting out transport services will be inevitable where air transport, and to a large extent, sea or river distribution is involved. However, in many developing countries with scarce transport resources, efficient private-sector transportation companies are still evolving and may not be sufficiently competitive or efficient. In such situations, regional and interregional cooperation and collaboration among various government agencies, nongovernmental organizations (NGOs), donors, and the private sector can help maximize available transport resources.
Effective quality assurance procedures are needed to ensure that pharmaceuticals are correctly handled before, during, and after transit, to avoid damage.