Costs of multiplicity in public health supply chains in Burundi

Abstract

As the public health system in Burundi transitions from a mode of emergency humanitarian response to a sustainable operation, there is a significant opportunity to reduce costs by eliminating the duplication of functions served by multiple parties. Numerous multi-lateral agencies and NGOs play a significant role in the public health supply chain. Additionally, Burundi has several vertical programs focused on specific communicable diseases such as HIV/AIDS, malaria and tuberculosis, which have parallel distribution systems. This thesis assesses the costs of multiplicity in the public health supply chain in Burundi, focusing on identifying the factors contributing to multiplicity and evaluating their cost impacts. We specifically analyze the transportation and inventory costs under four different distribution scenarios in the context of a proposed health sector structural reform while using the current system as a baseline. The analysis also discusses several other relevant factors that affect the costs of multiplicity. The research suggests that the Ministry of Health in Burundi can reduce costs, and improve availability of drugs by shifting from a pickup mode to a delivery mode of distribution, sharing assets between the central procurement agency and vertical programs, and improving the cash flow in the system.