Lessons from the Global Fund-Supported Procurement and Supply Chain Investments in Zimbabwe: a mixed methods study

Abstract Introduction Access to essential medicines, vaccines and other health technologies are strategic pillars of any health system. To this end, the Global Fund partnered with the Zimbabwean government to provide end-to-end support to strengthen the procurement and supply chain within the health system. This was accomplished through a series of strategic interventions that included infrastructure and fleet improvement, training of personnel, modern equipment acquisition and warehouse optimisation. Methods The impact assessment employed a convergent mixed methods design, that combines quantitative and qualitative research methods. The quantitative part entailed the analysis of program data covering the period 2018 – 2021. The qualitative part comprised key informant interviews using a structured questionnaire. Informants included stakeholders that were privy to the Global Fund-supported initiatives in Zimbabwe. The data collected through the interviews were transcribed in full and subjected to thematic content analysis. Results Over 90% of public health facilities were covered by the procurement and distribution system. Timeliness of order fulfilment (within 90 days) at the facility level improved from an average of 42% to over 90% within the 4-year implementation period. Stockout rates for HIV drugs and test kits declined by 14% and 49% respectively. Population coverage for HIV treatment for both adults and children remained consistently high despite the increasing prevalence of people living with HIV. The value of expired commodities was reduced by 93% over the 4-year period. Further, there was consensus that support from Global Fund was instrumental in improving the country's procurement and supply chain capacity. Key areas identified include improved infrastructure and equipment, data and information systems, health workforce and financing. The majority of the participants also cited the Global Fund-supported warehouse optimization as critical to improving inventory management practices. Discussion Government and the health donor community, need to collaborate through joint planning and implementation in order to strengthen health systems. Organizational autonomy and sharing of best practices in management while strengthening accountability systems are fundamentally important in the efforts to build institutional capacity.