2012年-世界发展银行全球_Kenya_Medical_Supplies_Authority___A_Case_Study_of_the_Ongoing_Transition_from_an_Ungainly_Bureaucracy_to_a_Competitive_and_Customer-Focused_Medical_Logistics_Organization_20页_881kb

Summary of Kenya Medical Supplies Authority (KEMSA) Transformation

Core Content

The Kenya Medical Supplies Authority (KEMSA) is a state-owned health logistics service provider with the mandate to procure, warehouse, and distribute medical commodities to public health facilities and other public sector entities. This case study explores KEMSA's transformation from a bureaucratic state-run agency to a competitive, customer-focused medical logistics authority, highlighting key success factors, challenges, and recommendations for future sustainability and performance.

Main Objectives of the Study

• To understand and document key success factors in KEMSA's transformation
• To assess KEMSA's preparedness for the new devolved structure
• To develop recommendations for enhancing customer service in the new competitive market
• To develop recommendations for achieving sustainability and higher performance while maintaining equity in health commodity distribution

Methodology

• Review of existing literature and technical reports
• Interviews with KEMSA management
• Verification of data on key indicators and visits to KEMSA warehouses
• Study of literature on other public sector logistics organizations

Background on KEMSA

KEMSA was established in 2000 as a state corporation to replace the Medical Supplies Coordinating Unit. In 2013, it transitioned from a Public Agency to a Public Authority under the Kenya Medical Supplies Authority Act, which granted it greater autonomy and flexibility in operations and staffing. This transition was pivotal in enabling KEMSA to adapt to the new devolved health system in Kenya.

Pre-2008 Struggles

Before 2008, KEMSA was viewed as a bureaucratic and inefficient agency. Key challenges included:

• Weak legal framework and political interference
• Erratic funding and budget disbursement
• Fragmented supply system (referred to as "spaghetti of flows")
• Poor visibility of stock levels at both the central warehouse and health facilities
• Lack of ICT infrastructure and capacity

These issues were compounded by a lack of strong leadership and governance, leading to a "low performance trap." Reforms during 2003-2008 were superficial and failed to generate sustained confidence in KEMSA.

Transformation from 2008 to Present

The transformation of KEMSA began in 2008 and continued through 2014, driven by:

• Leadership and Talent Recruitment: KEMSA began recruiting leaders with commercial and logistics expertise, moving away from civil servants and career bureaucrats.
• Legal Framework: The 2013 Act provided greater autonomy, reclassifying KEMSA and allowing for a higher salary scale.
• Governance Structure: A new Board of Directors was established with diverse members and clear roles and responsibilities.
• Transparency in Procurement: KEMSA improved transparency by posting procurement contracts online, increasing public confidence.
• Change Coalition: Leadership and vision were key in building internal and external support for transformation, especially with the external stimulus of devolution.
• Quality Assurance: KEMSA developed a robust QA system, including ISO 9001 certification, collaboration with the Pharmacy and Poisons Board, and in-house quality control.
• Adequate Staffing: Staffing was restructured, with 40 out of 90 employees retained at the start of the reform and expanded to 330 by 2014. Training and integrity testing were introduced.
• Procurement Department: A well-staffed and efficient procurement department was established with 23 full-time staff. Open tenders and international competitive bidding were the main procurement methods, with 95% of value sourced through these methods.
• Pull Distribution System: KEMSA transitioned from a push to a pull model, where orders are placed by health facilities. This model was later extended to all health facilities, including rural ones, with the help of an ERP system and LMIS.
• Outsourced Transport: KEMSA outsourced transport to private companies, enforcing SLAs and using PODs to ensure timely delivery and payments.
• Customer Orientation: KEMSA shifted its focus from the Ministry of Health to health facilities, creating a customer service department and a Supplementary Services Division to better serve diverse customers.

Key Lessons Learned

• Reforms that only address surface issues are ineffective.
• Political support is crucial for integrated transformation.
• Strong governance at the top is essential for successful reform.
• Transformation should start with:
  • Creating appropriate organizational structure
  • Attracting the right talent for leadership
  • Developing a performance management plan
  • Streamlining operational processes
  • Leveraging ICT
  • Focusing on areas of comparative advantage and outsourcing other functions
• Procurement and distribution must be integrated for a seamless supply system.
• KEMSA must invest in facility-level stock requisitioning and quantification to avoid stockouts, which can damage its reputation.

New Operating Model Post-Devolution

With the devolution of health financing to the counties, KEMSA now operates under a new model where:

• Who pays? Counties pay for commodities and associated fees, while program drugs (e.g., HIV/AIDS, Malaria, TB, RH) are still financed separately.
• Who procures? KEMSA continues to procure from manufacturers and suppliers, except for select program drugs.
• Choice of agency: Counties may choose to purchase from KEMSA, other suppliers, or through an MOU.
• Which products? Includes those procured by the Ministry of Health, KEMSA, and counties.
• Who places orders? Counties now place orders on behalf of all health facilities within their jurisdiction.
• Payment terms: Counties pay upfront or receive up to 30 days credit.
• Delivery frequency: Quarterly in most cases, with monthly deliveries to hospitals.
• Transport: Private transporters are used, with some flexibility for counties to receive supplies at a single location.

Recommendations

1. Objective Communications: KEMSA should communicate factual performance data to all stakeholders to dispel negative perceptions and build trust.
2. Third Party Measurement of KPIs: Use third-party measurement to validate KEMSA's performance and enhance accountability.
3. Maintain Ubiquity and Uniformity of Service: Ensure that all health facilities, including rural ones, receive consistent and reliable service, even if they are less profitable.
4. Continued Investment in ICT: Maintain and expand ICT infrastructure to support real-time data collection and management.
5. Strengthen Governance and Leadership: Continue to build a strong, transparent governance structure and attract top-tier leadership.
6. Sustainable Operations: Focus on balancing sustainability and cost-efficiency while fulfilling its universal service mandate.

Conclusion

KEMSA's transformation represents a significant shift in its operational model, driven by devolution, strong leadership, and external support. The new model emphasizes transparency, customer orientation, and efficiency. While challenges remain, KEMSA is now better positioned to meet the demands of a competitive and decentralized health sector, with lessons applicable to other countries undergoing similar reforms.