Logistics and Waste Management
The Supply Chain Management System (SCMS) partnered with the US President’s Emergency Plan for AIDS Relief (PEPFAR)/Swaziland program to provide technical and financial support to the Government of the Kingdom of Swaziland’s (GKOS) Ministry of Health (MOH) in order to assist Swaziland in providing male circumcision for HIV prevention at a national level.
Over the course of the MC program, SCMS supported the MOH-led program in supplies and commodities procurement, warehousing, distribution, site logistics and waste management services. Each area is detailed below. The resources available in this e-Toolkit were developed for Swaziland in collaboration with the MOH, PEPFAR and implementing partners.
During 2011, SCMS quantified, procured, stored and distributed MC-related commodities, including HIV rapid test kits, MC kits, opportunistic infection (OI) drugs, medical equipment, general equipment, hospital furniture, laboratory commodities and consumables to a total of 27 ASI sites, as required by the program and as identified on the approved commodity list. Various laboratory supplies, consumables and equipment were procured and sourced using international and local markets. All drugs were procured internationally through US Federal Drug Administration (FDA)-vetted suppliers.
SCMS provided warehousing, picking and packing services to the ASI program through a subcontract with a local provider in Swaziland.
Delivery/Movement of Commodities
In collaboration with the partners and clinic sites, SCMS established a simple logistics system that permits inventory control at sites, including the re-ordering and resupply of inventory based upon programmatic performance and needs. Throughout the course of the program, there were a series of campaigns and regional waves (see communications resources) that have required the opening and closing of sites. SCMS delivered commodities and equipment to new sites and warehoused the unused commodities and equipment in between sites closing and opening.
Several organizations were responsible for the site logistics. Working with the Site Operations Coordinator, SCMS and the Uniformed Services Defense Forces (USDF) organized site assessments, preparation and set up. SCMS, through a subcontract with a local handyman, provided electrical and water hook-ups for health centers, primarily for the pre-fabricated units. Soka Uncobe, through SCMS, supported electricity and water at privately-owned health facilities. SCMS has also ensured the uninterrupted supply of MC activities through provisions of water tanks, water supply, generators and diesel supply at MC sites.
Health Care Waste Management (HCWM)
Working with the Ministry of Health, SCMS was responsible for the design and implementation of safe and secure collection, temporary storage, transport and final disposal of infectious waste generated by the ASI Program. The implementation plan used the six major regional hospitals as waste disposal sites. Healthcare waste (HCW) generated from non-hospital sites (18 MC sites permanent and mobile) was secured and transported through a privately managed HCW company to the six regional treatment centers: Mbabane Gov’t Hospital, RFM Hospital, Mankayane Hospital, Good Shepherd Hospital, Pigg's Peak Hospital, and Hlatikulu Hospital. Waste is secured and transported by two, third-party local subcontractors, who were specifically trained and authorized by the Swaziland Environmental Authority, in conjunction with SCMS. Stainless steel surgical instruments were disinfected, scrubbed and stored temporarily at each MC site. The local contractor collected these non-infectious instruments and offered them to a local scrap metal dealer for melting and recycling at no cost to the dealer.
To ensure that the HCW is properly disposed of, SCMS improved the HCW management and disposal facilities at Mbabane Government Hospital, Manzini-RFM, Mankayane, Good Shepherd and Hlatikulu hospitals. SCMS replaced incinerators at Mbabane Government Hospital, Manzini-RFM, Mankayane, Good Shepherd, and repaired the incinerators at Pigg’s Peaks and Hlathikulu Hospitals. SCMS also improved the temporary HCW storage and final disposal areas at these facilities.
In addition to SCMS playing an integral role in establishing and strengthening the HCWM component of the ASI program at the national level, the MOH was supported through the establishment of an integrated health care waste management strategy. A conference was held during the end of September 2011 which included over 50 participants across 30 government and nongovernment agencies. This included: regional and private hospitals; private companies; Swaziland’s National AIDS Program (SNAP); Hospice Home-Based Care; Swaziland Environmental Authority (SEA); the MOH and the city councils of Matsapha, Manzini and Mbabane. The objective of this two-day conference was to assist the Government of the Kingdom of Swaziland in developing an Integrated Healthcare Waste Management Plan to optimize the use of the donor and government resources in improving the overall health care system. The integration and direction of the government and donor-scarce resources are intended to minimize duplication of efforts and maximize the effect in improving the government programs.