A meaningful shift in relationships and a new vision for progress is driving Libya’s health information system and medical supply chain management. A pioneering project is building capacity throughout the system.
Libya was left with the legacy of a deeply under-developed health system. Extensive shortages of medicines and medical supplies, low stocks of vaccines and a lack of trusted information about the supply chain have been common place.
The population has better access to safe and essential medicines, and the health system is strengthened.
Thanks to close collaboration with national authorities and financial support from the European Union, WHO experts have been able to strongly advocate for improved supply systems and have supported people at all levels – from medicines warehouses to Ministries – to improve management practice.
We are all new to this important concept and we realise that more training is definitely needed to help improve our knowledge base, and to allow us to create a stronger network within the international Pharmacovigilance community.
Dr Hana Shtwei from the Ministry of Health stands proud as she recalls her training on how to improve the medicines supply chain management in Libya.
"I was fortunate to be among those selected for a workshop in Tunis, led by WHO experts on setting up a national Pharmacovigilance strategy. With expert input during the workshop, we were able to fine tune our ‘yellow card’ reporting scheme, to better capture relevant information on adverse drug reactions.”
Dr Shtwei works for the Pharmacovigilance Department and in just a couple of years, has seen how support from WHO and the EU-funded Strengthening Health Information System and Supply Chain Management project (2016-2018) has really made a difference to the country’s health system.
Over the last few years, there have been extensive shortages of medicines and medical supplies, low stocks of vaccines and a lack of trusted information about the health situation and the supply chain. In reality, medical supply chain management and the health information system were almost non-existent. Yet today things are really looking up.
"The workshop helped to guide us, as Libya’s national centre, on how to disseminate Pharmacovigilance within Libya. A few of us have since visited several hospitals and given basic awareness training on the concepts of Pharmacovigilance. We have also been able to fix 35 focal points in various hospitals to support the data collection process,” she says.
Such progress is no small feat in a country that has experienced great turmoil since the 2011 civil war. It was left with the legacy of a deeply under-developed health system.
In 2011 and 2012, Libya’s health authorities acknowledged that two main areas in the health system were particularly neglected: medical supply chain management and the health information system.
However, the country was still facing turbulence and conflict and it was almost impossible to tackle the problem.
It took until the latter part of 2016 before the Strengthening Health Information System and Supply Chain Management Project could get underway to start building institutional and individual capacities to reform supply chain management and integrate these reforms within the Ministry of Health.
As part of the Health System Strengthening Project, WHO has supported people at all levels – from those working daily in health care all the way up to Ministries – to improve their practice.
Advocacy and raising awareness complemented the technical work, and WHO set up meetings between key country pharmaceutical stakeholders to make progress on some instrumental issues.
A high-level consultation brought together WHO colleagues, stakeholders from pharma and nonpharma sectors, the Food and Drug Administration, and other Ministries to try to better coordinate actions across the nation.
Recommendations included ensuring better quality and availability of data, good governance, and improved coordination between stakeholders, enhancing technical capacity in critical areas and developing a comprehensive National Medicines Policy.
Since August 2017, a supply-chain working group of mid-level managers have come together once a month to discuss how to collaborate and make progress.
It’s definitely a challenge to keep things moving in Libya’s unsettled context. WHO is building institutional capacity, but still recognises the challenges that people face and continues to provides support where necessary.
The changes have been evident to all involved in the project. There has been a meaningful shift in relationships and a new and shared vision and drive for progress by country stakeholders.
There is now a Libyan Essential Medicines List to improve access to essential medicines and reduce costs, which is currently waiting for endorsement by the Ministry of Health. Libya’s National Drug.
Regulatory Agency is now strengthening its regulatory function by abiding to international standards, particularly in issuing marketing authorizations for products through the WHO SIAMED software.
The EU-funded Strengthening Health Information System and Supply Chain Management Project is pioneering in a country still facing complex challenges of lack of stability and political will, poor governance and a dearth of the instrumental components that a health system requires to function. It seems even more important therefore to continue the good work.
"We are all new to this important concept and we realise that more training is definitely needed to help improve our knowledge base, and to allow us to create a stronger network within the international Pharmacovigilance community. I know the Strengthening Health Information System and Supply Chain Management project is coming to an end soon, but we need the continued technical support that WHO offers, especially in Pharmacovigilance,” says Dr Hana Shtwei.
What does change look like on the ground?
"My name is Jumah Asad, and I work in the Shara El-Zawya Tripoli MSO warehouse. I left school at 15, and did not receive any formal training to work as a storekeeper.
I have been working in this warehouse for over ten years, and things have slowly deteriorated, particularly after the 2011 conflict.
Our senior management team informed me and other storekeepers about the WHO EU-funded Strengthening Health Information System and Supply Chain Management project which looks to assess warehouses in Libya.
The WHO team that came to assess the 15 stores in Tripoli composed of four technical areas: structural, electrical, mechanical and pharmaceutical. I did not realise that an assessment would be so in-depth and valuable.
While accompanying the team I came to appreciate how necessary it is to have an evidencebased assessment to inform potential refurbishment. I didn’t know that temperature, humidity and even sun-light can affect medicines in a bad way. Even health and safety was a new concept to me.
I don’t have basic tools to reach the ceiling to change light bulbs. I understand that it’s not possible for external organisations to refurbish the whole warehouse, but having some basic equipment available would help me perform better in my job.
I would like to see the work WHO is doing on supply chain management continued, as they only just started helping us make changes.
I did not realise that an assessment would be so in-depth and valuable.