In the fight against neglected tropical diseases (NTDs), the timely delivery of medicines is as critical as the medicine itself. While global pharmaceutical manufacturers donate large quantities of NTD medicines, last-mile delivery remains a major challenge, largely due to weak and fragmented supply chain inefficiencies that often result in expired stock and missed opportunities during mass drug administration (MDA), ultimately undermining the impact of these life-saving treatments.
Preventive chemotherapy (PC) is one of the key interventions aimed at reducing the prevalence of select NTDs through mass treatment of populations at risk in endemic areas, with the goal that several rounds of treatment with antibiotics should result in their elimination. To improve the availability and use of medicines for four PC NTDs: onchocerciasis, lymphatic filariasis, schistosomiasis, and soil-transmitted helminthiases, JSI and inSupply Health are implementing the Supply Chain Technical Support Mechanism (SCTSM) project, supporting eight countries: Kenya, Uganda, Tanzania, Ethiopia, Nigeria, DRC, Mozambique, and Madagascar. By aligning with industry best practices for supply and demand management, this mechanism aims to support the NTD roadmap, address supply chain challenges, and ensure the timely availability and reduce wastage of medicines for NTD interventions.
Since its November 2023 inception, the project has adopted a collaborative approach, which began with comprehensive scoping exercises in each participating country. The scoping phase included literature reviews, key informant interviews (KIIs) with national stakeholders, and limited site visits to deepen insights into local supply chain realities. The scoping workshop brought together Ministries of Health, the World Health Organization (WHO), and implementing partners to build upon the results from literature reviews, KIIs and site visits to understand the current country contexts, assess the supply chain maturity level, and establish consensus among local stakeholders on key supply chain challenges some of which include lack of logistics management information systems for NTDs, poor supply chain management capacities at various levels, poor quality and untimely forecasts and poor coordination of NTD supply chain activities among others. These efforts culminated in co-designing contextualised solutions that led to the development and validation of a five-year implementation roadmap for each country, providing a structured pathway for transformative action.
How SCTSM is Driving Supply Chain Solutions
As part of technical assistance, the SCTSM project has supported national NTD programs in the 8 countries preparing Joint Requests for Selected Medicines (JRSMs) for 2024 and 2025. This involved guiding countries through the application process and helping them respond to donor queries. The project has also worked to improve data collection methods that inform medicine quantification, exploring innovative approaches such as consumption-based forecasting. These efforts are aimed at ensuring that requests for medicines are both timely and reflective of actual needs on the ground.
In 2024, the project developed a multi-year forecasting tool, an Excel-based tool that forecasts a country’s demand for three consecutive years. Ministries of Health staff from all eight countries were trained on its use and subsequently able to generate forecasts for the 2025 to 2027 period. These forecasts were presented at the NTD Supply Chain Forum in September 2024 and later updated and shared with pharmaceutical donors in April 2025. The tool considers various contextual factors, including disease endemicity, planned surveys, and available funding for Mass Drug Administration (MDA) campaigns.
The project has achieved important milestones, but ongoing challenges continue to affect the effectiveness of NTD interventions, most notably, expired medicines. While the key reasons for expiries outlined are poor inventory management, poor MDA planning and resource constraint, the project contributed to preventing further expiries by ensuring the timely utilisation of available short expiry medicines. In countries like Uganda, where funding constraints disrupted MDA campaigns, more than 10 million tablets of Praziquantel (PZQ) were at risk of expiry. Efforts were made to integrate the MDA into Integrated Child Health Days, and approximately nine million tablets were utilized before they could expire. Tanzania faced a similar challenge, with eight million nearing expiry in early 2025. In Kenya, timely intervention and internal resource mobilization allowed the national program to conduct an MDA and utilize the 415,650 tablets of Praziquantel before they expired in February 2025. These situations underscore the vital importance of sustained funding and timely action to ensure that donated medicines are effectively utilized.
Another major challenge has been the delay in preparing and submitting Joint Application Packages (JAPs). In all project countries, the JAP process lacks institutionalization and standardization, leading to submissions that are often late or of poor quality. This problem is compounded by limited technical capacity within national NTD programs, which hinders their ability to manage the complexities of the JAP process effectively.
Funding gaps have further strained program implementation. The sudden suspension of USAID-funded NTD projects left many countries grappling with limited resources to support critical activities such as training, supervision, and logistics for MDA campaigns. This has hampered efforts on for example the development of MDA tools, the facilitation of Community Health Workers and the redistribution of unused commodities.
Moreover, the persistence of fragmented supply chain systems has hampered efficiency. In most countries, NTD commodities are still managed through vertical systems that operate separately from the mainstream Ministry of Health supply chain infrastructure. These parallel systems result in fragmented storage sites with varied storage conditions and their distribution outside of routine delivery cycles. Even in countries making strides toward integration, aligning MDA schedules with national supply timelines remains a logistical challenge. The reliance on emergency orders to meet urgent needs continues to drive up distribution costs and strain resources.
In response to these complex challenges, the SCTSM project has implemented several strategic interventions. One of the most impactful has been the integration of NTD services with other health programs. In Uganda, for instance, deworming medicines were distributed through Integrated Child Health Days, reaching more children while reducing operational costs. Kenya has similarly adopted a harmonised approach by aligning school-based and community deworming efforts. Community Drug Distributors (CDDs) are now engaging in extended medicine distribution that spans several weeks, increasing access and minimising the risk of missed treatments.
To tackle data and logistics inefficiencies, the project has prioritised the strengthening of logistics data systems. This includes developing new data collection tools, integrating NTD commodities into electronic Logistics Management Information Systems (eLMIS), and utilising electronic Community Health Information Systems (eCHIS). In addition, dashboards have been created within the District Health Information Software (DHIS2) to support real-time tracking and accountability of medicine distribution. These measures have enhanced visibility from the last mile to the national level and contributed to improved data-driven decision-making.
The multi-year forecasting tool continues to be a cornerstone of the project’s success. By anticipating supply needs years in advance, countries are now able to streamline their JAP submissions and plan medicine shipments in alignment with MDA schedules. This proactive approach has improved coordination, ensured timely availability of medicines, and facilitated more efficient resource allocation. The forecasting tool has also proven invaluable in harmonizing epidemiological and quantification data during the JAP application process. Its widespread adoption has facilitated timely application submissions and is increasingly being used as a tool for domestic resource mobilization.
Lessons Learnt and the Road Ahead
The results of these efforts are beginning to show. While the NTD supply chain in many countries remains only partially organized, significant progress has been made toward systematizing supply chain practices. Countries are now developing and implementing standardized NTD supply chain plans with clear standard operating procedures (SOPs) for inventory management, distribution, and data reporting. Capacity-building efforts are being made to equip national and sub-national teams with the skills required to implement best practices, from the forward flow of commodities during MDAs to the reverse logistics required to manage returns and redistribution.
Several lessons have emerged over the course of the year. First, adapting program design to local contexts such as aligning drug distribution with school calendars or integrating with existing health events, has significantly increased reach and efficiency. Second, investing in robust digital tools has allowed programs to continue to monitor stock levels in real time, reducing waste and enabling faster response to emerging needs. Lastly, early and coordinated planning using NTD supply chain technical working groups (TWGs), and the use of multi-year forecasts, continues to be essential in avoiding delays and aligning partner efforts.
These lessons are now shaping the next phase of NTD supply chain strengthening. With improved tools, stronger systems, and a growing sense of government ownership, countries are being better positioned than ever to sustain progress and ensure equitable access to NTD medicines.
The SCTSM project is co-designed by WHO Geneva, ESPEN (WHO-AFRO), USAID, the Gates Foundation, and pharmaceutical partners and is funded by the Gates Foundation. It’s implemented by JSI and inSupply Health in close collaboration with Ministries of Health, the World Health Organisation (WHO), national NTD programs, and local and international implementing partners.
