Navigating Pharmaceutical Supply Chains: Insights and Guidance from Dr. Grace Waiharo

1. Briefly introduce yourself (The person and your academic qualifications so far)

My name is Dr. Grace Waiharo. I am a pharmacist by training and have also studied leadership and management. With over 25 years of experience across different sectors in the pharmaceutical industry, I am currently focusing on the pharmaceutical supply chain.

2. Where are you currently working, and what does your job entail?

I currently work for Chemonics International, an American-based organisation headquartered in Washington, DC, that serves as a United States Agency for International Development (USAID) contractor for supply chain services across various health areas. These include HIV, malaria, maternal and child health, family health and global health security. As the Senior Supply Chain Advisor, my role involves ensuring that programs supported by the American government in Kenya, such as National Aids and STIs Control Program (NASCOP), the malaria program, and the Department of Family Health, receive health products and technologies procured with USAID funding promptly. To achieve this, I oversee supply planning, procurement, clearance, delivery, and inventory management of products, ensuring all relevant tax waivers are obtained on time.

3. What propelled you to transition from the conventional clinical (hospital) setting to the corporate non-pensionable world?

Other than during my internship and a brief locum stint in a hospital, my professional career has primarily been in the retail and wholesale/distribution sectors. In 2005, I left my role as a company pharmacist for a renowned distributor and joined Catholic Relief Services to support the establishment of ART (Antiretroviral Therapy) clinics in faith-based hospitals, funded by the American government’s President’s Emergency Plan for AIDS Relief (PEPFAR). This initiative specifically targets faith-based institutions with dedicated funding.

In this role, I was responsible for setting up pharmacies in the ART clinics, providing training on ART commodities, and disseminating technical information, such as the modes of action of various antiretrovirals (ARVs). I also trained staff on dispensing ARVs, which initially came as single molecules that had to be combined at the dispensing point, managing opportunistic infections, and monitoring treatment failures, among other responsibilities.

I began as the in-charge of Kenya, but in 2006, my responsibilities expanded to the region, covering Kenya, Uganda, Tanzania, Rwanda, Zambia, and Nigeria. In 2009, USAID awarded a five-year contract to a consortium led by Chemonics International. One of the partner organisations hired me to oversee forecasting and quantification and to serve as the Head of Operations, a role I held until the project ended in 2015. 

Following the project’s conclusion, I continued as Head of Operations for the organisation, streamlining supply chain activities for commercial operations based on the experience gained from the project. I remained in this position until March 2021, when I began working directly for Chemonics International. Working in both the private sector and the NGO world has been pensionable, and my organisation contributes 10% of my gross salary to the pension scheme.

4. As a seasoned pharmacist with vast experience in supply chain management of health commodities, what challenges have you faced in your line of work and how did you overcome them?

Like in many other fields, COVID-19 caused significant disruptions in the supply chain, affecting the availability of raw materials and causing delays due to interruptions in container availability and movement restrictions. Projects that relied heavily on technical assistance from experts also suffered due to limited travel. Consequently, local capacity had to be mobilised to handle activities beyond their usual mandates.

I trained local staff to effectively manage the necessary activities to ensure an uninterrupted supply of critical health products and technologies. This often required shifting stock from one area to another and reducing established buffer levels. Although things are slowly returning to normal, the pandemic has highlighted the importance of building local capacity. The idea of Africa being able to produce commodities to support its population is a very positive development that should be encouraged.

5. The COVID-19 pandemic disrupted global supply chains which led to diminished supplies of life-saving commodities due to the imposition of strict measures by some countries (restriction of exporting essential health commodities such as ventilators and some medicines); what lessons did you pick during the pandemic and how can supply chain pharmacists be better prepared for future pandemics and crises?

Lesson 1: Capitalising on Local Human Skills and Capabilities

Africa has significant capacity in terms of human skills and capabilities, which we should capitalise on. During the COVID-19 period, international experts were unable to travel to the continent, yet critical health services, including HIV and malaria treatment, continued unabated. It was the Africans, particularly Kenyans, who made this possible.

Lesson 2: Leveraging Technology to Enhance Business Operations

We can leverage technology to streamline business operations. Platforms like Zoom, Microsoft Teams, Webex, and Google Meet enabled the world to continue functioning with minimal physical travel. Our children attended online classes, which seemed like a pipe dream before COVID-19. By applying the lessons learned during this period, we can elevate the pharmaceutical supply chain to the next level.

Lesson 3: Building Self-Sufficiency in Manufacturing

In times of crisis, it is often “each man for themselves and God for us all.” This was evident during the allocation of COVID-19 vaccines when Africa received almost nothing. This experience underscores the importance of striving to make Africa a manufacturing continent that is less dependent on imports from overseas.

6. Based on your experience, what are the benefits of having a pharmacist in the supply chain management team? What unique skill set does a pharmacist bring to the team that is unmatched by the other healthcare cadres? 

I manage the pharmaceutical supply chain, which involves handling health products and technologies. Whenever medicines need to be managed, pharmacists must be involved, as they are the experts in pharmaceuticals. My responsibilities include overseeing cold chain management, which encompasses sub-zero, 2-8 ⁰C, and ambient temperature requirements.

Additionally, there are other critical technical aspects of pharmaceuticals, such as storage, pharmacovigilance, and post-market surveillance, all of which depend on the specialised knowledge of pharmacists. Ensuring product quality from end to end is not possible without the involvement of pharmacists.

7. I am certain that the terms ‘third-party logistics’ and ‘change management’ ring a bell in your mind; kindly elaborate on your role in these areas.

As a supply chain manager, I utilize third-party logistics agents to provide services including container stuffing, shipping, customs clearance at the port of entry (whether by sea or air), ground transport to the warehouse, and subsequent warehousing and inventory management.

Traditionally, the role of a pharmacist is perceived to be limited to retail/community pharmacy, hospitals, and industry, with some venturing into academia. However, the scope of a pharmacist’s role is much broader, encompassing the entire lifecycle of medicines from research and development to obsolescence. The breakthrough for pharmacists in the supply chain came with PEPFAR funding, which provided substantial donor money to buy ARVs and offer capacity-building (training) primarily to pharmacists. This was based on the realisation that while pharmacists possess technical knowledge about medicines, the combination of this knowledge with supply chain management skills is crucial to ensuring an uninterrupted supply of quality medicines to the last mile.

This shift required significant change management skills, involving discussions in various forums and the willingness to venture into unconventional pharmacy areas. Pharmacists needed to become comfortable and competent in these new roles. Changing the mindset about pharmaceutical supply chain management is still a work in progress. Many still mistakenly view it as merely moving boxes, a task they consider suited for the unskilled. However, effective pharmaceutical supply chain management requires specialised knowledge and skills to ensure the proper handling, storage, and distribution of medicines, ultimately ensuring product quality and patient safety.

8. Could you elaborate on the significance of teamwork and the Harambee spirit among professionals in your field, given the observed interconnected nature of the goods supply chain, which resembles more of a web than a linear chain?

There are numerous players involved in the supply chain, each with specific trade contract responsibilities and liabilities outlined in International Commerce (INCO) terms. These terms comprehensively define the chain of custody, clearly assigning responsibility for the consignment throughout its journey.

9. What is the most fulfilling and satisfying aspect of your career?

The most fulfilling and satisfying aspect of my career is knowing that the work I do ensures that over 1.3 million Kenyans who rely on ARVs never miss their daily dose and do not have to worry about interruptions in their treatment. I have complete control over the process and can guarantee uninterrupted service delivery.

10. What advice do you have for any young pharmacist interested in supply chain management who does not know where to start?

I currently mentor several young pharmacists, and our first step is to assess their experiences during internships or their initial years of work. They often realise that supply chain management is already integrated into their daily responsibilities, even if it has not been highlighted. Once we identify their starting point, we pinpoint specific areas for improvement based on their interests, and we progress from there. Shadowing an experienced pharmaceutical supply chain manager can greatly facilitate navigating this field. The demand for supply chain experts has grown significantly with the rise of many donor-funded health programs.

11. Did you receive mentorship during your early career as a pharmacist? How else can we improve on mentorship as pharmacists?

I would like to express my gratitude for the support provided to pharmacists during the early days of PEPFAR programming under the funding approved by then USA President George W. Bush. I underwent various capacity-building sessions, including:

1. Commodity management training conducted by Management Sciences for Health (MSH),
2. Leadership and management mentorship through participation in technical working groups such as procurement planning and commodity security committees across programs, including the Ministry of Health via NASCOP,

iii. On-the-job training and collaboration with different implementing partners, where we shared best practices and lessons learned,

1. Training as a Trainer (TOT) to capacity-build mission hospital staff on managing new health products and technologies, especially for HIV programs. I prioritised staying updated with the latest information to provide current data to those I trained and mentored.
2. Support provided to other countries like Uganda, Tanzania, Rwanda, Zambia, and Nigeria where our project was implemented, involving coaching and mentoring local teams. These visits offered insights into governmental operations, enabling the design of tailored training, coaching, and mentorship programs relevant to each country’s context.

Pharmacists can benefit from consolidating their experiences and focusing on their areas of interest. Once identified, setting SMART (Specific, Measurable, Attainable, Relevant, Time-bound) goals can guide them toward their desired career paths. Given the vastness of the pharmaceutical field, maintaining focus on a specific area helps young pharmacists achieve their professional aspirations effectively.