Integrating Eyeglasses into Liberia's Government Supply Chain

The good, the bad, and the unexpected of exploring integration within imperfect systems.

Integrating reading glasses into government supply chains is a formidable challenge faced by many eye care NGOs striving for sustainable government-led delivery. Many have pondered over strategies, with some achieving success and gleaning valuable insights from their efforts.

In this article, EYElliance shares our experiences in integrating reading glasses into Liberia's community health supply chain managed by the Ministry of Health—revealing both the successes and challenges we encountered on this journey

Let's dive into the complexities of this integration and the unexpected lessons we learned along the way.

Understanding Liberia's Supply Chain

Liberia boasts a relatively well-established and functioning government supply chain, which is a significant asset in our mission. Though the systems is not perfect. It is however an opportunity for us to explore how integration can be achieved within an imperfect system. Key players in the Ministry of Health include the National Supply Chain Focal Point for the Eye Health program, and the National Community Health Program responsible for community health services and vision screenings.

An idealised representation of Liberia’s government supply chain for eyeglasses.

In an ideal scenario, reading glasses are seamlessly integrated into the supply chain, moving from the Ministry of Health to the Central Medicine Store and then down to health facilities at the district and community levels. However, achieving this ideal flow presented us with numerous challenges and lessons.

Learning #1: Sometimes You Just Gotta Make It Work

One of our key takeaways from this integration journey is the necessity of adapting to the system's realities. Despite the fact that Liberia has a well-designed supply chain on paper, we encountered challenges in practice. To make it work, we couldn't reply on creating parallel systems. We had to ensure the Ministry of Health (MoH) took full ownership of the inclusion of reading glasses into the supply chain.

Our experiences reminded us of the importance of relationship building and training. The appointment of a the National Supply Chain Focal Point proved pivotal to the project's success. He helped us understand system bottlenecks, navigate bureaucracy, and even ensured the integration of reading glasses into the Electronic Supply Chain Management System (ELMIS). Finding and connecting with such key figures within the system can be a game-changer in achieving functional integration.

Learning #2: 10,000 Stickers

Upon receiving the donation of reading glasses, we faced the daunting task of managing over 50 different combinations of powers and styles, each with its own numbering. To address this challenge, we had to first understand the scope of the problem.

Our stock-taking efforts revealed a shortage of manpower at the Central Medicine Store (CMS), which necessitated the hiring of day workers. Training became essential to ensure accurate recording of power, style, and model details for each pair of eyeglasses, especially considering the labelling variations on each pair.

To simplify stock management and prevent Stock Keeping Unit (SKU) proliferation, we collaborated with the MoH and CMS staff to create a system that reduced over 50 variations to just nine options. Each pair was labelled consistently based on power, model, and style, significantly streamlining the supply chain. This required printing and adhering 10,000 relabelling stickers—a massive effort that paid off in the long run.

Effective stock management reduced over 50 variations of eyeglasses to just nine Stock Keeping Unit (SKU) options.

Learning #3: Breaking Bureaucratic Bottlenecks

Further downstream in the supply chain, we encountered unexpected challenges related to leakage and stock-out prevention. Even with a paper-based tracking system supporting the ELMIS, leakage wasn't always straightforward.

For instance, stock-outs at district health facilities could occur due to the direct dispensing of stock intended for Community Health Assistants (CHAs). District health facilities sometimes found themselves in the position where they ran out of eyeglasses to dispense to individuals coming into their facilities. This caused pressure to directly dispense stock intended for CHAs, causing stock outs further downstream. To prevent this, reading glasses intended for CHAs were secured in locked cupboards, requiring two keys to unlock. This safeguarded the stock for CHAs and prevented dispensing at the district level and the knock on effect of stock outs downstream.

Understanding and addressing leakage also extended to CHA training. Initially, the plan was to issue reading glasses to CHAs during their training. However, ineffective stock tracking led to delays, emphasizing the need for better initial stock management within the supply chain.

The Way Forward

Integrating eyeglasses into Liberia's government supply chain was not without its challenges and surprises. Our journey taught us valuable lessons about adapting to imperfect systems, understanding stock-keeping processes, and addressing bureaucratic bottlenecks. While Liberia's supply chain may serve as a model for some, it also highlights the need for innovation and flexibility when integrating eyeglasses into various systems worldwide.

As we continue to work on creating a world with equitable access to eyeglasses, we encourage others to share their experiences and collaborate on finding solutions to similar challenges. Together, we can improve the lives of countless individuals by providing them with the gift of clear vision.