SHORT REPORT

Local Sourcing and Supplier Development in Global Health:Analysis of the Supply Chain Management System’s LocalProcurement in 4 CountriesPrashant Yadav,a Sarah Alphs,b Clinton D’Souza,c Gordon Comstock,d Iain Bartonc

Local suppliers reported that after doing business with PEPFAR’s global procurement and distribution project foressential HIV/AIDS medicines and supplies, they achieved revenue and asset growth, improved their qualitystandards, acquired new contracts with other businesses, and hired more employees.

ABSTRACTFrom 2006 to 2014, Supply Chain Management System (SCMS), the global procurement and distribution project for the U.S. President’sEmergency Plan for AIDS Relief (PEPFAR), distributed over US$1.6 billion worth of antiretroviral drugs and other health commodities,with over US$263 million purchased from local vendors in 14 countries in sub-Saharan Africa. A simple framework was developed and39 local suppliers from 4 countries were interviewed between 2013 and 2014 to understand how SCMS local sourcing impactedsupplier development. SCMS local suppliers reported new contracts with other businesses (77%), new assets acquired (67%),increased access to capital from local lending institutions (75%), offering more products and services (92%), and ability to negotiatebetter prices from their principles (80%). Additionally, 70% (n=27) of the businesses hired between 1 and 30 new employees afterreceiving their first SCMS contract and 15% (n=6) hired between 30 and 100 new employees. This study offers preliminary guidanceon how bilateral and multilateral agencies could design effective local sourcing programs to create sustainable local markets forselected pharmaceutical products, laboratory, and transport services.

BACKGROUND

Amidst a growing concern about sustainability ofglobal health aid, and in a context of increasing

focus on aid-recipient countries taking over their healthbudgets, the development of national program capacityhas been attracting considerable policy interest.1–5 Thereis a strong interest in identifying viable institutionalframeworks and policy options that can help countriesgraduating from foreign development assistance forhealth to effectively manage their health systemswith local implementing partners.2 Many donors anddevelopment agencies, especially the United StatesAgency for International Development (USAID), havean increased focus on how to make programs moreeffective, more enduring, and less costly throughprocurement reform, sustainable partnerships, and localsolutions.

This imperative for greater sustainability and highervalue formoney ismost pronounced in the procurementand distribution programs run as part of global healthinitiatives such as the U.S. President’s Emergency Planfor AIDS Relief (PEPFAR); the Global Fund to FightAIDS, Tuberculosis, and Malaria; and Gavi, the VaccineAlliance. USAID had initiated a strategy to increase localprocurement with an intent to promote sustainabilityand country ownership of its programs.6 These trendsare based on a hypothesis that local procurement—thepractice of purchasing goods and/or services throughlocal suppliers—can help achieve sustainability andbuild the capacity of local market actors and institutions.

In 2005, USAID under PEPFAR established theSupply Chain Management System (SCMS) to providea reliable, cost-effective, and secure supply of productsfor HIV/AIDS programs in PEPFAR-supported countries.Between 2006 and 2014, SCMS distributed US$1.6 bil-lion worth of antiretroviral drugs and other health com-modities to various countries. One of the cornerstones ofSCMS’s mission is a commitment to developing the pro-curement and distribution capacity of host-countrygovernments and local NGOs, and selecting the mostappropriate procurement strategies for each productand geography. In tunewith this strategy, SCMS sourced

aDepartment of Global Health and Social Medicine, Harvard Medical School,Boston, MA, USA.b Independent researcher, Dar es Salaam, Tanzania.c Imperial Health Sciences and Partnership for Supply Chain Management,Bedfordview, Gauteng, South Africa.dManagement Sciences for Health and Partnership for Supply ChainManagement, Arlington, VA, USA.Correspondence to Prashant Yadav (Prashant_yadav@hms.harvard.edu).

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over US$263million of its overall spending duringthis period from local suppliers in 14 Africancountries.

When commercial companies seek local sup-pliers, the reason is typically to reduce costs andmeet local content requirements.7,8 While localpurchasing by global multinationals has shownthe benefits of lowering costs and achievingeconomic benefits,6 local procurement may notwork for all product and geographical markets.In low- and middle-income country settings, thenumber of local suppliers who can meet thestandard for quality and reliability requiredfor producing pharmaceuticals and laboratorysupplies are extremely limited. As a result,intermediaries who add cost markupwithout con-tributing to value addition sometimes get addedinto the value chain. While increased cost was ofsome concern, the key goals of the SCMS localsourcing initiative were not necessarily costsavings but sustainability and local capacityenhancement.

The goal of this study was to understand theimpact of SCMS local sourcing on long-term de-velopment of a high-quality local supplier base.While supplier development has been extensivelystudied in the commercial sector9 and to someextent in high-income country public-sectorprocurement,10 it has not been studied systemati-cally for public/NGO purchasers operating ininternational health settings. This study aimed tounderstand how local sourcing impacts supplierdevelopment and long-term market health. Ourcontribution sheds new light on how bilateral andmultilateral agencies could design effective localsourcing programs to create sustainable localmarkets for selected pharmaceutical products,laboratory, and transport services.

METHODOLOGYThe commonly used methodology in economicliterature to assess broader intersectoral eco-nomic impact of an intervention is Input-OutputAnalysis.11 Input-Output Analysis looks at theinterdependencies of industries or economicsectors and estimates to what extent positive ornegative economic shocks affect a country’seconomy.11 While this type of analysis providesa useful way to assess overall economic impact,it does not capture firm specific managerialimpacts that are at the core of our study.Another important way to assess impact is theconcept of Shared Value,12,13 which assesses thegains to each stakeholder. Our study objectives

were to understand the strategic, managerial,and economic implications for organizations thatwere part of the SCMS local vendor network. Wedeveloped a simple framework of measurementthat was clear, practical, and grounded in thecountry context where this work was carried out.

The most direct impact measured was theincrease in business revenue for the supplierswhen SCMS procures a product or service fromthem. This revenue increase leads to further eco-nomic activity, including the creation of additionaljobs at the supplier. Furthermore, as suppliersexpand to meet additional or new needs, theypotentially acquire additional assets, such as awarehouse, a forklift, or laboratory equipment. Inaddition, as part of the local sourcing initiative,SCMS provided training, helped create standardoperating procedures, and enforced strict qualitystandards on the suppliers. This could improvesuppliers’ ability to better serve other customersand increase their competitiveness in seekingbusinesswith other companies. A clear predictablerevenue stream from SCMS may also enable sup-pliers to access capital at better terms from banksand financial institutions.We used a 3-part frame-work of potential direct, intermediate, and long-term impact to assess the overall impact of SCMSon its suppliers (Figure 1) and surveyed sampledfirms to help answer the 8 questions embeddedwithin the framework. We measured this usingthe indicators described in the Table.

We developed a survey and interview guide toassess these and additional changes in the supplier’seconomic position, relationships, and capacity overtime (Supplement). The methodology did notinclude any control group—specifically, local firmsthat did not receive a SCMS contract—and wasstrictly based on comparisons before and afterreceiving a contractual award from SCMS.

Sample SelectionAnalysis of SCMS spending revealed that morethan 90% of SCMS spending with local vendorsbetween fiscal years 2009 and 2011 was in 8 coun-tries (of 14): Côte d’Ivoire, Ethiopia, Kenya,Mozambique, Nigeria, South Africa, Tanzania, andZambia. We sampled 50% of the 8 countries basedon logistical/geographical clustering. The studywascarried out in Ethiopia, Kenya, Mozambique, andTanzania. Instead of interviewing and obtainingrecords from every single vendor in each of thesecountries, the below was used as inclusion criteriafor vendors:

1. Contract award value over US$15,000.

Globalcommercialcompanies oftenseek localsuppliers toreduce costs andmeet localproductionstandards.

Through theirrelationship withSCMS, localsuppliersbenefitted fromincreasedrevenue,additionalresources toexpandoperations, andreceived trainingand technicalsupport to helptheir businessesimprove andgrow.

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2. Supplied at least 1 order to SCMS between2006 and 2013.

3. Representation from different industries, suchas laboratories, pharmaceutical, informationand technology services, logistics, andwarehousing.

4. Representation of both smaller and largerbusinesses.

A total of 39 vendors across all 4 countrieswere interviewed. The interviews were carriedout over the period of May 2013 through January2014.

Profile of Local SuppliersThe local suppliers spanned from small vendors ofoffice supplies or maintenance services to largepharmaceutical and laboratory supply companies.Before delving into understanding the impact oflocal procurement, it is necessary to understand

who the local suppliers are, how long they havebeen in business, and how many employees theyhave.

Job Function of RespondentsSurvey- and interview-based business impactstudies often rely on interviews with line staffwho have a limited understanding of strategicissues, such as the development of new serviceofferings. For this study, the research team inter-viewed respondents withmanagerial and strategicexperience who were at the leadership level ateach supplier. More than 20 of the respondentswere chief operating officers or owners of thefirm,which gave us an understanding of how localsourcing has transformed their business.

Industry of Local SupplierA large portion of money spent at the locallevel was on suppliers of pharmaceuticals and

TABLE. Indicators for Impact Assessment

Impact Indicator Data Source

Revenue Annual revenue pre-/post-SCMS award Supplier company records

Business output/productivity # training programs conductedGood storage practicesAccess to working capital

Supplier company records and interview

Assets (e.g., vehicles) # of assets obtained/sold locally Supplier company records

Employment # of additional jobs created post-SCMS award Supplier company records

Market competitiveness # of contracts obtained post-SCMS award Supplier company records and interview

Range of services offered # and types of services offered post-SCMS award Supplier interview

Abbreviation: SCMS, Supply Chain Management System.

FIGURE 1. Impact Assessment Framework

Local suppliersranged from smalloffice suppliers tolargepharmaceutical orlaboratorycompanies.

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laboratory services or reagents. Of the vendorsinterviewed (N=39), 24 were suppliers of labora-tory, medical supplies, and pharmaceuticals(Figure 2).

Age of BusinessOf the 39 local suppliers interviewed, 27 had beenin operation for 5 years or more at the time of theinterview. This demonstrates that amajority of thelocal vendors are established firms and are notnew players that have created only to serve SCMS.

Size of BusinessThe reported median annual revenue of local sup-pliers was between US$1 million and US$5 mil-lion, with some earning as high as US$30 millionthrough US$49.9 million (Figure 3).

The distribution of the size of the businessesvaried considerably by the industry. All of thepharmaceutical and laboratory suppliers (n=24)reported an annual revenue greater thanUS$1 million, with many earning up to and overUS$20 million. Stationary suppliers tended to besmaller, with 2 of them having revenue lessthan US$500,000 each year. Vendors supplyingvehicles, including forklifts and trucks, were thelargest vendors by type, with 2 reporting an an-nual revenue of over US$10 million. As noted inthe sampling framework, only local businesseswith a contract award over US$15,000 were

included in the study, which slightly biased thissample toward larger companies.

Number of EmployeesSCMS local vendors interviewed included a bal-anced mix of smaller businesses with less than25 employees and larger businesses with over200 employees (Figure 4).

BranchesOf the 39 businesses interviewed, 24 said they hada branch in another location. Multi-locationalbusinesses have a larger footprint, allowing themto provide services not only in the capital city butalso in other parts of the country.

Number of CustomersThe sampled businesses represented a balancedmix of companies that ranged from having lessthan 50 customers to having more than 500.

Vendor’s Total SCMS Contract Award ValuesSCMS provided the research team with the valuesof contracts awarded to vendors in Ethiopia,Mozambique, and Tanzania. Among these ven-dors (n=28), 26 were awarded contracts with atotal value over US$100,000. Themajority of ven-dors received contract awards valued between US$100,000 and US$500,000 (Figure 5).

FIGURE 2. Industry/Sector of Firms in the Sample

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The distribution of contract value variesconsiderably by the industry in which localvendors operate. In total, 3 manufacturersreceived contracts valued over US$500,000;8 of the pharmaceutical and laboratory suppli-ers (distributors) received contracts betweenUS$100,000 and US$500,000, 7 received con-tracts valued between US$500,000 and overUS$10 million, and 1 received a contract valuedless than US$50,000; and 2 of the suppliers

supplying stationary and other office consum-ables received contracts valued less than US$50,000.

RESULTSRevenue GrowthAlmost all (n=36) of the 39 businesses interviewedreported that their company had experiencedgrowth since their first contract with SCMS.

FIGURE 4. Number of Employees in Respondent Firms

FIGURE 3. Annual Revenue (in US$) of Firms in the Sample

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Labor Changes and Employment GenerationA majority (n=33) of the firms reported anincrease in the number of employees afterreceiving a contract from SCMS. Of the 33 firms,27 hired between 1 and 30 new employees afterreceiving their first SCMS contract and 6 hiredbetween 30 and 100 new employees (Figure 6).Employee salaries have a trickle down/multipliereffect on the local economy.

Asset GrowthA majority (n=36) of the 39 firms interviewedreported an increase in asset ownership aftertheir first SCMS contract. The most commonlyacquired assets were warehouse space, com-mercial vehicles, and additional office space(Figure 7). These are generic assets that can beeffectively leveraged for other clients. The ma-jority (n=25) of respondents reported acquiringnew assets over US$100,000 (Figure 8).

Overall Impact of SCMS BusinessWhen the respondents were asked to reflect onthe impact of SCMS on their businesses, abouthalf (n=19) of 39 businesses interviewed saidthat SCMS had positively impacted their business,

2 reported that working with SCMS negativelyimpacted their business, 3 reported both positiveand negative impacts, and 9 said that SCMS hadno impact on their business (Figure 9). Of the19 firms who reported that a contract with SCMShad a positive impact on their business, 8 statedthat doing business with SCMS improved theirreputation, enabling them to win new clients.

Of the 2 vendors who reported that workingwith SCMS negatively impacted their business, thefirst cited that delayed payments from SCMS con-strained their company financially and the secondreported that working with SCMS had negativelyimpacted their company’s reputation when facility-level stock-outs of a product they had supplied toSCMSwere attributed to their business.

A total of 9 vendors responded that SCMS hadno impact on their business. We analyzed thesevendors in greater detail to understand the under-lying reasons for their lack of growth. We foundthat nearly all (n=7) of the firms did not have anyactive contracts with SCMS in 2013 and that theirearlier contracts were mostly one-off procure-ment arrangements. Of the 2 remaining firms,1 was in financial distress with significant debtdue to outstanding payments from large clients,including the national government, and did not

FIGURE 5. Distribution of SCMS Total Contract Value (US$) to Firms in the Sample

Abbreviation: SCMS, Supply Chain Management System.

Note: Kenya respondents were not included. When provided a range, the average of the range is included in this analysis.

Amajority(84.6%) of thefirms reported anincrease in thenumber ofemployees afterreceiving acontract fromSCMS.

About half(48.7%) of39 businessesinterviewed saidthat SCMS hadpositivelyimpacted theirbusiness.

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FIGURE 6. Number of New Employees Hired After Contract With SCMS

Abbreviation: SCMS, Supply Chain Management System.

* 1 firm reported a decrease in their employees after the start of SCMS contract.

FIGURE 7. Types of New Assets Acquireda After Start of SCMS Contract

Abbreviation: SCMS, Supply Chain Management System.a More than 1 response was allowed.

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attribute its financial issues to SCMS. The otherwas a large well-established business that hadreceived its first contract with SCMS in 2013, buthad many larger clients than SCMS.

DISCUSSIONWhen large global firms source from local suppli-ers it provides a powerful channel through which

the global firm’s knowledge and skills can be dif-fused directly to the local suppliers, or indirectlyto local firms through a spillover effect.7,14,15

However, sometimes it is difficult or impossible tofind local suppliers who meet the internationalquality standards or capability requirementsneeded to expand the supply chain. Supplier de-velopment should be a key part of public andNGO procurement in such markets.

FIGURE 8. Estimated Value (in US$) of New Assets Acquired

FIGURE 9. Type of Impacta of SCMS Contract on Firm’s Business

Abbreviation: SCMS, Supply Chain Management System.a More than 1 response was allowed.

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The results of this study show that, in mostcases, local suppliers under the SCMS local sourc-ing initiative increased employment, achievedrevenue and asset growth, improved their qualitystandards, and became more equipped to acquirenew customers. Admittedly, some of this growthwould have occurred due to overall growth in theeconomy/sector. Furthermore, firms with effec-tive business processes, strong management,good governance, and a past record of growthwere more likely to grow faster than their peers.Given SCMS’s selection criterion for local vendorsfavors firms with such attributes, it became harderto establish to what extent their growth was dueto SCMS contracts and know-how and howmuch would have occurred irrespective of those2 factors.

Local suppliers need capital to continuallyupgrade the quality, breadth, and depth of theservices they offer. In order to meet global stan-dards and further grow their businesses, localsuppliers require sufficient capital to invest inbuildings, machinery, equipment, trucks, andproduct inventory. High interest rates, lack oflonger-term loans, and the absence of creditrecords hinder the ability of small- and medium-sized suppliers to survive and grow. About a quar-ter (n=29) of the 39 local SCMS vendors in thisstudy reported that their access to capital fromlocal lending institutions increased after theybegan doing business with SCMS. This shift resultsfrom the predictability of demand and greater con-fidence by local banks in suppliers with track re-cord of doing business with a large internationalfirm. Evidence shows that alleviating workingcapital constraints substantially enhances businesssustainability.16 To that end, supplier financingsolutions that can provide greater access to capitaland further enhance the growth of local suppliersneed to be explored. Commercial companies oftenconduct a supplier sustainability gap analysis,which helps to identify the constraints currentsuppliers are facing in leveraging their enhancedcapabilities to further grow and diversify theirbusiness. This type of analysis can help bilateraland multilateral agencies, host country govern-ments, and their implementing partners identifyopportunities and work together to design localsupplier development programs. A key challengeto this approach is that when local suppliers areuncompetitive, forcing local sourcing through“local content requirements” can lead to high-cost production of low-quality products. A moreappropriate policy intervention is to create invest-ment vehicles that allow stronger linkages

throughwhich productivity know-how can be dif-fused from global firms to local companies.

Our findings show that local supplier develop-ment of smaller firms would require the buyinggroup to provide a support role through coaching,mentoring, and other methods of transferringbusiness know-how. For more established localfirms (such as the ones in this study sample), thebuying group’s key role is their ability to providepredictable demand, guaranteed financial flows,and the reputational benefits of doing businesswith a large global firm (Figure 9). Local supplierdevelopment is an effort- and resource-intensiveactivity that requires substantial staff time to bedevoted to finding, auditing, and selecting localsuppliers, and then mentoring or coaching theirstaff to improve their business processes.

Due to the frequent use of formal tenderingin public procurement, public buyer–supplierrelationships often do not have an explicitsupplier development component built intothem. Organizations such as SCMS and theUSAID Global Health Supply Chain Program –

Procurement and Supply Management Project(GHSC-PSM) have more flexibility in their sourc-ing and procurement practices to embed supplierdevelopment into their programs. To realize localsourcing objectives, specifically local firm growth,local economic impact, and program sustainabil-ity, multi-year programs/initiatives should adopta strategic approach to local supplier develop-ment. They should also build in key performancemetrics into health commodity procurement tomeasure the factors related to improving the qual-ity of local labor force, local firm growth, and localeconomic impact.

As a large share of health commodity procure-ment transitions to national government financ-ing, it is important to embed local supplierdevelopment programs into the transition plans.It remains unclear if some of the benefits to localfirms—such as easier access to local credit becauseof a fixed contract with a global organization orthe reputational benefits associated with doingbusiness with a global organization—would be asrelevant when their main customer becomes thenational government instead of a group likeSCMS or GHSC-PSM. These are crucial areas ofmarket and supplier development that requirefurther examination.

CONCLUSIONThis study offers preliminary guidance on howbilateral and multilateral agencies could design

A suppliersustainability gapanalysis helpscommercialcompaniesidentify theconstraints facedby their suppliersto further growtheir business.

Programs shouldadopt a strategicapproach to localsupplierdevelopment anduse keyperformancemetrics tomeasure growthand impact.

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effective local sourcing programs to create sustain-able local markets for selected pharmaceutical prod-ucts, laboratory, and transport services. Furtherinvestigation is required to better understand theprocurement pathways that lead to local suppliersinvesting in new assets, institutionalizing new qual-ity standards, recruiting new employees, or creatingnew service offerings.

Acknowledgments: The authors gratefully acknowledge comments fromPeter Smith and Rich Owens and the local suppliers interviewed for thisstudy.

Funding: PY and SA acknowledge research support from the WilliamDavidson Institute at the University of Michigan for this study.

Competing Interests: CD, GC, and IB are employees of SCMS. SAreceived travel assistance to visit 4 countries for the study. PY reports nocompeting interests.

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Peer Reviewed

Received: February 21, 2018; Accepted: August 20, 2018

Cite this article as: Yadav P, Alphs S, D’Souza C, Comstock G, Barton I. Local sourcing and supplier development in global health: analysis of theSupply Chain Management System’s local procurement in 4 countries. Glob Health Sci Pract. 2018;6(3):574-583. https://doi.org/10.9745/GHSP-D-18-00083

© Yadav et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view acopy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-18-00083

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