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How MSF Works: Delivering Aid
November 9, 2012
This article is part of the Fall 2012 issue of the MSF Alert newsletter.
Haiti 2010 © Julie Remy/MSF
Bruno Delouche is the deputy general manager for MSF-Logistique, MSF’s logistics hub in Merignac, France, near the Bordeaux International Airport. MSF-Logistique procures, stores, and ships medical and non-medical supplies to many MSF projects around the world. Here, Bruno, who has worked for Logistique for 17 years, talks about how supplies get to the field—often in just 24 hours.
HOW IS LOGISTIQUE ORGANIZED?
The best way to describe MSF-Logistique is as a nonprofit humanitarian purchasing and distribution center. It is a licensed pharmaceutical institution, meaning we have permission from the French authorities to operate a business that deals with drugs. That’s why we have four pharmacists on staff. We are also licensed to hold materials in customs. All of our supplies are officially in transit because nothing in our warehouse is destined for use in Europe. With this status we avoid customs taxes, can store products for as long as needed, and can ship to the field right away, without worrying about clearing customs.
We have around 100 staff people working on purchase, procurement, transportation, the validation of both medical and nonmedical products, and administrative tasks to make sure we comply with national and international standards.
HOW HAS LOGISTIQUE EVOLVED OVER THE YEARS?
Logistique was founded 25 years ago as a way to make sure MSF had supplies for our field projects at our fingertips. Today, we have around 20,000 items in our database and about 4,000 in stock at any one time. About 3,000 of those items are medical—including therapeutic foods, which we classify as medical—and about 1,000 are non-medical.
We don’t stock everything; some we order from manufacturers or from our subsidiary in Dubai. It depends how quickly they can ship. A week is okay for a regular project, but for emergencies, we need to have everything ready to go. We have an assembly and transportation set-up that can provide more than 100 tons of medical and non-medical supplies within 24 hours, if needed. Over the past five years, we shipped 5,000 tons of supplies each year.
Nowhere in the world is there another civilian logistics center that can provide drugs and non-medical items assembled in more than 500 ready-to-use kits designed for specific types of emergencies. MSF pioneered this approach and remains the only humanitarian organization doing it. We are often contacted by other organizations interested in our kits, but we don’t have the capacity to help them.
An exception is our partnership with the World Health Organization (WHO) on sleeping sickness. When the drug for this disease went out of production, WHO signed a contract with a pharmaceutical company to continue to produce the drugs and asked MSF to distribute them. We realized you needed more than just the drug to treat a patient, so we created kits for sleeping sickness that we send out to Ministries of Health who need it—and WHO pays for it.
ARE MOST OF YOUR DRUG SUPPLIERS FROM EUROPE?
Not at all! Our main suppliers of oral drugs and vaccinations are in India, “the pharmacy of the world.” We began our relationship with Indian suppliers in 2000, when MSF began treating HIV/AIDS and launched the Access to Essential Medicines Campaign. We now also use Indian manufacturers for drugs for TB, malaria, and other diseases.
For most injectable drugs—anesthetics, anti-bacterials, and parenterals, for example—we buy mainly from European manufacturers because assessing quality for these drugs is a highly complex process. We rely on the MSF International Pharmacist network to validate our drugs, as well as WHO. That’s why the number of pharmacists in MSF has increased in the past decade.
I can’t stress too strongly the importance of quality. With globalization, you can find any medicine anywhere, but the major issue is quality. You cannot procure drugs based on cost alone.
HOW DOES ORDERING WORK?
For an emergency, we draw up a list of emergency stock with the operational centers. This list is made up primarily of specialized kits we assemble in our warehouse.
For regular procurement for ongoing field projects, we have order forms based on WHO’s Essential Medicines List for supplies like malaria drugs, meningitis vaccines, or ready-to-use therapeutic food. We also have non-medical items like vehicles and spare parts, radio communication equipment, water treatment supplies, and so on.
Then the teams in the countries receiving the goods need to have everything in place to receive them—warehouses, transportation, and all the paperwork.
DO YOU BUY ANYTHING LOCALLY?
We buy some non-medical items locally—like mosquito nets, shelter materials, and so on. And we are increasingly using local producers for ready-to-use therapeutic food. We have an international staff person dedicated to quality control, and she has visited factories in places like Niger, the Dominican Republic, Kenya, and South Africa that make ready-to-use food and has approved them for our use.
ARE THERE ANY RESPONSES THAT STAND OUT FOR YOU?
The last really big one was Haiti. Normally, when there’s a disaster in one part of a country, we still have logistical support in another part of the county. But with Haiti, we couldn’t send supplies to Port-au-Prince, so we sent them to Santa Domingo instead, in the Dominican Republic, arranging for transportation by land to Port-au-Prince. This included our modular hospital kit, which is made up of 14 tents covering 90 square meters [nearly 1,000 square feet] each, with two operating rooms. We worked around the clock for several weeks, while continuing to supply our other missions.
But even when it is exhausting, we have a clear picture of why we exist. From beginning to the end, MSF Logistique is managed by MSF people for MSF people. So we are careful to do it right, for our field teams and our patients.