National Drug Stockout Risks in Africa: Analysis of the Global Fund Disbursement Process for Procurement from 2002 to 2013

Despite substantial financial aid from international donors for procurement of health products, stockouts of life-saving drugs related to prevalent infectious diseases are still widespread in Africa. Addressing the lack of research on why these stockouts occur, we study the relationship between The Global Fund to Fight AIDS, Tuberculosis and Malaria and its grant recipients. Specifically, we leverage extensive historical fund disbursement and drug procurement data to build a discrete-event simulation model predicting the joint impact of procurement and grant disbursement processes on national drug availability for the Global Fund’s recipient countries in Africa. This model is validated against cumulative stockout levels inferred from historical grant implementation lengths, and used to evaluate potential high-level modifications of disbursement or procurement processes. Results show the existence of substantial intrinsic stockout risks in many countries, due to the unpredictability of fund disbursements and the frequency of grant performance monitoring performed by the Global Fund. Interventions increasing fund disbursement levels to protect against disbursement timing uncertainty are predicted to be more effective than others that include regional buffer stocks and bridge financing.