In the latest piece in our thought leadership series - Stronger together: Health supply chain voices - Dr. Jacob Kuutuome explains why national investment is needed in both last-mile delivery and workforce development.
Across the African continent, the final stretch of health supply chains – the last mile – is no longer an abstract logistical concept. It is often here where a child with malaria gets treated, where a mother in labour receives oxytocin and where HIV-positive clients receive essential medication. In a region with uneven geography, infrastructure limitations and fragile systems, reliable last mile delivery (LMD) saves lives.
In Ghana, a 2025 national LMD assessment shows that while significant progress has been made in delivering health commodities to over 7,000 facilities, the system remains fragile. With 91 percent of regional logistics staff reporting service improvements and declining stockouts of key malaria and maternal health products, there is no question that LMD is working better than ever. However, this success is sustained almost entirely by donor funding. Without national investment, digital capacity building and institutional ownership, the gains remain at risk. What’s more, if countries don’t develop strategies to develop and maintain a professionalised health supply chain management (SCM) workforce, health systems are unlikely to be able to deliver for patients.
A regional blueprint to finance last mile delivery
Amidst operational challenges and funding uncertainties, Ghana’s National Health Commodity Supply Chain Master Plan (2023–2027) addresses LMD through a systems lens. It proposes key reforms that align with People that Deliver’s focus on SCM professionalisation and workforce development.
The plan outlines a national HR strategy for supply chain management that includes workforce mapping, standardisation of job roles, competency frameworks and the integration of pre-service training for logistics roles into public health curricula. In response to donor transition pressures, the plan proposes a gradual increase in government financing, with defined co-financing targets and a costed roadmap for LMD scale-up. It envisions a fully integrated digital supply chain ecosystem, linking the Ghana integrated logistics management information systems (GhiLMIS), e-procurement platforms, drone logistics systems and District Health Information System 2 (DHIS2) to enhance end-to-end visibility and real-time decision-making.
This master plan not only signals political commitment, but it also offers a structured pathway to transition from donor-reliant operations to sustainable, domestically financed systems. It is not just a national plan; it is a continental model.
African countries seeking to future-proof their supply chains, especially the last mile, should look to Ghana’s master plan for guidance. Its emphasis on institutionalisation, systems thinking and workforce development mirrors the best global practices and reflects the kind of long-term stewardship needed to withstand external shocks. To move from aspiration to implementation Ghana and its peers must ensure that such master plans are not shelved but resourced, monitored and continuously adapted.
Last mile delivery is an investment
Ghana has realised that reliable LMD is a strategic investment and other African governments must do the same. Recent events have made this clearer than ever. The 2025 USAID stop-work order on health supply chain activities in Ghana exposed a core vulnerability: the overreliance on external funding to sustain routine distribution of essential medicines. Overnight, several regions experienced disruptions in deliveries, stock imbalances and delays in reaching service delivery points, all because critical LMD functions had not been integrated into national or regional budgets. While cost comparisons in Ghana reveal that 3PL providers offer greater delivery reliability than public vehicle fleets, their funding remains entirely donor dependent. The average cost per delivery, though justifiable for quality and performance, remains unaffordable under current domestic allocations. As the Ghana Health Service's 2025 assessment (not yet published) confirmed, no region except for Western Regional Medical Stores (RMS) has committed budgetary resources for LMD and most operate without any contingency financing. This RMS has been self financed since its inception.
In Ghana the private sector has demonstrated its value in improving LMD performance. Ghana’s engagement with third-party logistics (3PLs) companies such as MASS Logistics and Skynet has shown how professional fleet management, real-time tracking and contractual accountability can transform service delivery. This has been achieved by meticulous compliance with contracting qualification and eligibility criteria and key performance indicators (KPIs) – these are set across the entire LMD operational stages and payment for services is tied to companies’ ability to fulfil these KPIs.
Outsourcing doesn’t mean abdication of responsibility. Public institutions must train logistics managers in contract negotiation and performance oversight, create national guidelines for 3PL accreditation, monitoring and renewal and ensure knowledge transfer from vendors to public staff as part of service-level agreements. Guidance is available in the PtD outsourcing toolkit.
Sustainable LMD systems must blend public stewardship with private-sector innovation, while ensuring that the public sector retains the capacity to lead.
The USAID stop-work order should serve as a wake-up call, not only for Ghana but for all countries navigating donor transitions. To safeguard health access, governments must urgently institutionalise LMD funding within national and subnational health budgets, including RMS operations and fleet management. They must establish co-financing mechanisms with national health insurance schemes or decentralised government funds. They need to develop and monitor donor transition plans with clear timelines, cost-sharing strategies and performance benchmarks. And they must be advocates of domestic resource mobilisation through parliamentary health committees and inter-ministerial collaboration.
Donor-funded efficiency cannot replace locally owned resilience. The last mile must be financed: not out of convenience but out of necessity.
A health system is only as strong as its workforce
Behind the successful delivery of essential medicines lies the often-invisible work of health supply chain personnel who plan, coordinate, communicate and solve logistical challenges in real time. And yet, across the African continent, this workforce remains under-recognised, under-resourced and under-supported.
Ghana’s 2025 LMD assessment illustrates this clearly: while 91 percent of RMS managers reported improved LMD performance, 46 percent of staff cited shortages and insufficient training as persistent constraints. Many service delivery points rely on clinical personnel to perform logistics functions due to the absence of dedicated supply chain officers. This diverts essential staff from patient care and often leads to errors in inventory management or delays in reordering.
As PtD has long advocated, the success of any health supply chain is contingent on the competency, availability and support of the workforce managing it. The lack of skilled logistics personnel is not merely an operational issue; it directly impacts stock availability, patient outcomes and the return on investment in health commodities. Strengthening the SCM workforce is essential to achieving health goals and sustaining delivery innovations across public and private sectors.
Currently, Ghana has no national supply chain workforce development plan and while ad hoc training occurs it is often linked to donor programmes and there is limited institutional ownership of a workforce strategy. The Ghana Ministry of Health has no direct budget for SCM workforce development. Standard operating procedure compliance, digital tool adoption and cold chain maintenance are all inconsistent where staff are untrained or unqualified.
To professionalise and sustain LMD, Ghana and its peers must map and define SCM roles within health systems at all levels. They need to integrate pre-service and in-service training on LMD processes into national curricula. They should establish clear career pathways and professional certification mechanisms. And they need to institutionalise continuous mentorship, supervision and peer learning platforms at national and district levels.
The goal is to build a competent, supported and adequately staffed supply chain workforce embedded across both public and private sectors. Without this, the systems designed to deliver life-saving commodities will always remain vulnerable, no matter how well funded or technologically advanced. Human capital must be recognised as the cornerstone of LMD. Trucks and tablets do not deliver health outcomes, trained people do.
Likewise, new technologies are only as effective as the systems and people that surround them. For countries embracing digitisation as a means of supporting sustainable LMD, they must ensure that the SCM workforce has the necessary skills, and this means expanding digital literacy and training across all supply chain tiers.
Call to action: Reclaiming the last mile
The future of health equity in Africa will be determined by the strength of our supply chains. If vaccines, antibiotics, contraceptives and diagnostics do not reach the people who need them, the promise of universal health coverage cannot be fulfilled.
Development partners must invest in transition. Governments need to own the last mile – financially, operationally and politically. Local actors must be empowered with the tools and authority to deliver results. And of course, all of this must go in tandem with ensuring that every healthy system has a SCM workforce that is capable of and supported to deliver for the people it serves.
About the author
Dr Jacob Kuutuome is a Ghanaian supply chain expert, academic and systems leader with over 15 years of professional experience in health procurement and logistics across Africa. He is the deputy chief procurement manager and head of procurement and supply chain at St. Michael’s Catholic Hospital and serves as a part-time lecturer at KNUST, where he supports curriculum development in health and pharmaceutical supply chains. He holds a PhD in Procurement and Supply Chain Management and is a chartered member of CILT (UK), Ghana Institute of Procurement and Supply, and professional member of CIPS (UK).
References
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