Impact Stories

How Strong Leadership in Eastern Cape Improved Medicine Stock Availability


Eastern Cape, South Africa, faced chronic shortages of essential medicines and supplies, resulting in treatment interruptions, particularly for chronic diseases like HIV, TB, and diabetes. Stock availability at depots was critically low due to ineffective leadership, lack of accountability, poor inventory management, and staffing shortages.


In 2012, the Eastern Cape Department of Health partnered with Spark Health Africa to launch the Transformative Leadership and Culture Change (TLCC) initiative. The approach entailed provincial team adopting a multi-disciplinary approach, igniting a mindset shift and gaining senior leadership support to address root causes of stock-outs.

1. Multi-disciplinary Team Setup

  • Comprising managers from various disciplines to address the problem comprehensively.

2. Mindset Shift

  • Facilitated by Spark Health Africa through workshops and mentoring, focusing on systems approach to problem solving using data.

3. Leadership Commitment

  • Engaged provincial senior leadership to support the initiative and allowed access to depots for analysis.

4. Structured Problem Solving

  • Developed an evaluation tool to analyse depot value chain processes, focusing on infrastructure, staff, budget, supplier management, and logistics.


Key actions include:

  • Placing community service pharmacists in Mthatha depot.

  • Reassigning community health workers and re-purposing auxiliary workers as pharmacist assistants.

  • Streamlining ordering processes and requiring weekly stock reports from health facilities.


Within six months, medicine availability at depots increased from 54% to 95%, achieving targets ahead of schedule. This allowed the team to shift focus to maintaining adequate stock levels at health facilities.

Lessons Learned

  • Teamwork across functions and disciplines is crucial for system-wide interventions.

  • Engaging the right stakeholders creates an enabling environment for implementation.

  • Timely data reviewed by appropriate stakeholders drives accountability.

  • A systematic and structured approach aids in problem-solving.

  • Effective inventory management requires addressing both technical and behavioural components.

Eastern Cape Province, South Africa