Demands of the Job

Every day is an adventure.  It's not always the kind of adventure we are hoping for or the kind of adventure we were anticipating.  But we learn a lot along the way and try to steer the ship despite the ever shifting current and the occasional tsunami.
If you've ever been a part of international development programs - often called "projects",  you know how they work....donor organizations make contributions with the expectation that the teams they appoint to do the work will make them proud and create a story that allows them to promote (if not merely share) the outcome of their generosity.  This is a wonderful thing when it works well.  Such "Projects", however, have become known as sources of 'easy money' to government officials in 3rd world countries - not because the administrators hand out gobs of cash, but because the projects themselves are able to allocate funds as they deem appropriate - buying vehicles, hiring support staff for government officials and paying for trips under the guise of 'capacity enhancement' (aka training and education).  One such project, I have learned has paid for my government counterpart's education at Johns Hopkins University - (and, yes, I too would like to have ridden that train!)
Nonetheless, I share this with you only because I want to differentiate the kind of work that I am engaged with from a "project".  We are a team of government advisors.  Our role is to develop plans that aim to put the healthcare system on a path toward increased access, improved quality and affordability.  We collaborate with the government to devise these plans, although sometimes (more often than not) we generate the ideas, plans and do the analysis to justify the recommendations and then work to gain the support of the government in moving forward.  It's a seemingly noble, lofty and daunting initiative that we signed up for with the intention of working collaboratively with government, EDPs (External Development Partners, aka donors), NGOs and a variety of other stakeholders depending on one's area of focus - in my case; suppliers, regional and community healthcare leaders and other members of the Nepal medical and drug supply chain.
As mentioned earlier, donors are well intentioned, and their intentions are as formidable as they are well-directed.  This, of course, presumes that they are directed at all.  You need only walk the streets of Kathmandu to realize just how many NGOs have penetrated Nepal - each with the goal of providing a service or program that is intended to improve some aspect of the lives of the people of Nepal - be it their roads, water supply, energy, education or healthcare delivery.  Strangely, but not surprisingly, there is no regulation or true coordination of such activities.  This creates a problem for anyone trying to see what is truly going on here.  Here's an example;

As we all know, HIV/AIDS is a pandemic which spans the globe - some countries hit harder than others and none have had it as hard as South Africa.  Fortunately for Nepal, HIV/AIDS affects less than 1% of the population of the country, but unless managed carefully, the downward trend, resulting from a strong supply of ARVs (drugs to manage the disease) and other commodities for infections, could quickly reverse and spiral out of control.
Over the last month, Nepal has been teetering on the edge of disaster with respect to the mismanagement of supply to the population struggling with this disease.  How can this happen? Glad you asked (but in a minute you may not be).  In most countries, there is an established body known as the CCM or country coordinating mechanism.  This body is tasked with coordinating the efforts of the many NGOs (non-government organizations) - that work to fill the void in services that the government cannot provide due to lack of funds, personnel, skills, etc.  They can also help to identify areas of risk prior to outbreaks of disease, famine, conflict, etc and then marshal the resources where they are needed.

In Nepal, the CCM responsible for coordination of HIV/AIDS commodities seems to have had a lapse in control and consequently the supply of the drugs and service providers for people living with HIV/AIDS are on the verge of being interrupted.  For an AIDS patient, this can be devastating.  Even a brief interruption of essential medicines to manage this disease can result in new strains of the disease that cannot be managed by conventional drugs, necessitating the development of new clinical cocktails and much experimentation.  It is a truly precarious and difficult situation.
To address this situation, the Global Fund has agreed to provide an uninterrupted supply of HIV/AIDS products to Nepal.  But before they do, they are asking that we define and implement the logistics and supply chain that will ensure for quality control and efficient distribution of these items.  This is an essential component of my work here - and they want to see this achieved over a remarkably compressed time frame.
Without boring you with the details, this equates to much more than sweating the small stuff.  This will be an all out race to the finish.  Deep breath! More later.