In some parts of eastern Cameroon, accessing malaria supplies can still require hours of travel on difficult roads. Through the Equity Access Malaria Initiative, community actors, health authorities and civil society organizations are working to better understand supply chain bottlenecks and improve access to treatment in remote communities.

“Since I was assigned as head of the Petit Pol health area, I’ve had several motorcycle accidents while travelling to Bertoua to collect malaria supplies because there are no cars in Petit Pol… I have no choice but to use motorcycles despite the weather and the bad roads. During the rainy season, travel becomes extremely difficult. When the motorcycle throws you to the ground, you get back up and continue the journey.”

This is the daily reality for health workers in Petit Pol, a locality in the Doumé health district in eastern Cameroon, where most residents belong to the Baka Indigenous communities. Here, when a health facility runs out of rapid diagnostic tests, antimalarial medicines or other essential supplies, replenishment is rarely a simple matter of sending an email or making a phone call. It can mean travelling long distances on damaged roads with limited transportation options, just to restock a health facility or community health workers. Meanwhile, patients wait.

The “last mile”: an often invisible challenge

In Cameroon, transporting malaria commodities to remote communities remains one of the weakest links in the health supply chain. What health actors refer to as “the last mile” — delivering medicines and supplies to the most remote areas — continues to be a major bottleneck affecting access to malaria treatment.

In many health districts, stock-outs are frequent, both in health facilities and among community health workers. These shortages complicate timely malaria treatment, especially for children and populations living far from urban centers.

In the East Region, Indigenous Baka communities are particularly affected. Geographic isolation, poor road conditions, logistical constraints and limited communication infrastructure all contribute to the difficulty of maintaining regular supplies.

Understanding the bottlenecks before proposing solutions

In May 2024, Cameroon’s National Malaria Control Programme (NMCP), in collaboration with Impact Santé Afrique, conducted an assessment to document key bottlenecks affecting the malaria supply chain in Cameroon. The goal was not only to identify stock-outs, but also to understand where and why disruptions were occurring: coordination gaps, delays in validation processes, challenges in transmitting orders, weak monitoring tools, transportation constraints, and incomplete information flow between different levels of the health system.

A few months later, in October 2024, stakeholders involved in the supply chain — including Ministry of Health officials, NMCP teams, regional actors and technical partners — gathered for what was described as a “system in the room” workshop.

Using a participatory approach, participants mapped every stage of the supply chain, from procurement requests to the delivery of commodities at health facility and community level. Each actor was able to explain their role, their operational realities and the challenges they face on a daily basis.

The discussions also highlighted an important point: stock-outs are not always caused by a lack of medicines. They can also result from administrative delays, coordination challenges or weak information sharing between different actors.

Bringing coordination back to the center

Among the key recommendations that emerged from this workshop were the revitalization of coordination mechanisms among supply chain stakeholders and the strengthening of logistics management tools.

In this context, Impact Santé Afrique (ISA) and the Directorate of Pharmacy, Medicines and Laboratories (DPML) collaborated on the development of a draft ministerial decision for the establishment of the National Health Products Coordination Platform.

On March 19, 2025, the Minister of Public Health signed Decision No. 0412 establishing, organizing, and governing the National Health Products Coordination Platform in Cameroon. The platform operates under the authority of the Minister of Public Health and is mandated to:

• Ensure continuous coordination among stakeholders of the National Supply System (SYNAME) and regularly update the mapping of these stakeholders;
• Promote the rational management of health commodities and the optimal functioning of the logistics management information system;
• Monitor the implementation of recommendations arising from health product quantification exercises conducted by various health programs and projects;
• Oversee the execution of supply plans and commodity redistribution plans;
• Support, in collaboration with relevant institutions, advocacy efforts aimed at mobilizing financial resources for the procurement and management of health products;
• Identify risks affecting the supply chain and propose appropriate mitigation plans.

ISA’s role in this process primarily involves supporting stakeholder dialogue, documenting challenges observed in the field, and facilitating discussions around potential solutions and improvement opportunities.

Digital tools to help reduce stock-outs

In 2025, the NMCP developed an online application allowing public health facilities to place orders for malaria commodities digitally. At the same time, the DPML continued assessing implementation of the Integrated Logistics Management Information System (LMIS), a digital platform designed to monitor stock levels and commodity flows across different levels of the health system.

While these activities were already included in institutional workplans, the studies and discussions conducted under the Equity Access Malaria Initiative helped maintain attention on stock-out challenges and supply chain weaknesses.

For the head of the Petit Pol health area, these changes could significantly improve day-to-day work. Through the online ordering system, she will gradually be able to submit orders directly from an Android phone, without systematically traveling to Bertoua. District-level authorities and Regional Technical Groups will be able to validate requests remotely before forwarding them to the regional structures responsible for delivery.

The objective is to reduce delays, limit risky travel and improve the availability of malaria commodities in remote communities.

Beyond logistics: a question of equity

Behind supply chain discussions lies a broader issue: equitable access to healthcare.

When a health facility experiences malaria stock-outs in a large city, alternatives may exist nearby. But in remote localities like Petit Pol, a shortage can mean days without treatment. And for families living far from health facilities, every delay matters.

Ultimately, the issue is not only about stock management. It is also about the ability of the health system to reach all populations — including those living in the most difficult-to-access areas.

Article written by Gildas NDJOME

Impact Santé Afrique (ISA)