“The better prepared we are, the more efficient the response”: an interview with Enock Foster from the Government of Malawi

In March 2023, cyclone Freddy brought devastation to a country already facing its worst cholera outbreak in two decades. The disaster claimed thousands of lives and left millions of people in need of urgent assistance.??

Extreme weather events, such as Freddy, are projected to become more frequent and severe in Malawi in the coming years making the country more vulnerable to climate-related disasters like flooding. To help prepare the country, WFP is partnering with the Government to implement an ambitious emergency supply chain preparedness plan with the support of partners such as Takeda Pharmaceuticals. We talked to Enock Foster , Branch Manager at the Central Medical Store Trust (CMST) – the logistics arm of the Ministry of Health – to understand how some of these preparedness measures are helping the country cope with recurring disasters.?

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How long have you been working for the CMST??

I have been working for the CMST for over 10 years. I joined as a pharmacist-in-charge, responsible for warehouse and inventory management. My job was to monitor and replenish the stocks of medicines that are provided to public health facilities across the country. I then became the Branch Manager, overseeing one of the CMST’s warehouse operations. I look after 28 staff members and we are responsible for providing health supplies to nine districts and one central hospital in our area. My responsibilities are broad and include budgeting, compliance, operational planning, staff training and development. I also advise the CMST’s executive management and report on the risk of running out of stocks of medicines or other supply chain-related issues.??

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Why are preparedness efforts so important???

Preparedness means that you are ready to face any kind of disaster. It gives you the confidence that you’ll know what to do when a disaster strikes - that’s especially important in disaster-prone areas such as those we work in here in Malawi. Preparedness helps to reduce the damage to people, livelihoods and infrastructure. When it comes to disease outbreaks, it means responding more efficiently to avoid an escalation of the number of cases and further spread of the disease.? At the end of the day, disasters will continue to happen, they can’t be avoided, so what’s important is to carefully prepare for them.??

You participated in two Supply Chain Simulation Exercises co-hosted by the Ministry of Health (MoH), Department of Disaster Management Affairs (DODMA) and WFP in 2022 and 2023. What were your impressions???

An immersive and interactive simulation exercise simulates the response to an emergency. The two SimEx organized were fictional, but they felt real – I felt like I was dealing with a real disaster. I was taken by surprise and pushed out of my comfort zone. That’s the best way to practise and to learn.??

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What did you take away from these exercises and how did they impact your work??

In every disaster, communication and coordination between stakeholders is key. You can’t respond alone; you need to understand the role of other stakeholders and work with them to ensure an efficient response. It’s important to define clear roles and responsibilities to avoid duplicating activities and wasting resources. In Malawi for example, many stakeholders are responding together, including the MoH, DODMA, the Water Sanitation Hygiene (WASH) Cluster led by UNICEF and of course the CMST. During an emergency, the CMST is responsible for consolidating the list of relief items needed for the response and for making sure that emergency supplies are delivered to all disaster areas. Since the SimEx, we’ve established coordination meetings with other stakeholders, such as UNICEF, and this has really improved communication.??

The need to preposition stocks is another key learning from the SimEx. During the last cholera outbreak, there was not enough stock available and the number of cases quickly escalated. Prepositioning medicine and other health supplies in the south would have prevented this escalation. Some medicines used to treat cholera are also used for the treatment of other conditions, such as diabetes. You don’t know when disaster is going to strike, or where, but you can stockpile key supplies. Prepositioning is still a challenge in Malawi today, especially as some commodities have short shelf lives. There are also regulatory and budgetary issues, but this is something we are working on.??

Finally, we’ve also improved the way we manage information and use data for decision-making. We’ve started monitoring our stock levels using the dashboards produced by the MoH with WFP’s support. The SimEx helped us to understand which information was available and how we could efficiently use it. These dashboards are incredibly helpful to ensure that treatments are available when and where needed, especially when the rainy season starts every year and increases the risks of flooding and disease outbreaks. ?

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What were the main differences between the two Simex you joined??

I joined the first SimEx as a participant and the second one as a facilitator. As a facilitator, I was able to help design the scenario. The first SimEx involved a small group of people, while the second one included a wide range of organizations. It took place right after the end of the cholera outbreak in August 2023 so it gave us an opportunity to reflect on what could have been done better.??

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The SimEx were organised at the Humanitarian Staging Area (HSA) in Bangula, Nsanje District, in the south of the country. Why is this location relevant???

The fact that the SimEx happened in the south of Malawi made it feel more real – this is where the risk of floods is the highest. The HSA is also a key location: past real emergency responses were run from there. It was established in 2021 and it’s a great asset to reduce the response time in emergencies because it offers storage facilities to preposition supplies while also providing training facilities. The SimEx started in the city of Blantyre but suddenly we were taken by bus to another city and before we knew it, we were at the HSA, working around the clock for a full week to plan and implement the response. We even jumped on motorcycles and boats to go visit a couple of health facilities – including a facility that had been badly affected by cyclone Freddy. This made it all more real.??

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What would you say to countries or communities who are interested in organizing their own SimEx in the future??

My recommendation to the Governments and countries who are considering conducting a SimEx: go for it. It’s important to plan carefully as it is costly, but it’s worth it. It’s also crucial to involve as many stakeholders as possible from all organizations in charge of the response. The design of the SimEx should be done in a way that participants are taken by surprise. They shouldn’t know what they are going to experience. That’s why it’s better to conduct a SimEx in a disaster-prone area to make it feel real and relevant.??

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What should happen next in your opinion??

For me, the next step in Malawi is to continue engaging as many stakeholders as possible and to deliver a policy to institutionalise the recommendations from SimEx.

I want to draft key recommendations for the CMST’s executive management. I also think it would be useful to conduct more SimEx in other disaster-prone areas of the country. If there is an opportunity to attend another SimEx, I will be available.?

Supply Chain has been the backbone of WFP’s operations for over six decades positioning WFP uniquely to support humanitarian and development actors with supply chain services across sectors. To learn more about how the World Food Programme is partnering to strengthen health supply chains in Malawai click here.