Keeping the Shelves Stocked: Designing HIV, TB and Malaria Commodity Supply Chains That Survive a Funding Shock

For years, the pallets simply arrived. Antiretrovirals, rapid diagnostic tests, antimalarials, all procured somewhere far away and delivered to the central medical store as an in-kind donation, complete with the forecasting and logistics that put them there. For a supply-chain manager, the donor did not just pay for the commodities. It quietly ran the machine that moved them.

That is what makes the current moment different from a budget cut. The main US-funded global health supply mechanism, which spent $1.15 billion in 2024 on donated commodities and technical assistance across 73 countries, is scheduled to be terminated by 30 May 2026 without a clear transition plan. For a national programme, the task is no longer replacing a line item. It is rebuilding an operating system while the medicines still have to reach the shelf.

That work has an order to it. Understand what a donor-run chain actually removes when it leaves, protect the pipeline for the commodities that cannot lapse, hold forecasting together while the data is unstable, and transition deliberately towards a national system built to absorb the next shock rather than shatter on it.

Why a donor-run supply chain fails differently from a donor-funded programme

When a donor funds a programme, its withdrawal leaves a funding gap you can, in principle, fill with other money. When a donor operates your supply chain, its withdrawal removes the machine itself: the forecasting, the international procurement, the warehousing, and the last-mile delivery that together put a box of medicine in a clinic. Money alone does not rebuild that overnight.

This distinction matters because of how the replacement is being discussed. Much of the conversation has centred on shifting procurement to pooled mechanisms such as the Global Fund's wambo.org platform, which primarily handles purchasing and has not historically provided the warehousing and last-mile logistics that a full supply chain requires. A pooled-procurement platform can replace the buying. It does not, on its own, replace the pipeline. The gap that actually causes a stock-out is the logistics layer, and that is precisely the part a purchasing platform leaves untouched.

The consequences of underestimating this are already measurable. By April, 65% of National Tuberculosis Programmes in Africa reported negative impacts, nearly 30% of malaria chemoprevention campaigns intended to protect 58 million children were off-track, and by early June more than 60,000 people were estimated to have died following disruptions to HIV treatment. These are not procurement statistics. They are the human cost of treating a supply chain as a purchase order rather than a system.

What to protect first: continuity of the commodity pipeline

Before redesigning anything, protect the flow of the commodities whose absence causes irreversible harm. Antiretrovirals, TB medicines, and antimalarials sit at the top of that list, because a treatment interruption for a patient already on therapy carries a clinical cost that no later restocking can reverse. Map where the pipeline for these is thinnest, and defend those points first.

The organising principle is the same one that governs any triage: protect by irreversibility, not by volume or visibility. In supply-chain terms that means knowing your months-of-stock position for each critical commodity, identifying which items are closest to stock-out, and holding a rational buffer at the points where resupply is least certain. A buffer is not hoarding. It is the deliberate slack that keeps a fragile pipeline from snapping at its weakest link.

There is a second failure mode that a shock makes worse, and it runs in the opposite direction. When demand data is disrupted and procurement is uncoordinated, expiries spike alongside stock-outs. Malawi's transition illustrates the risk vividly: the country faced 37,000 vials of a long-acting HIV prevention product expiring in May 2026 even as it worked to secure supply elsewhere. Holding the pipeline together means matching stock to real consumption in both directions, which is only as good as the forecasting behind it.

Forecasting and quantification when the data is disrupted

Sound forecasting rests on consumption data, and a funding shock corrupts exactly that: when services are interrupted, staff are lost, and reporting lapses, the numbers you would normally forecast from stop reflecting real demand. The immediate task is to keep a functioning logistics management information system alive so that decisions rest on the best available data rather than on guesswork.

This is less about new technology than about disciplined use of what already exists. A recognised body of supply-chain practice points to a small set of high-value functions worth protecting through a transition: forecasting, a working logistics management information system (LMIS), support supervision, and warehousing and distribution. Where formal systems are strained, low-cost methods can carry real weight. A supply-chain strengthening project in Uganda kept HIV commodities moving through practical measures that any programme can recognise:

• Routine stock-level monitoring at facility level, so shortages are seen before they become stock-outs.
• Mentorship and support supervision, keeping skills and data quality from decaying when experienced staff leave.
• Spatial visualisation of stock indicators, making it obvious where shortages are clustering geographically.
• Simple order reporting from the field, including photographs of order forms submitted over messaging apps where connectivity is limited.

None of these depends on a donor-run platform. Each keeps the data flowing that everything downstream relies on, and each is within reach of a national or provincial team operating under budget pressure.

Transitioning from a vertical donor chain to an integrated national one

The endpoint of this work is a supply chain owned and run nationally, with donor-procured commodities integrated into the existing system rather than moving through a parallel one. Malawi's response points the way: alongside expanding community-based service delivery, the government began developing a plan to move HIV commodity warehousing and distribution to its Central Medical Stores Trust. A parallel chain collapses when its parallel funding stops. A chain built inside the national system is far harder to switch off.

The risk to manage is not transition itself but abrupt, unplanned transition. Advocates monitoring the supply-chain wind-down have been explicit that any handover must be deliberate and transparent, centred on continuity of care, with enough time to vet new partners and avoid the procurement failures that haunt rushed transitions. The lesson for a national programme is to sequence the change on its own terms wherever possible: secure the new warehousing and distribution capacity, test it against real volumes, and shift commodities across in a controlled way rather than in a single leap dictated by an external deadline.

There is also a planning window that will not stay open. The current US posture commits to covering the full cost of HIV, TB, malaria, and polio commodities through fiscal year 2026, with reductions after that. That commitment is best read not as reassurance but as a countdown: the interval in which to build the domestic financing lines, procurement relationships, and logistics capacity that the following year will demand.

Building a shock-absorbing supply chain: resilience as design

A resilient supply chain is one designed on the assumption that any single source can fail. In practice that means more than one procurement channel for critical commodities, membership of pooled mechanisms where they add genuine value, a domestic budget line that funds at least the core of the essential-medicines list, and enough data visibility to see a shortage forming weeks before it arrives. Resilience is an architecture, not a stockpile.

The components reinforce one another. Multi-sourcing reduces exposure to any one supplier or donor. Pooled procurement can lower unit costs once a country has the logistics to receive and distribute what it buys. A domestic commodity budget converts the most life-critical part of the supply chain from a donated input into a sovereign one. And strong data visibility is what allows a lean system to run without large, expiry-prone buffers, because it can act early instead of over-ordering defensively. Built together, these turn a supply chain from something that a distant decision can switch off into something a national programme genuinely controls. That control is the real meaning of security of supply, and it is the foundation everything else in a health system rests on.

Frequently Asked Questions

What happens when the main US supply chain programme ends? The mechanism that handled end-to-end procurement and delivery for HIV, TB, and malaria commodities in many countries is being wound down. Procurement may shift to pooled platforms, but those do not automatically provide warehousing and last-mile logistics. National programmes need a transition plan that covers the whole pipeline, not just purchasing.

Will the Global Fund simply replace it? Not directly. Pooled-procurement platforms handle buying rather than logistics, so they replace one layer of the chain and not the whole system. Countries still need to secure warehousing, distribution, and the data systems that move commodities to facilities, whether through national capacity or other partners.

How do we prevent stock-outs during a funding transition? Protect the pipeline for irreversible commodities first, hold a rational buffer where resupply is least certain, and keep the logistics management information system running so decisions rest on real consumption data. Watch both failure modes at once, because uncoordinated transitions produce expiries as well as stock-outs.

How much buffer stock should we hold? There is no universal figure. Buffer levels are set against consumption rate, resupply lead time, and how reliable each is during the transition. The more uncertain the resupply, the larger the justified buffer, balanced against the expiry risk of holding too much of a short-dated product.

Key Takeaways

The programmes that keep their shelves stocked through this transition are the ones that treat the supply chain as a system to be rebuilt, not a bill to be paid. A donor-run chain leaves more than a funding gap when it goes, and rebuilding it well follows a sequence.

• A donor-run chain removes an operating system, not just money. Purchasing platforms replace the buying; the logistics layer that prevents stock-outs still has to be rebuilt.
• Protect irreversible commodities first. Defend the pipeline for antiretrovirals, TB medicines, and antimalarials before redesigning anything else.
• Guard both failure modes. A disrupted transition causes expiries as well as stock-outs. Match stock to real consumption in both directions.
• Keep the data alive. A functioning LMIS and low-cost monitoring are what every downstream decision depends on, and both survive without a donor platform.
• Transition deliberately, not abruptly. Integrate commodities into the national system on your own timeline, and use the fiscal-year 2026 commodity commitment as a countdown to build capacity.

Rebuilding a commodity supply chain while keeping medicines flowing is demanding technical work, and the planning window is finite. This is the ground ChainOptix's Supply Chain service is built for: procurement, inventory management, and distribution of essential health commodities through exactly this kind of transition. If your team is planning its own path to security of supply, we would welcome the conversation.