Scott Dubin, a global supply chain and logistics specialist and convener of the Logistics Marketplace, a digital platform linking buyers with providers in health and humanitarian logistics, says weaknesses in medical distribution, rather than drug supply alone, remain a critical constraint on Nigeria’s healthcare delivery.
With preventable diseases such as malaria, tuberculosis and neglected tropical diseases continuing to pressure the system, Dubin argues that ensuring medicines reach frontline facilities reliably and on schedule is an operational challenge as significant as procurement itself. The Logistics Marketplace, backed by the Global Fund and the Gates Foundation, was established to address this gap by coordinating qualified local logistics providers and helping governments and development partners mobilise existing in-country capacity more efficiently.
Drawing on more than two decades of experience strengthening health supply chains across Africa, Dubin discusses with Business A.M’s ONOME AMUGE how improved logistics coordination could generate near-term public health gains even as enhanced structural reforms unfold. He also identifies last-mile distribution efficiency as one of the most immediate and practical levers for expanding healthcare access in Nigeria. EXCERPTS:
Nigeria spends heavily on essential medicines, yet shortages persist at frontline facilities. Where, in your experience, does the system most often break down?
Nigeria’s health supply chain is complex and decentralised, and it involves capable teams at federal, state, and facility levels who are working within real constraints. In a system of this size, shortages rarely come from one major failure. More often, they reflect smaller breakdowns that build up over time.
One common pressure point is the gap between planning and actual demand. Forecasting at the national level may be technically strong, but consumption patterns shift, enrollment changes, and outbreaks occur. When facility level data is delayed or incomplete, even solid plans can fall out of alignment with real need.
Visibility across levels of the system is another challenge. If stock information does not move quickly or is not connected, emerging imbalances may not be detected early. By the time the issue is obvious, a facility may already be out of stock.
Execution and coordination are just as important. Even when products are available upstream, getting them consistently to the point of care depends on clear roles, realistic distribution plans, and steady follow through. In large decentralised systems, small coordination gaps can translate into service interruptions.
There is also a governance dimension. When systems rely heavily on emergency reallocations or informal workarounds, accountability becomes more difficult. Strengthening predictability and transparency reduces not only stockouts, but also broader systemic risk.
Preventable diseases like malaria and TB remain widespread. How much of that burden can realistically be attributed to supply-chain failures rather than clinical capacity?
It wouldn’t be fair to attribute the burden of malaria or TB to supply chains alone. Clinical capacity, diagnostics, financing, community engagement, and health seeking behaviour all play important roles. Disease control is always a combination of factors.
At the same time, supply chains are often underestimated. A treatment protocol only works if the medicine is actually available. A diagnostic strategy depends on test kits reaching the facility. When stockouts occur, even capable clinical teams are limited in what they can do.
Logistics is not the only driver of outcomes, but it is foundational. It determines whether products move consistently through the system, whether excess stock can be redistributed before expiry, and whether facilities can respond to sudden spikes in demand.
So the disease burden cannot be pinned solely on supply chain failures. But without reliable and predictable delivery of commodities, even well designed health programs struggle to achieve their full impact.
What does ‘last-mile logistics’ actually look like in the Nigerian healthcare context, and why is it particularly difficult to get right?
Last mile logistics can mean very different things in Nigeria, depending on where you are.
In a major city, it might involve navigating heavy traffic and coordinating deliveries to dozens of facilities in a single day, while making sure documentation is completed properly at each stop. In rural areas, it can mean long distances on unpaved roads, limited storage capacity at facilities, and connectivity that is not always reliable. In some regions, security considerations add another layer of complexity.
But geography is only part of the story. Last mile logistics is ultimately about coordination. It requires accurate information about stock levels, reliable scheduling, vehicles suited to the terrain, trained personnel, and clear accountability. Products may need to move not only from warehouse to clinic, but sometimes between facilities to prevent expiry or respond to shortages.
Many deliveries do happen every day, and local teams make that possible. The difficulty lies in the scale and diversity of the operating environment. Nigeria is vast and decentralised, with very different infrastructure conditions across states. Coordinating thousands of facilities across those contexts requires strong data visibility and responsive management.
Getting last mile logistics right is less about a single truck or route and more about aligning information, incentives, and accountability so that the right products consistently reach the right place at the right time.
How does centralising and coordinating local logistics providers differ from traditional, vertically integrated supply-chain models used in public health?
In many countries, including Nigeria, public health supply chains evolved around administrative tiers and disease specific priorities. HIV, malaria, immunisation, TB, and essential medicines were often built as vertical programmes to address urgent health challenges. That approach delivered real progress and helped scale lifesaving interventions.
Over time, however, parallel structures can add complexity. Different programmes may plan and distribute slightly differently. Federal and subnational actors may each play a role. Logistics providers can be engaged separately across streams of work. None of this is inherently problematic, but it can reduce visibility across the system and make coordination more difficult.
A McKinsey analysis previously noted that Nigeria’s health system operated with nine separate supply chains and around 20 different data systems. When supply chains and information flows are fragmented at that scale, even capable teams can struggle to see the full picture or align efficiently.
Traditional vertically structured models often rely on predefined distribution pathways, managed either centrally or at subnational levels. Their strength is clarity of control. The trade off is flexibility. When demand shifts, emergencies occur, or capacity varies by geography, fixed channels can be slower to adapt.
A coordinated provider model takes a different approach. Instead of treating each pipeline as separate, it maps and organises the broader ecosystem of local logistics providers. It makes capacity more visible and easier to activate. Buyers can match the right provider to the right task based on geography, capability, and performance, rather than relying on a single predefined pathway.
The objective is not to dismantle existing systems. It is to reduce fragmentation, strengthen competition, and introduce flexibility within established structures. In a large and decentralised country, coordination becomes just as important as structure. When providers are visible and engagement is streamlined, the system is better positioned to handle both routine delivery and unexpected shocks.
Nigeria is a large, decentralised federation. How does fragmentation across states complicate medical logistics, and how can platforms like yours address that?
In Nigeria’s public health system, different levels of government play active roles in supply and logistics. Some commodities are managed federally, while states procure, store, and distribute many essential medicines through their own systems. That structure reflects the country’s federal design, but it can result in a patchwork of processes across programmes and states, each with its own workflows and information needs.
With that level of decentralisation, teams often end up identifying and engaging logistics providers independently. That takes time and effort. It also requires technical expertise to assess capacity, size contracts appropriately, and manage performance across regions.
What platforms like the Logistics Marketplace aim to do is reduce that friction. By making provider capacity visible in a structured way, across geographies, programmes and tiers can access a shared view of available services. Instead of building separate contact lists or running disconnected engagement processes, teams can search by capability and coverage and move through a more consistent approach.
Importantly, this does not remove local autonomy. States and programmes still make their own procurement and contracting decisions. The platform simply lowers the operational burden and improves visibility. In a system with many actors and overlapping responsibilities, shared infrastructure for engagement can strengthen coordination without centralising control.
You have worked across multiple African health systems. What distinguishes Nigeria’s logistics challenge from those of smaller or less complex markets?
Many of the underlying issues are similar across countries. Coordination across tiers, infrastructure gaps, funding constraints, and the need to balance speed with reliability are common themes. What distinguishes Nigeria is scale and diversity.
The country operates at a level of volume, geographic spread, and institutional complexity that few markets match. Within one national system, you have dense urban centres, remote rural communities, riverine areas, and regions affected by insecurity. Logistics models that work well in one setting may not translate easily to another. That requires flexibility in fleet types, routing strategies, and coordination structures. In many ways, it is not one operating environment, but several.
At the same time, Nigeria has a significant advantage. There is depth in the private sector logistics ecosystem. Industries such as oil and gas, manufacturing, and retail have driven the development of capable local firms with technical expertise and operational experience. That creates room for competition and innovation in a way that smaller markets sometimes cannot replicate.
So the challenge is not a lack of providers. It is how to coordinate and activate that capacity efficiently within a complex federal structure. When that alignment improves, the potential upside is considerable.
What role do local private-sector logistics providers play in your model, and how do you ensure quality and accountability at scale?
Local private sector providers are central to the model. The starting point is simple: capable firms already exist in the country, but many of them are not visible to the full market. Smaller or regional providers often access large contracts only as subcontractors, which limits their exposure and sometimes their margins.
The Logistics Marketplace is designed to make that capacity easier to see. In some ways, it functions like a structured directory. It does not certify providers or replace due diligence. Instead, it standardises how information is presented so buyers can compare capabilities more easily and make informed decisions.
Providers create and maintain their own profiles, and buyers remain responsible for procurement and contracting. What changes is the level of transparency. Coverage areas, assets, cold chain capacity, and service offerings are visible in a consistent format. Engagement happens in a more structured environment rather than through informal networks.
At scale, transparency and competition reinforce accountability. When information is clearer and markets are more open, capable local firms can compete directly. That strengthens resilience and reduces overreliance on a small number of intermediaries.
How do you balance speed and reliability, especially in rural or hard-to-reach areas where infrastructure is weak?
In public health, reliability has to come first. In a well functioning system, most products should already be where they need to be. Facilities should not depend on urgent deliveries just to avoid stockouts.
When emergency shipments become routine, it usually signals that something upstream needs attention, whether forecasting gaps, delayed procurement, or weak coordination. Speed matters in genuine crises, but day to day stability is what protects patients.
In rural or hard to reach areas, that stability depends heavily on planning. Roads may be poor, weather can disrupt access, and security conditions can shift. A resilient system builds buffer stock, realistic delivery schedules, and flexibility into its design rather than relying on just in time logistics. There will always be moments when rapid response is necessary. Outbreaks and unexpected spikes in demand do occur. But the broader objective is to reduce how often those emergency responses are needed. A predictable system creates confidence for providers and patients alike.
What are the most common misconceptions policymakers have about fixing medical supply chains?
One common assumption is that supply chain challenges can be resolved by adding more resources to the existing structure. More trucks, more staff, more funding. In some cases that helps, but often the constraints are structural rather than purely operational.
The way responsibilities are distributed, how information flows, how providers are engaged, and where coordination sits within the system all shape performance. If those fundamentals are not aligned, simply expanding capacity does not address the root cause.
Another misconception is that logistics is a back office function. In most competitive industries, logistics is treated as a strategic capability because it directly affects reliability, cost, and performance. Health systems do not always approach it with that same level of strategic focus.
There is also a tendency to prioritise short term fixes because the results are visible and politically important. Quick improvements matter. But long term gains often come from less visible reforms, such as improving transparency, strengthening coordination mechanisms, and investing in prevention rather than reacting only when stockouts occur.
The shift is not about replacing government leadership. It is about modernising how logistics is organised so governments can focus on oversight and outcomes, while execution becomes more efficient and predictable.
With health budgets under pressure, how do you make the economic case for investing in logistics coordination now rather than later?
The economic case is stronger than many people realise.
Nigeria carries the heaviest burden of neglected tropical diseases in Africa, accounting for roughly a quarter of cases on the continent. WHO data suggests around 165 million Nigerians require preventive treatment for at least one NTD. Deloitte has estimated that if elimination targets are met by 2030, the country could unlock approximately 18.9 billion dollars in productivity gains between 2023 and 2030, along with an additional 5.8 billion dollars in freed caregiver time. They also projected up to 7.2 billion dollars in lifetime earnings losses for school age children if infections remain untreated.
Those figures are not primarily about procurement. In many cases, treatments are donated or externally funded. The question is whether they consistently reach communities, particularly in rural areas, and whether distribution systems can support large scale campaigns without delay or wastage.
When medicines remain in central warehouses, arrive late, or require repeated emergency shipments, the economic cost compounds. Investing in logistics coordination is not an added luxury. It is a structural efficiency reform. Compared to the potential productivity gains, the cost of improving coordination and provider engagement is relatively modest.
Reliable logistics protects both health outcomes and economic performance. Under budget pressure, that return on investment becomes even more relevant.
Looking ahead, what metrics should Nigeria be using to judge whether its health supply chain is actually improving?
If Nigeria wants to assess whether its health supply chain is improving, the most meaningful indicators are those that reflect what happens at the point of care.
Operationally, that includes lower stockout rates, stronger order fulfilment, and closer alignment between supply and actual demand. It also means facilities are stocked according to plan rather than relying on emergency redistribution. These kinds of measures show whether the system is becoming more predictable and less reactive.
From a citizen perspective, the picture is even simpler. Improvement means a patient does not have to visit multiple facilities to find a medicine. It means treatment is not interrupted because a commodity is unavailable. It means healthcare workers consistently have what they need to deliver care safely and effectively.
In many private sector industries, performance is judged by availability and reliability. Public health supply chains should aim for the same standard. When medicines are consistently available at the point of care and continuity of treatment improves, that is a clear sign of progress.
Ultimately, a well functioning supply chain should be almost invisible to the person receiving care. If what they need is there, consistently and without disruption, the system is doing its job.
If you had to prioritise one logistics reform that Nigeria could implement in the next 12 months, what would it be and why?
If I had to prioritise one reform, it would be a disciplined, system wide mapping of performance and cost, followed by transparent publication of those findings.
Before introducing new structures, outsourcing models, or technology platforms, there needs to be a shared understanding of how the current system is performing end to end. What are the true logistics costs across tiers? Where are stockouts most frequent, and why? How long does it actually take for commodities to move from central stores to facilities? Where is capacity underused, and where is service falling short?
Performance should not be assessed only through internal operational indicators. It should also reflect what citizens experience. How far are patients travelling to access medicines? How often are they asked to return because products are unavailable? Are treatments interrupted due to distribution gaps? Those outcomes are directly tied to logistics design.
Without that baseline, reform becomes difficult to target. Once cost, service levels, and patient level impact are clearly mapped, decision makers can make more informed choices. In some areas, coordination improvements may be sufficient. In others, redesigning contracting models or engaging different providers may improve value, even if the cost structure changes.
The goal is not simply to reduce expenditure. It is to understand the relationship between cost and performance. Transparent data allows policymakers to weigh trade offs openly and decide where improved service justifies investment.
In a large and complex system, clarity is the foundation. Everything else follows from that.
