Managing Change and Disruption in Healthcare Supply Chains: A Case Study Example

Context

This case study is based on practical guidance shared during Health Procurement Africa’s (HPA) Ask the Expert webinar on managing change and disruption in healthcare supply chains. The session was delivered by HPA procurement experts, drawing on experience from Nigeria and the UK to explore how organisations can prepare for, respond to, and recover from supply chain disruption.

Watch the full Ask the Expert webinar recording here.

Introduction

Healthcare supply chains are international, extended, and complex — characteristics that make them highly vulnerable to disruption. Conflicts, pandemics, climate events, regulatory shifts, and supplier failures can all interrupt supply. Effective disruption management operates across three levels: preventive and contingency actions to manage known risks; recovery plans for when contingency measures prove insufficient; and lessons-learned processes to build lasting resilience.

Supply chain mapping is a critical preparedness tool: identifying all players across the supply chain, the borders which goods cross, transport routes, and the points at which specific risks could materialise. What-if scenario planning and stress testing — simulating conflicts, weather events, or supplier failures — allow organisations to assess vulnerability before disruption occurs.

Case Application: Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria

The NCDC manages Nigeria’s strategic stockpile of medical countermeasures — medicines, diagnostics, PPE, infection prevention and control equipment, and laboratory supplies — for preparedness and response to public health emergencies. The supply chain operates under conditions of unpredictable demand, uncertain supply, regulatory barriers for biological and diagnostic products, and the need to respond to multiple simultaneous hazards.

The NCDC’s approach is risk-based and intelligence-driven. Epidemic intelligence — gathered from affected communities and local governments through emergency operations centres — feeds into a multi-functional risk assessment covering surveillance, laboratory capacity, supply chain readiness, and commodity availability. This informs an annual quantification and supply plan, reviewed quarterly and more frequently during outbreaks. Hotspot mapping enables strategic prepositioning of stock ahead of seasonal peaks. A risk calendar disaggregates expected demand by period, guiding when to procure, when to preposition, and when to scale up or down.

Case Study 1: COVID-19 — Global Supply Disruption

When COVID-19 hit in 2020, the NCDC was less than two years old and had minimal storage capacity (approximately 200 square metres). Borders closed, global PPE demand surged, local supply was absent, importation was difficult, and lead times were unpredictable. Health facilities, treatment centres, and frontline workers required immediate support.

The response combined emergency partner engagement, offshore sourcing, and domestic production. The organised private sector converted textile factories to produce simple PPE locally — though quality assurance became a significant challenge, requiring product demonstration and inspection by subject matter experts before acceptance. Storage was expanded tenfold to approximately 2,000 square metres. Development partner stockpiles and long-standing supplier agreements were leveraged. The experience established the NCDC’s strategic stockpiling approach and strengthened its offshore sourcing capability, which has since been replicated across other emergency responses.

Case Study 2: Cholera 2021 — Regulatory Barriers to Emergency Sourcing

An unprecedented rise in cholera cases in 2021 — the highest in five years — rapidly exhausted national stocks of IV fluid (Ringer’s Lactate solution). Local manufacturers could not meet the surge. International sourcing was the only option, but domestic protection policies and regulatory restrictions on importation of this product created additional barriers alongside the logistical challenges of a bulky, high-freight-cost commodity.

The NCDC engaged at executive level to secure regulatory waivers and exemptions. A development partner’s long-standing agreement with a manufacturer in India provided the supply route: because the procurement framework was already in place, the NCDC only needed to secure funding and arrange importation. The emergency use pathway established by the Food and Drug Agency was critical to navigating the regulatory barrier quickly. The lesson: relationships and plans built outside of emergencies determine what is possible within them.

Case Study 3: Lassa Fever — Supplier Exit and Minimum Order Quantities

Lassa fever is endemic in Nigeria, accounting for approximately 90% of global cases annually. Demand is highly predictable and grows as surveillance strengthens. For years, a local supplier provided the antiviral medication (ribavirin) at short notice. When that supplier exited the market, the NCDC sought global alternatives — only to find that international production had halted due to uncertainty about the product’s inclusion on the global essential medicines list. No manufacturer was willing to produce at the quantities Nigeria alone could justify.

This case reinforced a key principle: sometimes resilience means ensuring that a single supplier does not exit the market. Earlier supplier relationship management — understanding the viability challenges they faced — might have secured local supply continuity.

Lessons Learned

• Recovery plans are as important as contingency plans — and less commonly in place. Organisations need defined emergency team structures, clear responsibilities, and communication protocols for disruptions that exceed pre-planned responses.
• Supply chain mapping and scenario planning identify vulnerabilities before they become crises. Identifying single points of failure, border dependencies, and transport risks allows preventive action while options remain open.
• Strategic stockpiling has a cost, but the cost of not holding stock is greater. The NCDC accepts expiry risk as a manageable trade-off against the risk of stockout during a public health emergency. Cross-hazard repurposing of commodities reduces waste.
• Relationships and pre-existing agreements determine what is achievable under pressure. In both the cholera and COVID-19 cases, access to supply depended on partnerships and frameworks built before the emergency.
• Demand pooling increases leverage and unlocks supply. Aggregating requirements regionally — across countries or programmes — can meet minimum order quantities that no single organisation could justify alone.
• Disruptions are opportunities to build permanently better systems. The reactive phase reveals weaknesses; the recovery phase is the moment to embed structural improvements rather than return to the status quo.

Conclusion

This case study demonstrates that managing disruption in healthcare supply chains requires preparation at all three levels: preventive action, contingency planning, and recovery. Nigeria’s NCDC experience across COVID-19, cholera, and Lassa fever illustrates that no two disruptions are the same — global competition, regulatory barriers, and supplier exit each demand a different response. What is consistent across all three is the value of intelligence-driven planning, pre-built relationships, strategic stockpiling, and a commitment to learning from each disruption to build supply chains that are more resilient the next time.