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[DATE][SPEAKERS NAMES]

The 6th Global Health Supply Chain Summit

November 18 -20, 2013Addis Ababa, Ethiopia

 

Seeking the Transformative in Supply Chains for Public Health: Informed Push as a Case Study

Ellen T. TompsettSr. Programme Officer, Reducing Stockouts

Addressing challenges of data capture and trained HR

Producing dramatic results – Zimbabwe & Mozambique

Dramatic results – Nigeria and Senegal

Zimbabwe

Alan BornbuschPublic Health Adviser

DTTU – The Basics

Truck loaded with products; quantities based

on previous quarter consumption data

Truck drives with stock to facility

DTTU team calculates consumption and stock

on hand; tops up to maximum stock level

Product availability > 95%Facility coverage > 98%

Cost effectiveness

8

Cost Drivers

Scalability

10

Sustainability

Mozambique

Wendy ProsserProgram Manager

Dedicated Logistics System (DLS) streamlines vaccine distribution

13

DistrictStorage

ProvincialStorage

Health Centers

1. Leave provincial level with:

- medical supplies - equipment, parts - information

3. Return to provincial level office:- input data- analyze information- address problems- prepare for next trip

2. Site visit (in coordination with district level):- record & stock inventory- service equipment- supportive supervision- collect data

Level jumping * Task shifting * Data use * Optimized transport loops * Supportive supervision

DLS is more cost-effective and efficient than diffused distribution

14

$5.03 - - - - - - - - Cost per child vaccinated - - - - - - - $6.07$1.18 - - - - - - - - Cost per dose delivered - - - - - - - $1.50

DLS province in Mozambique Non-DLS province in Mozambique

17% more cost-effective 21% more efficient

Pilot resulted in 93% coverage rate for all childhood vaccines

54%

10%

16%

20%

27%

48%

8%

17%

27%

Process to sustainability and to scale

15

2006: Expansion to one more province

2002: One province

2011: Operating in four provinces

2015 ???

Poor quality of data collected at

health centers

Insufficient use of data for

decision-making

Root causes of the challenges to reach sustainability

16

Lack of dedicated and accessible funding stream

Insufficient commitment to consistent

implementation

Lack of alignment with national

priorities

Insufficient capacity and motivation to

use data

Insufficiently trained & managed distribution team

Budget shortages (fuel, per diems, vehicle and cold chain

maintenance and repairs)

Lack of dedicated and available

vehicles

Insufficient personnel for fully implementing DLS

Poor Vaccine Supply Chain Performance

FundingLeadership

Human Resources Transport

Poorly managed vehicle fleets and

maintenance systems

Implementation Issues

Environmental Factors

Inconsistent Implementation

of DLS

Data

Senegal

Leah HasselbackProject Director

Informed Push Model

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Pull flow with orders Informed Push Model: push flow without orders

3PL

Orders

Product retrieval

Difficulties encountered

Delivery

Proceeds recovery

Regional Supply Pharmacy

SDP

Regional Supply Pharmacy

District

SDP

▪ Systematic delivery to restore stock levels

▪ Order-delivery form signed with proceeds to recover and quantity of delivered products

▪ Payment for quantities consumed (not quantities delivered)

▪ Margins maintained

Information▪ Retrieve

products with own means (e.g., rental, taxi)

▪ Poor forecasting of needs

▪ Cash flow problems

▪ Etc.

District

Scalability and Sustainability

19

6-month pilot in 2 districts. Expansion to cover the regions of Dakar (12/12), Kaolack (1/13), and Thiès (4/13). Saint-Louis managed by PNA.

Explore the integration of other products, PNA management test, sustainability planning.

Expansion to the regions of Diourbel, Fatik, Kaffrine, Matam, Louga.

Adopted as national FP strategy and MoH requested national expansion. Decision for PNA to sustain the system.

Full integration of the model in the health system. All regions managed by the PNA.

2012 – July 2013

Geographic Coverage

August 2013 – July 2014

August 2014 – July 2015

August 2015 – July 2016

IPM managed by the PNA

Region covered by IPM

Expansion to the regions of Tambacounda, Ziguinchor, Sechiou, Kolda, Kedougou.

PNA takes over management of Dakar, Kaolack Thiès.

Sca

ling

Sus

tain

ing 559 SDPs 1000 SDPs

1367 SDPs

Costs & Sustainability

Cost Recovery Model• Total estimated annual

costs at scale for family planning: $500,000

• Total expected annual costs recovered at scale: $1,040,000

• Division of Reproductive Health and Child Survival to commit 50% of cost recovery ($520,000) to IPM logistics costs

Open Questions• 3PLs in rural regions?• PNA to manage 3PLs?• Cost of PNA

management?• Cost of integrating other

products?– Other finance sources:

program fees, high margin products, line in state budget, donors

• Cost-effectiveness analysis of the IPM

Nigeria

Emmanuel Ogwuche

Direct Delivery and Information Capture (DDIC) Model

Increased product availability

Visibility in the supply chain

Health workers focused on providing services

Logistics data available for decision making

Improved Commodity Availability in Ebonyi

Period1

Period2

Period3

Period4

Period5

AL 1x6 77.05% 1.64% 0.93% 1.52% 0.49%

AL 2x6 78.69% 1.64% 2.80% 3.03% 2.46%

AL 3x6 78.69% 1.64% 2.80% 5.56% 3.94%

AL 4x6 77.05% 1.64% 1.87% 1.52% 1.48%

RDTs 80.33% 1.64% 2.80% 5.05% 2.46%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

Pe

rce

nta

ge

Sto

cko

ut

Malaria Commodities

Scalability

• Scaled from 61 to 204 health facilities in 4 runs in Ebonyi• Scaled from 79 to 116 health facilities in 2 runs in Bauchi. Will reach 165

HF’s in November 2013• In 2014 will scale up to 2 additional states and Federal Capital Territory

Cost-Effectiveness Study 2014

• Questions– Can the DDIC effectively ensure the delivery of

commodities to facilities, as well as effectively capture key commodity availability information?

– Is the DDIC system affordable?

• Strategy– Data Quality Audit– Costing survey to include average cost effectiveness:

• Total annual costs

• Total annual operating costs

– Compare multiple distribution models in Nigeria including DDIC

– Compare across states and within states

Country Ownership/Sustainability

• Engagement with Nigeria government at all levels

• Use of public sector personnel as DDIC Team Leaders

• Collaborative efforts with various agencies in the country

• Integrating commodity distribution for different health programs