Health&Humanitarian

thesupplychainreview

PhotocourtesyofVillageReach

Issue1

April2016

ProducedbyPSA,inconjunctionwiththeOxfordUniversity

InternshipProgramme

2016byPSA,ltd.AllRightsReservedReproductioninwholeorinpartwithoutpermissionisprohibited.

PrintedintheUnitedKingdom.

1

Editor'sNote

Commentsfromtheeditorial

team

Contents

SpotlightonInnovation:

PartOne

ExtremisTechnology

VillageReach

Pioneeringanewapproach

tosupplychain

management

ANDREWBROWN

ProfessionalisingHealth

SupplyChainCadres

AMustfortheSustainable

DevelopmentGoalsand

HealthEquity

12

InterviewwithPamela

Steele

Insightsandguidancefrom

anindustryleader

14

...................................................................................................................................................................................................

187Habits

ofthesuccessfulhealth

supplychainprofessional

Stayingintheloop

Usefulagenciesand

networksforthehealth

supplychainprofessional.

178

5

6

2

...................................................................................................................................................................................................

20

24

27 35 Mainstreaminggenderin

healthsupplychains

Amoderateddiscussion

InsiderInformation

5Thingsthehealthand

humanitariansupplychaincan

learnfromFMCG.

30Leadingtheway...

Takingacloserlookat

Sudan'sNationalMedical

SuppliesFund

33

CHRISWRIGHT

MakingSenseof...

SupplyChainIntegration

CommentPiecebyChris

Wright

CounterfeitDrugs

OldEnemy,newsolutions:

howinnovativetechis

leadingthefight.

ArticlebyOscarBoyd

SpotlightonInnovation:

PartTwo

TransAid

38InternalAffairs

OxfordUniversityinternsshare

theirexperiencesafteraweek

workingatPSA.

3

Health&

Humanitarian

thesupplychainreview

EDITORINCHIEF

EDITORIALTEAM

PamelaSteele

Editor

EditorEditor

YunaChang

PhilipMatthewsRossKing

HOWTOREACHUS

MAINOFFICEPamelaSteeleAssociatesLtd.

PramaHouse,267BanburyRoad,Oxford,OX27HT,UK

PHONENUMBER+44(0)1865339370

WEBSITEwww.pamsteele.co.uk

©2016byPSA,ltd.AllRightsReservedReproductioninwholeorinpartwithoutpermissionisprohibited.MagazineNameisaregisteredtrademarkof

Publisher.PrintedintheUnitedKingdom.

4

FromtheEditors

EditorialTeam

YunaChangPhilipMatthews

RossKing

SSupplyChainupplyChain

ManagementManagement.Sincethe.Sincethe

termwascoinedinthetermwascoinedinthe

1980s,ithasbecomea1980s,ithasbecomea

newbuzz-phrasenewbuzz-phraseinboth

globaleconomic

discourse,andthe

professionalmanagement

sector.Thethreewords

describeavastand

complexindustry,

comprisingthemyriad

systemsoforganisation,

people,activities,

informationandresources

involvedinmovinga

productfromsupplierto

customer.

Alltoooften,perhaps,the

termsupplychain

managementprompts

connotationsassociated

withthedarker-sideof

capitalism.Indeed,the

mostobviousfruitsof

globalsupplychainsare

coffee,cheapclothesand

therawmaterialsutilised

inmoderntechnology-the

exploitativesystems

involvedinthe

procurementofsuchitems

iswellknown.

....................................................................................................................................................................................................

However,toviewthese

aspectsastheonlysideof

globalsupplychain

managementwouldbe

misleading;infact,supply

chainmanagementplaysa

crucialroleinboththe

developmentand

humanitariansectors,

enablingpeopleinthe

developingworldtoaccess

conventionalmedicineand

othervitalresources.

Itisonthishumanitarian

aspectofthesupplychain

networkthatthispublication,

afore-runnerinitsfield,

wishestofocus.Healthand

Humanitarianisamagazine

forprofessionalsinthe

developmentsector,both

strategistsandimplementers,

seekinginformationonall

aspectsofthehumanitarian

supplychain.

OurhopeisthatHealthand

Humanitaianwillprovidea

platformforthediscussionof

thechallengesinvolvedinthe

sector,willactasabillboard

forexcitingdevelopments,and

willalsofosterconnections

betweendifferentprojectsand

parties.”

YunaChang,RossKing,PamelaSteele,PhilipMatthews(Photo:PSA)

5

Ineachedition,

‘HumanitarianSupply

Chain’takesacloser

lookattheworkof

twoorganisationswe

feelaredoing

particularlyinteresting

andeffectiveworkin

thehealthand

humanitariansector.

Theaimistobetter

understandtheir

operations,the

challengestheyface

andhowtheyare

connectedtothe

largerdevelopment

sectorsupplychain.

ThisQuarter,weare

throwingthespotlight

on…Extremis

Technologyand

TransAid.

Extremistechnologyis

aprivatesector

humanitarian

organisation,

establishedinthe

wakeofthe2010

Haitidisaster,which

seekstogive

sanctuarytodisplaced

peoplethroughoutthe

worldthroughthe

provisionofrobust,

portableshelters.The

focusisnoton

immediateaidinthe

aftermathofnatural

disaster-whether

earthquake,

hurricaneorflood-

butonproviding

reliefinthe

transitionalperiod,

betweenemergency

responseand

permanent

settlement.Water,

sanitation,education,

healthservices–all

ofthesearemade

easierandmore

possiblewithsafe,

secureandrobust

shelter,builtaround

thefamilyunit.

Extremisisaprime

exampleofhowtheSeed

EnterpriseInvestment

Schemeisbeing

harnessedtoback

innovation,andasan

exportbusinessinthe

engineeringand

manufacturingsector,

Extremisisagreat

exampleofwhatnew

businessesintheUKcan

achieve."

Chancellorofthe

Exchequer,George

Osborne

Photos:ExtremisTechnologiesImage:TheHuShsheltercanbeassembledinunder30minutes,housing4to6people.

....................................................................................................................................................................................................

Themostnotablefeature

ofExtremisTechnology

isitsgroundbreaking

approachtoproviding

shelter,designinga

rangeofrevolutionary

newformsofshelters

specificallyfordisaster

relief.Extremis

Technology’sflagship

productisthe‘Hush1’,a

portablefold-flatshelter

thatcanbeerectedin

analmostpop-up

fashionwithouttheneed

fortools,additional

partsorskilledlabour.

Crucially,theycanbe

erectedin

approximatelythirty-

minutes,ratherthan

Spotlighton:PartOne

ExtremisTechnologies

Afeaturelengthinsightintodesigninnovation

ArticlebyPhilipMatthews

6

....................................................................................................................................................................................................

takingdaysorweekstoassemble.The

shelterscanbemountedontoseismic

isolatorstoprovidesomeprotectionin

earthquakezones,andthereare

opportunitiestoaddfurthertechnologiesfor

watercaptureorenergygeneration.

ExtremisTechnologieshas,moreover,

branchedoutfromtheoriginal‘Hush1’

designtocreatethe‘Hush2’,amorerobust

sheltercapableofwithstandingcategory5

hurricanes,andalsothe‘Push’,amore

sophisticatedtemporaryaccommodation

equippedwithelectricitypanels,waste

management,atoilet,shower,bedand

worktable.

SpeakingtotheHealthandHumanitarian,

CEOofExtremisTechnologyJuliaGlenn

outlinedthedistributionprocessofthe

shelters:

“Weincreasinglyrelyonlocal

manufacturers(incountry)tomanufacture

anddistributeourHuShshelters.Thatway

wecanuselocalfactorsofproductionand

stimulateoverseaseconomies,especially

wherethisstimulationismostneeded.Our

shelterscanbetransportedonthebackofa

flat-bedlorry,andonceoffloaded,canbe

putupby3-4peopleinlessthantwo

minutes”.

TheUKChancellorGeorgeOsbornewas

quicktorealisethepotentialofExtremis

Technology,praisingtheorganisationasa

“greatexampleofwhatnewbusinessesinthe

UKcanachieve”.

Intermsofcomplementarytechnology,

ExtremisworksalongsideGravityLight,an

innovativeoff-the-gridlamp,whichproduces

lightenergysimplythroughutilisinggravity

andweight,thuseliminatingneedforthe

expensiveandpollutingkerosenelampsused

by1.1billionpeopleglobally.

Interestingly,alargeproportionExtremis

Technology’sfunding-£280,000-isentirely

‘crowd-sourced’fromcharitableindividuals,

andmuchoftherestisraisedintheformof

angelinvestment.

Ifyouwouldliketosupporttheworkof

ExtremisTechnology,onecanmakea

donationthroughtheirwebsite:

http://www.extremistechnology.com/

7

VillageReach:VillageReach:

PioneeringanewapproachtosupplychainPioneeringanewapproachtosupplychain

managementmanagementArticlebyYunaChang

....................................................................................................................................................................................................

implementthe‘Dedicated

LogisticsSystem’(DLS),anew

modelforvaccinedistribution,

bornfromacomprehensive

approachtoimmunization

supplychain(iSC)system

design,incorporatingtransport

loops,leveljumping,directdata

collectionandutilization,and

dedicatedlogisticianstocreate

amoreefficientvaccinesupply

chain.Theresultsfroman

independentevaluation

completedattheendofthe

pilotin2008revealeddramatic

improvements.TheDLSand

themanagementapproaches

accompanyingitplayeda

significantroleinthemarked

improvementinimmunization

coveragewithareductionin

vaccinestockoutsfrom80%to

regularlyabout1%permonth,

increasedcoverageofDTP-3

immunizationrisingfrom70%

to95.4%,[1]andgreatly

improvedthesupervisionand

trainingofhealthfacilitystaff.

FromitsrootsinCabo

Delgado,theDLShasbeen

rolledouttofouradditional

provinces,andcurrentlycovers

500ruralhealthcenters

servingapopulationofmore

than8million.[2]On-going

monitoringoflogisticsdata

indicatesacontinuedand

sustainedhighlevelofiSC

performancewithstockouts

regularlylessthan5%

percentacrossallprovinces.

Dr.FranciscoMbofana,

NationalDirectorofPublic

HealthinMozambique,

EmiliaAlbinoChilauleahealth

workerwhovaccinateschildrenat

clinicservedbytheDLS.(Photo:

VillageReach)

n2002,CaboDelgado

wasthefirstprovince

inMozambiquetoI

praisedtheimplementation

ofDLS,notingthatithas

madeadirectimpact(where

implemented),resultinginan

increaseinimmunization

coverageandfuelsgreater

efficiencyofthevaccine

supplychain.

NotonlyhastheDLS

improvedtheimmunization

supplychaininMozambique

whereimplemented,butit

alsohasimplicationsfora

wholenewwayofthinking

aboutsupplychainlogistics

andplanning.Keyto

[DLS]hasmadeadirectimpact(whereimplemented),resultinginanincreasein

immunizationcoverage-Dr.FranciscoMbofana

....................................................................................................................................................................................................

FeatureArticleFeatureArticle

ImmunizationataMozambiqueclinicImmunizationataMozambiqueclinic((Photo:VillageReach)

VillageReach’sinnovationis

applyingaholistic,

comprehensiveapproachto

supplychaindesign.It’snot

justaboutpatchingupholes;

it’sabouttakingthesupply

chainsystemasawholeto

solvelogisticsproblems,

utilizingan‘end-to-end

perspective'.Thisiswhere

theapproachofsystem

designcomesin.

8

VillageReach:VillageReach:

PioneeringanewapproachtosupplychainPioneeringanewapproachtosupplychain

managementmanagementArticlebyYunaChang

....................................................................................................................................................................................................

implementthe‘Dedicated

LogisticsSystem’(DLS),anew

modelforvaccinedistribution,

bornfromacomprehensive

approachtoimmunization

supplychain(iSC)system

design,incorporatingtransport

loops,leveljumping,directdata

collectionandutilization,and

dedicatedlogisticianstocreate

amoreefficientvaccinesupply

chain.Theresultsfroman

independentevaluation

completedattheendofthe

pilotin2008revealeddramatic

improvements.TheDLSand

themanagementapproaches

accompanyingitplayeda

significantroleinthemarked

improvementinimmunization

coveragewithareductionin

vaccinestockoutsfrom80%to

regularlyabout1%permonth,

increasedcoverageofDTP-3

immunizationrisingfrom70%

to95.4%,[1]andgreatly

improvedthesupervisionand

trainingofhealthfacilitystaff.

FromitsrootsinCabo

Delgado,theDLShasbeen

rolledouttofouradditional

provinces,andcurrentlycovers

500ruralhealthcenters

servingapopulationofmore

than8million.[2]On-going

monitoringoflogisticsdata

indicatesacontinuedand

sustainedhighlevelofiSC

performancewithstockouts

regularlylessthan5%

percentacrossallprovinces.

Dr.FranciscoMbofana,

NationalDirectorofPublic

HealthinMozambique,

EmiliaAlbinoChilauleahealth

workerwhovaccinateschildrenat

clinicservedbytheDLS.(Photo:

VillageReach)

n2002,CaboDelgado

wasthefirstprovince

inMozambiquetoI

praisedtheimplementation

ofDLS,notingthatithas

madeadirectimpact(where

implemented),resultinginan

increaseinimmunization

coverageandfuelsgreater

efficiencyofthevaccine

supplychain.

NotonlyhastheDLS

improvedtheimmunization

supplychaininMozambique

whereimplemented,butit

alsohasimplicationsfora

wholenewwayofthinking

aboutsupplychainlogistics

andplanning.Keyto

[DLS]hasmadeadirectimpact(whereimplemented),resultinginanincreasein

immunizationcoverage-Dr.FranciscoMbofana

....................................................................................................................................................................................................

FeatureArticleFeatureArticle

ImmunizationataMozambiqueclinicImmunizationataMozambiqueclinic((Photo:VillageReach)

VillageReach’sinnovationis

applyingaholistic,

comprehensiveapproachto

supplychaindesign.It’snot

justaboutpatchingupholes;

it’sabouttakingthesupply

chainsystemasawholeto

solvelogisticsproblems,

utilizingan‘end-to-end

perspective'.Thisiswhere

theapproachofsystem

designcomesin.

9

Aswithmanyprivatesectorapproachesto

supplychain,theDLSisbasedonefficiency.

Itusesanapproachofstreamlining,

professionalizationandcontinuous

improvementtoproducethemostefficient

supplychain.TheDLScanbecharacterized

bythreekeycomponents:

1.STREAMLINEDDISTRIBUTION

PROCESS.Thisinvolvesre-assignmentof

tasks,leveljumpingandoptimizeddelivery

routes.Supplychainmanagementfunctions

arefocusedashighupinthesupplychainas

isgeographicallypossibleattheprovincial

level,consolidatingresponsibilitiesand

focusinglimitedresources.Dedicated

logisticiansaretrainedforandtakeon

multiplesupplychainresponsibilities,

includingbasicmaintenanceofequipment

(see#3below)whichisintegratedinto

deliverytosavetimeandresources.

2.DATAVISIBILITY.Anopensource

informationmanagementsystem,OpenLMIS

(locallyreferredtoasSELV)providesreal

timedataformoreaccuratedatacollection

andutilization.Distributionisdemand-driven,

basedondelivery-levelconsumptiondata

fromhealthfacilitiesanalyzedbydedicated

logisticians.Thedataisusedforregular

follow-upsessionstoassesswhere

improvementscanbemade,which

logisticiansthenimplementinacycleof

continuousimprovement.

3.CONSOLIDATIONOFLOGISTICSTASKS.

AspecialisedFieldCoordinatordelivers

vaccinesandsupplies,repairscoldchain

....................................................................................................................................................................................................

InspectingavaccinerefrigeratorataMozambique

healthcenter.(Photo:VillageReach)

equipment,collectsandreportsdata,and

providesactiveandongoingsupportive

supervisionandtraining,allowingfrontline

healthworkerstofocusonpatientcare.

Theinfographicbelowillustrateshowkey

elementsofDLSdifferfromthemulti-tier

approachtypicalinmanylow-andmiddle-

incomecountries,andtheimpactofthese

changesonvaccineavailabilityandcostin

Mozambique’sprovinceswhousetheDLS:

10

....................................................................................................................................................................................................

DLSisnotjustastopgap

measureinsupplychain

management,asitgoesfar

beyondimprovementtoa

singlecomponentofthe

supplychain.VillageReach

hasworkedcloselywiththe

MozambicanMinistryof

Health,especiallyatthe

provinciallevel,toensureitis

appropriateforthecontextand

managedbytheprovincial

government.Originally100%

NGO-funded,theDLSnow

operatesonacost-share

modelbetweenthe

government(DPS)and

VillageReach,both

contributingtotheoperational

costsofdistribution.Although

VillageReachcontinuesto

providetechnicalsupport,

vaccinedeliveryis

government-runandmanaged,

ensuringitslong-term

sustainabilitybyallowingitto

adapttoshiftsinpolitical

realities.

BerturAlface,MedicalChiefof

GazaProvincenotedthatDLS

‘givesusmorevisibilityintothe

datacomingfromthehealth

centerswithimproved

frequency,regularity,and

quality.Andthishasmadethe

datacredible,creatingmore

confidenceinthedistribution

systemandinthegovernment

andprovidingmoreevidence

fordecision-making’.

Infact,thislevelofleadership

andownershipbyMinistryof

Healthwasoneofthekey

contributingfactorstotheDLS

winninganawardforsupply

chainexcellenceatthe2015

GlobalHealthSupplyChain

Summit.Theawardrecognized

theMinistryofHealth’s

willingnesstoquestionthe

statusquointermsofsupply

chainlogistics,anditsabilityto

drivedecisionsbasedon

evidencetoensurevaccines

areavailabletoallchildrenin

Mozambique.Fittingly,a

MinistryofHealth

representativewasthereto

accepttheawardonstage.

Changeleadershipiskeyto

thescaleandsustainabilityof

successfulinnovationslikethe

DLS.Creatinganenabling

environmentandgenerating

politicalwillforchangetakes

timeandismostsuccessful

whendrivenbychampions

ofchangeatthecountry

levelasillustratedinthe

progressionoftheDLS

expansionfrompilotto

currentday(seetimeline)

Evidence-driven,flexibleand

efficient,theDLSisan

exampleofnext-generation

iSC.Itdeservestobe

recognizedasacrucial

game-changer,proofofthe

importanceofsystemdesign

anditsimpacttoimprove

supplychainperformance.It

istimetomoveawayfrom

singleissueimprovement

andfocusonamoreholistic,

comprehensiveapproachto

immunizationsupplychains.

11

ProfessionalisationCorner...ProfessionalisationCorner...

Thisissue,fromThisissue,fromANDREWBROWN,HealthSystemsANDREWBROWN,HealthSystems

StrengtheningConsultantStrengtheningConsultant::

ProfessionalisingHealthSupplyChainCadres–ProfessionalisingHealthSupplyChainCadres–

AMustfortheSustainableDevelopmentGoalsandHealthEquityAMustfortheSustainableDevelopmentGoalsandHealthEquity

Althoughitis2016,onethirdofthe

world’spopulationisstillwithoutaccessto

essentiallife-savingmedicines.Asweusher

intheeraoftheSustainableDevelopment

Goals,therehasneverbeenamore

importanttimetorenewourfocuson

developingthehealthsupplychainsin

countrieswiththegreatesthealthneeds.

Thesehealthsupplychainsarethe

‘arteries’ofhealthcare,withoutwhichthe

healthproductsneededbyhealthworkers

couldnotflowtothepatientswhoneed

them.Manyofthesepatientsarecurrently

dyingfromillnessessuchasmalariathat

aretreatablebymodernmedicine.Many

clientsareinneedofreproductivehealth

commoditiestoachievetheirfamily

planninggoals.Manymen,womenand

childrenneedcontinuoussupplyofARVs

forHIV/AIDStreatment.Thelistgoeson.

Weunderstandthathealthsupplychains

arecomplexsystemsthatneed

infrastructure,products,data,systemsand

people.HealthSupplyChainprofessionals

insufficientnumbers,atthecorrectplaces,

withthecompetenciestomanage,develop,

andsustainthesesystems.Although

significantprogresshasbeen

documentedagainsttheMillennium

DevelopmentGoals,alotremainsto

bedone.

In2011,ThePeoplethatDeliver(PtD)

Initiativewasbornwitha‘visionofa

worldwherenationalsupplychain

workforcesareplanned,financed,

developed,andsupportedinaway

thatensuresequitableandsustainable

accesstothemedicinesandother

commoditiesneededforoptimal

healthoutcomes.’

Asthe‘PtDEvidenceforImpactBrief’

notes,PtDhassucceededinbringing

theneedtodomoretosystematically

improveandprofessionalisecadres

involvedinhealthlogisticsandsupply

chainactivitytothefrontandcenterof

supplychaincapacitydevelopment.

PtDhaspublishedastrongevidence

base,hasmadetoolsandguidance

availablefromitsin-country

experiences,andhasequipped

supplychainprofessionalswith

advocacytoolstofurtherengagein

localcontexts.

12

Supportingtheprofessionaldevelopment

ofhealthlogisticsandsupplychaincadres

isakeyleaverofchangeifhealthsupply

chainsaretobedevelopedandsustained

todeliverthehealthproductsrequiredfor

healthprofessionalstodeliverthecare

patientsneed.Particularlyindeveloping

countrycontexts.TheInternational

AssociationofPublicHealthLogisticians

(IAPHLwww.iaphl.org)isanopenaccess

associationactivelyengaginghealth

supplychainprofessionalsglobally.Their

missionistosupportthe

professionalizationofsupplychain

managersandothersworkinginthefield

ofpublichealthlogisticsandcommodity

security,withparticularfocuson

developingcountries,equipping

individualstostrengthenthehealthsystems

inwhichtheywork.

IAPHLhasamembershipofmorethan

3500from135countries,across

academia,countrygovernments,UN

organisations,privatesectorandtechnical

partners.Asamemberyoucanengagein

activediscussionsonsupplychaintopics,

askquestionsofexpertsandshareyour

stories.IAPHLisalsoahubfore-learning

opportunities,jobopportunitiesand

sharingdetailsofglobalprojectsandbest

practices.Iplacewhereyoucanlearn,

shareandgrowasahealthsupplychain

professional.

Iwouldencourageindividualhealth

logisticsandsupplychainworkersand

organisationstoengagewithbothPtD

andIAPHL.Tobothtakeadvantageof

theresourcestheyofferandtoconnect

totheglobalsupplychaincommunity

sothattogetherwecanworktomake

medicinesavailabilityforpatientsa

realityforeveryone.

13

PamSteeledeliversatrainingcourse(Photo:PSA)

....................................................................................................................................................................................................

ANINTERVIEWWITH...ANINTERVIEWWITH...

PamelaSteelePamelaSteele

Inthisissue,the‘Healthand

Humanitarian’teamspoketoPamela

Steele,founderandCEOofPamela

SteeleAssociates,theleading

internationaldevelopmentsupply

chainconsultancy.Pamelawasborn

andeducatedinKenya,andholdsan

MScinBusinessAdministrationand

anMBAinSupplyChain

Management.BeforefoundingPSA,

sheworkedforWorldVision

International,theInternational

CommitteeoftheRedCross,Oxfam

GreatBritain,UNFPAandUNICEF.

Q.Whatwasyourmotivationfor

foundingPamelaSteeleAssociates?

A:Afterovertwenty-fiveyearsofwork

inLogisticandSupplyChain

Management-includingworkfor

leadingNGOsandtheUN-Iasked

myselfthequestion:whatnext?I

decidedthatIwantedtogointo

consultancyandusewhatIhadlearned

14

Weliveinanincrediblyvolatile

worldtoday...Weneedpeoplewho

areready.

....................................................................................................................................................................................................

inthefieldtohelphealthandhumanitarian

organisationoperatemoreeffectively.Iwas

itchingtohelpwithoutfeelingrestrictedby

organiation'sbureacraciesandtoomuch

talkevenwhenliveswereatrisk.

Ihadwitnessedalackofsupplychain

competenceandaweakworkforceinthe

frontline.Therewerepeoplealwayswilling

tohelp,buttheydidn’thavetheknowledge

ortoolstodotheirjoborlackedleadership

andsupervision.Developingprofessional

peopleisvital-that’swhyweoffertraining

coursesinhealthandhumanitariansupply

chainmanagement.Also,havingcomefrom

Kenyaandworkedinternationally,Ifeltthis

wasthebestwaytogivesomethingbackto

mybelovedcontinentwhilstalsobeingfully

valuedformyskillsandexperience.

Q:Whatdidyoulearnfromyourwork

withNGOsandtheUN-whatdidthese

organisationdowell,andwhataspects

couldbemoreeffective?

A:Iamimmenselyproudofmytimeatthe

NGOsandUN.Thereisnothinglikegoing

outintothefieldandseeinghowyourwork

ishavingadirectimpactonpeople’slives,

andIenjoyedbeingpartofalargerproject.

Thatsaid,therearemanyareaswherethe

UNandotherorganisationcan,andmust,

improve.Emergencyresponsesareoften

chronicallyuncoordinated,resultingin

competitionbetweenaidagenciesanda

fragmentedapproach.IfUNICEFand

Oxfamarebothprovidingwater,for

example,whoisprovidingothervital

resourcessuchasmedicalsupplies,shelter

orfood?Lackofcoordinationand

collaborationreallyfrustratedme.Duringthe

tsunamitheweaknesseswerefullyexposed

andtheinternationalcommunityletdownthe

affectedpopulationwhichledtothesetup

the'Cluster'systemtoimprovecoordination

butthisisstillaworkinprogress.

Q:WhatisspecialaboutPSA?

A:ThefundamentaldifferencebetweenPSA

andmanyotheraidorganisationsisour

attitude.Let’sgoanddoitisourguiding

mantra.Wejustplant,wedon’tcarewhether

therainwillcomeornot;wehavelesstime

towaste,wereacttowhatweseewhenwe

seeit.

Weliveinanincrediblyvolatileworldtoday.

Naturaldisastershaveincreasedoverthe

years,andinsecurityisalsoincreasing.One

eventinthecorneroftheglobecantilt

everything.Thatiswhyweneedpeoplewho

areready.Weshouldallbe‘first-aidtrained’

andreadyto'makeithappen'!Weneed

agilepeoplewhoareabletochangegear,

notpeopleoperatinginonlyone

compartment.

Q:Tellusaboutaparticularlyexciting

projectthatyouarecurrentlyworkingon.

A:Wearegoingtobeanimplementing

partnerfortheBillandMelindaGates

Foundation’sprojectinNigeria.Ilovethe

thought-processbehindtheproject,takinga

15

holisticapproachandtryingtoreallyanalyse

therootsofsupplychainbottlenecks,a

processentirelyownedandledby

governmentchangeteam,withtheGates

Foundationsupportingontheside.Youcan’t

justarriveinthefieldandtellpeoplewhatto

dobecauseyouhavethefunds.

TheGatesFoundationiscommittedto

workingwithanyonewhoiswillingtowork

withthemandcontributemeaningfully.PSAis

asmallcompany,notoneoftheregular

nameschosenforsuchprojects,butthey

havefaithandtrustinusandwecan'twaitto

unleashourhiddentalents!

Q:OneofPSA’scoreservicesisits

trainingcourses-whyiseducationso

important?

A:Healthandhumanitariancontextsarevery

complex.Thingsyoulearnthroughformal

educationgiveyougeneralknowledge.

However,whenyoumoveintopractice

particulalrythehumantariancontext,it

demandscertainskillsinhowyoudealwith

vulnerablepeopleandhelppreservetheir

dignity,howyoumanageoperationsin

complexenvironmentswithweak

infrastructuresandlimtedresources,or

corruptsystems.Youneedstrongpeople

skills,andwell-developedpeople.Knowledge

ofculture,politicalsituations,andreligious

practisesandinterpersonalskillsareallkey

toeffectivehealthandhumanitariansupply

chainmanagement.

Q:Whatareyourthoughtsonbeinga

womaninsupplychainlogistics?Does

thesectorhavefartogointermsof

addressingitsgenderimbalance?

Ibelievethateveryoneshouldhaveequal

opportunities.Havingsaidthat,Irealisethat

oftencertaingendersfacespecific

challenges.Fortunately,Iseewomen

breakingbarriersinthefieldallaroundme,

manyofwhomhavegonefurtherthanmein

veryremoteareas.Iwanttomakethis

known:givemeavuvuzela!Ihavealways

Knowledgeofculture,politicalsituations,

andreligiouspractisesareallkeyto

effectivehealthandhumanitariansupply

chainmanagement.

beenastrongadvocateinencouragingmore

womentojointhesector.

Q:Howdoyouenvisageasustainable

futureforthehumanitariansupplychain?

A:Threethingsarevital.Firstly,weneeda

well-trainedworkforce.Secondly,theymust

bewellequippedwiththetoolsandresources

theyneedtodothejob.Thirdly,theymustbe

led,supportedandcontinouslydeveloped.

Weneedpeopleoperatingonthesamepage,

quicklyandeasilytransferringknowledge.

PamSteele(Photo:PSA)

16

STAYINGINTHEloopInordertobetterunderstandthechallengestacklingtheglobal

communityandtrulyprofessionaliseasanindustry,itis

importantforustohelpeachother.Herearesomeuseful

agencies,globalactors,andothercontributingmembersdoing

justthat.

TheInternationalAssociationofPublicHealthLogisticians

(IAPHL)isaprofessionalassociationdedicatedtoimproving

publichealthsupplychainmanagementbypromotingthe

professionaldevelopmentofthosewhoworkwithhealth

supplies,includingnurses,pharmacists,andotherscarrying

outlogisticstasks.IAPHLsupportssupplychain

professionalsbyprovidingthemwithaccesstoresources,

joblistings,andfacilitatedlistservdiscussionsrelatedto

publichealthsupplychainmanagement.

TheHLAisanindividualmembershipassociationfor

humanitarianlogisticsprofessionals.Ithasbeenestablished

asaneutralinterfacebetweenaidorganisations,the

privateandacademicsectors,andotherinterestedparties

andaimstomanageawidespectrumofissues:advocating

professionalism,harnessinginnovation,establishing

standards...

ThePeoplethatDeliver(PtD)Initiativeisabroadcoalitionof

organizationsfromaroundtheworldthatstrivestoimprove

thehealthsupplychainworkforceindevelopingcountries.It

isbasedonglobalrecognitionthatwithouttrained

professionalstomanagethehealthsupplychains,drugs

andotherhealthsuppliesdonotreachthepatientswho

needthem.

17

InsightsintothefieldInsightsintothefield

PamelaSteele,CEOofPSAshares

her‘7habits’ofhighlysuccessful

healthsupplychainprofessionals.

Crucially,forPamela,habitsare

morethansimplerepeatedactions

-theyareanoverlapping

combinationofknowledge,skills

andattitudeswhichempoweryou

tomoveforwardinthedirection

youwish,ratherthanreactingto

events.Throughthesehabitsyou

realiseyourpotentialtobecomea

leaderandinspirationtoyour

employeesandcolleagues…

....................................................................................................................................................................................................

1.BEPROACTIVEAsuccessfulprofessional

inthehealthand

humanitarianfieldmust

anticipatethefuture,

doingwhateverisintheir

powertoimprovethe

situationforstakeholders.

Centraltothisisgood

research,ofpotential

risks,oftheunique

situationofthesupply

chaininquestion,andof

overallsupplychain

effectiveness.

7Habitsofthe7Habitsofthe

SuccessfulHealthSuccessfulHealth

SupplyChainSupplyChain

ProfessionalProfessional

2. KEEPYOURENDGOALINMINDOfcourse,the‘endgoal’ofhumanitarianwork

isalmostalwaystosavelives.Thismission

mustbeattheheartofeverydecisionyou

makeasahumanitarianprofessional.Itisno

use,forinstance,forresourcestoarriveto

wheretheyareneeded,iftheyaredamaged

andcannotbeused.Alwaysaimtoproduce

thebestvalueforcustomersandpatients.

3. LISTENFIRSTForbestoutcomes,supplychainprofessionals

mustalwaysstayintunewithworkersand

recipientsontheground-whatchallengesdo

theyface,andhowcanyouhelpthem?

18

....................................................................................................................................................................................................

Asanysuccessful

healthand

humanitariansupply

chainprofessionalwill

tellyou,1+1=3.

4. PRIORITIZEEFFECTIVELYItisvital,intheinterestsofsavingtimeandmakingeffective

decisions,thatyouplanandprioritise.Youmustmovequickly

andbebold,yetalsostayflexible.Forexample,youmustensure

thatcommoditieswhichexpirefastaredeliveredfirst.

5.EMBRACE

INNOVATIONEffectivehumanitarianorganisationsmustalways

balanceexperiencewithnewtalent,andkeep

abreastofthelatestdevelopmentsinthefield.One

steptowardsthisistoensurethatallstaff

continuouslyreceivefreshtrainingandsupervision.

Asanysuccessfulhealthandhumanitariansupply

chainprofessionalwilltellyou,1+1=3.Bythis

theymeanthatmorecanbeachievedinateam

orientedorganisationwhichvaluesrelationships

andwherecolleaguesaremotivatedandconflict

isdealtwithswiftly.Afterall,humanresourcesare

themostimportantaspectofanycompany

6. ENCOURAGEDIVERSITYANDCOLLABORATION

Noorganisationcanlastlongwithoutprioritisingtheneedsofits

variousstakeholders.Thisrequireshighemotionalintelligenceandan

eyeforquality.Tipsincludeputtingfacestodata,andpresenting

informationinanaccessibleformwhichismorelikelytospurdecision-

makersintoaction.

7. CONSIDERSTAKEHOLDERNEEDS

19

LEADINGTHEWAY... ...Sudan'sNational

MedicalSuppliesFund

‘Supplychain

management’maybethe

currentbuzzwordin

privatesectorindustries,

butitisaconceptthatis

severelyunderusedby

governmentsintheir

logisticalroadmaps.Yet

inaworldwherehigh-

qualityhealthcare

increasinglyrelieson

teams,collaboration,and

interdisciplinarywork,

supplychainleadership

isessentialforoptimising

healthsystem

performance.Thereis

growingappreciationfor

thefactthatsupplychain

leadershipengagement

andfocusdrives

improvementsinhealth

caredeliveryquality,

reducespatientharm

andcontributestobetter

healthimpacts.

Sudan’sMinistryof

Healthhasbeenoneof

thefirstgovernment

departmentstorecognise

theimportanceofsupply

chainperformancein

improvingtheprovision

ofvitalservices.Inabold

investmentforthefuture,

theNationalMedical

SuppliesFund(NMSF)

hasforegroundedthe

trainingand

professionalizationof

supplychainstrategists

andimplementersinits

policy.Inthisarticlewe

examinehowthishasled

tothecreationofan

innovativeandeffective

methodofnationalhealth

provisioninSudan.

TheNMSFwasfounded

in1991astheCentral

MedicalSuppliesPublic

Corporation(CMS),

beforebeingrenamedin

2015.Asaparastatal

organisation,itwas

designedtoworkwithin

thegovernmentofSudan

whileexercisingadegree

ofdiscretionand

autonomyinhowit

operated.Itisrarethat

supplychainconcerns

arerepresentedinthe

boardroom,butunderthe

leadershipoftheDirectorGeneralDr.Gamal

KhalafallaMohamedAli,theNMSFhasbeen

forgingnewpathsintheareaofnational

supplychainmanagement.Thisisnotan

easytaskgiventhelackofhardcashandthe

proliferationofsanctions,whichhasseverely

affectedthesupplyofmedicinetoordinary

peopleinSudanwhohavenoconnectionto

politics.

TheNMSFderivesitsvibrancyfromits

multiplestakeholders,eachofwhichmakes

auniquebutessentialcontributiontothe

runningofthecorporation.NMSF

stakeholdersoperateonaprincipleof

continuousinvolvement,allowingthemto

discernexactlywhatisneededforits

improvement.TheMinistryofHealthisthe

biggestplayer,providingNMSFwitharound

75%ofitssales(therest

comesfromprivate

sectorenterprises).

Othersincludethe

MinistryofFinanceand

NationalEconomy,the

CentralBankofSudan,

theDirectorateof

Customs,andtheUnited

NationsDevelopment

Programme.These

bodiesprovide

specialisedstaff,funds

forprocurement,and

budgetsfordistribution,

dependingontheirarea

ofexpertise.

Insteadofbeingtied

downbygeneric

governmentpolicies,the

NMSFdecidesitsown

workforcepolicies,and

thisisacrucialaspectin

howitisableto

constantlyreformand

improveitsoperation.To

preventstagnation,the

DirectorGeneralleadsan

annualupdateofthe

supplychainstrategy.

NMSFisnotjustabout

simplisticcostefficiency.

Infact,itrecentlyshifted

fromapolicythat

emphasizescostasthe

primaryconsideration

whenchoosingbetween

competingproducers,to

apolicyofquality-

assuredmedicines.

Thereare400

employeescurrently

workingfortheNMSF,

whoareallpartofa

Continuous

Development

Programme(CPD)

fundedbyNMSFitself.

DirectorGeneralGamal

Khalafallawantstomake

surethatsenior

directors,middle-line

managersandtactical

staffwerealltrainedto

SudanseniormanagersattrainingrunbyPSAinSept,Dubai2015(Photo:PSA)

20

LEADINGTHEWAY... ...Sudan'sNational

MedicalSuppliesFund

‘Supplychain

management’maybethe

currentbuzzwordin

privatesectorindustries,

butitisaconceptthatis

severelyunderusedby

governmentsintheir

logisticalroadmaps.Yet

inaworldwherehigh-

qualityhealthcare

increasinglyrelieson

teams,collaboration,and

interdisciplinarywork,

supplychainleadership

isessentialforoptimising

healthsystem

performance.Thereis

growingappreciationfor

thefactthatsupplychain

leadershipengagement

andfocusdrives

improvementsinhealth

caredeliveryquality,

reducespatientharm

andcontributestobetter

healthimpacts.

Sudan’sMinistryof

Healthhasbeenoneof

thefirstgovernment

departmentstorecognise

theimportanceofsupply

chainperformancein

improvingtheprovision

ofvitalservices.Inabold

investmentforthefuture,

theNationalMedical

SuppliesFund(NMSF)

hasforegroundedthe

trainingand

professionalizationof

supplychainstrategists

andimplementersinits

policy.Inthisarticlewe

examinehowthishasled

tothecreationofan

innovativeandeffective

methodofnationalhealth

provisioninSudan.

TheNMSFwasfounded

in1991astheCentral

MedicalSuppliesPublic

Corporation(CMS),

beforebeingrenamedin

2015.Asaparastatal

organisation,itwas

designedtoworkwithin

thegovernmentofSudan

whileexercisingadegree

ofdiscretionand

autonomyinhowit

operated.Itisrarethat

supplychainconcerns

arerepresentedinthe

boardroom,butunderthe

leadershipoftheDirectorGeneralDr.Gamal

KhalafallaMohamedAli,theNMSFhasbeen

forgingnewpathsintheareaofnational

supplychainmanagement.Thisisnotan

easytaskgiventhelackofhardcashandthe

proliferationofsanctions,whichhasseverely

affectedthesupplyofmedicinetoordinary

peopleinSudanwhohavenoconnectionto

politics.

TheNMSFderivesitsvibrancyfromits

multiplestakeholders,eachofwhichmakes

auniquebutessentialcontributiontothe

runningofthecorporation.NMSF

stakeholdersoperateonaprincipleof

continuousinvolvement,allowingthemto

discernexactlywhatisneededforits

improvement.TheMinistryofHealthisthe

biggestplayer,providingNMSFwitharound

75%ofitssales(therest

comesfromprivate

sectorenterprises).

Othersincludethe

MinistryofFinanceand

NationalEconomy,the

CentralBankofSudan,

theDirectorateof

Customs,andtheUnited

NationsDevelopment

Programme.These

bodiesprovide

specialisedstaff,funds

forprocurement,and

budgetsfordistribution,

dependingontheirarea

ofexpertise.

Insteadofbeingtied

downbygeneric

governmentpolicies,the

NMSFdecidesitsown

workforcepolicies,and

thisisacrucialaspectin

howitisableto

constantlyreformand

improveitsoperation.To

preventstagnation,the

DirectorGeneralleadsan

annualupdateofthe

supplychainstrategy.

NMSFisnotjustabout

simplisticcostefficiency.

Infact,itrecentlyshifted

fromapolicythat

emphasizescostasthe

primaryconsideration

whenchoosingbetween

competingproducers,to

apolicyofquality-

assuredmedicines.

Thereare400

employeescurrently

workingfortheNMSF,

whoareallpartofa

Continuous

Development

Programme(CPD)

fundedbyNMSFitself.

DirectorGeneralGamal

Khalafallawantstomake

surethatsenior

directors,middle-line

managersandtactical

staffwerealltrainedto

SudanseniormanagersattrainingrunbyPSAinSept,Dubai2015(Photo:PSA)

21

bespeakingthesamevocabularyand

operatingonthesamewavelength,in

ordertooptimizesupplychain

performanceatalllevels.Theannual

numberoftrainedemployeeshas

increasedfromonly10in2010tomore

than580andthetrainingbudget

increasedfromlessthanUS$40,000to

US$670,000in2014.Thebuildingofa

newNationalTrainingCentreintime

forDecember2016isdesignedto

bridgethegapbetweeneducationand

training,withaparticularemphasison

managerialroles.Coursesinclude

MedicineSupplyManagement,Drugs

andTherapeuticsCommitteesand

Pharmacoeconomics,aswellasmore

generaltrainingintopicssuchas

HumanResourcesManagementor

LeadershipandOrganisational

ChangeManagement.

Thisisinadditiontoengagingexternal

firmstoprovidefreshperspectiveson

management.InSeptember2015,

PamelaSteeleAssociates,aSupply

ChainCapacityDevelopment

Company,deliveredafive-daytraining

coursetoelevenMinistryofHealth

officials.Itfocusedonkeytopicssuch

asleadingstrategy,leadingchange,

andleadinganddevelopingothers,for

supplychaindirectorswhooperatein

difficultsituationswhereresourcesare

scarce.InFebruary2016theyagain

sent5oftheirstateandheadoffice

Sudansponsored5ofitsstafftoattendhealthsupplychainmanagementcoursesinDubai,2016

(Photo:PSA)

22

stafftotraininhealthsupplychain

management,and13ofitssecondline

managerstotraininleadershipand

humanresourcemanagement.

NMSFhassupportedthisgeneralpush

fortheprofessionalizationofsupply

chainmanagementbyfundingsolid

investmentsininfrastructure,toolsand

supervision,tocreateanenabling

workingenvironmentforall.NMSF

employeesareencouragedtonetwork

withprofessionalssuchasSudan

PharmacistUnionandtheNational

InstituteforMedicalSpecialisation,ina

systemofactivemutualsupport.

Employeesalsohavefreeaccessto

morethan13,000electronicjournals

and25,000electronicbooks,and

frequentlyparticipateinworkshopsand

conferences.Theresultsareclear;

DirectorGeneralGamalKhalafallareportedthat

‘theannualnumberoftrainedemployees

increasedfromonly10in2010tomorethan580

andthetrainingbudgetincreasedfromlessthan

US$40,000toUS$670,000in2014.

PamelaSteele,CEOandFounderofPamela

SteeleAssociates,commentedthat‘having

spentfiverewardingdayswiththem,Inowknow

howcommittedthedirectorsfromSudan’s

MinistryofHealtharetoimprovingthelivesof

thepeopleofSudan’.Withoutadoubt,Sudan’s

long-terminvestmentinhumanresources

throughtraining,resourcesandcontinuous

improvementstandsoutasablueprintforfuture

modelsofnationalsupplychainmanagement.

(Photo:PSA)

23

TransAidisaninternational

charitythatidentifies,

champions,andimplements

localtransportsolutioninthe

developingworld.Itwas

foundedin1980becauseofa

recognitionthatlogisticsand

transportskills,something

takenforgrantedintheUK’s

commercialsector,was

desperatelyneededto

improvetheefficiencywith

whichhumanitarianaidwas

beingdeliveredglobally.

TransAidisfocusedonlong-

termdevelopmentratherthan

disasterrelief.Thisincludes

gettingmedicinestorural

dispensaries,ensuring

ambulanceservicesoperate

effectively,supportingfarmers

toreducetheirtransportcosts

andtrainingtruckdriversto

handletheirvehiclessafely.

Oneofthemainchallenges

facedbyTransAidisthat,due

tothenatureofitswork,theorganisationmustoftenreach

communitiesinextremelyisolatedlocations,thedistance

andharshterrainmakingsupportingsuchcommunitiesvery

difficult.However,asGaryForster,CEOofTransaid,points

out,“ifitishardforustogettothem,it’sevenharderfor

themtoaccesshealthfacilities”.

ThispointisbroughthomebyastoryGarytellsof

TransAid'sworkinMadagascar:“Ourgreatestsuccess?I

canpointtoindividualwomen,whoweretransportedmore

than40kmbyabicycledrawnambulanceinrural

Madagascar,andreachedhealthcarejustintimetosave

theirlivesandthatoftheirunbornbaby”.

Anecdotessuchastheseareindicativeofawiderpicture:

reliabletransportinfrastructureisessentialforensuring

accesstomedicalcare,andTransAidisleadingtheway.

Spotlightoninnovation:

PartTwo

TransAid

Afeaturelengthinsightintodesigninnovation

ArticlebyPhilipMatthews

....................................................................................................................................................................................................

CEOGaryForster

24

....................................................................................................................................................................................................

Indeed,theWorldBankestimated75percentofmaternaldeathscanbeavoidedthrough

timelyaccesstoessentialchildbirth-relatedcare.Respondingtothiscrisis,TransAidhave

introducedmanyinnovativeandcommunity-ledemergencytransportinterventions,which

haveenabledpeopletoreachmedicalhelp.Theseincludebicycleambulances,oxand

donkeycarts,andmotorcycleambulances.InNigeria,topickanotableexample,TransAid

implementedanEmergencyTransportSchemetohelptransportpregnantmothers

experiencingcomplications.Todateover10,000womenhavebeentransferredtohealth

facilitiesandinmanycasesthoseinterventionswerelifesavingformotherandchild.

AnexcitingcurrentprojectforTransAidiscalled‘MOREMAMaZ(MobilizingAccessto

MaternalHealthServicesinZambia).Thisaimstoincreasetheuseofmaternalandnewborn

healthservicesamongruralcommunitiesinZambia.Theprojectisachieving

transformationalchangeforwomenandgirls,particularlythosewhoareunder-supportedat

householdandcommunitylevel,bysupportinggovernmentpartnerstoscaleupcommunity

engagement.UnderMOREMAMaZ,ruralcommunitiesareempoweredtoincreasematernal

newbornhealthawareness,addressaccessandaffordabilitybarriers,andtackleunderlying

socialproblemsthatcontributetonegativehealthoutcomes,suchasgender-basedviolence.

25

....................................................................................................................................................................................................

However,despiteTransAid’sachievements,

therearestillmajorchallengesfacingthe

healthandhumanitariansupplychain,afact

GaryForsterenthusiasticallyconcedes:“In

manycasesthechallengesfacinghealth

supplychainshaven'tchangedallthatmuchin

thelast25years.Whilegovernmentshavegot

betteratmanagingtheirownmedicinesupply

chainsthereisstillhighdemandforskills”.

Lookingtothefuture,Garybelievesthatthemostpressingissuesinneedofreformareskills

developmentandgreatermaintenanceforequipmentandvehiclesinthehealthand

humanitariansupplychain.

IfyouwanttodiscovermoreabouttheworkofTransAid,visittheirwebsiteat:

http://www.transaid.org/.

26

makingsenseof...SUPPLYCHAININTEGRATION

Astronghealthsystemcannot

functionwithoutawell-designed,

well-operated,andwell-maintained

supplychainmanagementsystem.

Supplychainindustryresearchshows

thatthebestcommercialsector

supplychainsevolvethroughstages

ofmaturityandimproved

performance(Lockamyand

McKormack,2004).Researchon

publichealthsupplychainsin

developingcountriesillustratesthat

theyalsoevolvethroughstagesof

maturitytowardsanintegrated

supplychainthatlinksallpeople,

information,andactivitiesfromthe

top-end(sourceofsupply)tothe

bottom-end(customersseekinghealth

services)ofthesupplychain(McCord

andOlson2011).Thegreaterthe

maturity,themoreagileandresilient

supplychainsaretorespondto

change,includingthestressesof

unexpectedevents—disease

outbreaks,conflicts,environmental

disasters,etc.—thatdrive(andcan

disrupt)humanitarianresponse.

Integrationcanbeviewed

fromdifferent

perspectives.Vertical

integrationconsidersthe

supplychainend-to-end;

allactors,processes,

assets,etc.Horizontal

integrationinvolves

groupingproductsacross

healthprograms(HIV,

reproductivehealth,

maternalandchildhealth,

immunization)and

commoditytypes(essential

medicines,vaccines,

injectiondevices,

contraceptives,

diagnostics)intocommon

supplychainchannels.

Verticalintegration

providesgreatervisibility

anddata-driven

decisionmakingtoanalyze

andoptimizesupply

chains,guidinghorizontal

integration,product

segmentation,network

optimization,business

processreengineering,

andotherperformance

improvementstrategies.

VerticalIntegrationVerticalIntegration

Averticallyintegrated

healthsupplychainhas

visibilityofinformationand

activityupanddownthe

chain,fewerstepsinits

processes,andgreater

coordinationand

predictabilityofdemand

betweenallthelevelsand

Figure1:SupplyChainMaturityFramework(JohnSnow,2012)

CHRISWRIGHT,SeniorTechnical

AdvisoratJohnSnow,Inc.,

unpacksthisinnovativeapproach

tosupplychainlogistics

27

actorsinthesystem.Thisincludeslinkingall

theactorsinvolvedinmanagingessential

healthcommoditiesintoonecohesive

supplychainmanagementorganization.

Theorganizationcanoverseeallfunctions,

levels,andpartners,ensuringanadequate

supplyofessentialhealthcommoditiesto

theclientswhoneedthem(JohnSnow,

2012).

Drawingoncommercialandpublichealth

experience,thesupplychainevolution

frameworkcanhelpcountriesdetermine

theircurrentlevelofmaturityandmakea

plantostrengthentheiroperationsto

achieveandtrackprogressalongthe

evolutionarytrajectory(ibid).

Horizontal(Product)IntegrationHorizontal(Product)Integration

Horizontalorproductintegrationcombines

themanagementofsomeoralllogistics

functions(e.g.,procurement,storage,

distribution,andlogisticsmanagement

informationsystems)fordifferentcommodity

categories(e.g.,familyplanning,HIV,

malaria,andtuberculosis)intooneshared

supplychain.Themostcommonlymerged

functionsarethoseofstorageand

distribution.Thestartingpointforthistype

ofintegrationistheassumptionthat

disease-orprogram-specificsupplychains

areinherentlywastefulandinefficient

(USAID|DELIVERPROJECT2011).

Ashealthcarefacilitiesincreasinglyoffer

integratedhealthcarepackages,allthe

productsrequiredforprovisionofthese

servicesneedtobeavailable.Historically,

thishascontributedtoanunderstandingof

integrationasputtingallproductstogether

ononetruck.However,integrationisnot

onlyaboutprovidingholistichealthservices

ordistributingproductstogetheronthe

sametruck;itcanbeaframeworkto

characterizesupplychainimprovements

withinpublichealth.However,focusingon

theintegrationofsupplychainsfordifferent

programswillnotautomaticallyimprove

performance;ultimately,amoresystemic

approachisrequired.Furthermore,

integrationofproductsmustbeconsidered

withinthecontextofproductcharacteristics.

Themostobviouscharacteristicsareshelf-

lifeandspecialhandlingorstorage

requirements,suchascoldchain.Therefore,

anyattempttointegrateproductsmustalso

segmentthemaccordingtocommon

characteristics.

SegmentationSegmentation

Publichealthsupplychainsarenotonly

growing,theyarebecomingmore

complicated.Currentsystemsarelessand

lessabletocopewiththegrowing

complexities.Supplychainsegmentation

offersagoodsolutionformanagerswho

wanttostreamlineandconsolidate

program-specificsupplychains,andwho

alsounderstandthatthereisnoone-size-fits-

allsolutioninpublichealth.Supplychain

segmentation,astrategictool,managesa

widerangeofproductsandimproves

efficiencybyidentifyingsimilar

characteristicsintheproductsand/orits

customers,who,inthiscasearetheservice

deliverypoints.Productsareplacedinto

segments,whichcanthenbemanagedas

separatesupplychannels,basedonthe

criteriaandprioritieswithineachsegment.

Coldchainproducts,shortshelf-life

products,bulkyproducts,andfastmoving

productsarecommonsegmentationgroups

thataretypicallymanagedinseparate

28

supplychannels.Vaccinesare

sometimessegmentedintoroutine

immunizationandsupplemental

(campaign)logisticschannels.

BenefitsofIntegrationBenefitsofIntegration

Integratedsupplychainshave

collateralbenefitsforahealth

system.Acohesive,well-performing

publichealthsupplychainhelps

buildthefoundationforastrong

pharmaceuticalmanagementsystem,

providesessentialinformationfor

managinghealthprogramsand

financingmechanisms,andhelpsto

achievethelevelofaccountability

exemplifiedinthecommercial

sector.Anintegratedsupplychain

managementorganizationhasthe

capacitytolearnfromerrors,self-

assess,andadaptthrough

continuousimprovementprocesses.

Itleveragesresourcesfromallparts

ofthesupplychainandenables

rationalimplementationof

innovativenewtechnologies.w

technologies.

FURTHERREADING:

JohnSnow,Inc.January2012.

GettingProductstoPeople:TheJSI

FrameworkforIntegratedSupply

ChainManagementinPublic

Health.Arlington,VA.:JohnSnow,

Inc.

LockamyIII,Archie,andKevin

McCormack.2004.“The

DevelopmentofaSupplyChain

ManagementProcessMaturity

ModelUsingtheConceptsof

BusinessProcessOrientation.”

SupplyChainManagement:An

InternationalJournal,vol.9no.4:

272-8.2

McCord,JosephandNadiaOlson.

2011.SupplyChainEvolution:

IntroductiontoaFrameworkfor

SupplyChainStrengtheningof

DevelopingCountryPublicHealth

Programs.Arlington,VA.:USAID|

DELIVERPROJECT,TaskOrder4.

USAID|DELIVERPROJECT.2011.

SupplyChainIntegration:

SeamlesslyLinkingthePieces.

Arlington,VA.:USAID|DELIVER

PROJECT,TaskOrder1.

29

Articleby

RossKingRossKing

5ThingstheHealth5ThingstheHealth

andHumanitarianandHumanitarian

supplychaincansupplychaincan

learnfromFMCGlearnfromFMCG

Howisitthen,wheremedicineisinvolved,thereisstilla75daydelaybetweenamanufacturers'productionanditsdelivery?

Thanks tomodern economies of scale and highly efficient supply chains, thedevelopedworldnowbenefits fromalmost instantgratification.Acustomisedcomputer from Japan takes only a week to be assembled and arrive on theother side of the world; clothes from Vietnam are made, shipped and soldgloballyinthesamebreath.Inordertobuylocalfood,ithasbecomenecessarytobuyfromaspecialrangeoforganicorlocallysourcedproduceinsteadofthenowcommon-placeimportedvariety.

Howisitthen,wheremedicineisinvolved,thereisstilla75dayaveragelagtimebetweenproductionanddeliverytothedevelopingworld?Demandformedicinalaid is high, owing to newandextant international crises like theZikaVirus andEbola, yet despite these pressures, the global health and humanitarian supplychainremainsclunkyandinefficient.

Inordertobetterservepeopleinneedofsupport,hereare5lessonswecanlearnfromtheworldofFastMovingConsumerGoods.

....................................................................................................................................................................................................

1. SegmentationByeffectivelysplittingupthedifferentavailablemarketsandgoodsintomore

specialisedcategories,supplychaininefficienciescanbereducedby

segmentationaccordingtothecharacteristicsofproductsandthe

requirementsofcustomers.

InsiderInformationInsiderInformation

30

....................................................................................................................................................................................................

2. AgilityTheabilitytochangeandrespondquicklytoemergingcrisesorchanging

consumerdemandiscrucialforhumanitarianagencies.Therefore,

buildinganoperatingmodelthatcanbetterrespondtodemandshiftsand

customerwishesisparamount.

3. MeasurementConsumer-goodscompaniesusemetricssuchasthemanufacturing-

frequencyindextomeasuretheshareofSKUsthatareproducedwith

highfrequency.Thisissomethingthatcouldbeimplementedby

healthcareproviderstoincreasesupplychainefficiencyandcutdown

oncosts.

31

....................................................................................................................................................................................................

4. AlignmentInordertobuildacost-effectivesupplychain,thehealth-caresectorneedsto

adoptpracticesalreadyfoundintheFMCGsector.Globalstandardscanbe

createdandimplemented(suchasinternationalbarcodes)tofacilitatedata

interchange,processesandcapabilities.Theseglobalstandardsmayalsohelpto

reducethecirculationofcounterfeitmedicinesandthusimprovequalityofcare.

Barrierstoeffectivecommunicationandpartnershipsareoftenculturalasopposed

totechnical.However,foranymutuallybeneficialpartnershipstoemerge,allparties

mustshareacommonsetofvaluesandgoalsincludingalong-termvision,

willingnesstoshareinformation,andworkasateam.

Collaboration5.

Byworkingtoimprovebothindividuallyandcollectively,these5keyelementscanbe

puttogooduseinordertoradicallychangethewaythehealthandhumanitarian

supplychainworks,andhelpthosewhoneeditmost.

Sources:McKinseyonlinearticles/HLA/PSAblog.

32

CounterfeitDrugs:

oldenemy,newsolutions.articlebyOscarBoyd

Techleadsthewayinthefightagainstcounterfeitmedicine:

Anemailpingsintoyourinboxpromisinguntoldriches.Amemberofwest-africanroyaltyAnemailpingsintoyourinboxpromisinguntoldriches.Amemberofwest-africanroyalty

isinneedofyourassistance,justtransferhim£100andthemoneywillbeyours.Itisisinneedofyourassistance,justtransferhim£100andthemoneywillbeyours.Itis

clearthatthisisafake,arusedesignedtotrapthemostgullible.Trashit,andnoharmisclearthatthisisafake,arusedesignedtotrapthemostgullible.Trashit,andnoharmis

done.done.

Whenitcomestomedicine,however,fakesarerathermoredifficulttospot.For

someonewithtechnicalknowledgeandamindforcrime,substancessuchaschalk,

flourandstarchcanbeshapedtoimitateanypillonthemarket.Labellingand

packagingarelikewisecopiedtocreateaproductthatlooks,ineveryway,identical

totherealthing.Withoutspecialistequipment,therearefewmeansoftellingthereal

fromthecounterfeit,untilpeoplefallsickordiefromuntreatedillnesses.

Theeasewithwhichcopyingcantakeplacehasallowedthecounterfeitindustryto

thriveacrossAfricannations,whereitisnowamulti-billiondollarindustry.TheWorld

HeathOrganisationestimatesthatinsomeregionsofAfrica,over30%ofthe

33

medicinesonsalearecounterfeits,afigurethatappliestobothbrandedandgeneric

varietiesofmedicine.TheInternationalPolicyNetwork,aBritishthink-tank,estimatesthat

globally,700,000deathsayeararecausedbyfakemalariaandtuberculosisdrugs,

withapproximately100,000ofthesedeathsinAfricaalone.

InanespeciallytragiccaseinNovember2008,childreninNigeriastartedtodie

followingunexplainedfeversandvomiting.Threemonthsand84deathslater,officials

tracedtheillnesstoamedicinecalledMyPikinBabyTeethMixture,apainkillersyrup

notdissimilartoCalpol.Thecauseofthesedeathswassimple,butdisastrous.An

unlicensedchemicalvendorinLagoshadsoldMyPikincounterfeitpropyleneglycol-a

commonmedicalsolvent-whichwasthenaddedtobatch02008oftheBabyTeething

Mixture.Instead,thechemicalwasdiethyleneglycol,which,whilstsimilarinlookand

smelltopropyleneglycol,isusedasanindustrialsolventtomakeantifreezeandbreak

fluid.Wheningested,diethyleneglycolattacksthenervoussystemandcausesliver

damageandkidneyfailure.Inthiscase,three-quartersofthechildrenmadesickby

batch02008ofMyPikinBabyTeethingMixtureeventuallydied.

Illnessanddeatharenottheonlyconsequencesofcounterfeitmedicines,bacterial

resistanceisalsoemergingasaseriousthreat.AstudypublishedbytheInternational

JournalofTuberculosisandLungDiseasefoundthat9.1%ofdrugssampledworldwide

failedbasicqualitycontroltests.ThefailurerateinAfricawas16.6%oraboutonein

everysixpills.Poorqualitypillsarelesseffectivewhencombattingcommonbacterial

infectionssuchastuberculosis,contributingtothedramaticriseofresistantstrainsin

AfricaandAsia.

Acrucialissueinthefightagainstcounterfeitsisweakenforcement.Alackoftraining,

manpowerandissueswithcorruptionhavecripplednationalenforcementagenciesand

allowedfortheproliferationofcounterfeits.Whilstsomeprogressisbeingmadeatthe

governmentlevel-suchasNigeriaandCameroon’scounterfeitdrugscooperation

agreement-ithasbeenlefttoenterprisingstart-upstofilltheregulatoryvoid.Start-ups

suchasmPedigreeNetworkandSproxilhavedesignedsystemsthatallowlegitimate

drugmanufacturerstolabeltheirpackageswithencryptedcodes.Toverifyamedicine’s

legitimacy,consumerssimplyscratchoffthelabelonthepackageandtextthecode-

freeofcharge-tothecompanythatmaintainsthesystem.Iflegitimate,thecompanywill

thensendaconfirmationtoverifythemedicine.

Thesestart-upsareprovingrevolutionary.ClientsofmPedigreeincludethedrug

companiesAstraZeneca,RocheandSanofiandthecompanyhasofficesinEgypt,

Ghana,India,Kenya,Nigeria,andTanzania.Withoverthreequartersoftheworld’s

populationowningamobiledevice-afigurelikelytorise-smart-verificationoptions

havehugepotentialtoreducethetradeincounterfeitdrugsandthedeathsandillness

associatedwiththem.

34

MainstreamingGender:MainstreamingGender:

HealthandHumanitarianSupplyHealthandHumanitarianSupply

ChainsChains

LastDecember,PSAinitiatedandmoderatedLastDecember,PSAinitiatedandmoderated

anIAPHLonlinediscussionentitledanIAPHLonlinediscussionentitled

‘MainstreamingGenderinHealthSupply‘MainstreamingGenderinHealthSupply

Chains’.HereweseeanexclusivereportonChains’.Hereweseeanexclusivereporton

theresultsofthesediscussions.theresultsofthesediscussions.

Thediscussionwascarriedoutinthree

sessions,including‘Theimpactofgenderon

healthsupplychaindelivery’,

‘Mainstreaminggenderinhealthsupply

chains’and‘TheimpactofHRpolicieson

genderbalanceinhealthsupplychains’.

Withatotalof32responsesfrom13

differentcountries,thisonlinediscussion

capturedavarietyofviewpointsfrom

individualswhooccupyarangeof

positionswithinhealthsupplychains

includingpharmacists,programme

managers,senioradvisers,supplychain

consultantsandprogrammedirectors.

Thequestionofwhytherearesofew

womeninhealthsupplychainsand

humanitarianlogisticshasrecentlyrisento

prominencewithinthehealthlogistics

literature.Therecontinuestoberelatively

fewfemalehumanitarianlogisticiansin

healthsupplychains,andthisis

particularlyworryinggiventhat

respondingtothegender-specific

Womenintheaftermathofthe2005Tsunami(Photo:UNFPA)

35

requirementsofendbeneficiariesiscentralto

theoverallhumanitarianaim.

Theroleofahumanitarianlogisticianstarts

withevaluatingtherequirementsofbothmale

andfemalebeneficiaries,ensuringgoodsare

deliveredtoaddressthoseneeds,and

guaranteeingallbeneficiariesaccess.An

exampleofgenderinsensitivityinhumanitarian

logisticswasseenintheaftermathoftheIndian

Oceantsunamiof2004wherethedistribution

ofsanitaryitemswascontrolledbymale

officialswhogavethemoutoneatatime,

forcingwomentogobackrepeatedlytoask

formore(Steele,2014).Further,anda

particularlystrikingexampleofagender

insensitiveresponsetoahumanitariandisaster,

wasthepurchaseofpoorlydesigneditems

suchastranslucenttentswhichshowedwhen

femaleswereinsidealone,thusheighteningthe

riskofsexualviolence(WISE,2006).Inshort,

gendersensitivityremainsachallengein

humanitarianlogisticsanditisarguedthatthis

situationwouldbeamelioratedbythepresence

offemalelogisticianswhowouldbebetter

placedtoanticipateandmeettheneedsof

femalebeneficiaries.

Sowhyaretherefewerfemalelogisticiansin

supplychainprovisions?Thesecond

moderateddiscussionsoughttountanglethe

reasonsforthis.Participantssuggestedseveral

factors,includingthedifficultyofcombining

workandfamilylife,aswellasthemale-

dominatedimageofthelogisticsindustry.This

pointstoawiderissueofthe

underrepresentationofwomeninlogistics

education.InastudyconductedbyEuphoria

Consulting(2009),lessthan30%of

logisticiansregardschoolsanduniversitiesas

supportiveinencouragingwomentojointhe

industry.Oncetheydoentertheindustry,

womenarelesslikelytoachievemanagerial

roles.Manyindustrycodesofconduct,eventhose

thatdealspecificallywithgenderissues,failto

addressdeeplyembeddedstructuresofinequality

suchaslowwagesandthedesignationoffemales

tothelowestpaid,mostinsecurejobs.Astudyof

20workplacecodesconductedbyPersonand

Seyfang(2001)foundthatonlyathirdrelatedto

sexualharassment,atenthcoveredreproductive

healthandallwerepoorlymonitoredand

inspected.

Thismayseemtopaintarathergloomypicture

aboutthestateofgenderinhealthsupplychains.

However,thethirdmoderateddiscussionledto

someexcitingsuggestionsforhowtochangethe

perceptionofthelogisticsindustry,aswellasits

practices.Itwasagreedthatfemaleworkers

shouldbeconsultedwithateachstageofthe

designandimplementationofcodesiftheyareto

betrulygender-sensitiveIndeed,individual

organisationsneedtoassesshowtoreduceany

barrierswomenmayfacetoemployment,

includingsoftsolutions.Forexample,different

wordingofarecruitmentadmightattractmore

womentoapply.Onceinemployment,one

participantpointedoutthatmenarepromotedon

theirpotentialwhilstwomenarejudgedprimarily

ontheirperformance,andidentifiedtheneedfor

amorerigorousstandardisationofpractices.

Companiesshouldprovidewomenwithgood

maternityallowancesincludingobservingthe

mandatorymaternityperiodandhelpingwiththe

costsofchildcare;andorganisationsshould

awardwomendeservedmanagerialpositions.

Thereisstillmuchworktobeundertakeninorder

tochangeattitudesandseemorewomenas

humanitarianlogisticiansbutitissuggestedthat,

throughcooperationandovertime,thisgoalisnot

completelyoutofreach.

36

UNICEFLogisticsSpecialistSilviaUnedduinspectssupplies.(Photo:UNICEF)UNICEFLogisticsSpecialistSilviaUnedduinspectssupplies.(Photo:UNICEF)

37

InternalAffairsOxfordUniversityinternssharetheirexperiencesfromaweek

workingatPSA.

PamelaSteeleAssociates(PSA)iscarvingoutPamelaSteeleAssociates(PSA)iscarvingout

anicheintheOxfordareaforitsinternationalanicheintheOxfordareaforitsinternational

developmenttrainingschemes.However,thisdevelopmenttrainingschemes.However,this

smallcompanyisalsoofferingopportunitiessmallcompanyisalsoofferingopportunities

forlocalgrowthintheformofitsinternshipforlocalgrowthintheformofitsinternship

programmesprogrammes.

PSA,inconjunctionwithOxfordUniversity,

offers2differentkindsofinternships:afull

summeratthecompanyora‘micro-internship’

forjustoneweek.Eitherway,newrecruitsare

thrustintotheheartofoperationsfromday

one,andcanbeseenworkingalongsidestaff

onmajorprojectsfromtheoutset,helpingto

managesponsoredevents,orevenheading

uptheirownprograms.Onerecentintern,

RishandeSilva,single-handedlyproduceda

strategyforPSA’sbrandingandmarketing,

coordinatingthebusiness’growingonline

presenceandresourceswithexistingmodels.

So,whiletheaverageinternshipcan

sometimesofferlittlemorethananexcel

spreadsheetmasterclassandotherlessonsin

copyandpaste,PSAtakesanentirelydifferent

approach.Atthebeginningofourweekhere,

wewerepresentedwithataskthatmayhave

seemedgargantuaninitsscopeandambition

tobecompletedinlessthan5days:organise,

createandsourcethecontentforanew

magazine.Notonlythis,butwewouldhave

todesignthelayoutourselves,findfunding

fromsponsors,advertisersanddonors,assess

thepotentialforprintinganddistributioninthe

UKandinternationally,allbytheendofthe

week.

Westartedoutcautious,thinkingabout

articleswecouldwriteandtentatively

emailingsmallcompaniesinthehopethey

wouldgetbacktous.AmeetingwithPam

completelyblewthisoutofthewater.She

listenedtoourideasandencouragedusto

bebolderinourvision,tonotonly

broadenourscopeofarticles,butalsoto

approachexpertsinthefieldforboth

contentandsponsorship.Armedwith

suggestionsforcontactsandahostofnew

ideas,wegottowork.Wewereamazed

attheresponsewegot:peoplewere

extremelyencouragingandgenerouswith

theirtimeandefforts,andthisinturn

inspiredustopushforahigherqualityin

ourwork.Pamconstantlycheckedupon

usandsentusnewideasandavenuesto

pursue,sothattheprojectwasdeveloping

rightupuntilthelastminute.

Thisweekhasbeenawhirlwind.We’ve

beenmasteringcompletelyunfamiliar

(Photo:PSA)

38

topicstoturnintoarticles,taughtourselveshowto

useaformattinganddesignprogrammeforthe

magazinelayout,aswellasconductingsustained

correspondencewithsomeextremelyinspirational

peoplefromthefield.ThePSAmicro-internship

hastaughtushowmuchcanbeachievedifthe

rightkindofpositivepressureisapplied,andthat

issomethingthatwillremainwithusformuch

longerthanthisoneshortweek.

Wehopeyouenjoythemagazine,andlook

forwardtofuturepublicationsfromPamandher

growingteam!

PhilipMatthews:Philipisasecondyear

HistorystudentatExeterCollege.

OriginallyfromScotland,heenjoys

debating,squashandplayingguitar.

YunaChang:YunaisathirdyearHistory

studentatWadhamCollege.

RossKing:Rossisathirdyearstudentat

PembrokeCollege,specialisinginArabic

andIslamicStudies.Hehasrecently

undertakenayear-abroadintheMiddle

East,duringwhichheplayedrugbywith

theJordaniannationalteam.

InternteamwithPSAProgrammeSupportOfficer,AnnaTighe.

(Photo:PSA)

Health&Humanitarian

thesupplychainreview

PhotocourtesyofVillageReach

Issue1

April2016

ProducedbyPSA,inconjunctionwiththeOxfordUniversity

InternshipProgramme