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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
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%
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
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
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