A field-driven framework to assess and improve the network flexibility in humanitarian supply chains

The efficient and effective response to disasters depends critically on humanitarian supply chains (HSCs). Therefore, HSCs need to be flexible to absorb or adapt to sudden shocks and dynamically shifting trends. The adoption of flexibility from different fields into HSC have led to a lack of a consistent understanding what flexibility mean, and how it can be measured. My presentation mainly is composed of three discussions: first, the concepts of flexibility for HSC; second, a framework to measure flexibility in HSCs; and third, corresponding findings from a case study after the 2015 Nepal earthquake. Our analyses for Nepal case depict high dependency of flexibility in HSC downstream on delivery, IT support and fleet criteria, among the others. Implementing the framework on nine humanitarian organizations (HOs), we find low levels of network flexibility in the majority of them. Therefore, we conclude that, although incorporating flexibility may not result in cost-efficient solutions, it improves the capacity to react to changes and develop a resilient or agile HSC. In this regard, we provide a discussion of the implications of our work for research and practice.

Achieving Efficiency in Health Logistics with Global Healthcare Supply Chain Standards

In the healthcare industry, logistics manage the flow of materials, products and patients data, and oversees the flow of information linked to these physical flows, in order to ensure quality and safety at a high level of performance and efficiency, from the manufacturer to the patient. GS1's global, multi-sector identification standards make it possible to follow drugs and medical devices from the manufacturer to the patient, improving efficiency, security, patient-care/safety, traceability and recall readiness.

Assessing the Opportunity to Develop Supply Chain Talent and Innovation in Africa

This presentation begins with a review of current educational offerings and research activity in supply chain management and related fields across major educational markets in Africa. This is followed by a summary of interviews with selected African companies regarding SCM talent and innovation needs. The presentation closes by exploring SCM as an emerging educational pathway and considering options for expanding research coverage to meet innovation needs

Catch-Up Scheduling for Vaccination

To ensure coverage against vaccine-preventable diseases for children, adolescents, and adults, and to aid individuals, caretakers, and providers in making vaccination decisions appropriately and in a timely manner, Georgia Institute of Technology in collaboration with the Centers for Disease Control and Prevention (CDC) developed the Catch-Up Immunization Schedulers, decision support tools for creating catch-up immunization schedules. In most countries, there are published immunization recommendations for children and adults, which contain recommended ages and specific rules regarding the minimum and maximum allowable age that each vaccine dose may be administered, and include minimum gaps between doses of the same vaccine.  The immunization recommendations for adults may depend on factors such as medical condition, lifestyle, and work environment, in addition to age and vaccination history. If an individual misses one or more doses of a recommended vaccine, it is typically a health-care professional’s job to create a catch-up vaccination schedule which is feasible and maximizes the person’s coverage against vaccine-preventable diseases. This task is often very challenging and time-consuming. 

The catch-up scheduling problem for each targeted group is one of determining the best schedule (in terms of coverage) for each individual given their past vaccination history and current age.  Doses of a vaccine may not be scheduled unless they may be feasibly administered and are not contraindicated. Through an easy-to-use interface, the scheduler accepts input from the user including date of birth, the dates of administration for each dose and the number of doses of each vaccine that have been administered.  The tool then determines the recommended immunization schedule using a dynamic programming (DP) algorithm. The schedulers simplify and expedite the tedious process of constructing immunization schedules, eliminates errors, and help improve protection against vaccine-preventable diseases.

Classification of Private-Humanitarian Supply Chain Partnerships and Contracts Designs

Our research analyses private-humanitarian supply chain partnerships and contract designs based on empirical data, collected by interviewing experts both from leading commercial companies and humanitarian organizations. First, we examine how the two sectors initiate partnerships and what the incentives for both sides are. Then, we classify the different types of contract designs and framework agreements applied in the different phases of disaster response.

DEA-Based Efficiency Evaluation of Road Rescue and Relief Bases of Yazd Province Red Crescent Society

Today in Iran, due to the significant expansion of roads and increasing number of vehicles, as a result, an increase in road accidents, Red Crescent Society of Iran decided to establish permanent, mobile and temporary road relief and rescue bases around the country as a humanitarian intervention. These Road Rescue and Relief bases set up in every thirty kilometers and will respond to accidents rapidly. The bases are equipped year-round with ambulances, light and heavy rescue vehicle, rescue kits and also professional human resources as rescuers and delivering services. To make sure that these bases continue their activities with better performance, an evaluation on the performance of the bases are therefore necessary. 

Designing the Global Health Supply Chains of the Future

While not looking to forecast the future, we aim to challenge and broaden assumptions about what comes next and how you participate in the coming changes.We are looking to stimulate thinking about global health supply chain design so that governments, global agencies, and private actors support relevant and timely investments. We can all help ensure that patients around the world achieve dramatically improved access to affordable healthcare – when, where, and how they want it. In this presentation, we will highlight trends we believe will impact your organization and consider the actions you can take to address them. We are at a time, when economic forces and the spread of technology are coming together in a way that at this is a time for being overly optimistic about healthcare supply chains in developing countries.

Gavi / Deutsche Post DHL Partnership

In January 2017, the Gavi, The Vaccine Alliance and the Deutsche Post DHL Group signed a strategic partnership to improve vaccine supply chains. The first initiatives for this partnership are focused in Kenya supporting the development of a Visibility & Analytics Network (VAN) by providing a transport support hub (TSH) to coordinate the upstream supply chain management and visibility while also exploring new solutions for downstream vaccine delivery.

Health Supply Chain Transformation Project in Kaduna State (Nigeria)

Nigeria is undergoing significant supply chain transformation across the country, with several major donors making investments in various initiatives in operation at both the federal and state levels. In Kaduna State, the Bill and Melinda Gates Foundation (BMGF), with the aid of its technical partner Pamela Steele Associates (PSA), is supporting the state with the Kaduna Public Health Supply Chain Transformation Project, which aims to transform the state’s public health supply chain. 

The Kaduna State health supply chain is beset by several problems, including the high cost of the supply chain, the low availability of essential medicines and commodities and, at the same time, the unacceptably high level of wastage, with the system continuously showing low levels of accountability and insufficient performance management. In addition, overstock in Central Medical Stores and understock in local health facilities suggest the state faces significant ‘last-mile’ distribution challenges. Fundamentally, the supply chain suffers due to a structure that is dependent on donor funding and that has resulted in nine separate supply chain programmes. Information processes are cumbersome as each programme separately collects a distinct set of data for its own supply chain. Also, each programme has a parallel distribution system despite their similar commodity flows. The state is seeking to align with the national policies and strategies of the Federal Ministry of Health’s National Products Supply Chain Management Programme for integration of the supply chain, through the National Supply Chan Integration Project (NSCIP).

Information Systems for Supply Chain Management: The Case for Separate but Interoperable Applications for LMIS and HMIS Data

Routine health information systems (RHIS) are essential for monitoring and evaluation (M&E) of health service delivery, and for planning and managing resources. Two pillars of RHIS are health management information systems (HMIS) that collect and use service data from health facilities, and logistics management information systems (LMIS) that collect and use pharmaceutical supply data from health and storage facilities. In recent years, donors and country governments have invested heavily in software applications that improve the collection, transmission, storage, and use of both types of data. A variety of electronic LMIS (eLMIS) software solutions have been deployed in low- and middle-income countries. These systems are designed specifically to support the automation of supply chain workflows and business logic, which can include inventory management, demand planning, requisition/allocation, order fulfillment, receipt confirmation, track-and-trace, etc. They also provide notifications and alerts to users who have actions pending or who are running low on stock, which has helped streamline approvals and order processing, reducing lead times.

Some stakeholders are attempting to use a single common software platform--DHIS2--to collect and manage both HMIS and LMIS data. This approach can make sense in certain circumstances, especially for data capture, but the complex business logic required for supply chain management requires a robust fit-for-purpose application to support routine operational transactions. This presentation will make the case for separate but interoperable applications that are designed and built to meet the unique needs of each data set and their primary users.

Innovative Use of Data and Management Best Practices to Improve Public Health Supply Chain in Ten Countries in Kenya

The IMPACT Team approach is a feasible management tool for county supply chain managers to use data and a structured process to drive prioritization, decision-making and action planning around supply chain improvement. inSupply introduced the approach as a result of the devolution of health services in Kenya in 2013, which shifted responsibilities and budgetary authority to the counties and demanded stronger analytic and leadership capacity for supply chain management at the county level.

The IMPACT Team Network approach - a people- and data-centered system to build supply chain leaders and skills - along with a structured framework for routine data and analytics use to drive decision making and action planning around supply chain improvement. inSupply and the Ministry of Health selected the 10 focus counties for IMPACT Team implementation. To fill the gap in data visibility and analytics, inSupply identified existing logistics data for contraceptive and vaccine supply chains and worked with county leaders to create key performance indicators to drive the quality-improvement process. inSupply developed a user-friendly, excel-based, Indicator Tracking Tool with one dashboard for each supply chain per county.

Integrated and Responsive Vaccines Information Management system - The Case of VIMS in Tanzania

In Tanzania, existing data management initiatives and technologies for managing routine immunization data, cold chain equipment, and stock management data are not integrated. Non-adherence to national eHealth strategies and uncoordinated efforts by development partners often lead to innovative systems that operate in silos.

inSupply partnered with Clinton Health Access Initiative, PATH, and VillageReach under IVD’s leadership to create an integrated immunization information system that would also be configurable and freely adoptable by additional countries. In December 2014, IVD organized a Vaccine Information Management System (VIMS) requirements review workshop with representation from key stakeholders. VIMS brings together functionality from three stand-alone component specific systems; the District Vaccine Data Management Tool (DVDMT), the Stock Management Tool (SMT), and the Cold Chain Inventory Tool (CCIT). Each partner organization brought in unique resources, competencies, and experience and was involved in all aspects from system design to development to deployment. The team supported continuous improvement through collective evaluation of jointly agreed upon key performance indicators and change management. IVD provided overall leadership and coordination through weekly progress meetings and each partner led the development of a VIMS module. The partners worked collaboratively to fulfill a single set of requirements for VIMS, initially prioritizing requirements within their scope and making amendments during the course of the project. 

Leveraging Partnerships to Scale Up Health Services Delivery for Mobile Populations in Africa

This presentation focuses on how North Star Alliance, a nonprofit health services delivery organization, provides health services delivery for mobile populations along the transport corridor in Africa. North Star Alliance has adopted a containerized clinic model, operating a network of 38 Roadside Wellness Centres, to advance health services delivery in Africa. The organization's core model is premised upon principles of logistics and supply chain management.

This presentation focuses on two key issues pertaining to North Star’s operations: i) strategies for partnership and alliance-building along distinct stages of the health care delivery supply chain, and ii) challenges and trade-offs for a non-profit in coordinating and managing partnerships with diverse actors along the health care delivery supply chain.

The presentation will also discuss the complexities a non-profit health services delivery organization confronts as it strives to mobilize resources in an increasingly competitive global health funding environment where each nongovernmental organization attempts to persuade prospective partners that its project is more valuable than those of another nongovernmental organizations. Throughout the presentation, a focus will be on how North Star manages trade-offs that emerge for a nonprofit, as it simultaneously strives to achieve goals of scale, sustainability and health equity.

Mitigating Supply Chain Challenges through the Application of a New, Sequential Assessment Tool (MIAAF): Developed Based on a Case Study of a Pharmaceutical Supply Chain

The two facilitators analyzed a case study of the Ethiopian Public Health Commodity Supply System (EPHCSS) which is supplying more than 3000 health institutions all over the country. The supply network actors are manufacturers, third party transportation providers, the governmental Pharmaceuticals Fund and Supply Agency (PFSA) with a central hub, 11 regional hubs and 7 subhubs, and the health institutions.

Process and activity flows of the supply network was mapped in a process model to get a thorough understanding of the EPHCSS. Analysis of the model identified tension points relating to each of the supply chain challenges- stock outs, overstock, counterfeit products and inefficient recalls. To analyze the tension points identified, data was collected using a triangulation of interviews of actors in the supply network, standard operating procedures, and the authors work experience in the Ethiopian health supply system. Based on the process model and the analysis, we identified the potential for mitigating supply chain challenges by enhancing visibility. Based on the insight of the case study, the constraints of the Ethiopian supply system, references to similar projects, and cases from literature; improvement recommendations are suggested. Finally, those improvement recommendations are analyzed for a fitness of relevance using supply chain visibility scorecard methodology.

Mobile Solution for Health Logistics Management Information Systems in Resource-Limited Settings

In resource-limited settings, medical commodity supply chains for public health care systems face a myriad of challenges, including incomplete data about consumption and stock levels. There is growing interest and uptake in these settings of electronic logistics management information systems (LMIS), largely focused on warehousing and distribution. This has provided improved visibility of data and more efficient supply chain management. However, access to data about stock movements at the health facility level remains as a gap in these systems. Clinton Health Access Initiative partnered with ThoughtWorks, Inc to develop a mobile solution appropriate for use with Android tablets at the health facility level by the Mozambican Ministry of Health (MoH).

Neglected Tropical Diseases Supply Chain Forum

2017 marks the 5th anniversary year of the London Declaration which brought together a diverse group of partners, including leading pharmaceutical companies, countries, donors, and implementers, who committed to support the WHO Roadmap targets to control, eliminate or eradicate neglected tropical diseases globally. Effective end to end supply chains are a key success factor, leading to the development of the NTD Supply Chain Forum (NTDSCF) as a unique collaboration between private and public organisations focused on supply chain optimization and innovation. The overarching goal for the NTDSCF is to identify gaps and challenges within the first mile of the NTD drug supply chain and work together to develop solutions. This workshop will be led by the Bill & Melinda Gates Foundation, DHL, GlaxoSmithKline, & Merck.

Optimizing Population Screening for Infectious Diseases: The Case of HAT Disease Control in D.R. Congo

A key element in fighting infectious diseases is to detect and control outbreaks as early as possible. One of the most rigorous control strategies is to perform exhaustive population screening, in which villages or populations at risk are visited and screened by a mobile team. Since budget available to maintain this costly approach tends to decrease when prevalence decreases, a key challenge is to minimize the risk of re-emergence by increasing the effectiveness of available mobile teams. This risk is of particular relevance in the context of Human African Trypanosomiasis (HAT), also called Sleeping Sickness, a disease that causes substantial suffering in the DRC and surrounding countries.

One way to improve effectiveness of mobile screening teams is to optimize their planning. This encompasses deciding which villages to visit and with what time interval to visit them so as to minimize the expected burden of disease. This talk discusses how we, based on close cooperation with local partners, mapped the relationship between HAT prevalence and planning decisions, and how this led to the development of simple and effective guidelines for planning decisions. We shall discuss how our research is impacting practice and how it provides input to the debate on elimination strategies.

Preliminary Results from Direct-to-Facility Vaccine Deliveries in Kano, Nigeria

A weak vaccine supply chain system significantly contributed to poor immunization coverage rates in Kano. The vaccine distribution system was characterized by a complex multi-layered architecture, inadequate funding and weak financial flow mechanisms resulting in largely ineffective delivery of vaccines to immunization service points. Having instituted a tripartite MoU with the Bill and Melinda Gates Foundation and Dangote Foundation to strengthen RI, Kano embarked on an ambitious transformation of its vaccine supply chain. One of the interventions involved streamlining the vaccine distribution architecture, by delivering vaccines directly from state cold stores to equipped health facilities, skipping the local government stores. The new delivery system utilized both insourced (managed by the state), and outsourced (managed by a private vaccine distributor) approaches. 

Procurement of Complex Medical Equipment

Since 1990, significant improvements in child health have been made. The under-five mortality rate has decreased by 49%, from 90 deaths per 1,000 live births in 1990 to 46 per 1,000 in 2013. However progress is hindered in many low- and middle-income countries by weak health systems and poor access to life-saving medical equipment commonly found in neonatal intensive care units (NICUs). The presentation outlines UNICEF Supply’s role in procurement of Essential Medical Equipment and the considerations for product selection, installation, training, after sales service and maintenance of complex capital equipment associated with the NICU environment. Access to these technologies requires a foundation of basic infrastructure including availability of medical gasses and clean, reliable electricity.  Proper selection of fit-for-purpose and high value-for-money equipment is essential. This requires ensuring products meet minimum specifications and manufacturers have the proper certifications demonstrating a robust quality management system. Clinical training, installation, and after sales service are also essential to ensuring the equipment is safe and effective. Finally, health technology management requires a cadre of well-trained clinical engineers who are knowledgeable and skilled at preventative and corrective maintenance and who maintain a robust spare parts supply to support this maintenance.

The presentation outlines UNICEF Supply’s role in procurement of Essential Medical Equipment and the considerations for product selection, installation, training, after sales service and maintenance of complex capital equipment associated with the NICU environment.

Solving the Challenge of Data Use and Monitoring Supply Chains with Easy-to-Use Solutions

There has been a recent focus in humanitarian supply chains on improving monitoring by introducing new technologies. Electronic Logistics Management Information Systems, new mobile technologies, and real-time monitoring tools are continuously developed and rolled out in the field with the aim to help health workers collect and transmit supply chain information for better decision-making and monitoring. However, there has been less of a focus on explaining why data should be collected in the first place, or how it should be used. As an alternative to developing more tools with complicated technologies, UNICEF Supply Division (SD) has focused on standardizing processes and indicators, supporting leadership and strengthening staff capacities and has developed a simple, visual way of monitoring focused on using existing data. This approach is being utilized internally as well as with government partners and may serve as an example of an effective low-tech approach toward having visibility in and monitoring supply chains. The benefits of these dashboards have been immediate: COs have been able to better manage the flow of supplies, prepare for the arrival of new supplies (e.g., customs clearance procedures), and improve future planning.

With this experience, UNICEF SD is packaging its own supply chain data for governments to use. The Visibility for Vaccines (ViVa) website is a simple, visual tool that enables Ministries of Health to monitor the status of their vaccine stocks and future projections. Countries like Afghanistan are logging into the website on a weekly basis to monitor their supplies and take corrective action to avoid vaccine stock-outs or over-stocking. This presentation will outline the common challenges with regards to using supply chain data and monitoring; how UNICEF is addressing these challenges internally through simple solutions using existing data; how UNICEF is working with Governments on supply chain data use through simple tools; and likewise, how Governments are working with UNICEF support to improve availability and use of own data.

Spatial Allocation of Resources for Epidemic Control: A Greedy Heuristic versus Dynamic Programming Approach

Rapidly evolving infectious disease epidemics, such as the 2014 West Africa Ebola outbreak, pose significant health threats and present challenges to the global health community due to their heterogeneous geographic spread. Policy makers must allocate limited intervention resources quickly and often in anticipation of where the outbreak is moving next. We develop a two-stage model for optimizing when and where to assign Ebola treatment units (or other interventions) across geographic regions during the outbreak's early phases.The first stage uses a Susceptible-Infectious-Removed (SIR) transmission model to forecast the occurrence of new cases at the region level, capturing connectivity among regions.

The second stage compares two approaches to efficiently allocate resources across affected regions: (i) a greedy heuristic prioritizing regions based on their basic reproductive number, R0, which delivers good results when Ebola case data are limited, and (ii) an approximate dynamic programming (ADP) algorithm coupled with the underlying calibrated epidemic model, which finds a better solution when more nuanced data are available. Although we illustrate our model’s utility for the 2014 Ebola epidemic, which has fortunately abated, the general methodology could be applied to other emerging outbreaks—such as the ongoing Zika virus epidemic—and other interventions (e.g., vaccination, mosquito control, community education).

Strengthening Stewardship of Outsourced Logistics

In a range of settings John Snow, Inc. (JSI) has guided public health partners to achieve an ideal balance between the use of public and commercial sector logistics resources to address bottlenecks and improve both the quality and efficiency of the in-country health commodity supply chains that deliver products to people. As these supply chains mature healthcare delivery implementers now have more opportunity to become not just procurers of services, but rather stewards of outsourced commercial logistics services. Done well this approach ultimately contributes to building an environment where suppliers want to be engaged, are confident that they will be compensated, and are vested in contributing to the greater public good.

This oral presentation by JSI and their collaborator Imperial Health Sciences (IHS) outlines different approaches for engagement of healthcare providers with commercial logistics services ranging from the adaptation of commercial best practices to stewardship of service providers within the broader, integrated public health supply chain. During the oral presentation a principle discussion point will be about how healthcare delivery implementers can consider thinking about working with commercial logistics providers, not just in terms of singular transactional procurements of services, but as professional resources that can be continually consulted and learned from.  JSI’s work in Myanmar, Malawi, Ghana, and Nigeria, where it collaborated, on behalf of the national programs and donors with service providers, such as IHS, to leverage the use of logistics resources, will be used as a case study for discussion.

Strengthening the Family Planning Supply Chain in Indonesia: An Innovative, Holistic , and Locally-sourced Approach

Indonesia’s National Population and Family Planning Board (BKKBN) in partnership with the “My Choice” Program is strengthening the supply chain for family planning, to improve consistent access to a choice of contraceptives at health facilities across three provinces in Indonesia .  Over the past decade, Indonesia’s contraceptive prevalance rate has remained stagnant in part due to inconsistent access to contraceptives, especially long acting contraceptives, at service delivery points. Although stock outs have often been a hot conversation topic, these discussions have focused on non-achievement of service targets and have not precipitated larger discussions on the overall supply chain system. 

Over the last two years, BKKBN and the ‘My Choice’ program have worked in three provinces to address the supply chain challenges through a holistic systems strengthening approach. The work is guided by three core themes – organization, collaboration and information -with an aim to making systems more efficient and sustainable. First, we have built organizational capacity through piloting redesigned standard processes and modern training tools such as video tutorials and mobile apps for supervision. In addition, we have created multi-level collaboration through quality improvement techniques and the use of whatsapp groups. Lastly, we have improved data visibility, quality and use by equipping stakeholders with tools to maintain accurate logisitic records and reports and created an inventory management and monitoring tool that facilitates easy decision making in particular guiding the distribution of stock to maintain adequate stock levels and monitor the overall strength of the the supply chain. 

In our oral presentation we will describe the methodology, intervention design, midterm impact results (conducted in February 2017), and lessons learned. The presentation will highlight the successes and lessons learned in the efforts to strengthen supply chains within and across the various decentralized system levels and provide others working in this field with some innovative, locally produced solutions for improving supply chain performance.  

Supply Chain Management - 500,000 Houses Reconstruction Post 2005 Earthquake, Pakistan

The earthquake of 2005, destroyed over 500,000 houses in the affected area, spread over 30,000 sq km and killed over 73000 people, in the Northern Pakistan. To reconstruct the seismic resistant destroyed houses an owner driven  strategy was formulated by Earthquake Reconstruction and Rehabilitation Authority (ERRA) in Pakistan and incorporated the indigenous technologies and practices i.e Batar and Dhajji; of construction by communities side by side contemporary construction technologies.

The Development of a Minimum Initial Service Package Kit for Safe and Legal Abortion to the Full Extent of the Law

The Minimum Initial Service Package (MISP) for Reproductive Health is a set of life‐saving commodities and activities to be implemented at the onset of every humanitarian crisis. The MISP includes planning for comprehensive reproductive health services integrated into the primary health program, including the provision of RH equipment and supplies. The kits are designed to respond to three month’s need for supplies and can be ordered directly through the UNFPA AccessRH procurement service.

Although abortion is legal in several humanitarian host countries, particularly in cases of rape, and many donors and governments have recommended that abortion services be available where they are legal, the only MISP kit available to practitioner organizations is for the management of complications of an unsafe abortion (kit 8). This kit includes MVA and misoprostol but does not provide guidance for using these technologies for induced abortion, nor do the kits include mifepristone, the gold standard WHO-recommended medication for induced abortion. While the Interagency Field Manual for Reproductive Health in humanitarian settings mentions the need to provide safe induced abortion when it is legal, there is currently no way to access mifepristone or technical assistance to enable humanitarian practitioner organizations to build skills or access commodities they might need to provide this service.  

A number of humanitarian practitioner advisors on the Inter-agency Sub-Working Group on Safe Abortion have recommended the creation of a new abortion kit in a new parallel privately marketed system.  The group has suggested the development of a new kit based on the MISP system for distribution to humanitarian agencies, including MVA, misoprostol alone, or mifepristone and misoprostol for induced abortion.  This presentation describes the results of preliminary interviews and examines options for the development, distribution, awareness-raising, evaluation, pre-positioning, and feasibility of the new kit exploring the potential for positioning the kit within the UNFPA system and outside, examining partners and distributors based on preliminary recommendations.

The People Factor: A Systematic Approach for Assessing Human Resources for Supply Chain Management

Human resources (HR) for health is an integral part of any health system and the immunization programme is no expectation. With the increasing supply of life-saving vaccines worth billions of dollars in many countries, there is need to strengthen the in-country workforce to not only effectively manage immunization supply chain activities but also to help ensure sustainability and ownership of these important tasks. HR being cross-cutting, it is also expected that through these approaches and interventions the overall supply chain will be strengthened as well. The HR assessment for immunization supply chains gives a holistic approach to assessing HR needs using a “tripod” mechanism.

The assessment provides an in-depth look into HR challenges using evidence-based data for further improvement. This tool has been successfully administered in seven countries namely Ethiopia, Kenya, Malawi, Zambia, South Sudan, Uganda and Lesotho resulting in recommendations which have been factored into supply chain strategic planning processes and continuous improvement plans for the immunization supply chain. Coupled with this improvement is the visibility provided through this assessment to country governments on their HR needs for systematic and informed planning. This topic is also of interest with ongoing plans to incorporate the questionnaire within the effective vaccine management assessment (EVMA) tool 2.0 which is the standard assessment for immunization supply chains.

Towards a GS1 based Supply Chain data exchange and visibility

Lack of consistent logistic and product electronic data exchange standards have lead UNFPA to face unreliable manual data entry and incomplete data while interfacing with its global suppliers. GS1 standards have been long recognised in the health supply chain to streamline product identification, data capture and track and trace event sharing. UNFPA has been working with national governments and key suppliers to successfully test shipment data (ASN/Despatch Advice) electronic data exchange and will continue to expand this to cover all critical commodities in the coming years. Having recognised the importance of reliable supply chain data for product identity, capture & share through barcode identification, logistic track and trace, stock-out management, inventory management and planning.

The direct benefits of this data exchange, besides facilitating internal data analysis and significantly reducing time consuming manual work efforts, will be that national government warehouse management systems and health management systems will continuously have up-to-date electronic shipping data information originating from the suppliers, provided through UNFPA’s IT system. The system of utilizing standardized GS1 data - and master data shared by suppliers via the procurement entity and routed through a single data warehouse all the way to recipient country governments’ electronic logistics systems - could then be further expanded for NGOs, UN agencies and other humanitarian agencies to reduce (or avoid) data source siloes by each donor entity. 

Transportation Auctions in the Last-Mile

Despite broad skepticism of "Uberization" in last-mile freight, the model has already arrived for both less-than-truckload (LTL) and truckload (TL) businesses in India's private sector. However, these novel offerings have largely ignored rural markets and operated almost solely in the urban freight-management space. Over the past 18 months Logistimo introduced a crowd-sourced door-to-door logistics model for rural regions, wherein live auctions were conducted via mobile phones to source transportation services from a pool of informal private sector drivers, fulfilling orders from pharmaceutical distributors in a district-level hub city to 10 taluka-level towns, and ultimately to >770 villages in northern Karnataka (India). In order to achieve unit economic sustainability, sufficient volumes and route density were paramount challenges in a geographically spread-out rural environment. The business therefore engaged with customers across many sectors – including agricultural inputs, fresh produce, FMCG, home appliances, consumer durables, solar equipment, textiles, industrial goods, pharmaceuticals, arts & crafts. Through piggybacking on larger volumes generated across industries, pharmaceutical distribution could achieve economic viability. Electronic auctions stimulated competitiveness and enabled effective utilization of excess truck capacity to meet customer demands, thus improving market efficiency and further reducing costs. This orchestration of a previously informal transportation market has resulted in a >80% increase in driver incomes, among other positive business impacts observed for distributors and village retailers. Further insights were gleaned in terms of pre-existing user incentives, pricing, and the complexity of bringing a novel service offering to market. 

We acknowledge that last-mile transportation is only a component of healthcare supply chains, but it is often cited as an important gap. Local ownership of healthcare supply chains can be seen through the lens of local engagement via market mechanisms. We argue that commercial mechanisms – a direct link between payers being naturally incentivized to ship consignments, and service providers being proportionally rewarded at every step in the value chain – are inherently sustainable because it addresses only what can be achieved through existing incentive structures and existing capacity.

UNFPA RH Kits, Third party procurement, WFP and Global Fund Collaboration

The presentation will start out by featuring a short background section on UNFPA and its procurement position as the largest public sector procurer in the world of reproductive health commodities. It will then describe one of UNFPA’s standard humanitarian interventions which is the provision of reproductive health kits that contain life-saving medicines, supplies including contraceptives and medical equipment to address the immediate sexual and reproductive health needs of a community in crisis. This section will also display numbers of kits dispatched, the cost involved and number of pregnancies and death prevented by these interventions. Lastly, this section will describe how eligible clients, i.e. governments, NGOs and other UN agencies can acquire these kits from UNFPA.

The second part of the presentation will provide an overview of collaborative engagements in the procurement and supply chain area and in particular discuss UNFPA’s collaboration with WFP in the freight and logistics area, with other UN and non-UN entities including the Global Fund and the private sector. The WFP collaboration strives at uniting UNFPA’s procurement expertise in reproductive health commodities with WFP’s logistics expertise to create mutually benefiting economies of scale by leveraging key strengths and capacities of both organizations. The collaboration with other UN agencies, non-UN entities and the private sector focus on achieving better value for money by sharing data and/or tools and standardize processes and/or guidelines and thereby optimize use of resources.

Lastly, the collaboration between the Global Fund (GF) and UNFPA was established to provide access to quality assured, competitively priced RH commodities for GF principal Recipients by channelling all requests for lubrication, male- and female condoms to UNFPA for procurement. Due to the increase in UNFPA’s procurement volume of these commodities, this collaboration has the further benefit of allowing UNFPA to better shape supplier markets for the benefits of all parties.

Vaccine Cold Chain Data Visibility to Inform Decision Making: A Phased Approach for Technology Adoption and Expansion in Mozambique

Introducing appropriate innovative technology is an integral part of strengthening the vaccine supply chain. In 2014, the Mozambique Ministry of Health decided to assess the benefits of different cold chain temperature monitoring methods and to scale the best solution for the country. The engagement of the Ministry and partners was critical to the success of selecting and expanding the right solution, and this phased approach is an example of a sustainable implementation model for technology expansion in supply chain. 

With data visibility into vaccine cold chain equipment performance, it is possible for the Ministry of Health to identify exactly which refrigerators need replacement, make informed decisions regarding replacement models, and devise accurate budgets for procurement. 

The data on common root causes of cold chain failure across the country makes it possible to plan and budget for spare parts, technicians, tools and training. In sum, this innovative use of cold chain data is a powerful model for strengthening the cold chain system, allocating resources, and streamlining management practices. 

This presentation will cover the benefits and challenges of this implementation and will provide recommendations to other countries that want to replicate the successful introduction of cost-effective, innovative technologies to improve their vaccine supply chains.

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