The 2018 HHL Presenters:
With support from BullCity Learning, VillageReach is working with cold chain technicians in Malawi to develop an interactive application to support preventative maintenance and repair of cold chain equipment. The application is based on video training filmed in the country and reviewed by subject matter experts. This presentation will highlight the steps taken to develop the cold chain maintenance application and give a first look at some of the content that will be available in the application.
Since the Health and Humanitarian Logistics Conference in 2015 when the Africa Resource Centre was first introduced, the organization has developed, remodeled and grown substantially, and this presentation aims to update HHL participants on ARC today. The Africa Resource Centre is now fully operational in 4 regions, Senegal (supporting Francophone West Africa), Nigeria, South Africa (supporting Southern Africa) Kenya (supporting East Africa). ARC has established trusted relationships as an independent strategic advisor to multiple African countries, supporting MoHs to improve availability of medicines and health products through supply systems strengthening. We partner with donors and strategic partners to help improve the return on investment to strengthen supply chains in Africa. With increasing investments from various partners and donors such as the Bill and Melinda Gates Foundation and the Global Fund to Fight Aids, Tuberculosis and Malaria into the organization, ARC’s work has managed to extend support to multiple countries.
With the experience of emergency response in a humanitarian crisis such as Ebola, Zika, Cholera and natural disasters it is more important than to evaluate the readiness of supply chain systems and lay a strong system foundation for a sustainable humanitarian logistics response. Each country government must be empowered to own and lead response efforts by implementing a system to understand short-term and long-term plans for humanitarian response, including how to align with existing systems and mechanisms. As countries are developing their systems for humanitarian response, they must consider a number of factors ranging from policies, strategic frameworks, action plans and adequate resources. The presentation will highlight efforts and lessons learned from Global Health Supply Chain Technical Assistance (GHSC TA-TZ) project, implemented by PwC to address logistics responses and how the approach can be adopted by other countries as they strengthen their own supply chains for global health emergencies.
The United States Agency for International Development (USAID) Global Health Supply Chain Technical Assistance Program in Tanzania (GHSC-TA-TZ), as a technical assistance implementing partner to the Government of Tanzania (GOT) on health commodities supply chain strengthening, is committed to the provision of strategic planning and implementation assistance through supply chain costing and financing strategies. Despite significant improvement in the supply chain over the decades, unavailability of medicines has continued to be a major block into realizing the intended population health of Tanzanians. One of the major factors attributable to these frequent stock outs has been inadequate financing and operational inefficiencies among others. Lack of a total, holistic approach in estimating the total health commodities financial needs made it unclear whether the current funding envelope from all sources was sufficient to cover the total health commodity financial needs and whether better management of direct funds to health facilities would help to realize efficiency gains to minimize any financial gaps that may exist. Through this study, we assessed the range of funding sources available at a health facility to compare with the total health commodity needs for that facility, namely for public health facilities including dispensaries, health centers and district hospitals under the Local Government Authority (LGA).
Dagu, a local pharmaceutical inventory management system for health facilities developed by JSI, is currently being used in more than 750 public hospitals and health centers across Ethiopia. AIDSFree, ARRA, UNHCR, and USAID collaborated to implement and support the system including, training and intensive field level and remote telephone support, to all 24 refugee camp health centers. Of those deployments, 11 facilities are using the system regularly to redistribute overstocked and near expiry items and generate reports and requisition forms (RRF), bimonthly report for resupply in an average of 90 minutes, as opposed to the two days it took them to do so manually. With consistent use, Dagu is revolutionizing supply chain management at refugee camps by minimizing commodity shortages, and overages, improving stock management (maintaining inventory levels between minimum and maximum) and increasing access to and accuracy of information for upstream resupply planning.
The Theory of Change for Building Human Resources for Supply Chain Management (HR4SCM TOC) was developed to describe the impact of interventions and investments in human resources for supply chain management (SCM), which aim to improve supply chain performance through the availability of commodities at the service delivery point. Up until now, this type of model did not exist and linking previous investments and interventions to their impact in supply chain performance was neither distinct nor clear. The HR4SCM TOC will enable SC practitioners to capture and understand the pathway of change that connects interventions and investments in human resources (HR) to health supply chain performance improvements and ultimately to improved health outcomes. Applying a TOC process will help practitioners acknowledge and assess impact in hard-to-measure areas, such as capacity strengthening and institutional development. The HR4SCM TOC is a valuable learning tool that allows governments, donors and technical partners to appreciate the complexities that govern HR in health supply chains and to understand how programs and interventions can navigate the complex environment to create change.
The humanitarian space is complex, crowded and competitive. To satisfy heightened public and donor scrutiny, those operating in this space must demonstrate increased transparency and deliver proven results. Well-designed collaborative projects between traditional humanitarian actors and the private sector can enable a bespoke blend of expertise that drives efficiencies, delivers effective results and satisfies donor requirements. Crown Agents is working alongside 3 INGOs in a Consortium designed to respond to the health needs of South Sudanese refugees residing in the West Nile region of Uganda. Using this project as a case study, the presentation will highlight the benefits that collaboration can bring to a health and humanitarian supply chain.
Nord Kivu province in the eastern Democratic Republic of the Congo is home to a decades-long conflict that has ravaged the public healthcare system, including the supply chain for sexual and reproductive health (SRH) supplies. Since 2011, CARE’s Supporting Access to Family Planning and Post-Abortion Care (SAFPAC) Initiative has supported the government health system to provide a wide range of contraceptive services, especially long-acting reversible contraceptive services, in several health zones in Nord Kivu. In the first year of the SAFPAC initiative, health facilities experienced reoccurring stockouts of implants, pain medicine, and high-level disinfectant. To address this problem, we trained and supported Health Area Development Committees (aka CODESA) to provide oversight of stock inventory management by participating in monthly supportive supervision visits to health centers during which they conducted physical inventories to compare stock holdings to stock inventory records and to make sure that products in short supply got re-ordered right away. By involving CODESAs in the oversight of stock inventory management, we reduced the number of stockouts in the health centers we support to nearly zero while building mutual trust between communities and government health authorities.
The IMPACT Team Network is a people-centered, data-driven approach to improving the performance of the supply chain by focusing on quality, efficiency and customer services. IMPACT stands for Information Mobilized for Performance Analysis and Continuous Transformation and uses a continuous improvement process to using data and addressing supply chain bottlenecks. IMPACT Teams help to create a culture of data use in the public health supply chain sector by building skills and commitment to reviewing KPIs regularly, identifying problems and implementing solutions. During this presentation, JSI will share experiences of implementing IMPACT teams across nine countries in Sub-Saharan Africa and South East Asia.
India’s immunization program faces multiple supply chain challenges due to it’s scale, terrain, socioeconomic conditions, cultural and linguistic diversity. The problem is compounded by limited infrastructure in terms of electricity, internet access and a lack of skilled health workers. Therefore unsurprisingly, supply and demand were misaligned, leading to both excess stock and stock-outs across the network. India has begun overcoming these challenges through an evidence-driven approach, maturing information systems through a logical pathway. The presentation will explain the evidence-driven theory of change, and share 3 data use cases driving positive outcomes in the program.
Data is the bloodline of any supply chain system. A key enabler to countries attaining their sustainable development goals is the consistent availability of key medicines, or in the case of Ethiopia, its Health Sector Transformation Plan. Over the last 14 months, the Pharmaceuticals Fund and Supply Agency (PFSA) leadership has begun transforming the organization’s data use culture. The hypothesis employed was that a concurrent emphasis on the automation of business processes and the consistent use of information systems to support those processes would result in improved data quality and eventual use. By enhancing data usage and quality to complement increased data visibility, PFSA increased commodity availability across a number of program commodity groups including HIV, immunization and malaria, ultimately improving health outcomes of Ethiopia’s citizens.
Autonomous aerial systems have the potential to play a critical role in last mile delivery of health products. Our analysis looked at AAS vs. well-managed traditional modes of last mile delivery such as 4x4 vehicles and motorcycles. Taking into account geography, AAS characteristics, characteristics of products being transported, and product demand patterns, in combination with 12 months of health facility data from three country datasets, the analysis helped define use cases for cost-effective AAS use. This modeling approach is being tested in Tanzania and Malawi and our presentation will cover the overall analysis and some initial lessons and findings from initial country-level deployments.
The implementation and management of the Integrated Pharmaceuticals Logistics system (IPLS) are being supported by AIDSFree, a USAID funded project, implemented by John Snow, Inc. AIDSFree has been supporting the health facilities in Ethiopia through routine planned supportive supervision to facilitate the IPLS implementation. The project covers over 1200 facilities every quarter including up to 6000 linked health posts. The regular and well planned supportive supervision visits were instrumental in helping bring the required changes in the reporting rate, data quality, and visibility. Overall recordkeeping and reporting have shown significant improvement, 99% of sites visited in the major regions (91% of emerging) have been able to complete and submit the standard Reporting and Resupply Form (RRF) to PFSA which is the public supply agency for the country.
Pharmaceutical sector governance and a strong medicines regulatory capacity is essential to protect the public from counterfeit and substandard products. Low and middle-income countries (LMICs) have varying pharmaceutical regulations intended to address local needs, but that results in a proliferation of unique requirements for product developers. Ensuring the quality of donated medicines and supplies is critical especially during global health emergencies. Many countries are seeing increasing numbers of substandard and falsified medical products that pose an unacceptable risk to public health. This presentation will provide an overview of these challenges and the various measures to address these challenges being taken by a number of different stakeholders, including National Regulatory Authorities, implementing partners and pharmaceutical companies.
In collaboration with UNICEF, Mozambique developed an Essential Medicines Programme, where the KIT component is delivering a package of essential medicines, dressings and surgical materials to each of Mozambique’s 1.561 Health Centers. From 2009, the Government of Mozambique took over the budgetary responsibility, and is continuously together with development partners enhancing the KIT component. The kits exist next to large supply programs for targeted deceases and for hospitals, and they do for a relative low percentage of the total budget for Public Health products deliver a security for a basic supply to primary health facilities.
Making essential medicines available has been a challenge for years. The logistical challenges of pharmaceuticals, the combination of expiry dates, temperature control, quality, and manufacturing lead times are considered. Essential Medicines kits were developed as a logical solution to the challenges of logistics in environments with physical and administrative challenges in distributing essential medicines. Thereafter has pull based mechanisms and informed push mechanisms therefore been advocated, followed by investments in systems and people. Removing the kits as a solution in many countries. Today there is still a widespread lack of availability, in terms of essential and specialized drugs in many developing countries, despite these investments in pure pull based mechanisms, there is today still widespread lack of availability in terms of essential and specialized drugs in many developing countries. This is combined with new challenges of a need for traceability and quality control.
The purpose of the presentations at the conference is to open up the discussion on how essential medicine kits as an integrated part of the national supply chain can contribute to secure availability, and how kits as push system in the medical infrastructure can be combined with a range of new tools increasingly available in developing countries.
Over the past decade, the Tanzania supply chain has seen a transformation in a number of areas in order to support the development of an agile, flexible and sustainable health supply chain and contribute to improving the health status of Tanzanians. With the implementation of USAID funded programs, the supply chain transformation has evolved from filling large gaps in Tanzania supply chain management to enhancing governance and continuously improving previously implemented changes. Key examples of this evolution in the supply chain transformation. Through this presentation, we will highlight the evolution of the supply chain transformation in Tanzania and highlight the planned next steps for this journey.
To improve the management of the medicine supply chain, South Africa has adopted the Visibility and Analytics Network (VAN) - a combination of People, Process, Technology and Policy, organized coherently to improve medicine availability - as the operating model to enable data-driven decision making. This presentation will detail the progress made to date, lessons learned during the implementation journey and the next steps in the evolution.
The Patent Information Initiative for Medicines, (Pat-INFORMED) is a new initiative representing a partnership among the World Intellectual Property Organization (WIPO), the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), both based in Geneva, Switzerland, and 21 global pharmaceutical companies. Pat – INFORMED is a search engine to help pharmaceutical procurement agencies determine the patent status of a medicine. Its goal is to facilitate access to and improve the availability of pharmaceutical patent information and to informed procurement decisions. possible. The initiative has two components: a freely searchable database listing INNs, patent (or rights holders), patent grant dates and jurisdictions; and, the ability to contact the rights holder directly via email to confirm status or request additional information. Pat – INFORMED will launch officially on September 25, 2018, in Geneva, Switzerland and WIPO and IFPMA are actively seeking procurement specialists to test the platform in advance of the launch.
Cold chain equipment (CCE) is essential for the immunization supply chain to maintain vaccines at the ideal temperature range (between 2◦ and 8◦ Celsius) to ensure vaccine safety and preserve potency. Temperature Monitoring in Vaccine Supply Chain is very essential and need to be monitored continuously throughout the supply chain. In Tanzania, JSI and Nexleaf working with the Government to install Remote Temperature Monitoring (RTM) devices at the lower health facilities across the country which improves cold chain equipment temperature data visibility for the purpose of improving cold chain storage performance, reducing vaccine wastage, and ensuring potent vaccines are administered to the clients.
The Government of South Africa procures in excess of USD 1.3M medicines every year. To enable medicine availability across all levels of the supply chain, the Government must have a strong contracts management capability that can hold its suppliers accountable to negotiated terms and conditions within their contracts, including service levels, cost controls, and quality standards. Doing so requires personnel that is appropriately skilled to negotiate contracts and analyze large amounts of information, informed with easy-to-access performance data, and empowered to take action to address performance issues.
To reinvigorate family planning services the National Population & Family Planning Board (BKKBN) in Indonesia is working with the My Choice project. JSI is partnering with BKKBN to holistically strengthen family planning supply chain systems. A supply chain assessment, conducted in 2015 by the project identified the insufficient use of logistics data for decision making, a lack of standard supply chain processes and coordination across divisions, and poor supply chain practices. This presentation will outline the improvements made through a multi-faceted intervention package that standardized and strengthened organizational processes, increased the use of data and information for decision making and improved coordination and collaboration across divisions and levels. Results from an endline assessment conducted in quarter one of 2018 will be presented.
Women and girls affected by crises face increased risks of maternal morbidity and mortality, unintended pregnancy, and sexual violence; yet during emergencies, access to life-saving sexual and reproductive health (SRH) services and supplies is often disrupted. This presentation will discuss SRH supply chain challenges and opportunities in diverse crisis-affected settings and will identify collaborative actions that can be taken to improve supply chain resilience and continuity of access to SRH supplies. It will discuss new global guidance on how to improve SRH commodity security throughout the emergency programming cycle, from pre-crisis preparedness measures, to acute and protracted humanitarian response, to the transition from a crisis to a more stable phase of development. Key opportunities exist, particularly in crisis preparedness and recovery, for governments, multilateral agencies, and non-governmental organizations across the humanitarian-to-development spectrum to collaborate on improving access to SRH supplies. Improving availability and access to SRH supplies in crisis-affected settings would save lives and better serve the needs of people affected by emergencies.
In Tanzania, MCSP is working with the Government of Tanzania (GoT) and in-country partners to expand access to high-quality reproductive, maternal, newborn and child health services (RMNCH). The immunization program uses target populations to estimate vaccine and related supplies based on census data which may be accurate at a national level but loses accuracy to sub-national level estimates, particularly at health facility level. This has resulted in illogical immunization coverage rates but also a high risk of stock-outs because some health facilities serve a client population that is larger than the target population upon which their resupply was based. MCSP supported subnational in triangulating target population and consumption data from previous months to identify true vaccine and related supply needs. The stock-outs have been reduced from 17% in 2015 to 3% in 2017 of the health facilities in the council. Shifting to consumption-based needs estimation reduces stock outs, creates a more agile and adaptive supply chain and better response to true supply need of the health facility, as a service point.
OpenLMIS is an open source, web-based, electronic logistics management information system (LMIS) software purpose-built to manage health commodity supply chains. The OpenLMIS initiative incorporates a community-focused approach to develop open source and customizable LMIS systems specifically designed for low-resource settings. Globally, OpenLMIS has made a significant impact on the availability, and quality, of logistics data for management. This presentation will introduce the OpenLMIS Initiative and Community, describe the impact of the software globally, explain the software’s commitment to open, standards-based development, and share the Initiative’s vision for shared benefit across implementations.
Project Last Mile (PLM) is a public-private partnership that shares the business acumen and route-to-market innovation of the Coca-Cola system with Ministries of Health across Africa to improve the availability of life-saving medicines. In South Africa, PLM partnered with the National Department of Health (NDoH) to support their Central Chronic Medicine Dispensing and Distribution (CCMDD) initiative, a program that enables patients to pick up their chronic medicines in convenience, community-based retail locations where they live and work, helping to both improve medication adherence and decongest public health facilities. As of March 2018, there were 3216 health facilities registered with the CCMDD programme (~65% of all facilities in the eight participating provinces), over 2M patients cumulatively enrolled, and a total of 847 external pick-up points established through negotiations with local retailers. According to interviews held with key stakeholders, Project Last Mile’s strategic use of data; intersectoral communication; responsive leadership, and the introduction of route-to-market innovations have contributed to CCMDD’s successful expansion.
Although Ethiopia's hospitals serve populations ranging from 125,000 to 5 million people depending on their capacities, the design of their infrastructure including pharmacies, and stores were not suitable to serve the intended populations. The absence of standard pharmacy dispensary counters was unsuitable for patients and professionals, leading to dissatisfied patients and long wait times. After an assessment, standardization and renovation of hospital medical stores and dispensaries became mandatory. Shelves and counters were standardized and store designs were improved in a sample of 15 hospitals, which ultimately increased hospitals’ capacity to monitor stock handling and proper use of medicines. The final design is planned for implementation in 150 hospitals.
Coordination among the organizations is important to improve a resource efficient and timely response. While humanitarian organizations (HOs) in the field are at the forefront of the coordination efforts, there is little empirical research on their joint logistics efforts. We empirically investigate the coordination of joint logistics efforts among the network of humanitarian organizations operating in Iran (e.g. the government, UN agencies, Red Crescent Societies, INGOs). The key challenges and solutions recommended by the humanitarian practitioners are summarized and discussed.
Many of the world’s vaccine supply chains are broken and aren’t getting life-saving and life improving vaccines to adults and children who need them, especially in low- and middle-income countries. Vaccine supply chains are complex systems. Stakeholders and decision-makers need to pay close attention to these systems in order to understand and address the bottlenecks, stock-outs and vaccine wastage that routinely occur, especially in areas with limited resources. HERMES 1.0 is a systems modeling software application that allows users to analyze the complexities of a vaccine supply chain. HERMES can provide insight as to how the supply chain is functioning and determine the potential impact of making systems changes.
An unprecedented number of emergencies globally have resulted in rapidly growing demands for continuous availability of quality health products to support comprehensive health services for the vulnerable populations affected by these crises. John Snow, Inc. is working hand-in-hand with donors (USAID, OFDA, UNFPA) and governments to identify best practices, design innovative tools, and develop manuals and trainings for managing supplies in humanitarian settings. Planning, financing, sourcing and delivering health products is extremely challenging in complex and changing environments and varies by the stage of emergency; yet, partners must work to develop creative methods of predicting and responding to increasing demand along the humanitarian to development continuum to serve the needs of refugee and internally displaced populations.
The NGO Action Contre la Faim (ACF) joined forces with Kuehne Logistics University and HELP Logistics to conduct a Return on Investment (RoI) study on the delivery of Non-Food-Items (NFI) kits in context of the relief responses to the earthquakes in Haiti and Nepal. The major objective of the study was to get a better understanding of potential areas of preparedness investments and identify the most beneficial ones. As a result, the RoI study found that, indeed, major cost and lead time reductions can be realized through timely and adequate supply chain investments.
Over the course of the 20th Century, an enormous effort was devoted to ending global hunger and eradicating famine. Was it successful? While global nutrition rates have improved and famines have decreased in frequency and magnitude, food insecurity remains a major problem. Access to food and threat of famine are still used as political weapons against vulnerable populations, especially people living in rural areas, or those who have been displaced by war or disaster. This presentation examines the qualitative history of a dozen major famines that occurred over the 20th Century on three continents, identifying some common historical vulnerabilities of impacted populations, and also some areas of resilience that non-comparative analyses have missed. “The Future of Famine” pays particular attention to the imperfect, but continuously improving role aid agencies, particularly NGOs, have played in identifying and mitigating famine emergencies. Finally, the presentation asks important questions; given a detailed and nuanced history of the past experience of famine, what can we expect from future famines? How can aid agencies respond better to the anticipated needs of at-risk populations?
Healthcare workers are a scarce resource in sub-Saharan Africa. With so few trained healthcare professionals available, Ministries of Health must allocate these workers in facilities across the country to meet demand while also taking into account a workers’ preferences for where they way to be placed. The Task Force for Global Health has collaborated with Centers for Disease Control, Georgia Institute of Technology, Jhpiego, and Health Informatics Research and Training Center to create the Workforce Allocation Optimization (WAO) Tool: a decision support tool used to analyze the demand for health workers and produces results for optimal placement of each healthcare worker. The tool uses an evidence-based approach to drive allocation decisions. The tool has the functionality to use health indicators to inform prioritization (i.e., epidemiological data, disease burden, housing accommodations, population to HCW ratio, health facility capacity (# of beds, equipment, etc.), and health services). The goal of the model is to fulfill demand and maximize employee satisfaction as represented by their preferred locations subject to limitations defined by demand and other information needed for successful operation. This presentation reviews the initial need for the tool, optimization model logic, and applications of the tool.
With the ongoing trend to focus on improving supply chain networks in the public health sector, mainly driven by actors within this environment, it seems supply chain design and optimization become very important topics to address. Workshops on supply chain design and optimization in Malaysia, Myanmar, Rwanda and Kenya have shown that the two most important factors influencing supply chain design in the commercial sector, customization (standardized versus individualized product) and service (lead time), are rated in the top three most important factors by participants from the public health sector as well. Decisions regarding specific dilemmas that the public health sector is facing like, among others, integration versus multiplicity and global versus national supply chains also influence the design of supply chains and have an effect on the lead time. To be able to illustrate the effect of supply chain design on cost and lead time, Argusi has developed a network design game in which participants can design a supply chain themselves and see the effect of their decisions.
Much of the work in health systems strengthening is targeted at rural settings, which experience a complex set of limitations within their existing distribution systems. These limitations, coupled with geographic and infrastructural challenges, ultimately leave gaps in the service provided to patients. Unmanned Aerial Vehicles (UAVs) or Automated Aerial Systems (AAS) can address these obstacles by circumventing challenging infrastructure on the ground, speeding up delivery processes, and making supply chains more responsive.
This presentation will elaborate on the procurement process for UAVs or UAV services, which is unchartered territory for many organizations seeking to apply the technology within their own supply chain activities by testing and implementing it. In an effort to contribute to the knowledge base of the UAV community and prevent organizations from reinventing the wheel or starting from zero, we would like to share our experiences to benefit others undertaking a similar effort.
Although an enormous quantity of commodities moves through supply chains, an understanding of the storage and transportation environment for ambient products is limited from international transport through the last mile. Occasional temperature and humidity monitoring is conducted at central and regional warehouses, while temperature monitoring along in-country transport, storage at facilities, and throughout last-mile distribution via community health workers is scarce, if implemented at all. Through low-cost, smart technology in the form of temperature and humidity monitoring sensors, the age of “the internet of things” (IoT) now allows greater visibility into the conditions experienced by the health commodities. This presentation will showcase lessons from a temperature monitoring pilot in Mozambique, highlighting the installation of smart sensors, data collection methodology, as well as data analysis and visualization being tested for further studies and implementation.
A diverse group of industry players—including manufacturers, freight forwarders, donors, and procurement services agent—will share their next generation “control tower” or “VAN” (value-added network) ambitions and how they are taking up the challenge. Objectives: