The 2019 HHL Presentations
Two Bill & Melinda Gates foundation-funded projects (SCALE and Contraceptive Without Borders) and one USAID-funded project (Afya Tamiza) are working side-by-side in the arid/semi-arid lands (ASAL) of Kenya host remote, hard-to-reach, and migratory populations to increase demand, improve service delivery and strengthen supply chains for the provision of community based services, including family planning. Unlike traditional evaluation approaches, Developmental Evaluation (DE) focuses on timely utilization of evaluation data, supporting adaptive learning and innovation in complex environments, like Kenya’s ASAL counties. The evaluation team will identify barriers and facilitators to demand generation, service delivery and supply chains; uncover trends in implementation, service, and client outcomes; and document implementation and structural dynamics to inform program adaptation. During this presentation, we will discuss this innovative methodology, including the process of creating a complex theory of change and how our collective process including routinely discussions with stakeholders leads to testable adaptive strategies.
Developed in 2017, USAID's Emergency Supply Chain (ESC) Preparedness Framework responds to the essential need for a multilateral and multisector approach to strengthening both global capacity and individual nations' capacity to prevent, detect, and respond to infectious disease threats. In Liberia a multi-sectoral team of experts led by the Ministry of Health is currently customizing the Framework with support from Project Last Mile to target emergencies caused by diseases with human, animal and environmental factors, and which pose pandemic threats to the country and world at large. In this presentation, we will explore the applications of the three modules embedded within the ESC Preparedness Framework: (1) people and processes, (2) commodity planning, and (3) logistics and transport. The purpose of the framework is to establish a system that manages all the commodities necessary to respond to an outbreak and ensures that they get to the point of care as efficiently as possible.
Siloed and fragmented information systems are one of the most significant barriers to using data effectively to manage and strengthen supply chains, both in public health and humanitarian settings. The Zenysis software takes advantage of powerful open source technologies, machine learning, fuzzy logic and artificial intelligence to rapidly integrate, clean, standardize and store data from multiple fragmented sources; and its analytical capabilities have been used to improve supply chain efficiency and health system performance. The Zenysis platform integration with country's Central Medical Store and National Malaria Control Program's database allowed the Ministry of Health to identify opportunities to improve availability of antimalarial health commodities and ways to improve targeted interventions to reduce malaria disease burden. This presentation will describe at a low to moderate technical level how the Zenysis platform functions to integrate systems and improve supply chain performance, the advanced analytics available in the platform and milestones achieved from the previous case studies.
This case focuses on PLM’s partnership in Mozambique with the Central Medical Stores (Central de Medicamentos e Artigos Medico, CMAM]. Using geospatial analysis and routing software from Frontline Research Group and support from Coca-Cola Beverages Africa, PLM is planning optimized distribution routes in all provinces, while building CMAM capability to sustain this function. Data on the road network, health facilities, high-risk points of interest, and medical storage units, were shared with Humanitarian OpenStreetMaps Team (HOT) after the Idai cyclone in Sofala province to assist with disaster relief, highlighting the extended benefits of route optimization. Using actual drive-time data from Nampula province, we will present 1. how geomapping spatial software and analysis can be applied to optimize routes, plan vehicle usage, address seasonal variation, and save costs, and 2. how private sector expertise can be integrated into public sector operations for sustainability.
*Rapid Fire Educational Workshop
In countries in sub-Saharan Africa, the management of the immunization supply chain is often entrusted to underqualified personnel; faced with this situation, Logivac Center has developed a short training course in immunization logistics in Francophone-speaking Africa. From 2015 to 2019, 8 editions of the LogVac training were funded by Gavi and AMP and organized by the Logivac center, and a total of 181 learners from 17 French-speaking African countries benefited from the training. The LogVac training comes as a result of the shortage of training programs in logistics for actors in the vaccine supply chain of African countries. The African countries' support for this training is quite strong and the technical and financial partners of the vaccination programs are encouraged to support this initiative of the Logivac center.
Due to a newly implemented electronic logistics management system (eLMIS) in Zambia and Tanzania, and Vaccines Information Management System (VIMS) in Tanzania, the public health system's connectivity has improved in life-changing ways, enhancing inventory management and access to integrated stock information for decision makers. Leadership and ownership transition of eLMIS from donor and partners to the national governments is critical to ensuring self-reliant management of the system through consistent funding of operational overhead and staffing costs; management of daily system needs, existing and future upgrades, and redesigns; and to building capacity within national staff for sustained implementation. In this presentation, we will discuss our experience building local ownership of eLMIS and VIMS in Zambia and Tanzania, similarities and differences in the process in each country, and present lessons learned for supply chain transitions in other countries, such as policy change requirements, technical skills development strategy, resource mobilization for implementation costs, and data use for decision making.
A feature of the Healthcare Procurement and SC workforce, especially in low income countries, is that there are very few healthcare professionals that have been fully trained in critical SC functions such as procurement management, warehouse management, distribution management, high staff attrition rates, and reassignment of staff. This situation is then further compounded by the rapid, and near continuous introduction of new healthcare products (medicines, diagnostics and vaccines). To address these needs, Empower, with support from INSEAD HRG, has developed, improved, and implemented the Ghana SC Digital Learning Platform, which is a 4-part integrated learning solution that leads to long-term institutional memory in Procurement and Supply Chain. The Platform is country-specific and country-managed, and delivers on-line access to a blended, adult-based, learning approach; with following features: a) customized competency-based learning to a geographically dispersed staff; b) continuous on-the-job learning supported by mentors active within the digital platforms c) mechanism to rapidly disseminate information on new product introduction d) peer-to-peer collaboration.
The use of the paper-based system for the health logistics Management Information System had challenges such as data accuracy, timeliness and feedback turnaround time due to level of efforts in collecting, aggregating and analyzing data. To address these challenges, the Ministry of Health and USAID collaborated together to introduce eLMIS to provide real-time inventory data, order visibility, coordinated order processing and warehouse management functionalities. All public health facilities are using the eLMIS to provide end to end supply chain data visibility and availability in real time, reduced order processing cycle time from 4 days to 45 minutes and level of effort at Health facility level from 3 people to 1 person; data accuracy has also improved from 25% to 85%. The eLMIS has significantly strengthened health commodity management by automating supply chain and logistics processes from central level to service delivery points and increased data visibility for decision makers to strategize supply chain interventions.
In the immediate aftermath of Cyclone Idai, the GHSC-PSM project in Mozambique mobilized a team of supply chain advisors lead by Mr. de Jong and his Ministry of Health counterpart Mr. Mbota to address the immediate needs in Beira. A decisive plan of action was developed to repair the damages to the infrastructure, reestablish warehouse management systems, and secure and recuperate health commodities, including a temporary warehouse to storage and manage medicines donated from around the world. This presentation will walk through lessons learned from developing and operationalizing an Emergency Response Plan in the span of two weeks and will serve as a resource for other countries to better understand the mechanics of Emergency Response Planning for supply chains. Outcomes of this presentation will ensure attendees will better understand how to apply a systems-level approach to address and plan for natural disasters and understand the utilization of human and physical resources for operational success.
EPSA faces an ever-increasing demand for public health services, plus a need to improve current performance - all with limited capital and human resources. The Proof of Concept demonstrates how, through a public-private management partnership, it is possible to achieve improved service quality with high volume, using existing infrastructure, personnel and systems. The intervention, funded by USAID through its Aids-Free project in Ethiopia, introduced different approaches: 1) Optimization of inventory management to increase velocity of throughput, 2) On-the-job training of staff to enhance operational and management skills, 3) Process audit to drive performance through compliance and visibility, and 4) Review and update KPIs, SOPs, and staff JDs to meet GDP standards to create the foundation towards achieving formal certification/accredited quality management system (GDP/ISO). As a result, we reduced wastage and cost to serve, extended network's life expectancy through increased storage by 23.5%, increased inventory accuracy and GDP compliance level.
Goals: Assist in understanding Guinea Worm (GW) disease spread in Chad and evaluate the effectiveness of potential interventions
Nico Vandaele: Introduction
Catherine Decouttere: Immunization Systems from Routine Immunization to Outbreak Response
Kim De Boeck: The Role of Distribution and Delivery in the Vaccine Health System in the Sub Sahara Context
Stany Banzimana: Insights form the Rwanda Health System
Marika Engel: Some Sub Sahara Aspects of the HIV Health System
Prior to supply chain Integration, the vaccine supply chain in Ethiopia was characterized as “inefficient and unacceptable”, and distribution was described as chaotic. Supply Chain Management Transition Plan was prepared, and the high level plan envisaged procurement of cold rooms, refrigerated trucks, relocation of existing cold rooms to PSA(Pharmaceutical Supply Agency) hubs, design and implementation of an LMIS, development of SOPs, and complete training and recruitment of staff. Main benefits of immunization supply chain (iSC) integration were level elimination, enhanced performance, cost savings and improved efficiency. The other benefit of the transition is that vaccines benefited from integration into the existing PSA LMIS system, increasing real time vaccine inventory visibility to 100% & 80% respectively at Hubs and Woredas.
Habtamu Berhe Mekonnen, Capacity Building Lead Advisor, JSI, AIDSFree
Globally, momentum is building around the use of global standards in healthcare – particularly standards for identification, data capture, and data exchange – for the purpose of enabling pharmaceutical traceability. The USAID Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM) project has been an early leader in working to evaluate and shape effective approaches to traceability and usage of GS1 global standards though hands-on engagement with stakeholders throughout the global health supply chain. This presentation will give a high-level overview of the use of global standards for traceability in the supply chain, outline the approaches in use by GHSC-PSM to implement traceability throughout the supply chain, and highlight available resources for interested stakeholders.
Rachel Smith, Global Standards Engagement Analyst, IBM, USAID GHSC-PSM Project
In Rwanda before November 2017, each public health program was conducting its own quantification exercise at different times, with separate funding mobilization meetings resulting in inefficient utilization of time and scare resources. The iCPDS was created to reduce time needed to carry out quantification and supply monitoring activities and their associated cost. In November 2017, 40 participants from Ministry of Health and its partners, including United Nation agencies, Society for Family Health, United States Agency for International Development and Center for Disease Control and Prevention, conducted a quantification exercise for all public health commodities covering a period of 7 years. Quantification and supply plan monitoring, through the iCPDS has shown several efficiencies such as optimizing the utilization of available funds, human resource time and supply chain staff capabilities in meeting cross-cutting programmatic goals and targets, sustainability, and help the resource management committee in mobilizing resources for all programs and other essential medicines.
Supporting sustainable and efficient scale-up of viral load testing is central to achieving the UNAIDS third “90” target and ensuring access to quality diagnostic services in the fight against HIV/AIDS. Working through the MOH and country stakeholders, GHSC-PSM collected data from more than 1,500 clinics and 45 laboratories with molecular capacity to conduct viral load(VL) /EID/TB testing and to map the current molecular laboratory network and virtual modeling of several scenarios which improved utilization and patient access to VL/EID testing. By optimizing the location of several molecular instruments, the final model demonstrated increased utilization and national Viral Load coverage from 40% to 65% without procuring additional instruments. The activity demonstrates strategic use of existing resources to provide greater testing access for patients by formalizing sample referral lanes and creating greater testing efficiency.
From July to December 2018, the Rwanda Biomedical Center (RBC) worked with Zenysis Technologies to integrate data from multiple fragmented health information systems into a single unified platform for advanced analysis. As a result, analysts and decision-makers from RBC can now combine data from seven formerly siloed data sources for analysis the first time, surfacing actionable insights that decision-makers can use to improve health sector performance. For example, these integrations now make it possible for RBC decision-makers to identify where to allocate resources to improve availability of medicines, plan and monitor the impact of interventions to reduce disease burden, monitor infectious disease outbreak across multiple integrated systems in near real time, and identify and resolve data quality issues within integrated sub-systems themselves.The workshop presenters RBC M&E Division Manager, Dr. Albert Tuyishime, and the Zenysis Africa Regional Director, Mr. Bernard Laurendeau, will discuss the Rwanda case study, describing the process to access and integrate data and train users on the platform and sharing examples of the insights that RBC has achieved to date using the Zenysis rapid interoperability platform.
Although governments sign international laws protecting universal right to health, in most humanitarian crisis, HIV program is poorly addressed as the hosting countries do not include them in their strategic plans. The aim of this study is to describe the integration of HIV services in Nyabiheke refugee camp into National HIV program through descriptive statistics to analyze key outcomes. Throughout the year 2018, 123 migrant were on Antiretroviral Treatment (ART) with female preponderance to male at the ratio of 2.6 and 37 migrant women enrolled to PMTCT program. Through the integration of HIV services for refugees in the existing national HIV programs, Rwanda improved the level and quality of HIV service provided to refugees.
In July 2017, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project began partnering with Namibia's Nutrition Assessment and Counseling Support (NACS) program in managing therapeutic and supplementary food (TSF). To achieve a sustainable solution, GHSC-PSM worked closely with stakeholders including the NACS program, the Central Medical Store (CMS), and the Office of the Prime Minister (OPM), to integrate TSF into the national pharmaceutical supply chain by embedding a logistics officer within the CMS to utilize existing inventory management tools and cost-saving opportunities. Starting in March 2018, more than 200 health facilities from all 14 regions of Namibia began ordering and managing TSF using the same mechanism through which other essential medicines and supplies are managed and delivered. The integration achieved an estimated cost-savings of NAD 93,000 ($6,650)/month on warehouse leases, cut down on transportation costs, and improved the availability of demand-based data for resupply planning.
Kenya has experienced emergencies ranging from natural disasters, infectious disease outbreaks and man-made crises. In 2018, the USAID Global Health Supply Chain-Procurement and Supply Management project’s Afya Ugavi Activity assisted Kenya in adopting the Emergency Supply Chain (ESC) framework with experts from two government ministries of human and animal health through a One Health approach, which focuses on multisectoral prediction, detection and response to infectious diseases with zoonotic origins. The resulting ESC framework has evidence-based protocols to utilize existing public health supply chains and to increase availability of health commodities critical for effective emergency response. It establishes the ground for Kenya’s National Action Plan for Health Security and 5-year Global Health Security Roadmap, and it will improve response through rapid access to essential commodities while reducing costs and increase Kenya’s WHO JEE score from 1(no capacity) to 3(developed capacity).
This paper reviews the cost of vaccine delivery operations in Kano state, Nigeria to identify levers and trade-offs available to decision makers in low resource settings to minimize vaccine delivery cost from regional cold stores to service delivery points. After modeling actual and approximate costs incurred in the traditional, insourced, and outsourced delivery systems, five factors were found to significantly influence the unit cost of vaccine deliveries per facility: number of health facilities, delivery layers, distribution outsourcing options, delivery frequency, and automobile options. Decision makers can minimize unit costs of delivering vaccines per health facility by streamlining the number of delivery layers, using cheaper automobile options, delivering to more health facilities, keeping vaccine deliveries insourced and/or increasing the delivery frequency. In minimizing vaccine delivery cost, decision makers must consider the ability to navigate difficult terrains with different automobile options, trade-offs on timeliness of deliveries and even reliability of their cold storage devices.
Despite the fact that business corporations make massive donations as a strategy for their Corporate Social Responsibility (CRS) when responding to disasters, they don’t usually count on approaches to link the assessment of humanitarian supply chain performance to the performance of their CSR. As a way to measure the performance of Corporate Social Responsibility (CRS), this study focuses on the impact that massive corporate donations may have on the disaster affected people by assessing the performance of the humanitarian supply chain. The empirical study develops three systematic phases to identify key performance indicators (KPIs): validating KPIs using Likert scale, prioritizing KPIs using analytical hierarchy process (AHP), and finally building CSR score supported by a linear model. Finally, this study assesses the performance of the supply chain in the light of the impact on the people affected.
The world needs scalable, sustainable solutions to get medicine and health workers to remote areas. Health Access Connect (HAC) sets up monthly integrated care outreach clinics using motorcycle taxis to bring government health workers and their supplies to remote villages of Uganda, focusing on HIV testing, anti-retroviral treatment, family planning, and maternal & child health services. Communities contribute money (~$0.55 per patient) to pay for transportation costs and ensure sustainability. Under this model HAC is serving over 33 remote villages with monthly outreach clinics that average 43.0 patients (44.2% male) per outreach.
JSI Research & Training, Inc. (JSI) has partnered with the Indonesian National Population & Family Planning Board (BKKBN) and University of Minnesota to strengthen family planning supply chains in public sector clinics. Using an implementation research approach, the project evaluated supply chain system weaknesses, and designed and tested an innovative package of four data-centric interventions in 11 districts. The package included: (1) a consumption-based inventory control system to reduce stock imbalances; (2) capacity building in logistics recording and reporting; (3) quality improvement teams to strengthen data use; and (4) a mentorship and on-the-job training program. As a result, we find that the use of stock cards by health facilities can lead to a 34% reduction in the odds of stock-outs and that the initiatives overall contribute toward mitigating the risk of stock-outs.
Humanitarian organizations, donors, and governments pre-position emergency supply their region of interest to facilitate rapid response to crisis needs at various warehouses without formally analyzing how effective this rapid response capacity can address future humanitarian needs. This may result in surplus stock, positioned too far for effective deployment, sitting idle (or expiring) in some locations and insufficient stock in other locations to provide timely response. Our main contribution is to develop context specific optimization-based metrics that support assessment of an organization's disaster response capabilities in addressing a portfolio of anticipated disaster risks in the future. Our analysis considers the organic (owned) inventory of an organization, the contingent capacity from suppliers on contract, and incorporates a portfolio of transportation resources to move items from pre-positioning warehouses to disaster locations.
The timing and magnitude of many public health and humanitarian crises cannot be known in advance, so plans to deal with such crises must be made before the events occur. This talk describes three modeling approaches that we have used to inform preparedness policies in the United States. The models were developed based on problems faced by the US Centers for Disease Control and Prevention, the US Strategic National Stockpile, and the US Department of Homeland Security. The models focus on: logistics of response to a disease outbreak, prepositioning of medical countermeasures, and stockpiling decisions for public health emergencies. We describe how models of this type can provide insight into complex public health and humanitarian preparedness planning problems – and thus support effective response to crises when they occur.
Project Last Mile (PLM) shares the route-to-market expertise of The Coca-Cola Company with Ministries of Health across Africa to improve availability of essential medicines. In partnership with the Central Medical Stores (CMS), PLM designed and piloted a last mile delivery model (LMDM) based on a PreSell distribution model used by Coca-Cola which leveraged existing CMS resources to ensure optimal allocation and to replenish stock at all 51 health facilities in Liberia monthly. A12-week long pilot study showed that an average availability of essential medicines in public facilities improved from 33.2 to 47.4 of 142 commodities (+43%), and independent interviews with stakeholders showed support for this LMDM, citing improved data visibility, accountability, and service expectations at facility-level. In conclusion, private-sector distribution models can be adapted for the public sector, and may improve availability of essential medicine but with adequate stock at central level to maximize benefit.
Jonathan Halse, Country Lead, Project Last Mile
Ghana's Ministry of Health leveraged the supply chain master plan and the impact of the unfortunate Central Medical Stores fire incident as a great springboard for reforming the country's entire public supply chain, focusing on 3 main reform interventions. The reforms included establishing procurement efficiencies through framework contracting; ensuring efficient data production and use, while facilitating end to end visibility, and supporting data analytics using information technology; and leveraging private sector for effective distribution of health commodities up to the last-last mile. The presentation will cover the approach used, lessons learned, and the resultant impacts.
The collective pilot studies of Unmanned Aircraft Systems (UAS) exploring last mile logistics and public health supply chains showed that the implementation of drones might not always translate into immediately identifiable health outcome changes or cost savings. Reason for this are tied to multiple factors: lack of in-country technical capacity, unfinished regulatory processes, high costs of very first roll-outs and bringing all in country stakeholders in agreement, the short duration of actual UAS flight trials, and etc. Overall there seems to be a consensus that UAS integration requires a longer-term system design approach, and there is a limitation of available funding streams tied to vertical programmatic areas. The Interagency Supply-chain Group (ISG) UAS Coordination, has been working since June 2018 with numerous implementing partners to harmonize available tools, monitoring and evaluation frameworks to track success of UAS projects, and also explore ways to help countries bridge some of the gaps that are preventing system redesign projects to scale.
In 2002, Ghana's Ministry of Health’s policy to ensure the direct scheduled delivery of commodities from the Central Medical Store (CMS) to Regional Medical Stores (RMS) and Service Delivery Points (SDP) was plagued with inadequate transportation and other challenges, destroying various health commodities including critical HIV commodities worth over $50 million. The Government reached an agreement with the Global Fund and USAID to implement supply chain reforms, including the implementation of a last mile distribution (LMD) system. The LMD in Ghana collaborated with private sector third-party logistics (3PL) transportation service providers to deliver commodities from the RMS to SDPs along designated routes on a scheduled basis to replace multiple uncoordinated commodity pick-ups by individual facilities from the RMS. A costing study revealed that health facility pick-ups were about $40 higher than LMD through 3PL and reduced the average stock-out rate of tracer commodities by 10%, and these findings supported the use of 3PL LMD implementation to accelerate towards achieving Ghana’s 90-90-90 goals.
Complex humanitarian environments necessitate systems to enable that actors can respond to disruptive events as effectively as possible. HELP Logistics is a program of the Kuehne Foundation, is at the forefront of analyzing and engaging with supply chain resilience with its Humanitarian partners. HELP uses a Supply Chain Resilience Tool to conduct this analysis. This combines elements of metrics and systems dynamic into a single tool that enables organizations to analyze the resilience of their supply chain capabilities in the event of a disaster, by defining likely scenarios in advance and by simulating how their supply chains would respond in the event of these scenarios. This tool was created by the Kuehne Logistics University and WFP under a DFID funded program and has been piloted in countries across Africa by HELP Logistics. Its results enable organizations to predict commodity demand, logistics capacity requirement and costs, amongst other variable; all of which together affect the overall response capability of an organization / country.
In 2018, Gavi and Dever-based technology company Parsyl entered into a Partnership to demonstrate the value of the Parsyl solution to improve vaccine supply chain quality management and reduce closed-vial wastage, thereby increasing the odds that children in Gavi-supported countries receive safe and potent vaccines. As part this 24-month project, Parsyl has engaged with the Ministry of Health (MoH) in Senegal to implement Parsyl’s technology platform in 75% of the country’s clinical sites. In this oral presentation, representatives from Parsyl and the Senegalese MoH will provide a project overview and report in tandem on some of the early results, key challenges and learnings, and future directions for the project. Particular emphasis will be on how new technology was integrated into the existing EPI system and how data was used to empower behavior change of users at different levels of the supply chain.
Nexleaf Analytics’ low-cost remote temperature monitoring (RTM) technology monitors temperature and power availability in real time to improve immunization delivery in low-income countries. Nexleaf’s RTM systems help governments protect the vaccine supply for over 12 million babies born each year. To sustain its 99% overall vaccination coverage (as reported by the 2017 WHO UNICEF Estimates of National Immunization Coverage) and the high quality of its immunization services, The Tanzania Ministry of Health is leading a countrywide effort, in partnership with Nexleaf Analytics and JSI Research & Training Institute, Inc., to strengthen the vaccine cold chain through the scale up of RTM solutions, targeting coverage in 5000 health facilities by 2020. This presentation will focus on the lasting effects of a cold chain system solution on the vaccine supply chain, and showcase how system failures can be identified and resolved through data and analysis all the way to the last mile of the cold chain.
Recognizing a significant gap in the availability of adequately-sized and effectively-maintained pharmaceutical-grade, central storage hubs, USAID and the Global Fund collaborated with the Federal Ministry of Health (FMOH) to construct and operationalize two pharmaceutical-grade warehousing facilities in Abuja and Lagos. The USAID Global Health Supply Chain-Procurement and Supply Management (GHSC-PSM) led the implementation of a public-private partnership (PPP) framework, supported a project management team of partners and government counterparts to develop the business case, administer the procurement process, and secure approvals with oversight by the Infrastructural Concessionary Regulatory Commission (ICRC) for conformance with regulatory standards. The full business case (FBC) approved in November 2018 is the first infrastructural management PPP initiative the FMOH successfully executed through the ICRC guidelines, explaining its endorsement by the highest-level in-country policy makers. Though a lengthy and rigorous process, this PPP initiative serves as a replicable and sustainable model for State-level governments in Nigeria to leverage private sector resources and expertise to address warehouse management challenges and improve access to quality medicines within the public healthcare system.
To address longstanding gaps in last mile delivery management within low resource settings, Chemonics International developed TransIT, a cloud-based, non-subscription SaaS system that enables access to transportation information along the supply chain while minimizing infrastructure and maintenance costs. The system collects electronic proof of delivery (e-POD) through a mobile application for drivers, and feeds transportation data including GPS coordinates, time stamps, and electronic proof of deliveries to a single dashboard for centralized management.
Low availability of essential medicines in low- and middle-income countries poses a risk for patients due to treatment delay or discontinuation. It also has consequences for the facilities themselves due to lost sales and goodwill, degrading their financial position and capabilities to invest. We studied inventory management practices and understocking through semi-structured interviews with inventory managers and facility owners of 39 health facilities in Nairobi where there is an abundance of suppliers with short lead times, but availability of many essential medicines is rather low. This talk discusses root causes related to 1) inventory control skills, 2) inventory control policies or systems, 3) time constraints, 4) budget constraints, 5) incentives for inventory control, and 6) supply failures.
inSupply Health, Ltd is using a Human Centered Design (HCD) process to co-design and test prototypes of innovative supply chain solutions for migratory and hard-to-reach communities in Northern Kenya. Under HCD principles, an initial, “inspiration” phase of HCD process field-based research establishes a deeper understanding of the community’s practices and traditions by interviewing community actors including women, their husbands, and community leaders, which enables the team to design prototypes that are responsive to the context. The HCD process is time and resource intensive; however, investing upfront in innovative methods that lead to situationally appropriate, tailored interventions that are completely user-driven is critical for reaching remote, mobile populations with effective, sustainable solutions. This presentation will outline the HCD methodology used, the themes identified through the inspiration phase, and the prototypes that will be tested in July-August 2019.
When operating in a complex system with a diverse set of stakeholders, policies, and incentives, it is vitally important to understand the dynamics of the system in order to identify leverage points and barriers to change. The USAID/Uganda Feed the Future Market System Monitoring Activity, implemented by the MIT Humanitarian Supply Chain Lab and The George Washington University, has developed tools for mapping and measuring complex systems, which can be used for planning, impact measurement, collaboration, learning, and adaptation. We will review several case studies of how these tools have been successfully applied, as well as an example of the tools in action using the Ugandan agricultural inputs supply chain.
The frequency, duration, extent, and location of temperature excursions in health supply chains is known to have adverse effects on the efficacy and quality of commodities. To monitor the conditions faced by health commodities, remote sensors with internet of things technology are leveraged. Three donor organizations have contributed to this work enabling data collection through remote sensors across international shipments and in six country distribution networks. Sensors produce a significant amount of data for aggregation and analysis, which stakeholders can then use to inform mitigation, product storage, and distribution best practices.