Presentations

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.

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.

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.

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.

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.

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

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.

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.  

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.