Presentations

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.

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). 

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.

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)[1] 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.

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.

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.

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.

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. 

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.

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.

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.

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.

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.

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.

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.

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.