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African Regional Conference on Immunization (ARCI) Optimize - Senegal Collaboration

African Regional Conference on Immunization (ARCI) Optimize - Senegal Collaboration «  Highlights on the Moving Warehouse Distribution System ». Dr Thierno Seydou Nourou GUEYE, Pharmacie Nationale d’Approvisionnement. Optimize – Senegal Collaboration.

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African Regional Conference on Immunization (ARCI) Optimize - Senegal Collaboration

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  1. African Regional Conference on Immunization (ARCI) Optimize-Senegal Collaboration « Highlights on the MovingWarehouse Distribution System » Dr Thierno Seydou Nourou GUEYE, Pharmacie Nationale d’Approvisionnement

  2. Optimize – Senegal Collaboration

  3. Collaborative Agreement betweenGoS and Optimizesigned on November 4th, 2009 with the following goal: To evaluatestrategies for strengthening the healthsupplychain to face future challenges caused by the increasing volumes of more costly new vaccines in Senegal Senegal Saint Louis Region

  4. The problem

  5. Former regionalsupply system in Saint Louis: • From central to regional vaccine store: quarterlyshipments • Districts collected vaccines fromregional store every 2 months • Health postscollected vaccines from Districts everymonth. • Distribution schedulescould not berespected: • Districts and healthpostsused ambulances, motorcyclesor public transport to go to upperlevel to collecttheir vaccines and supplies • Theyused to go whentheycould and not whentheyhad to. • Incompleteorderfullfillmentwasfrequentatreg'l & district levels: • Stockouts & multiple trips to upperlevelwerealsofrequentbothat district & health post levels • Nurses wereobliged to close healthpostsseveraldayseverymonth.

  6. Supply Chain Integration – Nat'l to Reg'l Level

  7. Convention MoH& PNA signed in October 2010 and renewed in June 2012.

  8. Regional Distribution thru the Moving Warehouse

  9. Official launch of the Moving Warehouse (MW) • Distribution of vaccines & immunization supplies • RH, AIDS, Mal. & Tub. products, & essential drugs October 2010 From March 2011 From early 2012

  10. VariousRoles of the MovingWarehouse

  11. Main Roles • Topping up stocks of vaccines • Consumption data entry via Internet, • Monthlydeliveries to 110 healthpostssinceJune 2011 • Delivery of essential drugs & free products for reprod. health, AIDS, Mal. & Tub. control programs: 2012 27 Oct. 2010: WHO Representative handing the keys of the MW trucks to the Minister of Health The 2 trucks constituting the Moving Warehouse SupplementalRoles • Supportive supervision • Refrigerator maintenance • Collection of filledsafetyboxes • Distribution of vaccines & supplies for mass campaigns (NIDs, etc.).

  12. Advocacy & Communication (A&C)

  13. Prior & during the MW implementation, a lot of A&V was necessary to convince & engage stakeholders & health workers. Official launch by Health Minister Visit by Members of the Parliament Event organization Document prod. & diffusion Film, TV & radio shows Posters & flyers, etc. Training & sensitization Health workers, Distr. & Reg'l Teams Health Committees, Pgrm Managers

  14. Some Results from the Moving Warehouse

  15. Vaccines & Immuniz. Supplies distributed by the Moving Warehouse in 2011 & 2012 Reproductive Health Products distributed by the Moving Warehouse in 2012

  16. How the system isworking

  17. PRA Availsproducts Districts MedicalRegion MovingWarehouse Ordering & monthlypayment to PRA with profit Coordination Program M&E Distribution Topping up of stocks atSDPs Service Delivery Points (SDPs) Transmission of data on stock & consumption (order) to District Sale of productswith a margin Monthlypayments to District after a margin Flows and roles of stakeholders Flow of products Financial flow Order Coordination/Monitoring Evaluation

  18. Rights & Responsibilities

  19. Moving Warehouse: Performance Modeling & Cost

  20. VMI* Simulation model to assess vaccine availability • Excel-based cost model to assess total & unit costs. VMI Simulation Model Components taken into account for the costing (Excel) + * Vaccine Modeling Initiative – (University of Pittsburg)

  21. Moving Warehouse Performance • & Cost – Comparison of Various Scenarii

  22. * MW + Rota & PCV – Unconstrained* MW + Rota & PCV - Constrained MW + present EPI schedule * Baseline system + Rota & PCV – Unconstrained* Baseline system + Rota & PCV - Constrained Baseline system + present EPI schedule * All storage & transport capacities are adjusted to satisfy needs. Vaccine availability at health post level (%) Logistics costs per dose at health post level (USD) NEXT

  23. The MW distribution-based system increases availability: • From 89% (baseline) to 99% • This system seems just slightly less costly than baseline: • With present schedule: 0.29 vs 0.33 $/dose • When rota & PCV are introduced: 0.53 vs 0.54 $/dose • With rota& PCV & all constraints removed : 0.20 vs0.23 $/dose. • However, all costs are borne by vaccines only: • When other public health programs start paying, cost will reduce. • In addition to cost, other aspects must be considered: • Solving existing problems linked with the baseline system. • Additional advantages listed on next slides.

  24. AdditionalBenefits of the MovingWarehouse Distribution – based System

  25. Improved service quality Improved vaccine management Additional advantages Minimized risks of stockouts Continuous temp. monitoring Removing excess stocks: avoid expiry Accurate data on stocks & consump. Collection of filledsafetyboxes Distribution of vaccines and supplies for campaigns, etc. More time for healthpost nurses for healthcare provision Revitalization of supportive supervision (MW provides transport to supervisors)

  26. RisksLinkedwith the MW System

  27. System canbestranded by a LMIS misfunctioning. High cost of MW due to low utilization by other programs. Vaccines canbeatrisk in case of vehicle breakdown during distribution. St Louis Region'shealth programs willbe in trouble if MW system is not maintained. Potential Risks Mitigation Strategies • Data canbetransfered via SMS using mobile phones. • Advocacy to signMoUswithother public health programs. • During distribution, the 2 vehicles of the MW visitevery district together. • AdvocacywithMoH, PNA, District Health Committees & other programs to maintain the MW system.

  28. In ourownwords

  29. Dr Mamadou Diop (former Regional Medical Officer, St Louis): • "As the manager of the vaccination program in Saint-Louis Region, I’m thrilled with this new development. Whereas in the past there have been many challenges, the moving warehouse makes the management of the transport circuit and the delivery of drugs and vaccines much easier. Moreover, the innovative approach used in this project will allow us to adapt to the constantly changing future needs." • (OP.TI.MIZE – Issue # xx) • Dr Seydou Nourou Gueye (Regional Director, PRA St Louis): • "The moving warehouse has brought other benefits. By accompanying the truck on its delivery circuits, district and regional officers can now visit health centers and posts to provide regular supervision and training to health staff. At each stop, the moving warehouse team also collects safety boxes filled with used syringes, which are then returned to the district stores for safe disposal. • In Saint-Louis, the moving warehouse already delivers the vaccines required by Senegal’s measles and polio campaigns and will do the same for the country’s next meningitis campaign." • (OP.TI.MIZE – Issue # 13 July 2012)

  30. Conclusions

  31. The MW distribution-based system presentsnumerousadvantages as compared to collection-based system. • The MW system willbesignificantlylesscostlywhencosts are sharedwithdrugs & otherhealthproducts. • Givenitspotential, otherMedicalRegions are exploringpossibilities of adopting the MW system. • A scaling – up strategic plan has been submitted to MoH & partners (good prospects with USAID). • Lessonslearnedwillbesharedwithother countries: can IST/West Africa & AFRO assist in this effort?

  32. Nothing is impossible – never say never ... and trust staff (Optimize Team – Albania) Thank you!

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