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Integration of immunization supply chain with m alaria, TB, HIV and other supply chains

Integration of immunization supply chain with m alaria, TB, HIV and other supply chains Technet 2010 Consulation Kuala Lumpur, Malaysia Modibo Dicko, WHO / IVB - Optimize. Present supply chains. Government funding insufficient: call upon donors

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Integration of immunization supply chain with m alaria, TB, HIV and other supply chains

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  1. Integration of immunization supply chain with malaria, TB, HIV and other supply chains Technet 2010 Consulation Kuala Lumpur, Malaysia Modibo Dicko, WHO / IVB - Optimize

  2. Present supply chains • Government funding insufficient: call upon donors • Donors by-pass existing Government institutions because of their weakness • Numerous & duplicating supply chains: • On average per country: 17 funders, 19 procurement agencies and 84 distribution channels* • Stakeholders' roles & responsibilities unclear • Uncoordinated quantification, forecasting, planning, ordering: • Overstocks & expiries • Multiple stock management procedures: Undue workload * Data from 13 countries, WHO/EMP

  3. Supply Chain Integration – Why? • Increasing trend towards providing integrated services • Child health days/weeks, integrated campaigns … • Parallel supply chains are more costly to run: • 10+ supply chains for medical products in Kenya • Many health commodities require cold chain • Tunisia: 60+ non-vaccine drugs to store at 2-8oC • More products and complexity in the future • Incentive to consider more and better integration?

  4. Integrated supply chains • Less duplications • Simpler supply chain • More coordination • Donors and Governments must: • Put in place a National Coordination Mechanism for planning & procurement • Simplify, harmonize and align technical and financial procedures • Strengthen and use existing national system • Monitor, evaluate and share information.

  5. Supply Chain Integration – The Buzz

  6. Supply Chain Integration – How? • Segmentation approach: • Not a "one size fits all" • Respond to customer needs or product requirements.

  7. Supply Chain Integration – & Optimize? • 1. Landscaping • Integration RAVE • Logistics in Health landscape analysis • Literature review on SCI, incl. grey literature • Survey with EPI managers • 2. Demonstrating • SCI components in Senegal and Tunisia demonstration projects based on segmentation approach • 3. Facilitating • WHO Discussion Forum on Supply Chain Integration • UNICEF CCL sub-group on Integration and Logistics • Bio-Force and WHO-AFRO "Logistics for Health Training" • RHSC/USAID Professionalization of SCM Workstream • Optimize 2025 Vision and Integration (Tenet 3)

  8. Supply Chain Integration - Tunisia • The Definition • Storing and/or transporting vaccines with other health products • Reducing number of parallel health commodity supply chains • The Demonstration • Storing all temperature sensitive products in the same warehouse at national level and transporting them together to regional levels • Consolidating regional and districts stores to warehouse all cold, controlled temperature and dry health products together • Transporting all health products in the same delivery circuit from regional level down to health centre levels (moving warehouse part of the Net Zero Energy Supply and Cold Chain) • The Benefits • Alleviates storage capacity constraints in the supply chain – by better use of existing cold chain in the system • Reduces overall logistics cost – by reducing the number of parallel health commodity supply chains • Supports health systems strengthening and integrated approach to service delivery

  9. Tunisia: From This…

  10. To This… *Integrated supply chain from national to regional level for all drugs, temperature sensitive products & all human/animal vaccines

  11. Supply Chain Integration - Senegal • The Definition • Storing and/or transporting vaccines with other health products • Reducing the number of parallel health commodity supply chains • The Demonstration • Storing all temperature sensitive products in the same warehouse at national level and transporting them together to regional levels • Consolidating regional stores to warehouse all cold, controlled temperature and dry health products together • Transporting all health products in the same delivery circuit from regional level down to health centre levels (moving warehouse) • Integrating the LMIS • The Benefits • Alleviates storage capacity constraints in the supply chain – by better use of existing cold chain in the system • Reduces overall logistics cost – by reducing the number of parallel health commodity supply chains • Is health systems strengthening and supports an integrated approach to service delivery

  12. DPM Senegal: From This… PEV PNA Aéroport Port / Aéroport Dépôt Central PNA Outil Excel -> Distribution <- Système SAGE Collecte / Distribution Dépôt Régional PRA Outil Excel -> Collecte Collecte « PDA » Dépôt District Hôpitaux Rapports -> Collecte Autres programmes Postes de Sante * DPM: Department of Preventive Medicine ** PNA: National Procurement Pharmacy

  13. To This… Integration Phase: Vaccines & immunization supplies integrated in PNA supply system PEV PNA Port / Aéroport (A) PNA DPM Distribution <- Système SAGE Outil Excel -> (B) PRA Hôpitaux RM Outil Excel -> RM (C) Entrepôt Mobile <- Système nouveau District Dépôt Virtuel Postes de Sante Future stage: Fully integrated MIS

  14. Remaining challenges for demonstration projects • Equipment • How to cope with increasing needs for storage & transport capacity? • Information Systems • How to design / adapt an integrated LMIS? • How to integrate forecasting, stock management, reporting, etc? • Management • How to clarify accountability and roles and responsibilities? • Funding • How to manage vertical funding flows? • Human resources • How to move from vertical to integrated management? • How to manage fears: loss of responsibilities, job losses, etc? • How to prepare health workers for integration? • M&E • How to measure integration? M&E Indicators?

  15. Supply Chain Integration – & Optimize? • 1. Landscaping • Integration RAVE and understanding the value proposition of integration with the scope of the Optimize project • Supply chain and logistics in Health landscape Analysis • Literature review on integration with a focus on supply chains • Database on integration based on small survey with EPI managers • Compiling the grey literature on supply chain integration and country experiences • 2. Demonstrating • Supply chain integration components built into the Senegal and Tunisia demonstration projects • 3. Facilitating • UNICEF CCL sub-group on Integration and Logistics • WHO Discussion Forum on Supply Chain Integration • Optimize 2025 Vision and Integration (Tenet 3)

  16. Target Ensure NIPs benefit from SCI CCL Taskforce Sub-Group on Integration From Vertical system To Integrated system Joint Planning with Programs involved Essential Health Care Selection package Programs Integration Targets # Social mobilization # Integration Guidance Document Human Resources • Draft zero of the document ready. • ToRs for consultant to finalize ready. Positive attitude towards integated services Commodities # Lead-times # production-shipping Funding sources # Training Services -Providers Original slide: B. Jacquet, UNICEF/SD

  17. WHO Discussion Forum on SCI • Objective • To build consensus on common understanding • To identify concrete areas of collaboration between WHO departments and units at global, regional and country levels • To agree on priorities and emerging issues. • Activities • Providing a sounding board for country plans, proposals, queries • Providing a platform for exchange of ideas, experience, knowledge • Developing a Manual on Best Practices in SC integration • Training for public health program managers, health workers and supply chain managers • Linking with similar entities working on SC integration, etc. • Involved departments • Essential Medicines and Pharmaceuticals (EMP) • HIV / AIDS • Global Program on Malaria (GMP) / Roll Back Malaria (RBM) • Reproductive Health (RHR) • Immunization, Vaccines and Biologicals (IVB)

  18. Optimize Future Vision Tenet 3 Sub-Group • Tenet 3 formulation • Immunization supply systems are integrated with the supply systems of other health programs to maximize synergies, and make the most appropriate strategic links with the private sector. • Objectives • Develop a visionary goal for the assigned tenet • Gather information on work underway thru partnerscurrent efforts • Identify the gaps necessary to reach this visionary goal • Develop an action plan to address the identified gaps and needs. • Planned activities • Set up a working group on the tenet (done) • Work mainly thru conference calls on the above-listed objectives • Compile contributions (assign a consultant if necessary) & draft a plan • By Feb. 2011 finalize draft plan for discussion • By end March 2011 finalize plan, incl. ToRs for small grants to consultants/groups to further work on identified gap areas.

  19. Optimize Future Vision Tenet 3 Sub-Group • External members: • Alexis Heaton, JSI • Brent Burkholder, CDC • Ian McConnell, CHAI- Uganda • Beatriz Ayala-Ostrom, Consultant • Kaisamaija Valimaki-Erk, UNICEF PD HSS • David Ulrich, Abbott & Optimize PAG Member • David Lee, MSH • Adama Sawadogo, WHO/AFRO/WCO-DRC • Magali Babaley, WHO/EMP. • Optimize staff members: • Tina Lorenson klorenson@path.org  (PATH) • Patrick Lydon lydonp@who.int (WHO) • Modibo Dicko dickomo@who.int (WHO). • Additional members: • Membership still open: anyone interested?

  20. Proposed way forward • 1. Integrate the integrators • Merge the Optimize Tenet 3 and CCL Integration into 1 Group • WHO Discussion Forum remains but links closely with the above. • 2. Monitor & evaluate Senegal and Tunisia Projects • Generate data on actual implementation of SCI problems and ways to overcome them, incl. the integration & outsourcing nexus. • 3. Finalize CCL Guidance Document and Tenet 3 Workplan • Finalize Integration Guidance document and disseminate • Finalize the Tenet 3 workplan, incl. ToRs for small grants. • Conduct additional studies deemed necessary: • Operational research on existing experiences on SCI • Other studies as per Tenet 3 workplan • 5. Organize a workshop to draw lessons and adopt future plan: • Proposed co-organizers: Optimize, CCL, WHO Departments (Disc. Forum) • Tentative date: 3rd quarter 2011.

  21. Thank you! • www.technet21.org | www.path.org | www.who.int

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