Nigeria Health Supply Chain Strategy Workshop

1. Nigeria Health Supply Chain Strategy Workshop Abuja, Nigeria April 16-17, 2008

2. Nigeria Health Supply Chain Strategy Workshop • Context • Activities Presentation/Executive Summary • Enabling Environment • Product Selection • Quantification • Procurement • Inventory Control Procedures • Warehousing & Storage • Transport & Distribution • Product Use • LMIS • Organizational Support • Finance, Stakeholder/Donor Coordination • Quality • Prioritization Exercise • Full Presentation (Includes Goals and Challenges)

3. Nigeria Health Supply Chain Strategy Workshop • Context • Activities Presentation/Executive Summary • Enabling Environment • Product Selection • Quantification • Procurement • Inventory Control Procedures • Warehousing & Storage • Transport & Distribution • Product Use • LMIS • Organizational Support • Finance, Stakeholder/Donor Coordination • Quality • Prioritization Exercise • Full Presentation (Includes Goals and Challenges)

4. On April 16 & 17 of 2008, 70 stakeholders and experts representing organizations from across the Nigeria health supply chain… • Leadership Management & Sustainability Program • Making Medical Injections Safer • National Agency for Control of AIDS • Nigeria Indigenous Capacity Building Project • The Supply Chain Management System • Society for Family Health • US Government • Centers for Disease Control and Prevention • Department of Defense • USAID • UN Population Fund • Federal Ministry of Health • Food and Drug Services Division • Central Medical Stores • Family Health Division • National AIDS Control and Prevention Program • Public Health Department • International Center for AIDS Care and Treatment Programs/Mailman School of Public Health • Institute of Human Virology-University of Maryland • John Snow Incorporated • LIFESIGN • Axios • Clinton Foundation HIV/AIDS Initiative • CHAN/Medipharm • Crown Agents • Catholic Relief Services • EU-Prime • European Union • Family Health International/Global HIV/AIDS Initiative Nigeria • The Global Fund • Harvard School of Public Health AIDS Prevention Initiative … participated in a health supply chain strategy workshop

5. The Federal Ministry of Health strategic objective… “to strengthen the national health system such that it would be able to provide effective, efficient, quality, accessible, and affordable health services that will improve the health status of Nigerians through the achievement of health-related Millennium Development Goals.” … guided the proceedings

6. Workshop “activities” were intended to support Federal Ministry of Health policy guidance and strategies… • National Health Policy • National Drug Policy • National Essential Drugs Program • Other existing and planned policy documents and guidelines … and enable improved harmonization

7. Participants agreed on an overall workshop goal… “to develop a comprehensive supply chain management system strategic plan that supports national goals and is based on stakeholder needs, drives SCMS, USAID|DELIVER PROJECT, and JSI/Global Fund activities and which links to donor and stakeholder planning processes.”

8. …as well as a set of workshop objectives • Identify key themes that cut across supply chain functions • Develop supply chain goals and objectives • Build consensus among stakeholders on a 3-5 year strategy

9. Quality Quality Quality Quality Quality Breakout sessions were organized around 12 components of the health commodity logistics cycle

10. Participants were asked to answer three questions pertaining to each component area. • What are your desired goals/objectives for health sector supply chain management in Nigeria pertaining to this component area? • What are the challenges/gaps that exist that prevent attainment of these goals/objectives? • What activities should be undertaken to address these gaps?

11. Participants also considered if and how their answers would change across supply chains • Avian Influenza • Laboratory equipment • Essential drugs • HIV/AIDS • Vaccines • Blood Samples • OIs/STIs • Malaria • Reproductive health • Tuberculosis • Test kits • Others

12. Results of the workshop will inform supply chain activities in 2008 and beyond • Next steps/way forward • Proceedings document to be reviewed, revised and validated by participants and other partners • Narrative health logistics strategy to be drafted based upon proceedings document • SCMS, USAID|DELIVER, and JSI/Global Fund projects to guide and develop annual work plans based upon this strategy • Strategy document to be shared with stakeholders, donors and other health supply chain implementers as means to inform and harmonize national supply chain activities • Document to be reviewed and updated on a regular basis to reflect evolving needs and changing 12

13. Nigeria Health Supply Chain Strategy Workshop • Context • Activities Presentation/Executive Summary • Enabling Environment • Product Selection • Quantification • Procurement • Inventory Control Procedures • Warehousing & Storage • Transport & Distribution • Product Use • LMIS • Organizational Support • Finance, Stakeholder/Donor Coordination • Quality • Prioritization Exercise • Full Presentation (Includes Goals and Challenges)

14. 1. Enabling Environment: Opportunities & Activities • Multi-stakeholder review of policies including: • Contraceptive Logistics Management System • Petroleum Trust Fund • Expanded Programme on Immunization • Global Fund Malaria Project • Conduct capacity building and create incentive systems for operators • Improve supply chain awareness of relevant personnel within the enabling environment • Review current arrangements for customs clearance and engage relevant authorities to improve processes

15. 1. Enabling Environment: Opportunities & Activities (cont’d) • Support exemption policies for free health services • Support development of National Procurement Policy • Harmonize, integrate national supply chains • Improve financial management and financial system sustainability • Make the National Health Insurance Scheme accessible to all Nigerians • Establish, institutionalize and strengthen the Drug Revolving Funds at all levels of Government

16. 2. Product Selection: Opportunities & Activities • Strengthen institutions that are responsible for product selection through: • Training and capacity building • Infrastructure enhancement • Implement policy • Develop user friendly tools for data capture and analysis for decision-making • Enable information dissemination, review and feedback • Assess prevailing product use data bases

17. 3. Quantification: Opportunities & Activities • Provide training on quantification • Standardize tools • Monitor & supervise data collection • Develop data quality assurance checklists • Enable data feedback loops • Forecast needs at national level—conduct national quantification • Establish supply chain working group meetings, provide updated quarterly reports and review quarterly data • Conduct training on quantification

18. 4. Procurement: Opportunities & Activities • Advocate for more funds allocation to health commodities • Improve the system for the release of those funds within the Federal Ministry of Health and between ministries • Undertake inter-departmental advocacy within ministries/government departments concerning linkages between Finance, Procurement and Program Performance • Involve technical experts within the tender board • Develop/disseminate Procurement Policy

19. 4. Procurement: Opportunities & Activities (cont’d) • Build technical capacity of procurement personnel • Advocate for consistency and continuity of government policies • Develop long term procurement plans • Develop procurement standards • Develop and disseminate standard operating procedures (SOPs) for key procurement activities (eg. customs clearance, ICBD) • Establish National Drug Procurement Agency • Develop clear job descriptions that will articulate qualifications for procurement specialists

20. 5. Inventory Control Procedures: Opportunities & Activities • Learn from existing supply chain systems • Improve storage and distribution infrastructure • Establish and enforce inventory management standard operating procedures (SOPs) • Provide training in inventory management • Computerize inventory management at sites • Harmonize, simplify and distribute data collection tools • Undertake limited, well-supervised task shifting of inventory control activities where appropriate • Establish procedures for disposal of expired product

21. 6. Warehousing and Storage: Opportunities and Activities • Publish and implement standard operating procedures (SOPs) for inventory control and warehouse management • Undertake staff training in • Product awareness • Safety • Use of equipment • Others as appropriate • Provide appropriate clothing and safety equipment • Renovate buildings and equipment, (e.g. racking, air-conditioning)

22. 6. Warehousing and Storage: Opportunities and Activities (cont’d) • Advocate for budget earmarking to support ongoing sustainability of warehousing and the institution of quality assurance measures • Undertake appropriate disposal of expired and/or used products and supplies • Undertake pest control measures • Establish/improve communications network • Re-activate zonal warehouses • Establish periodic warehousing and storage practice supervision • Emphasize that donor support should not end once goods arrive in country

23. 6. Warehousing and Storage: Opportunities and Activities (cont’d) • Implement warehouse management systems • Implement appropriate packing and other equipment • Establish long term planning for warehousing based on forecast and procurement planning • Establish surge capacity for disease outbreaks • Disseminate the National Drug Policy and train management and staff in its enforcement.

24. 7. Transportation & Distribution: Opportunities & Activities • Explore Public/Private Partnership (PPP) and outsourcing options • Establish budgetary provisions for transportation and distribution services • Strengthen networking, at all levels in the system, with specific timelines • Government, at all levels, should improve the transportation network • Ensure sufficient buffer in the inventory control system

25. 7. Transportation & Distribution: Opportunities & Activities (cont’d) • Coordinate and harmonize transportation and distribution activities • Pre-qualify potential transportation and distribution vendors • Develop appropriate standard operating procedures and/or guidelines for transportation and distribution activities • Develop and provide training program for transportation and distribution companies

26. 8. Product Use:Opportunities & Activities Provide continuing education in product use Advocate for appropriate product use to policy makers Sensitize product users (i.e. clinicians, patients, technicians) to appropriate product use Employ, train and deploy staff knowledgeable in appropriate product use Improve conditions of service Improve incentives for staff Improve product use understanding/capacity in rural areas 26

27. 8. Product Use:Opportunities & Activities (cont’d) Disseminate Standard Treatment Guidelines (STGs) Improve product labelling Advocate for appropriate product use to appropriate authorities Make products available & affordable at the lowest tier of service delivery Strengthen relevant information management systems 27

28. 9.LMIS: Opportunities & Activities • Identify, access and utilize existing information and communication technology • Develop time-line for the provision of a data reporting and feedback system • Standardize, harmonize existing tools and protocols • Motivate and train staff in application use • Provide supportive supervision of LMIS development initiatives • Advocate for the importance of LMIS in broader supply chain strengthening

29. 10. Organizational Support: Opportunities & Activities • Develop clear, written job descriptions • Develop career progression schemes for logistics professionals • Provide supportive supervision to staff at all levels • Harmonize organizational support tools • Encourage advocacy for the importance of supply chain management functions from senior leaders of organizations

30. 10. Organizational Support: Opportunities & Activities (cont’d) • Build incentive schemes including performance based rewards where practicable: • to support logistics training • to encourage feedback & communication • to increase access to and adoption of organizational development tools & resources • to enable positive reinforcement • to allow for career development and enhancement through regular annual performance reviews, promotions and awards

31. 11. Finance/ Stakeholder Donor Coordination: Opportunities & Activities • Institute regular, supply chain-specific, stakeholder coordination meetings • Establish supply chain management coordination technical committee comprising national private sector, public sector and partner organizations • Institute coordinated procurement planning • Advocate to government officials for increased funding for supply chain management • Review and increase access to national health insurance scheme • Undertake social marketing as means to secure increased subsidization of commodities

32. 11. Finance/ Stakeholder Donor Coordination: Opportunities & Activities (cont’d) • Publish budgets, tenders, expenditures for government and donor program initiatives • Increase transparency, visibility to commodity pricing and procurement practices • Advocate for passage of The Health Act • Increase community involvement in program design • Advocate for review of the process of funds release • Improve planning • Explore public/private partnerships and outsourcing to competent companies of appropriate supply chain functions

33. 12. Quality: Opportunities & Activities • Develop national guidelines on supply chain • Disseminate National Drugs Policy through workshops, e-mail, hard copies, and other media • Develop and implement supply chain quality monitoring tools • Harmonize of vertical supply chains • Improve storage conditions, (e.g. power supply, cooling facilities, metal shelves, pallets etc.)

34. 12. Quality: Opportunities & Activities (cont’d) • Sensitize, advocate at all levels for the importance of supply chain management • Develop human capacity plans for improving quality to include hiring, continuous training, and task shifting where appropriate • Continue to strengthen of National Agency for Food, Drug Administration and Control (NAFDAC)

35. Nigeria Health Supply Chain Strategy Workshop • Context • Activities Presentation/Executive Summary • Enabling Environment • Product Selection • Quantification • Procurement • Inventory Control Procedures • Warehousing & Storage • Transport & Distribution • Product Use • LMIS • Organizational Support • Finance, Stakeholder/Donor Coordination • Quality • Prioritization Exercise • Full Presentation (Includes Goals and Challenges)

36. A prioritization exercise indicated general support for five categories of supply chain strengthening • National Quantification—Establishment of one national quantification; Improve the coordination of commodity quantification and procurement planning • Coordinated Supply chain(s)—Establishment of a supply chain management coordination committee comprised of public sector, private sector and other partners: Harmonize and standardize existing tools and protocols for logistics management information; Explore the integration of certain supply chain functions • Information Sharing—Summarization, publication, dissemination of policies, guidelines and other Federal Ministry of Health guidance • Skills Development—Staff, human capacity development through specific training and incentive schemes; Improve skills in quantifying national commodity needs • Public Private Distribution Partnership—Develop public-private partnerships to improve the transportation and distribution of health commodities,

37. Nigeria Health Supply Chain Strategy Workshop • Context • Activities Presentation/Executive Summary • Enabling Environment • Product Selection • Quantification • Procurement • Inventory Control Procedures • Warehousing & Storage • Transport & Distribution • Product Use • LMIS • Organizational Support • Finance, Stakeholder/Donor Coordination • Quality • Prioritization Exercise • Full Presentation (Includes Goals and Challenges)

38. 1. Enabling Environment: Goals • ASupply Chain Management System that is integrated, responsive, and supportive. That allows optimal service delivery by making medicines both accessible and affordable in a transparent and expeditious manner.

39. 1. Enabling Environment: Challenges • Policies are unclear, redundant, contradictory • Local manufacturers are not given the tools to be globally competitive • Inadequate political commitment • Lack of strengthened essential drugs program

40. 1. Enabling Environment: Opportunities & Activities • Multi-stakeholder review of policies including: • Contraceptive Logistics Management System • Petroleum Trust Fund • Expanded Program on Immunization • Global Fund Malaria Project • Conduct capacity building and create incentive systems for operators • Improve supply chain awareness of relevant personnel within the enabling environment • Review current arrangements for customs clearance and engage relevant authorities to improve processes

41. E1.Enabling Environment: Opportunities & Activities (cont’d) • Support exemption policies for free health services • Support development of National Procurement Policy • Harmonize, integrate national supply chains • Improve financial management and financial system sustainability • Make the National Health Insurance Scheme accessible to all Nigerians • Establish, institutionalize and strengthen the Drug Revolving Funds at all levels of Government

42. 2. Product Selection: Goals • Products must satisfy the majority of health needs of the patients of the area • Products should be selected by their: • Efficiency • Effectiveness • Availability • Safety • Accessibility • Systems and processes that are followed in the selection of commodities for use by patients and or clients 42

43. 2. Product Selection: Challenges • Government policies/ regulations which are unable to ensure transparency in product selection • Weak institutions and their incapacity to carry out product selection in terms of: skills, etc.: this affects product selection for health care projects • Lack of appropriate data for decision making • Inadequate finance • Environment: which affects • Selection of equipment • Product selection • Non existence of a budget line item for product selection • Weak regulatory enforcement at all levels 43

44. 2. Product Selection:Opportunities & Activities • Strengthen institutions that are responsible for product selection through: • Training and capacity building • Infrastructure enhancement • Implement policy • Develop user friendly tools for data capture and analysis for decision-making • Enable information dissemination, review and feedback • Assess prevailing product use data bases

45. 3. Quantification: Goals • National quantification based on data from throughout the system: • Morbidity • Consumption data • Plans for scale (up or down) • Supply plans—manufacture & transport delays • Self-life of product • Buffer needs & storage concerns • Costing implications 45

46. 3. Quantification: Goals (cont’d) • Achievement of “The Six Rights” • Well founded assumptions for forecasting • Quality and timely data • Use of data over time • Translation of data into procurement tools • Valid from patient level to national level • Strengthened quantification capacity at SDP, regional depots, CMS and procurement coordinator • Regular updates 46

47. 3. Quantification: Challenges • Lack of dedicated staff • Administration/management an added responsibility on clinical staff • Weak infrastructure to support an automated/IT system • Poor staff retention/motivation/supervision/ empowerment • Poor community distribution networks • Weak quantification skills 47

48. 3. Quantification: Challenges (cont’d) • Inefficient data collection and transfer • Procurement decisions not informed by quantification • Weak monitoring and supervision • Unequal access to tools • Shifting context e.g. Policy, scale up, prioritization, stock fluctuations • Inefficient reporting • Variable periodicity of data reporting • Parallel reporting systems (product line and type eg. Pharmacy vs. lab vs. clinic) 48

49. 3. Quantification: Opportunities & Activities • Provide training on quantification • Standardize tools • Monitor & supervise data collection • Develop data quality assurance checklists • Enable data feedback loops • Forecast needs at national level—conduct national quantification • Establish supply chain working group meetings, provide updated quarterly reports and review quarterly data • Conduct training on quantification

50. 4. Procurement: Goal • Efficient and timely procurement of priority health commodities to meet program needs 50