; clinton
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

clinton

VIEWS: 11 PAGES: 13

  • pg 1
									              GLOBAL HEALTH SUPPLY CHAINS




SCTL: San Jose, Costa Rica
July 21st, 2009                             1
TYPICALLY MOH SCM INVOLVES ACTIVITIES AT 3 DIFFERENT LEVELS

SC Activities at each level
                                                                                  Ministry Of             Focus at each level
• Product Registration                                                              Health
• Forecasting / Quantification
• Procurement                                                                                                Central/National
                                                                                                          • Central Co-ordination
•   Forecasting / Quantification                                                                           • Guidance / Direction
•   Procurement                                                                                                   • Target Setting
•   Storage                               Central Medical                                            • Procure / Store & Distribute
•   Inventory Management                   Store (CMS)
•   Transportation
• Storage
• Transportation
• Inventory Management
                                                                                                           Provincial/District
                                                                                       Provincial/
                                                                                      Regional WH             • M&E consolidation
                                                                                                         • Provincial Budget Mgmt
•   Storage                                                                                       • Liaison between Sites & Central
•   Transportation                                           Hospital/                                     • Storage & Distribution
•   Inventory Management                                    Hospital Lab
•   Dispensing
                                                                                                                             Site
• Storage                            Health Centre                         Health Centre/
• Inventory Management                                                                            • Patient Test, Care & Treatment
                                        /ICTC                                  ICTC
• Dispensing                                                                                                 • Report Completion
                                                                                                • Request & receive Commodities
                                                                                                                         • Storage

                                   Data Flow                       Product Flow
                             GLOBAL SUPPLY CHAINS

    Where I have come from ….                    To where I am now ….
Holistic Approach to SCM                 Silo’d view of SCM
Outsourcing of non-core competencies     In-source everything CMS, Procurement etc
Dynamic & Regular forecasting            Annual forecast/incorrect assumptions
Strategic relationships with Suppliers   No supplier relationships or perf mgmt
Pooled Procurement/ Draw down qtys       Annual Tendering w/single deliveries/no
VMI/ DSI                                 consolidation of procurement across system
Supplier Hubs                            High buffer stocks at all levels held at various
                                         stocking location
Direct Shipments/Cross Docking/ Merge
Route optimization                       Manual processes/tools, typically using
                                         excel/access database with no integration
SW Integration
                                         Some metrics identified but not always
Metrics used to identify weakness/set    appropriate or tracked, no CI
priorities. CI efforts
                                         Limited data availability and integrity
Data turned into Information
                                         Funding provided by multiple sources/with
High Level of Awareness of SCM           different priorities
- w/in organization                      Low level awareness of SCM
- in country eg: education               Vertical Supply Chains
- SCM strategies
                                         Decentralizing of SCM
THE GAP CONTINUES TO WIDENED BETWEEN DELVEOPED WORLD
          AND DEVELOPING WORLD SUPPLY CHAINS


     Private Sector/High Income                         Health Systems Developing World
 Focus on supply chain as competitive              • Lack of HR/specialized SCM knowledge
 advantage / increase profits
                                                   • Poor communications/data integrity
 Outsourcing allows focus on core
                                                   • Absence of metrics for performance/progress
 competencies and specialization
                                                   • Lack of strategic approach/ business
                                                   framework
                                                   • Funding provided by multiple stakeholders
 • Massive cost savings                            whose priorities are not always aligned

 • Reduction in inventory at all points in         Exacerbated by
 chain (cashflow benefits)                         • Investment in vertical supply chains
 Concurrent with                                   • Push to decentralize
 • Enhanced customer service
       - Shorter lead times                                         Result
                                             Patients
       - Increased customization
                                             • Go without
       - Improved quality                    • Or have to purchase meds privately

                                             MOH/Donors
                                             • Wasted investments/inefficiencies throughout system
                                             • Lost opportunity to make more effective use of funds
CHARACTERISTICS OF GLOBAL HEALTH SUPPLY CHAIN



   New Product  NPI = Forecasting & Procurement, limited focus on lifecycle planning
   Introduction:  Timing = 12-18 months for actual implementation
                    Uptake not very successful ending up with a lot of expired stocks

  Quantification:  Annual Forecast process using a 12-18 month planning window
                    Limited consumption data available, unconstrained demand not included
                    Assumptions not always appropriate (eg: Malaria AMC, Ess Meds distribution
                   history)
                    Forecast Accuracy is not tracked

  Procurement:  Tender 1/Year w/single deliveries & supplier selection driven by cost
                    Procurement processes are long cumbersome process driven by perceived
                   transaction efforts
                    Payments are made up front, even for donor commodities
                    Funding from National Budget can be unpredictable and insufficient
                    Supplier Performance Management does not exist
                    Govt Procurement Guidelines can be restrictive and favour local organizations
                    Many hospitas/labs do their own procurement but do not utilize Pooled
                   procurement to leverage economies of scale


                                                                                                     5
CHARACTERISTICS OF GLOBAL HEALTH SUPPLY CHAIN

          Storage:  Utlize CMS concept - central distribution to provincial warehouses & sites
                       Require sufficient space to store upto 12 months of inventory
                       Poor storage facilities and in many cases insufficient storage
                       Storage & Distribution costs are based on % of commodity prices not activity based
                      costs
                       CMS are typically parastatal and can be very bureaucratic with no revenue recovery
                      models
Inbound/Outboun  Customs Clearance can be cumbersome /Product waivers required for some
      d Logistics commodities
     Distribution:  Different trucks used for different commodities, no optimization of transportation
                      /routes
                       Cold Chain challenges in rural areas
                       Reverse Logistics doesn’t occur very effectively
 Inventory Mgmt:  High buffer stock levels - typically 2-3 months at site, 2-3 months at provincial level
                      and 6 months= at central
                       Inventory Balancing /Redistribution doesn’t happen very well and is usually through
                      an informal process
                       Little or no proactive management or tracking of Excess, Expired & Stockouts
                       Ongoing Shortages of commodities such as gloves, due to inaccurate ess meds
                      lists
                       Stock outs monitored at National Level not so much as site level
                       ARVs tend to have excess/expired as opposed to shortages
                       Many times stock turns up in Private Sector Clinics
                                                                                                              6
CHARACTERISTICS OF GLOBAL HEALTH SUPPLY CHAIN

    Technology  Fragmented systems and usually utilizing NGO developed tools
                   Technology solutions focus on point solutions for Forecasting, Inventory
                  Management, Data collection and are usually excel/access data base
                   Focus on central level not site level
   Resources:  Little awareness of SCM as a profession
                   Typically Pharmacists are in charge of SCM activities w/little or no training
                   Very little synergies between partners/disease specific programs & primary health
                  care systems
                   Task shifting needs to occur especially in resource constrained settings
                   Many personnel have multiple jobs
                   Salary inequities amongst MoH programs due to donors
                   Poor communications across the supply chain
                   People who gain from not fixing the issues
          Data:  Data collection is in place for disease specific programs, but little information is
                  available
                   Accuracy & completeness of data is questionable
                   Little or no data analysis is done except for reporting to the donors
                   Reports used for order fulfillment, however order qtys are typically determined
                  based on patient data
        Policy:  Treatment Guidelines/ Essential Meds list not updated on a regular basis
                   Payment processes
                   Procurement tendering - favor local suppliers
                                                                                                         7
      VERTICAL SUPPLY CHAINS LIKE THIS EXIST IN MOST DELVELOPING
                          WORLD COUNTRIES
                                                                                                                                                            République du Burundi
Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007                                                                       Ministère de la Santé Publique



                                                                                                                         REACTIFS
                   MEDICAMENTS                                                                  ARVs                                                                                                        Dispositifs
                                           ARVs          PALUDISME       TB        IO                                  sécurité du sang       VACCINS       Préservatifs           Contraceptifs
                    ESSENTIELS                                                                   Ped                                                                                                        Médicaux
                                                                                                                          (+ test HIV)




       Etat

    Bailleurs
    bilatéraux

    Bailleurs
   multilatéraux

   ONG/Privé


                    E      C   D      U                   C    U     G        O      U          M        A     P       C           B      G    C    U   G      G         C     P      C      F          I      K          C
                    T      A   F      E     FONDS         L    N     D        M      N          S        C     D       I           M      T    E    S   V      A         T     S      O      N          P      F          O
   Sources          A      M   I                          I    I
                                                                     F        S      I          F        F     M       C                  Z    P    A   C      V         B     I      R
                                                                                                                                                                                             U          P      W          N
                                           MONDIAL        N    T                                                                                                                      D                                   C
     de             T      E   D                                                     C                                 R                       B    I          I                             A          F
 Financement                                              T    A                                                                                                                      A                                   E
                           B                              O    I                     E                                                         U    D                                 I      P                            R
                           U                              N    D                     F                                                                                                D                                   N



                   P     C        I                       C          G        O                 M        A     P        C                 G     C        G               C     P       C      F         I        G        C
                   N                                      L          D               U          S        C     D        I                 T     E        V               T     S       O      N         P        F        O
   Structure             A        P                                           M      N
                   L                                      I          F                          F        F     M        C                 Z     P        C               B     I       R      U         P        A        N
    d'appro-             M        A        SEP/                               S      I                                         SEP/
                   T                                      N                                                             R                       B                                      D      A         F                 C
 visionnement            E                 CNLS           T                          C                                         CNLS             U                                      A      P                           E
                         B                                O                          E                                                                                                 I                                  R
                         U                                N                          F                                                                                                 D                                  N




   1er point        PNLT                              CAMEBU                      PEV     IMC       MSF      ACF    PNLO    CICR          CEPBU         GVC        PSI       CORDAID       ABUBEF PNSR             CONCERN
  de stockage




  2ème point
                           PNSR       Site de prise       HÔPITAUX       CDV      CNTS             IMC       ACF        PRISON                BPS       GVC        Grossiste   CORDAID            CDS         CPLS
  de stockage                                                                                                                                                        Privé
                                       en charge



   Structure                                                                       Site de prise
 dispensatrice          BPS           CPLS                               CDV                              SNT/CNT       CDT/CT                CDS                   Détaillants                         COCOLS
                                                                                    en charge

                                                                                                             PATIENT
RESULT OF POOR INFRACSTRUCUTRE, TRAINING AND LACK OF
                      RESOURCES
 BIGGEST IMPACT OF ALL: APPROX 2/3 OF SELECTED MEDS ARE
UNAVAILABLE IN PUBLIC HEALTH FACILITIES ON AVERAGE AT ANY
                           TIME*
*across developing world excluding LAC/Caribbean




 Average availability = 34.9% in the public sector and 63.2% in the private sector

                 Source: WHO, Health Action International, United Nations MDG8 Report
   CHAI’s Supply Chain Strategy is to empower
 governments to build cost-efficient, effective and
  sustainable national health care supply chains

1. Ensure sustainability through increased awareness and
   continuous source of SCM skills/knowledge in country. E.g. SCM
   Curriculum/Accredition, SCM Mentoring
2. Leverage resources from developed world, private sector. E.g.
   Partnerships, Applying lessons learned
3. Turn data into information E.g. Develop technology roadmaps
4. Secure funding for SCM specific programs, to help demonstrate
   effective solutions
EXAMPLES OF SCM ISSUES IN COUNTRY



India redistributes on a monthly basis as oppose to having the supplier ammend their delivery qtys each
quarter
India - Cold Chain for HIV Kits compromised because fridge isnt working
Many countries, testing doesn’t occur because they run out of reagents or machines are broken
Swaziland distributes ARVs monthly, but ess meds only every 2-3months if the trucks are in working
order
Botswana/Cambodia forecast Malaria using average monthly consumption
GF encourages procurement of high volume, single deliveries to achieve lowest cost
GF encourages up front payment to suppliers
PEPFAR training objectives are based on # of personnel trained not the effectiveness of the training
Per diem culture exists in training/workshops
Unconstrained demand is not captured especially for essential meds
in Mozambique if you are sick, it is best to have HIV, because you know you will get treated
Liberia is constantly running out of gloves
Communications between site & central are broken down and a lack of trust exists
10-30% of drug costs are allocated to storage and distribution of drugs for GF
Decisions are driven by budet & project not by commodity requirements
Public Health SC has been weakened by disease specific programs




                                                                                                          12
         PARTNERS AND DONORS INVOLVED IN SUPPLY CHAIN
                    MANAGEMENT ACTIVITIES

Major institutional donors providing       Key implementing agencies engaged
funding for health systems                 in health system strengthening

• GFATM    R8 procurement/SCM = $172m      • SCMS: Typically focused on
           or 8.7% of total phase one        Forecasting & Procurement at the
                                             national level
• PEPFAR $185m in 2007 to PFSCM (runs
         SCMS)                             • JSI/JSI DELIVER: Logistics focused,
                                             conducts assessments and develops
                                             tools (eg: Qantamed, Pipeline)
• USAID    Funds DELIVER, with JSI in 38
           countries (focus on             • MSH: MIS focused, usually on Inventory
           contraceptives) $100m 6 years     management tools, also an implementer
• AUSAID                                     of GMS Technical Assistance
                     No distinct SCM
                     budget but            • WHO: Technical Assistant for PSM
• DFID               incorporated            Plans
                     into many
                     activities            • UNICEF: Acts as Procurement Agent
• World Bank

								
To top