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[DATE][SPEAKERS NAMES]

The 6th Global Health Supply Chain Summit

November 18 - 20, 2013Addis Ababa, Ethiopia

 

GAVI Alliance immunisation supply chain strategy

Daniel Thornton, GAVI Secretariat

Overview

• Introduction to GAVI

• Issues with the immunisation supply chain

• Introduction to the strategy development process

• Next steps

GAVI Alliance: a public private partnership

GAVI supports immunisation in the world’s poorest countries

• Click to add text

Overview

• Introduction to GAVI

• Issues with the immunisation supply chain

• Introduction to the strategy development process

• Next steps

Immunisation supply chains: backbone of national immunisation programmes

Reports

Analysis

Forecasting

Ordering

ManufacturerShipments (air & sea)

Vaccine Arrival

National Store

Sub-national Stores

Health Centers

Service Delivery

Waste management

Records

6

Value, volume and complexity have grown rapidly

Compare 1980s to 2010

Challenge of reaching effective vaccine management standards

No country meets all minimum standards for all criteria, at all levels of the supply chain

A GAVI Alliance immunisation supply chain strategy is required

• Recognition that stronger immunisation supply chains are needed to achieve the GAVI Alliance mission

• Agreement that this topic requires more attention at all levels in order to:– improve the effectiveness and efficiency of immunisation

supply chains

– increase the resources for immunisation supply chains

– enhance collaboration across the Alliance (e.g. WHO/UNICEF immunisation supply chain Hub)

– leverage expertise and knowledge from other health sectors and the private sector

Overview

• Introduction to GAVI

• Issues with the immunisation supply chain

• Introduction to the strategy development process

• Next steps

GAVI Alliance immunisation supply chain strategy timeline

Q12013

Q22013

Q32013

Q42013

Q22014

Board discusses supply chain

Taskforce established

Cold chain work transferred to

taskforce

Q4 2012

Q12014

Landscape analysis findings

Taskforce reset

Framework to PPC

Presentation to Board

Q32014

Q42014

Strategy to PPC

SAGE discussion (1/2)

SAGE discussion (2/2)

Phase 1: Landscape analysis

Phase 2: Consultations & framework developed

Phase 3: Strategy development

Phase 4: implementation planning

EC 4 Mar

GAVI 2016-2020 strategy SAGE

1-3 AprBoard

Jun 18-19

GAVI immunisation supply chain strategy

PPC5-6 May

Identified challenges were prioritised into four working groups

Global

Interface

In-country

Data discrepancy country vs. global

Long lead times for approval

Multiple signals of demand received by manufacturers. Limited opportunity to reconcile

Lack of total cost perspective on portfolio and SC decision

Product specifications impact SCM Timing of approval

Poor quality of short-term country forecasts

Long lead-times and delays in getting shipment clearance

Vx intro decisions and scheduling are not robust enough and change frequently Frequent updates of forecast

to manufacturers

Last minute sharing of procurement plan

Missed return on investment from money on “Procurement Accounts”

Delay of co-funding

Lack of transparency into shipment data

Delivered products don’t match preferred specification

Limited transparency on demand frequency, size and location

Lack of SC processes / not well implemented

Ad-hoc delivery schedules

Insufficient transportation resources

Limited expertise to operate and oversee SC processes

Multiple levels of supply chain holding inventories

Insufficient or non-functional cold chain equipment

Suboptimal cold chain equipment selection

Poor equipment repair and maintenance

People and practices

Cold chain strengthening

Vaccine Products

Data for management

System optimisation

Priority working groups for approaching challenges

Iden

tifi

ed c

hal

len

ges

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Priority working groups

People & Practice

• Support access for quality pre-service and in-service training health supply chain training

• Advocate for recognition of supply chain management as a profession

• Strengthen management structures and systems

Data for management

Cold chain strengthening

• Define target specifications for better projects• Improve global guidance to countries• Set up feedback mechanisms for buyers and manufacturers. • Explore market shaping options

• Capture and share information about on-going projects• Identify gaps where funding should be targeted to help, and

encourage scale up of information systems identified as most likely to succeed in range of countries

System optimisation

• Support countries to streamline network designs in order to increase their efficiency, agility and effectiveness.

• Focus on transportation systems, synergies with private sectors and other health commodity supply chains

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Insufficient high performing human resource with appropriate expertise at global and local levels

Insufficient high

performing HR w/ appropriate

expertise at global/ regional

level

Insufficient high

performing human

resources with appropriate

expertise in countries

Lack of sufficient

expertise in existing staff

Insufficient overall number

of staff

Lack of proper incentives and performance management

CausesCauses Challenge

ChallengeWho is managing the immunization supply chain in

Benin (2012) ?

Who is managing the immunization supply chain in Benin (2012) ?

“When you use a nurse or a physician as a logistician, you lose the nurse or physician and you

don't get a good logistician!”

Dr. Saracino, former Minister of Health, Côte d'IvoireTFI members briefing, Harare, Oct.2006.

Source: AMP LogiVac Project

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Previous generation of GAVI health systems funding had little focus on supply chain training

% of GAVI HSS funding dedicated to HR training

Training funding dedicated to health supply chain training

29% ($16.3m) dedicated to training No health supply chain training

14% ($1.4m) dedicated to training No health supply chain training

23% ($10.3m) dedicated to training

~5% ($0.48m) of total training $allocated to logistics

(at time of evaluation training hadn't happened)

DRC

Ghana

Nigeria

Of 3 countries, only Nigeria provides logistics training, and at time of evaluation, training had not yet been implemented

Source: HSS Evaluations 16

Significant barriers to implementation of new tools and technology

Despite the promise of some existing tools and new technologies...

Despite the promise of some existing tools and new technologies...

...systems improvements are often challenging to implement in countries

...systems improvements are often challenging to implement in countries

Countries have a lack of choice and access to information on potential solutions

Costs of licensing and contracting are high• Country MoH have limited capacity to develop

contracts with information system providers

Cost and complexity of developing custom-made software

Lack of connectivity, reliable electricity and capacity to maintain systems at peripheral level imply that typical commercial systems are often not suitable

Lack of technical expertise at central levels needed to run and maintain systems once they are acquired.

Mobile Phones and Networks

Cloud Computing

Stock Management Tool (SMT), District Vaccine Data Management Tool (DVD-MT) Microsoft Excel-based tools for monthly

reporting, developed by WHO

Vaccination Supplies Stock Mgmt (VSSM) Access based tool developed by WHO Supports warehouse management Used for central/large subnational stores

Open LMIS Freely available resources for electronic

logistics management information systems

and other tools Commercially available systems developed by

profit and non-profit organisations

Source:, Project Optimize: Information Systems Action Plan, Expert Interviews, Village Reach: The framework for open LMIS 17

There are four critical cold chain equipment gaps at the facility level

SOURCE: CCEM data; country data; WHO/NPHCDA

▪ Many facilities that should have cold chain equipment (based on government plans) are not equipped today– Nigeria: <20% of 11,500 target facilities currently equipped

▪ Much of equipment which does exist is non-functional or not installed (e.g., due to poor maintenance)

▪ Significant portion of installed base is absorption, solar with battery, or domestic refrigerators with significant issues:– Expensive to run– Unreliable – Inadequate holdover – Risk to efficacy of vaccines due to poor temperature control

(e.g., freezing, etc.)

24%

42%

17%

17%

1 Extrapolated data from 7 countries representing >50% of GAVI birth cohort

▪ Smaller portion of installed base are ILRs and SDDs that:– Do not meet facility needs (e.g., 50% of facilities need <15L

capacity, but most too large)– Are of some risk to efficacy of vaccines (risk freezing if user

does not pack refrigerators correctly)

~134,000

Unequipped facilities

Unequipped facilities

Non-functional equipment

Non-functional equipment

Acceptable, but sub-optimal technology

Acceptable, but sub-optimal technology

Undesirable technology

Undesirable technology

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Example of system optimisation from India: milk run

INR 4200 per trip

INR 4200 per trip

INR 4200 per trip

INR 4200 per trip

• Presently each district books a private vehicle to source vaccines from divisional HQ at an average cost of INR 4200 per trip

• A round trip from Bhagalpur (milk run) will be ~300 km; even at a cost of INR 30 per km it will be only INR 9000 per trip

• Translating into an annual saving of ~INR 1,00,000• A similar saving may be replicated in vaccine transportation from district HQ to PHCs

Baseline: each district pays average INR 4200 to book separate trips

Solution: round trip milk run reduces distance, saves ~INR 100,000 (~$1500) per year

Bhagalpur division Bihar

SOURCE: Public Health Foundation India

Overview

• Introduction to GAVI

• Issues with the immunisation supply chain

• Introduction to the strategy development process

• Next steps

Next steps

• Continue to engage with countries, stakeholders, experts, throughout this process

• Draw upon existing knowledge and expertise, especially in the prioritised areas – People & practice – Cold chain strengthening – Data for management – System optimisation

• Launch request for expressions of interest to better understand the landscape of existing service providers and technical partners

Thank you