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The 5th Global Health Supply Chain
Summit November 14 -16, 2012Kigali,
Rwanda 
Optimization of Benins Vaccine Logistics
System Philippe Jaillard Hamadou Modibo Dicko
DATE
SPEAKERS NAMES
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Introduction Context

• Weak logistics affects Benin national
  immunization program (NIP)
• Inadequate storage capacity, vaccines and
  supplies stockouts, lack of dedicated, skilled
  human resources
• delay introduction of new vaccines and
  immunization missed opportunities
• Expansion of NIP
• Pending new vaccines introductions MenA, Rota,
  HPV, measles 2nd dose,
• Broader target population (12-24 months,
  adolescents, adults)
• Adaptation of new technologies and supply chain
  strategies
• Ministry of Health engaged to optimize its
  vaccines' logistics system
• Etats généraux de la vaccination (June 2012)
• Technical and financial supports from partners
• LOGIVAC project implemented in Benin
• Existing evidences and data 2008 NIP review,
  2010 cold chain inventory

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LOGIVAC a joint AMP and WHO project supporting
health logistics professionalization in Africa
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Optimization of Benins EPI Supply chaina
combinaison of method and tools a collaborative
process
EVM (WHO, UNICEF)
CCEM (PATH)
HERMES (Vaccine Modeling Initiative)
Optimized SC system we are aware that there
might be other confounding factors that
facilitate this optimization process Key issue
ensuring the successfully implementation and
country ownership!

• CCEM (Cold Chain Equipment Management) assess the
  quantity and functionality of cold chain
  equipment
• Dynamic inventory system that is continuously
  updated by the national level

• EVM (Effective Vaccine Management)
• assess the quality of the vaccine management
  system
• EVM assessment report
• EVM improvement plan (EVM-IP)

• HERMES (Highly Extensive Resource for Modeling
  the Supply chain)
• Virtual laboratory, can help in re-designing the
  supply chain
• Measure vaccine ava
• ilability and supply chain cost

Transport system evaluation
National cold room assessment
Workshop 1 identification of scenarii
Optimization planning
Workshop 2 strategic orientations
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Results (1/4) Effective Vaccine Management (EVM)
Assessment
Criteria Levels Levels Levels Levels Levels
Criteria National Department Regional/relais Lowest distribution level (Commune) Service delivery point
1 Vaccine arrival/receving 58 Non applicable Non applicable Non applicable Non applicable
2 Storage temperature 41 75 95 70 77
3 Storage capacity 33 55 28 70 69
4 Buildings, equipment transport 67 79 70 67 78
5 Maintenance 50 55 59 63 54
6 Stock management 72 79 74 61 59
7 Distribution 64 31 32 57 69
8 Vaccine management 68 81 57 62 80
9 Information system 78 89 100 61 Non applicable
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Results (2/4) CCEM Equipment source of energy
and age (SDP only)
Many fridges rely on Kerosene (expensive).
Many fridges are amortized and need replacement gt
50 older than 10 years.
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Results (2b/4) CCEM Option for reduction of
operational cost

• Replace absorption fridges gt10 years (n379)
  with
• Ice lined refrigerators where possible
• Solar direct drive refrigerator where no power is
  available
• Capital cost 258 728 USD
• Saving on operational costs 180 000 USD/year

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Results (3a/4) Supply chain design Actual
situation
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Results 3b/4 Supply chain design options
1. Consolidation to zone level
Status quo
3. 12 dept store commune level removed
2. Actual commune level removed
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Results (3c/4) HERMES Vaccine availability
Actual system Scenario 1 consolidation to Health zone Scenario 2 Acutal system without the communes (LDL) Scenario 3 12 departments and without the communes (LDL)
Vaccine availability 93 94 96 99
With Rota virus 71 64 91 93
Added capacity Rota Virus 100 100 100 100
4 loops-Added capacity Rota Virus 99 99 99 100
6 loops-Added capacity Rota Virus 99 99 99 100
10 loops-Added capacity Rota Virus 99 99 99 100
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Results (3d/4) HERMES For Each Scenario,
Capital Expenditures to Achieve and Annual
Operating Costs
Source The Business Case for Vaccine Supply
Chain Redesign in the Republic of
Benin EVMHERMES Analysis Consolidating Communes
to Zone Sanitaire plus Implementing a 4x4 Truck
Loop Delivery System to the Health Centers is the
Dominant Scenario Bruce Y. Lee, et all
(unpublished data)
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Results (3e/4) HERMES Logistics cost
estimations
Logistics Cost per Dose Administered for each
Scenario after Rotavirus Introduction and with
Capacity Added
Source The Business Case for Vaccine Supply
Chain Redesign in the Republic of
Benin EVMHERMES Analysis Consolidating Communes
to Zone Sanitaire plus Implementing a 4x4 Truck
Loop Delivery System to the Health Centers is the
Dominant Scenario Bruce Y. Lee, et all
(unpublished data)
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Results (3f/4) HERMES Logistics cost
estimations
Cumulative Cost Savings over time from
Implementing Redesign vs. Simply Augmenting
Capacity of Current System
Source The Business Case for Vaccine Supply
Chain Redesign in the Republic of
Benin EVMHERMES Analysis Consolidating Communes
to Zone Sanitaire plus Implementing a 4x4 Truck
Loop Delivery System to the Health Centers is the
Dominant Scenario Bruce Y. Lee, et all
(unpublished data)
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Results (3f/4) HERMES Vaccines logistics
costs

• Scenario 1 Consolidating Commune level to zone
  level
• Capital cost 234 087 USD
• Logistics Cost per dose 0,19 USD (with truck
  loop)
• Saving cost (cumulative)
• after 3 years 322 953 USD
• After 5 years 504 255 USD
• Dominant scenario, choosen by MoH

Source The Business Case for Vaccine Supply
Chain Redesign in the Republic of
Benin EVMHERMES Analysis Consolidating Communes
to Zone Sanitaire plus Implementing a 4x4 Truck
Loop Delivery System to the Health Centers is the
Dominant Scenario Bruce Y. Lee, et all
(unpublished data)
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Results (4/4) Conclusion from the 2nd
optimization workshop
Strategic Orientations
Global Optimization Plan

• Changing the EPIs supply chain design (reduction
  of of storage points)
• Acquisition of solar equipment (in replacement of
  Kerosene ones)
• Professionalization of health logistics (to
  properly handle change implementation)
• Optimization of resources (Integration in some
  segment of the SC)

• Equipment management system (LMIS, CC
  rehabilitation and maintenance plans)
• Transport management system
• Development of health logistics
• EVM Improvement plan (vaccine management)
• Investment plan for the logistics system

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EVM HERMES Pilot in Benin Next steps towards
the implementation plan
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Lessons learned and conclusion
Application and scale up
Lessons learnt

• Strong involvement within MoH
• High level cadres
• NIP director and team
• other directorates within MoH (equipment,
  pharmacy)
• Global partnership (PAG)
• Potential resistance due to change management

• Country willingness to make strategic change in
  NIP Logistics system
• Countrys ability to mobilize fund
• Assessment and modeling USD 35 000 (without
  HR)
• Optimization plan
• Strong technical supports from partners
• Implication of MoH agents
• Available and Skilled
• A valid inventory (lt 2 years old)

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Contribution to EVMHERMES in Benin

• VMI Bruce Y. Lee, MD, MBA, Shawn T. Brown, PhD,
  Diana L. Connor, MPH and Angela R. Wateska, MPH,
  Bryan A. Norman, PhD and Jayant Rajgopal, PhD,
  Brigid E. Cakouros, MPH, Sheng-I Chen, PhD, Erin
  G. Claypool, PhD, Leila A. Haidari, BS, Veena
  Karir, PharmD, Jim Leonard, Leslie E. Mueller,
  BS, Proma Paul, MHS, Rosyln Phillips, MPH,
  Michelle M. Schmitz, BA, Joel S. Welling, PhD,
  Yu-Ting Weng, MS
• AMP Benjamin Schreiber, Philippe Jaillard,
  Hamadou Dicko, Melanie Avella, Caroline LeBrun,
  Alfred Da Silva
• UNICEF Dmitri Davydov, Terry Hart, Flavia
  Guidetti, Bibata Pare, Hortence Kossou
• Bill and Melinda Gates Foundation Raja Rao,
  Skye Gilbert, James Cheyne
• PATH/Optimize Mercy Mvundura, Sophie Newland,
  Modibo Dicko
• OMS Aristide Sossou
• Ministry of Health in Benin Ndeye Bassabi,
  Justin Sossou, Justin Djidonou

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Thank you www.logivac.org www.amp-vaccinology.org

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