Health Systems Unit Department of Epidemiology and Public Health - PowerPoint PPT Presentation

Loading...

PPT – Health Systems Unit Department of Epidemiology and Public Health PowerPoint presentation | free to download - id: 844bb4-Yzg4Y



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Health Systems Unit Department of Epidemiology and Public Health

Description:

Health Systems & Policies Research Group Department of Epidemiology and Public Health Health System Challenges of Broken Supply Chains Don de Savigny – PowerPoint PPT presentation

Number of Views:57
Avg rating:3.0/5.0
Slides: 20
Provided by: Dond64
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Health Systems Unit Department of Epidemiology and Public Health


1

Health Systems Policies Research
Group Department of Epidemiology and Public Health
Health System Challenges of Broken Supply
Chains Don de Savigny Aliya Karim Swiss
Tropical and Public Health Institute University
of Basel d.desavigny_at_unibas.ch
2
Are essential medicines supply chains relevant to
value for money?
  • Yes Follow the money.
  • Where does most public health funding go?
  • To essential medicines and other health
    commodities drugs, vaccines, diagnostics, etc.
  • Only valuable if delivered.
  • Largest single cost center in the health system.
  • Usually 40-60 of total health expenditure of low
    income countries
  • Typical example Tanzania, pop 45 million
  • Total expenditure for essential drugs in 2012 was
    199.7 million USD
  • Expenditure sources
  • Printz, Naomi, Johnnie Amenyah, Brian Serumaga,
    and Dirk Van Wyk. 2013. Tanzania Strategic
    Review of the National Supply Chain for Health
    Commodities.
  • USAID DELIVER PROJECT, Task Order 1. 2011.
    Tanzania 2020 Supply Chain ModelingForecasting
    Demand from 20202024. Arlington, Va. USAID
    DELIVER PROJECT,

3
But expenditure enters a highly fragmented scene
Medicines Technologies supply chain
complexity Tanzania 2007
4
Lets briefly look at a specific case
Anti-malarial drugs in Tanzania
5
mHealth supply chain monitoring of
anti-malarials
Real-time monitoring
Source SMS for Life Tanzania
6
and the stockouts persist Last weeks
situation.
Real-time monitoring
Red if stock- out this week Green if stock
in Grey if no report yet
Source SMS for Life Tanzania
7
ACT total stock-outs this week in Tanzania
National Average 13 of health facilities have
no first line antimalarial treatment in
stock Regional Range 1 in Dodoma Region to
38 in Mara Region. District Range 0 in
Kongwa District to 75 in Ukerewa District
Source SMS for Life Tanzania
8
Tanzania in 2012
Malaria prevalence by region
Anti-malarial stock-outs by region
Data source Tanzania Malaria Indicator Survey
2011-12 Data Source Tanzania NMCP SMS for Life
2012
9
  • Pharmaceutical availability
  • Not just Tanzania
  • Not just antimalarials
  • OECD countries availability gt 90
  • Low income countries public sector average 38
  • Low income countries private sector average 60

Country Availability Year Source
Benin 40 2013 SARA (MoH)
Burkina Faso 47.7 2012 SARA
Burundi 34.8 2013 HAI
Congo 23.4 2007 HAI
DRC 45.7 2007 HAI
Ghana 68 2003 MoH
Kenya 87 2009 HF Survey (HAI/WHO/MoH)
Sierra Leone 35 2012 SARA
Tanzania 41 2012 SARA (IHI GF)
Zambia 49 2010 SARA (MoH/WHO)
But national averages mask a worse condition for
the poor and most rural populations
10
In-country supply chains are the weakest link in
the health system
  • GLOBAL SUPPLY CHAIN
  • Global demand supply planning
  • Voluntary pooled procurement
  • Price negotiation
  • Shipment coordination
  • IN-COUNTRY SUPPLY CHAIN
  • Quantification and forecasting
  • Procurement
  • Warehousing
  • Distribution to providers

Manufacturers
Patients
Prashant Yadav www.globalhealthmagazine.com
11
In-country procurement and supply management cycle
Source Modified from Rima Shretta
12
The private supply chain paradox
13
Contrasting public and private logistics
approaches
Private supply chains for Coca Cola, beer, soap,
shampoo and cell phone cards are incredibly
efficient in Africa.
14
Important structural contrasts between public and
private supply logistics
  • Public sector
  • Highly regulated
  • Lack of systematic information collection tools
  • Central assumption based supply chain planning
  • Higher need for traceability and security
  • Limited competition in distribution segment
  • Poor contract compliance on e.g. delivery lead
    time, etc.
  • Limited ability to create incentives
  • Completely different logistics systems
  • E.g. CMS cf. Cross docking

15
Supply chain systems a neglected issue
  • What typologies of supply systems are used in
    Africa?
  • Are there standard indicators of supply chain
    performance (incl. Stock-outs)?
  • Is there a logistics performance index best?
    What incentives would help?
  • How can costs and spending be better tracked,
    benchmarked and used?
  • What should an effective supply chain cost in
    relation to the commodities bill?
  • Why do public sector supply chains fail and
    private sector systems do not?
  • What can we learn from private professional
    logistics systems?
  • Should we privatize public sector supply and
    which parts?
  • How can we get a deeper structured understanding
    of issues affecting supply chains?

16
Some recent initiatives
  • Village Reach, Mozambique creative bundling
  • Affordable Medicines Facility AMFm (Global Fund)
  • ADDOs (Tanzania, Ghana, Zambia) Accredited Drug
    Dispensing Outlets
  • ACT Watch (Multi-country) third party market
    data
  • Missing medicines campaign (Malawi) Civil
    society mobilization
  • ColaLife (Zambia) secondary distribution
    channels for ORS zinc supplements
  • Outsourcing public health logistics 3rd party
    logistics (South Africa)
  • Bar codes for stock tracking, management and
    logistics (GAVI)
  • New tools (PSM Toolkit)
  • Capacity support (GF RBM LMIS Empower Health
    UNITAID ESTHERAID, UNICEF)
  • Dedicated programmes (MIT-Zaragoza International
    Logistics Programme Kuehne Institute for
    Logistics Management USAID DELIVER SCMS GF
    P4i, RBM PSMWG))
  • Stock-out hotline (GF) STOCKOUTS_at_theglobalfund.o
    rg

17
Addressing supply chain failure is a system-wide
issue
Who is accountable to ensure zero-stock out
performance?
What Procurement and Supply Management design
works best?
What stock-out and other supply chain performance
indicators need to be tracked?
Civil society and media must be enabled to exert
pressure for performance Public access and data
visualization
What percent of the essential medicines cost
should be devoted to ensuring delivery?
What incentives are missing and what
disincentives are obstructing supply chains?
Stock outs at front line facilities are the face
of a failed system for providers and the public
with fatal consequences
18
Summary point
Value for money in results based
financing? Re-double efforts to approach zero
stock-outs
19
No excuse for stock-outs Thank you
About PowerShow.com