Health & Humanitarian - the Supply Chain Review Issue 3, 2017

HEALTH & HUMANITARIAN The Supply Chain Review Issue 3 March 2017

In this issue

inSupply - innovations for supply chains

Produced by PSA Ltd in conjunction with the Oxford University Internship Programme

ABOUT US EDITOR IN CHIEF Pamela Steele Sara A. Khan

Table of

Contents

EDITORIAL TEAM Anne Prior Priyanka Raj William Hardyman

Professionalisation Corner A conversation with Ramatu Abdulkadir

4 AIDS Healthcare Foundation (AHF) Nigeria – serving more than 10,000 clients

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inSupply: Innovations for public health 10

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Health Supply Chain Transformation Project Kaduna State, Nigeria 12 2

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Pooled Procurement: Benin’s supply chain system for malaria commodities

Cover Photo © Tuger Akkaya 2005, Freeimages.com

Editor’s Note In recent years, the commercial supply chain sector has seen supply chains become more interconnected. But how does this global change apply and effect supply chains in the health sectors? Have these supply chains also become interconnected and increasingly complex or are we still looking at individual systems that operates in silos even within the same nation?

In this issue, we have featured a number of projects, either at its completion or still on-going, that have a thing in common; close collaboration between local governments and partners in order to create more coordination for health supply chains whether it is in the use of technology, capacity development of SCM or changes to human resources. This journey of collaboration has not been easy and many will say that we still have a long way to go. However, the mere recognition from the government apparatus that there is a lack of integration between parallel health supply chains is an important first step that should be commended and fully supported by partners and stakeholders in this sector.

In order for this change to last we need champions on all levels of the government, champions such as Pharm Ramatu Abdulkadir in Kaduna State, Nigeria. We are grateful to her for sharing her experiences in the public health supply chain sector and for being a role-model for women who would like to pursue a career in this field.

At the same time, donors need to ensure funding for innovation and new-thinking for health supply chains. As this issue shows, the inSupply project is doing exactly that. By focusing on areas such as information systems, better use of data and regional capacity development, we hope that the work done by inSupply will bring lasting improvements in health supply chain for the East Africa region in the coming time.

We would like to thank our guest editors for this issue from the Oxford University Intern Programme; Anna Prior, Priyanka Raj and William Hardyman. Their hard work and dedication has led to this issue of the Health and Humanitarian.

We hope you enjoy this issue!

The importance of government owned and led projects for greater integration in a national health supply chain has become key for projects to succeed and be sustainable. Therefore, projects such as Benin’s pooled procurement mechanism and Kaduna State’s Health Supply Chain transformation are on their way to successful implementation. This change is a fresh breath of air for the supply chain sector that has largely been unrecognised and underfunded for many years and people are for the first time seeing hope for establishing sustainable, resilient supply chains in resource constrained countries.

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PROFESSIONALISATION CORNER A conversation with Ramatu Abdulkadir Ramatu Abdulkadir is the Executive Secretary for the Kaduna State Drugs and Medical Supplies Management Agency (DMA) in Nigeria. She is a pharmacist by profession and has over 17 years of experience working in the public health sector. In 2016, she was appointed the Executive Secretary of DMA by the State Governor to take on this crucial role for the betterment of Kaduna State’s public health supply chain.

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“After graduation from pharmacy school, there’s the feeling that you can conquer any challenge relating to availability of medicines” She admits that she would have an ‘off’-day when she encountered stock-outs and weren’t able to support access to medicine when they were needed by her fellow Nigerians. This led to her journey into the health supply chain sector. As Ramatu states: “it was a difficult journey as the supply chain profession is still evolving and knowledge about the importance of the supply chain component is very limited within the pharmacy profession.”

Passion for helping people Ramatu has always known that she is passionate about helping people, especially when their health is being challenged and this passion led her to the pharmacy profession.

Ramatu pursued a Bachelor’s Degree in Pharmacy from Ahmadu Bello University in Zaria, Nigeria and an MSc degree in Pharmacology from Usmanu Danfodiyo University in Sokoto, Nigeria.

“After graduation from pharmacy school, there’s the feeling that you can conquer any challenge relating to availability of medicines.

But on getting to the field you realize that application of knowledge is even more difficult than acquiring it.”

Ramatu has high expectations to her profession as a pharmacist and to the public health sector overall. For many years Ramatu worked tirelessly as the Chief Pharmacist for the only specialized ear, nose and throat treatment centre in West Africa, namely the “National Ear Care Centre” in Kaduna, Nigeria.

This is how Ramatu realized the immense importance of supply chain management knowledge for the pharmacy profession. She has now become actively involved in the education and development of a new generation of pharmacists in Kaduna State by offering lectures on pharmaceutical products management to undergraduate students at Kaduna State University, Nigeria. She is also an accredited preceptor, supervisor and a fellow with the West African Postgraduate College of Pharmacist.

Women in Supply Chain When asked about being a woman in the field of supply chain, Ramatu acknowledges that, “it’s always twice as difficult for women than men, especially in a male dominated field. For us women, you have to prove (unfortunately to men) that you can do it…it doesn’t help that people think you have to be a hardliner to manage a government organization responsible for health supply chain management.”

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Ramatu Abdulkadir at the launch ceremony for the Pilot of the Kaduna State Supply Chain Transformation Project, with her the Commissioner of Health for Kaduna State, Nigeria.

January 2017

“I believe you can be a woman and effectively execute supply chain responsibilities, given you have the necessary skills”. So how does this mostly male-dominated field of supply chain achieve greater gender balance? Ramatu points out that, “the sector has a long way to go in promoting gender balance. This could be achieved by having role models i.e. women, who have excelled in the supply chain management discipline, should be widely celebrated and recognized. This would help to create an enabling environment for other women to get engaged in this field without fearing the need to reject the wonderful attributes unique to women.”

Ramatu realises that cultural norms play an important part for young women’s career choices. “Cultural norms are great barriers especially in our environment where it is believed that women should not be engaged in male dominated professions. It is also believed, erroneously, that the field of Health Supply Chain Management involves manual heavy lifting tasks unfit for women who are perceived to be delicate and fragile by the society. Some women also believe that you have to be more like a man to blend in [in the supply chain sector].”

Photo © PSA and FreeImages.com

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Looking to the future…

Ramatu knows that the public health supply chains in Kaduna State and Nigeria overall face challenges. There are many reasons for this as for instance lack of funding for strengthening supply chain and not enough focus on capacity development in Supply Chain Management as decision makers do not understand the importance of health supply chain management principles in the overall delivery of public healthcare services.

Ramatu also points to the fact that there is a need to implement new technologies and better use of data that can help track and trace health commodities from the point of procurement to last mile delivery to the end user.

On being asked if her expectations to her current position is being met, she explains that “my expectations are yet to be met, until every hospital medicine store is consistently stocked with the right amount of the right medicines.”

PSA would like to thank Ramatu for taking the time to speak with us and we wish her well as she continues her work in Kaduna State, Nigeria.

If you are a supply chain professional; the assessment will help you:

Health Supply Chain Skills Profile Online competency assessment for health supply chain managers and leaders PSA is pleased to share the news about a newly launched online tool that allows SCM professionals assess themselves against core competency areas required for effective health supply chain management.

This online assessment tool has been developed by PSA and measures technical, management and leadership competencies covering six key areas of health supply chain work as set out in the ‘People that Deliver Health Supply Chain Competency Framework for Managers and Leaders’.

The assessment is available in English, French, Spanish and Arabic and preparation/facilitator guides, as well as tips for taking the assessment, are available online.

For more information about the assessment and how you can take advantage of the special introductory offer, visit: https://www.skillsprofile.pamsteele.co.uk/

* compare your technical, management and leadership strengths and weaknesses against a benchmark group of managers working in the health supply chain; * increase your awareness of how your competencies and skills impact on your performance; * identify skills you need to develop further and address any areas limitations The assessment will help organisations: * make better recruitment decisions by providing information about candidates’ competencies to use as the foundation for competency-based interviews; * benchmark the competencies and skills of staff with managerial and leadership responsibilities; * identify which employees are suitable for promotion to the next level and which individuals need further development; * develop learning programmes to increase management and leadership skills and thereby improve performance After taking the assessment, participants receive a personal report providing a skills profile for participants’ technical, management and leadership competencies. This report can then form the basis for ongoing professional development for you or your team.

PSA’s support staff is available to help answer your questions at skillsprofile@pamsteele.co.uk

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AIDS Health Foundation (AHF) Nigeria AHF Nigeria is a collaboration between the Federal Ministry of Health (Nigeria), and AIDS Healthcare Foundation based in Los Angeles, USA. It is a not-for-profit NGO providing HIV treatment, prevention and advocacy services.

Since the commencement of operations in 2011, the program has tremendously expanded to over 30 healthcare facilities serving over 10,000 clients and conducted over 800,000 HIV tests.

AHF Nigeria contributes to the National HIV/ AIDS response by providing free comprehensive patient-centred HIV services which include: HIV Testing Services (HTS), PostExposure Prophylaxis, Anti-Retroviral Therapy (ART), diagnostic and laboratory monitoring of ART, diagnosis and treatment of opportunistic infections, Tuberculosis and HIV comorbidities, as well as Prevention of Motherto-Child Transmission of HIV (PMTCT).

The organisation engages expert healthcare teams who work with Government healthcare facility staff to ensure services are provided in line with approved standards. Clients are also offered health education, medication adherence counselling and support.

In addition, AHF Nigeria supports infrastructural development in hard to reach rural communities, where most of the supported healthcare facilities are located.

AHF Nigeria also works in collaboration with

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Civil Society Organizations and relevant stakeholders to advocate for the protection of rights and dignity of PLHIV. At the heart of AHF Nigeria’s work are the numerous clients they serve. It is hard to express the joy the staff feels each time HIVexposed infants, whose mothers were offered PMTCT services, test negative for HIV. Seeing bedridden patients who present with very high viral load values, get back to work after some months on ART, with appropriate counselling and monitoring is always humbling.

The positive outcome of the program inspires us to ensure medical supplies are always available.

AHF Nigeria engages a multi-organizational approach to efficient supply chain management of medical supplies required for the program.

In a comprehensive program like the AHF’s, strategic partnership with relevant institutions is important. AHF collaborates with the Federal Ministry of Health and other partners, who donate part of the medical supplies, while AHF Nigeria procures others.

AHF Nigeria also engages a multi-disciplinary approach, which focuses on building the capacity of all members of the healthcare team in supply chain management of HIV/AIDS supplies. This produces committed staff that go the extra mile (including ferrying medical supplies across rivers) to ensure the clients receive medical supplies on time.

AHF Nigeria also coordinates supply chain activities in the program from a central level, employing internal control mechanisms to ensure the supplies travel the supply chain seamlessly.

There are periodic internal and external audit exercises conducted to improve accountability for supplies at all levels. The program also monitors and evaluates supply chain indicators at the healthcare facility level, which translates to data used for making informed decisions.

This enables timely identification and resolution of supply chain challenges.

By: Ozioma Blessing Onokala AIDS Healthcare Foundation Nigeria Country Office, Abuja, Nigeria Photo Š Ozioma Blessing Onokala and FreeImages.com

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inSupply Innovations for Public Health Supply Chains “inSupply� is a learning project, implemented by JSI Research & Training Institute Inc. and funded by the Bill & Melinda Gates Foundation. The project is to develop a local pool of health supply chain consultants in East Africa that employ best practices and adapt private sector solutions for public health supply chains.

By Sam Schmader, inSupply

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The inSupply staff currently provides contextspecific regional and local supply chain management support in East Africa to strengthen contraceptive, vaccine, and essential medicine supply chains. They are also available to support other organizations with supply chain requirements.

Strengthening information systems: • In Kenya, efforts are underway to implement a Visibility and Analytics Network (VAN) to improve end-to-end supply chain data visibility, provide analytical tools, and promote processes for continuous system improvement. The initial theory of change development and feasibility study are now complete and the inSupply team is supporting the Ministry of Health and its’ other health supply chain stakeholders to plan for development and rollout.

• In Tanzania, inSupply along with the Ministry of Health Community Development Gender Elderly and Children (MOHCDGEC) Immunization and Vaccine Development (IVD) Program, Clinton Health Access Initiative (CHAI) and PATH have developed and rolled out a Vaccine Information Management System (VIMS) in seven regions to track vaccine and immunization commodities, cold chain assets, and routine immunization data at all levels of the system. National rollout is scheduled

inSupply: Innovations for Public Health Supply Chains ❖ Geographic Scope: Worldwide ❖ Countries: Kenya, Tanzania ❖ Client(s): Bill & Melinda Gates Foundation ❖ Services: Information System Development, Technical Assistance, Training, Capacity Development ❖ Technical Expertise: Health Supply Chain Management

to begin in March 2017 with continuous improvement and refinement of the system following user feedback.

Creating a culture of data use: • inSupply’s work in Kenya incorporates the IMPACT (Information Mobilized for Performance Analysis and Continuous Improvement) Team Network approach, a county-level effort to build a data use culture and empower and train staff to analyse and use data for supply chain decision making. IMPACT teams have been established in ten counties and use existing data and structures to update county-specific Excel dashboards to improve data use and visualization.

Building supply chain capacity in regional organizations: • inSupply’s partnership with the East African Community Regional Center of Excellence in Health Supply Chain Management at the University of Rwanda’s School of Public Health developed and mentored faculty to provide short courses and assist in drafting curriculum for a master’s course in supply chain management.

Targeted technical support: • As a part of a broader strategy for family planning access, inSupply provides technical assistance for the quantification of family planning and assists decision makers in optimally using available data for supply chain decision making, identifies whether contraceptives are reaching target populations, and establishes methodologies for benchmarking and evaluating contraceptive access.

Photo © Sam Schmader, inSupply

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Kaduna State

Public Health Supply Chain Transformation Project

by Anna Prior & Priyanka Raj, Oxford University Intern Programme

Countrywide, Nigeria is in the process of a significant supply chain transformation with the help and support of several major donors including the Bill and Melinda Gates Foundation (BMGF) and the National Supply Chain Integration Program started by the US Agency for International Development and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The main goal of this transformation is to integrate the multitude of national parallel supply chain systems to decrease duplicity and conflict, and to work to coordinate the private and public sector supply chain systems to increase efficiency and effectivity of health supply chain warehousing, distribution and transportation, and data visibility.

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a partner coordination unity to resolve the issue of parallel programs. In addition, a desk review of national and state policy documents was conducted. Adaptation of national plans and policies to state and local contexts, as well as involvement of stakeholders in this process was recommended.

The Ministry of Health in Kaduna State, Nigeria, with the support of BMGF and their technical partner Pamela Steele Associates (PSA), initiated the Kaduna Public Health Supply Chain Transformation Project. In Kaduna State, only a quarter of the essential medicine Stock Keeping Unit (SKU) are supported by donor public health organizations, while three quarters of the essential medicine SKU’s are provided by the government managed health supply chain systems in Kaduna State. The ineffective and inefficient government managed health supply system has led to frequent stock outs and an increase in prices of essential medicines, making them too expensive for the communities in need. To gain further understanding of the roots of these weaknesses, a two-day workshop was organized in March 2016 involving 30 participants from different government departments in Kaduna. They discussed solutions which included lifting the government embargo on employment, standardizing reporting tools and establishing

In response to identified weaknesses, the Kaduna State Government formed and led a State Change Management Team to act as the governing body for the transformation of the heath supply chain. The team utilized the RACI Matrix to clarify roles and responsibilities, and led a meticulous study to estimate the baseline costs of health commodities supply chain management.

Based on the diagnostic information gathered, in August and September 2016, the State Change Management Team met to design a pilot to transform the supply chain system, with the purpose of supporting the state as it “tests, learns and repeats” its management practices.

This will act as a preview to analyse the supply chain performance before committing to full-scale implementation by end of 2017.

The initiative shown by the Kaduna State Government highlights the potential for efficient and effective health supply chain management systems, which are designed and led by the government. As the government gains the skills and understanding to manage the dynamic processes involved in the health supply chain system, it increases its resiliency and reliability.

Photo © PSA

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Pooled Commodity Management & Monthly Supervision – game changers in Benin’s supply chain system for malaria

Malaria represents 40% of consultations and 29% of hospitalizations in Benin. The revised National Strategic Plan 2014-2018 stresses the importance of the rational use of malaria commodities and their availability at all levels to support effective case management. The National Malaria Control Program’s (NMCP) efforts, with support from the President’s Malaria Initiative (PMI), to improve access and use to malaria supplies are dependent on: (1) the availability of medicines and (2) efficient supply chain management at both the national and peripheral levels.

In 2012, a national supply chain assessment was conducted under the Ministry of Health (MOH) leadership. The results revealed several parallel distribution channels to donor funded activities that were not well coordinated with the National Malaria Control Program (NMCP).

This situation presents critical challenges in regards to: (1) frequent stock-out or overstocking attributable to the lack of coordination and communication with the NMCP and other partners; (2) lack of alignment to the national needs assessment and procurement plan; and (3) absence of an earlywarning system that would prevent an excess or a deficit of Rapid Diagnostic Tests (RDTs) and Artemisinin Combined Treatments (ACT).

Given the challenges of fragmented forecasting and stock management practices, in 2015, the MOH established a national

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pooled mechanism with all donors contributing to the procurement and distribution of malaria commodities. The principles and guidelines were mutually agreed to with the Roll Back Malaria partners including the Global Fund, PMI, UNICEF, and World Bank.

The mechanism involves the pooling of different stocks1 of malaria commodities acquired or received as donations by all actors involved in the fight against malaria without requiring the pooling funds.

The pooled mechanism is positioned to promote national local ownership of all malaria forecasting and management of commodities once in country and to improve the overall integration of supply chains across all malaria products and donors, ultimately reducing the risk of stock-outs at all levels, including the community level. The pooled malaria commodities management mechanism SOP includes five innovative principles based on the root causes of the problems identified by the

national supply chain assessment. To adhere to the above-mentioned principles and in particular the monitoring and storage conditions requirements, a strong monitoring mechanism is essential.

In 2015, Benin introduced a mechanism for “100% supervision� at the district level. This on-the-job capacity building approach is based on frequent monthly, focused supervision at every health center (public and registered private sector) every month. The objectives of the 100% supervision are to prevent stock-outs at the facility and district warehouse levels, and improve the timeliness, completeness, and coherence of LMIS reports.

The two innovations operate in synergistic topdown (pooled management) and bottom-up (100% supervision) directions, positively impacting stock management, LMIS data, and, ultimately, malaria case management. The supervisory teams esteem that the 100% supervision led to more reliable data, increased decision making/problem solving at the HF level, improved tracking of malaria commodities, and greater mobilization of local resources to address needs identified. Through the 100% supervision model, stock-outs were

easily identified, allowing an immediate response by the district management teams.

Sound coordination and communication practices between donors and the national malaria program, facilitated by the pooled malaria commodity management mechanism, improves pharmaceutical management practices.

Appropriate procurement plans, first-ex/firstout, commodity storage, development of risk assessments, early identification and management of over-stock/stock-outs, and fewer wasted resources are some of the notable achievements. The improvement in the supply chain metrics and indicators achieved through the 100% supervision, as part of the effort to strengthen the local level is evident. The approach was extended to two low performing districts in 2016 and is planned to be scaled up to 12 more districts in 2017.

In Benin, donor driven parallel systems and poor logistics management data have made management of commodities stock complex.

However, with the promising results shown in this early implementation stage in Benin, there is a consensus that these approaches truly can change the game of global health commodities management.

This is an excerpt from a paper by Cherifatou et al., 2016. Thank you to all authors.

Photo Š FreeImages.com

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Health & Humanitarian

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