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The 5th Global Health Supply Chain Summit
Optimization of Benin’s Vaccine Logistics System
Philippe Jaillard
Hamadou Modibo Dicko
[SPEAKERS NAMES]
November
14 -16, 2012[DATE]
Kigali, Rwanda
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
2
LOGIVAC a joint AMP and WHO project supporting
health logistics professionalization in Africa
4 Demonstration Sites
Reference Center
Training
Consulting
services
1• Establish a first regional logistics reference center in Benin
with a sustainable business model. .Expand to second location
(Eastern/Southern Africa) thereafter
2• Develop and implement tailored pre-service and in-service
training that provides professional certifications and meets the
demands of existing and future health & vaccines supply chains
3• Develop a professional network of logistics experts that provide
consulting services on health and vaccines logistics
Develop innovative
model logistics
systems;
Serve as
demonstration site for
students;
Evaluate impact of
using certified
logisticians on
immunization program
performance
5 LOGIVAC Consortium of partners (public organizations and private companies)
Promote the reference center / tools / project results; Support recognition of a common
professional qualification for health supply chain manager; Generate and disseminate vaccine
supply chain knowledge
3
3
Optimization of Benin’s EPI Supply chain:
a combinaison of method and tools; a collaborative process
CCEM (PATH)
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
HERMES (Vaccine
Modeling
Initiative)
EVM (WHO,
UNICEF)
EVM (Effective
Vaccine
Management)
assess the quality
of the vaccine
management
system
•EVM assessment
report
•EVM improvement
plan (EVM-IP)
Transport system
evaluation
Workshop 1 :
identification of
scenarii
HERMES (Highly
Extensive Resource
for Modeling the
Supply chain)
Virtual laboratory,
can help in redesigning the
supply chain
•Measure vaccine
ava
ilability and supply
chain cost
National cold room
assessment
Workshop 2 :
strategic
orientations
Optimization
planning
Optimized
SC system*
*: we are aware
that there might
be other
confounding
factors that
facilitate this
optimization
process
Key issue:
ensuring the
successfully
implementatio
n and country
ownership!
4
Results (1/4): Effective Vaccine Management
(EVM) Assessment
Levels
#
Criteria
National
Department
Regional/relais
Lowest
distribution
level
(Commune)
Service
delivery
point
1 Vaccine arrival/receving
58%
Non applicable
2 Storage temperature
41%
75%
95%
70%
77%
3 Storage capacity
Buildings, equipment &
4 transport
33%
55%
28%
70%
69%
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%
9 Information system
78%
89%
100%
80%
Non
61% applicable
• NOTE: satisfactory score for an EVM is 80%
5
Source: Benin’s EVM assessment 2012
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
> 50% older than
10 years.
6
Results (2b/4): CCEM – Option for reduction of
operational cost
Replace absorption fridges >10 years (n=379) 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
*Présentement le réfrigérateur 410 EK refrigerators est utilisé dans les sites qui ont >8 heures d’electricité par jour
7
Results (3a/4): Supply chain design
Actual situation
8
Results 3b/4 : Supply chain design options
Status quo
2. Actual +
commune
level
removed
1.
Consolidation
to zone level
3.
12 dept store
+ commune
level
removed
Results (3c/4): HERMES – Vaccine availability
Actual
system
Scenario 1:
consolidatio
n 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
99%
Virus
Source: Benin’s HERMES result 2012
99%
99%
100%
10
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
EVM+HERMES 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)
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
EVM+HERMES 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)
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
EVM+HERMES 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)
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
EVM+HERMES 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)
Results (4/4): Conclusion from the 2nd
optimization workshop
Strategic Orientations
Global Optimization Plan
• Changing the EPI’s supply chain
design (reduction of # of storage
points)
• Equipment management system
(LMIS, CC rehabilitation and
maintenance plans)
• Acquisition of solar equipment (in
replacement of Kerosene ones)
• Transport management system
• Development of health logistics
• Professionalization of health
logistics (to properly handle
change implementation)
• Optimization of resources
(Integration in some segment of
the SC)
• EVM Improvement plan (vaccine
management)
• Investment plan for the logistics
system
15
EVM + HERMES Pilot in Benin
Next steps towards the implementation plan
16
Lessons learned and conclusion
Lessons learnt
Application and scale up
• Strong involvement within MoH
• High level cadres
• NIP director and team
• other directorates within
MoH (equipment,
pharmacy…)
• Country willingness to make
strategic change in NIP Logistics
system
• Country’s 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 (< 2 years old)
• Global partnership (PAG)
• Potential resistance due to
change management
17
Contribution to EVM+HERMES 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
Thank you
www.logivac.org
www.amp-vaccinology.org
LOGIVAC – a project of AMP and WHO