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TITLE
The 5th Global Health Supply Chain Summit
Supply Chain Performance Approaches in
Global Health
Jennifer
Chavez
[SPEAKERS NAMES]
November 14 -16, 2012
Kigali, Rwanda
[DATE]
Objectives of Presentation
• Understand how metrics can improve health product
availability and support public health programs/improve
health outcomes
• Present and compare two examples of performance
measurement systems in global health
– WHO collaboration for HIV, malaria and TB
– USAID | DELIVER PROJECT
• Moving forward: What other areas do we need to consider
when applying metrics in different contexts
Why Measure Supply Chain Performance?
• Improve public health supply chain performance
• Use data to identify and explore root causes of challenges
• Assess and improve management of logistics functions at
all levels of the system
• Inform and modify investments in supply chain
strengthening
• Provide framework for local organizations to conduct
routine performance monitoring capacity and maintain
performance in the absence of external assistance
Two
Examples
Supply
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Chain Metrics Widely Used
TITLE
in Public Health
[SPEAKERS NAMES]
[DATE]
World Health Organization indicators for
Procurement and Supply Management System
• Purpose
– To harmonize country reporting requirements for increased
transparency, productivity and efficiency of programs
– To track performance of National Procurement & Supply
Management (PSM) systems
– To set early warning indicators of stockouts and overstocking
– To alert managers to areas requiring technical support
– Provide opportunities
• for collaboration across sectors and stakeholders including
procurement stakeholders to improve national distribution system
• Strengthen data quality assurance and regular data reporting
• Audience
– Procurement and supply management managers
– Donors
WHO PSM indicators: Background
• Collaboration between 2005-2008
– Various Donors
– Desk review, initial selection, field testing, refinement
• Focus
– Core PSM indicators
• Although, relevant for all national drug programs, donors and
institutions focused on ARVs, TB and malaria
– Harmonized indicators
• Highlight most critical problems
• Avoid duplication of effort
Metrics I
Indicators
Measures
Product
Selection
% of commodities in
National/WHO Standard
Treatment Guidelines
Prescription
% of ARV & TB patients treated
and rational use in line with treatment guidelines
% of initiating ARV patients
treated in line with treatment
guidelines
Quantification
and forecasting
% products received vs. planned
to receive
% of available quantity for
consumption that is used
Ratio between median price of
products and international
median reference value
% of orders delivered in full and
on time per supplier
% of orders to be cleared from
port that were cleared before the
deadline
Average # of days between arrival
at port and date of clearance from
port
Procurement
Prices and
Delivery Time
Purple represents early stockout warning indicators
Metrics II
Indicators
Inventory
Control
% of treatment sites submitting inventory
control reports on time
% of treatment sites placing
orders while the stock in
hand was below minimum
stock levels
% of treatment sites that had a stock out
at all during a define period
% of available items at each
treatment site
Availability
% of treatment sites that had a stock out
of a particular product during a defined
period
Average duration of
stockouts at i) each and ii)
all treatment sites
Quality
Assurance
% of product batches meeting QC
standards
Distribution
% of treatment sites receiving orders in full
and on time
Loss
% of quantities of each product loss per
total quantities available
Application of PSM Metrics
• WHO: Falls under the general M&E framework
• WHEN: Most metrics are measured periodically; others
triggered by SC event
• FROM WHERE: Many metrics require collection from
multiple peripheral points e.g., health centers, through
typical reporting process
• SO WHAT: All metrics have targets and signal action in
the event targets are not achieved
– Understanding root causes of deviation
– Initiation of steps to address root cause
– Early warning stockout metrics
USAID | DELIVER PROJECT
Supply Chain Performance Measures
• Background
– Standard industry metrics,
– Applicable across programs and countries
• Audience
• Supply chain managers, donors and project implementers,
government logistics management units
• Purpose
–
–
–
–
–
Monitor system performance
Provide routine feedback
Improve program management
Improve system performance at all levels of the supply chain
Report results and determine impact
INCREASE PRODUCT AVAILABILITY FOR IMPROVED HEALTH OUTCOMES
SCM Performance Measures Matrix by
Function (USAID | DELIVER PROJECT)
Types of
indicators
SCM Function
Quality
Response Time
Cost/Financial
Product Selection/
Forecasting /
Procurement
Supplier/Sourcing
(from purchaser’s
perspective)
Warehousing/Storage
Inventory Mgmt/
LMIS/Customer
Response
Distribution/Transport
Performance
Measures
Productivity
Some examples of Indicators
Inventory Management/LMIS/Customer Response
•
•
•
•
QUALITY: Stockout rate
RESPONSE TIME: Order lead time
order placed to received
COST/FINANCIAL: Value of unusable stock due to expiration/damage
PRODUCTIVITY: Facility reporting rates
Distribution/Transport
•
•
•
•
QUALITY: On-time arrivals: % shipments arriving as scheduled
RESPONSE TIME: Average delivery time from dispatch to destination
COST/FINANCIAL: Average transportation cost per km/m3/kg of
product
PRODUCTIVITY: Container capacity utilization per vehicle
Metric Count
Types of
indicators
SCM Function
Quality
Response Time
Cost/Financial
Productivity
Product Selection/
Forecasting /
Procurement
7
(WHO: 4)
2
4
2
Supplier/Sourcing
(from purchaser’s
perspective)
3
(WHO: 1)
2
1
1
5
3
2
3
Inventory Mgmt/
LMIS/Customer
Response
9
(WHO: 6)
3
4
4
(WHO: 1)
Distribution/Transport
5
(WHO: 1)
3
3
4
Warehousing/Storage
Lessons Learned about developing Supply
Chain Metrics
• Past experience shows that setting up performance
monitoring systems in public health is a long process
requiring commitment and a desire to harmonize by all
partners
• Requires building and incentivizing a culture to routinely
collect, report, and use data up and down stream
• Aim is to institutionalize performance measurement
capacity but governments face major human and financial
resource constraints
Measures Must Evolve as Supply Chains
Mature
• Investments work to
strengthen supply chain
management capacity and
help supply chains systems
evolve
• Overall indicators of
performance must be applied
and monitored to ensure
performance is maintained or
improved by investments
Measures Can Help Determine Enablers
• Although investments focus on
strengthening the supply chain,
these supply chain operate
within a wider context
• Supply chain performance is
affected by many things, many
of which are not under the
control of supply chain
managers
• Further research is needed to
help identify enablers and
constraints and areas where
direct investments have impact
Questions for Consideration
• Must select metrics that serve both donor and country purposes
• How can we measure sustainability, ownership and capacity of
MOHs to manage different Supply Chain functions?
• Need to find identify the key factors to be measured. What are
the true triggers of performance?
“All that can be measured is not necessarily worth
measuring” (Einstein)
• What other supply chain functions should be monitored and
evaluated? What other measures exemplify performance?
Questions for Consideration (continued)
• Is there a quality bias or is quality just a good basis for
harmonizing standards?
• How do we differentiate the “early stock out warning”
indicators from the other measures of performance?
• How do we determine the most practical indicators for supply
chain performance in a setting and maintain measure of
standardized indicators without becoming overwhelmed by
number of measures required?
• How do we measure the implications of supply chain
performance on general public health?
Thank you.