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Supply Chain Pilot Results | Zambia | May 2010
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Supply Chain Pilot Results | Zambia | May 2010



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  • Hopitals: system B by nature
  • The impact on morbidity and mortality would be even greater if stock improvements of all drugs

Supply Chain Pilot Results | Zambia | May 2010 Supply Chain Pilot Results | Zambia | May 2010 Presentation Transcript

  • Improving Patient Access to Essential Medicines in Zambia Results of a Pilot Project
  • Partnership Crown Agents USAID | DELIVER PROJECT USG/USAID The World Bank JSI Logistics Services DFID
  • Introduction Introduction
  • Why was the pilot designed?
      • Treatment of malaria lags behind successes in prevention efforts
  • Why is it difficult to deliver drugs?
  • Why was the pilot designed?
    • Percentage of time the facilities were stocked out of family planning commodities in a three month period in 2007 indicates a continuous shortage of these products.
    Source: 2007 Family Planning Logistics Indicator Assessment, USAID
  • Stockout bottlenecks often lie between the district store and the facility
  • Improving access to essential medicines in Zambia
    • Objective
    • Identify a cost-effective way to improve the availability of drugs through strengthening of the supply chain from MSL to districts and health facilities
    • Approach
    • The pilot compares the effectiveness of two different supply chain interventions to select one (or a combination/variation) that can be rolled-out nationally
  • Design
  • Distribution structure before the pilot 72 district stores Approx1700 health centers and health posts
  • Two interventions tested
    • System A:
    • Health centers/posts (HCs/HPs) place orders to District Health Officer (DHO) who sends aggregated monthly orders to MSL
    • DHOs store commodities and supplies HCs/HPs monthly
    • Districts are responsible for assembling orders for the HCs/HPs and coordinating delivery between the district and HCs/HPs
    • System B:
    • HCs/HPs place orders directly to MSL
    • Orders are packed at MSL in sealed packages for each individual facility
    • Districts only responsible for coordinating delivery or pick up of orders between the district and HCs/HPs
  • Two interventions tested (cont’d)
    • Common design features for A & B systems:
    • Drugs included in the system as full supply products:
    • Health Center Kits are disaggregated into individual drugs at the central level and DHO/facility orders are augmented by bulk stock available at MSL
    • Hospitals in the pilot follow the new ordering and information system and still receive supplies directly from MSL
    • At the request of the MOH, Commodity Planners dedicated to logistics based in DHO that did not have a pharmacist or pharmacy technologist (12 of the 16 districts)
    No. of Products No. in HC Kits Hospitals 44 NA HCs/HPs 39 11
  • Pilot evaluation design
    • Districts randomly selected from 50 peri-urban and rural districts in Zambia
      • 22 districts already included in CHAZ/Global Fund supported work
    • Total of 24 districts: 8 districts for system A, 8 districts for system B and 8 comparison districts
    • Pilot implementation for a one-year period
    • Baseline data collected in Dec-Jan 2008/09 and follow-up data during the same period in 2009/10
  • District Selection
  • Results Results
  • Reduced stockouts in A system Comparison of baseline and endline values in A districts *the reduction in stockout rate is statistically significant with respect to any observed change in control districts
  • Dramatically reduced stockouts in B system Comparison of baseline and endline values in B districts *the reduction in stockout rate is statistically significant with respect to any observed change in control districts
  • Another way to measure performance: Stockouts in Model B vs. Comparison Districts
  • More people get their lifesaving drugs in B districts Number of days of stockouts for the last quarter of 2009
  • Critical success factors
    • System incentivizes reporting
      • Motivates MOH staff
      • Increases reporting rates
    • Improved supervision and management structures
      • Logistics Management Unit based at MSL
    • Detailed Inventory Control System and Logistics Management Information System
  • Average reporting rates to MSL
  • Summary of results
    • System B performs significantly better than system A and comparison districts in terms of availability
    • There is a significant and large decrease in number of days of stockouts in B districts compared to control
    • Hence unmet demand is significantly lower in B districts compared to A and control
    • Reporting rates from district health offices to MSL have increased during the pilot period for both A and B districts to nearly 100%
  • Impact on under-five deaths due to malaria
    • If Model B were to be scaled up nationwide:
      • 27,000 child deaths due to malaria could be averted by 2015
      • Child mortality due to malaria could be reduced up to 37 percent
  • Next steps
    • Following consultations with MOH, the Ministry has expressed full support for scale-up of the pilot nationwide
    • Proposed way forward under discussion:
      • First step: sustain B, convert A into B for 12 months, initiate the consultative process on the exact scale-up model
      • Second step: phase in scale-up model nationwide
  • Funding needs
    • First step:
      • Sustaining B + conversion of A into B for 12 months:
      • US$ 1.35 million (0.35 already committed from USAID deliver)
      • OUTSTANDING NEED: US$ 1 million
    • Second step:
    • Nationwide scale-up:
    • Operational cost: US$300K-400K/month (approximately)
    • Capital cost: US$1.1 million (training excluded)
  • Why invest in the supply chain?
    • Total procurement budget for drugs (CPs and MOH): approximately US$100 million/year
    • The current system has systemic problems and drugs do not reach the beneficiaries
  • Why invest in the supply chain?
    • Existing system has a running cost of US$4.1 million per year (4.1% of current total drug budget)
    • Proposed new system has a running cost of
    • US$ 8.9 million (9% of current total drug cost)
    • Benchmarks: Private sector distribution cost of 10% and up is considered competitive in the pharma sector
  • Thank you