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

    1. 1. Improving Patient Access to Essential Medicines in Zambia Results of a Pilot Project
    2. 2. Partnership Crown Agents USAID | DELIVER PROJECT USG/USAID The World Bank JSI Logistics Services DFID
    3. 3. Introduction Introduction
    4. 4. Why was the pilot designed? <ul><ul><li>Treatment of malaria lags behind successes in prevention efforts </li></ul></ul>
    5. 5. Why is it difficult to deliver drugs?
    6. 6. Why was the pilot designed? <ul><li>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. </li></ul>Source: 2007 Family Planning Logistics Indicator Assessment, USAID
    7. 7. Stockout bottlenecks often lie between the district store and the facility
    8. 8. Improving access to essential medicines in Zambia <ul><li>Objective </li></ul><ul><li>Identify a cost-effective way to improve the availability of drugs through strengthening of the supply chain from MSL to districts and health facilities </li></ul><ul><li>Approach </li></ul><ul><li>The pilot compares the effectiveness of two different supply chain interventions to select one (or a combination/variation) that can be rolled-out nationally </li></ul>
    9. 9. Design
    10. 10. Distribution structure before the pilot 72 district stores Approx1700 health centers and health posts
    11. 12. Two interventions tested <ul><li>System A: </li></ul><ul><li>Health centers/posts (HCs/HPs) place orders to District Health Officer (DHO) who sends aggregated monthly orders to MSL </li></ul><ul><li>DHOs store commodities and supplies HCs/HPs monthly </li></ul><ul><li>Districts are responsible for assembling orders for the HCs/HPs and coordinating delivery between the district and HCs/HPs </li></ul><ul><li>System B: </li></ul><ul><li>HCs/HPs place orders directly to MSL </li></ul><ul><li>Orders are packed at MSL in sealed packages for each individual facility </li></ul><ul><li>Districts only responsible for coordinating delivery or pick up of orders between the district and HCs/HPs </li></ul>
    12. 13. Two interventions tested (cont’d) <ul><li>Common design features for A & B systems: </li></ul><ul><li>Drugs included in the system as full supply products: </li></ul><ul><li>Health Center Kits are disaggregated into individual drugs at the central level and DHO/facility orders are augmented by bulk stock available at MSL </li></ul><ul><li>Hospitals in the pilot follow the new ordering and information system and still receive supplies directly from MSL </li></ul><ul><li>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) </li></ul>No. of Products No. in HC Kits Hospitals 44 NA HCs/HPs 39 11
    13. 14. Pilot evaluation design <ul><li>Districts randomly selected from 50 peri-urban and rural districts in Zambia </li></ul><ul><ul><li>22 districts already included in CHAZ/Global Fund supported work </li></ul></ul><ul><li>Total of 24 districts: 8 districts for system A, 8 districts for system B and 8 comparison districts </li></ul><ul><li>Pilot implementation for a one-year period </li></ul><ul><li>Baseline data collected in Dec-Jan 2008/09 and follow-up data during the same period in 2009/10 </li></ul>
    14. 15. District Selection
    15. 16. Results Results
    16. 17. 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
    17. 18. 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
    18. 19. Another way to measure performance: Stockouts in Model B vs. Comparison Districts
    19. 20. More people get their lifesaving drugs in B districts Number of days of stockouts for the last quarter of 2009
    20. 21. Critical success factors <ul><li>System incentivizes reporting </li></ul><ul><ul><li>Motivates MOH staff </li></ul></ul><ul><ul><li>Increases reporting rates </li></ul></ul><ul><li>Improved supervision and management structures </li></ul><ul><ul><li>Logistics Management Unit based at MSL </li></ul></ul><ul><li>Detailed Inventory Control System and Logistics Management Information System </li></ul>
    21. 22. Average reporting rates to MSL
    22. 23. Summary of results <ul><li>System B performs significantly better than system A and comparison districts in terms of availability </li></ul><ul><li>There is a significant and large decrease in number of days of stockouts in B districts compared to control </li></ul><ul><li>Hence unmet demand is significantly lower in B districts compared to A and control </li></ul><ul><li>Reporting rates from district health offices to MSL have increased during the pilot period for both A and B districts to nearly 100% </li></ul>
    23. 24. Impact on under-five deaths due to malaria <ul><li>If Model B were to be scaled up nationwide: </li></ul><ul><ul><li>27,000 child deaths due to malaria could be averted by 2015 </li></ul></ul><ul><ul><li>Child mortality due to malaria could be reduced up to 37 percent </li></ul></ul>
    24. 25. Next steps <ul><li>Following consultations with MOH, the Ministry has expressed full support for scale-up of the pilot nationwide </li></ul><ul><li>Proposed way forward under discussion: </li></ul><ul><ul><li>First step: sustain B, convert A into B for 12 months, initiate the consultative process on the exact scale-up model </li></ul></ul><ul><ul><li>Second step: phase in scale-up model nationwide </li></ul></ul>
    25. 26. Funding needs <ul><li>First step: </li></ul><ul><ul><li>Sustaining B + conversion of A into B for 12 months: </li></ul></ul><ul><ul><li>US$ 1.35 million (0.35 already committed from USAID deliver) </li></ul></ul><ul><ul><li>OUTSTANDING NEED: US$ 1 million </li></ul></ul><ul><li>Second step: </li></ul><ul><li>Nationwide scale-up: </li></ul><ul><li>Operational cost: US$300K-400K/month (approximately) </li></ul><ul><li>Capital cost: US$1.1 million (training excluded) </li></ul>
    26. 27. Why invest in the supply chain? <ul><li>Total procurement budget for drugs (CPs and MOH): approximately US$100 million/year </li></ul><ul><li>The current system has systemic problems and drugs do not reach the beneficiaries </li></ul>
    27. 28. Why invest in the supply chain? <ul><li>Existing system has a running cost of US$4.1 million per year (4.1% of current total drug budget) </li></ul><ul><li>Proposed new system has a running cost of </li></ul><ul><li>US$ 8.9 million (9% of current total drug cost) </li></ul><ul><li>Benchmarks: Private sector distribution cost of 10% and up is considered competitive in the pharma sector </li></ul>
    28. 29. Thank you