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A Data Centric Approach to Driving Supply Chain Efficiency in Indonesia

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This poster was presented by Hery Firdaus and Bethany Saad at the International Conference on Family Planning (ICFP) in Kigali, Rwanda in November 2018.
Over the past decade, Indonesia’s contraceptive prevalence rate has remained stagnant, to reinvigorate family planning services in Indonesia The National Population & Family Planning Board (BKKBN) is working to ensure that women can choose from a variety of contraceptive methods as part of a “Right Method, Right Time, My Choice” strategy. One challenge to this strategy is inconsistent access to the full range of contraceptives, especially long acting contraceptives, at service delivery points (SDP).
Having a reliable, responsive supply chain that delivers quality contraceptives to service delivery points when and where they are needed is critical to ensuring the success of this strategy. JSI Research & Training Institute, Inc. (JSI) as part of the My Choice Project has been working with BKKBN to address the supply chain challenges.
Can contraceptive availability be improved by strengthening organizational supply chain capacity, multi-level collaboration, and data visibility and use? To achieve this the intervention package included
1) strengthening organizational capacity by redesigning standard processes and developing training tools such as video tutorials and mobile apps
2) improved multi-level collaboration through quality improvement techniques, mentorship, and on-the-job training and
3) improving data visibility, quality, and use through accurate logistics records and reports, creating an inventory management and monitoring tool that facilitates easy decision making, guides stock distribution to maintain adequate stock levels, and monitors overall performance of the supply chain.
Preliminary end line evaluation results suggest that the intervention package has improved supply chain performance and reduced stock outs, especially in areas where the full package was implemented.

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A Data Centric Approach to Driving Supply Chain Efficiency in Indonesia

  1. 1. INTRODUCTION Reliable, responsive supply chains deliver quality contraceptives when and where they are needed. Through the ‘My Choice’ project, JSI is partnering with Indonesia’s National Population & Family Planning Board (BKKBN) to strengthen family planning supply chain systems across four provinces in Indonesia, ensuring women have consistent access to a range of contraceptive options. Over the past decade, contraceptive prevalence rates in Indonesia have remained stagnant in part due to inconsistent access to contraceptives at service delivery points. To address critical gaps in the system, JSI collaborated with stakeholders at each level to design a comprehensive package of data centric interventions to strengthen the supply chain workforce, empowering them with new tools, skills, and information to enable holistic and continuous supply chain improvement. SUPPLY CHAIN BOTTLENECKS PROGRAM IMPLEMENTATION Using an implementation research approach, JSI partnered with BKKBN to evaluate supply chain system weaknesses, and design and test the intervention package in four provinces that comprised 11 districts with 650 service delivery points. A baseline assessment, conducted in November 2015, used a mixed method approach: quantitative facility surveys and qualitative group discussions. The results of the baseline were used to identify strengths and weaknesses in the current supply chain, inform intervention design, and provide a baseline for measuring effectiveness. The midterm review in January 2017 reviewed routine data and gathered qualitative feedback that informed adjustments in design and approach. The endline evaluation, completed in February 2018 was designed to measure changes in key supply chain indicators against baseline. The analysis includes a longitudinal evaluation of progress between baseline and endline with significance tests of outcomes at the two timepoints plus some trend analysis of the routine data. Qualitative data is analyzed by themes to supplement the quantitative results. GOAL METHODOLOGY IMPACT Inventory Management Use of service targets to make resupply decisions and an inadequate inventory control system resulting in stock imbalances. Communication and Collaboration Supply chain functions cut across multiple divisions and levels with minimal communication and coordination resulting in inefficiencies within the supply chain. Organizational Capacity The FP program lacked standardized processes and a mechanism for routine monitoring and supervision of the supply chain. High staff turnover made capacity building challenging. Logistics Management Information Systems BKKBN has a robust electronic LMIS but poor record management at SDPs compromises quality and limits use of the data. A strong and dynamic supply chain system for the family planning program that enables all people to have consistent access to a full range of contraceptive methods at all times. National Population & Family Planning Board CONCLUSION and WAY FORWARD 45% 15% 23% 30% 9% 14% 32% 6% 21% 2% 3% 17% Any Method IUD Implant Injectable Pill Condom Baseline (n=341) Endline (n=358) 47% reduction in number of SDPs stocked out * *Average of All Methods Percentage of SDPs stocked out on the day of the assessment 235% increase in number of SDPs using stock cards Stock card usage and accuracy at SDPs 24% 34% 80% 64% % of SDPs using stock cards % of accurate stock cards(matching physical stock) Baseline (n=341) Endline (n=358) 32% 37% 32% 27% 24% 49% 45% 50% 33% 28% IUD Implant Injectable Pill Condom Baseline (n=341) Endline (n=358) Percentage of SDPs with adequate stock (0.5 to 5 months) on the day of the assessment 37% increase in number of SDPs with adequate stock* *Average of All Methods A new min max inventory control system using consumption data, combined with standardized trigger points for emergency orders and reallocation of overstocks has resulted in providers becoming more pro active and the system becoming more adaptive to changing consumption patterns. This has reduced stock imbalances across facilities with a greater number of facilities maintaining adequate levels of stock. The institutionalization of Quality Improvement Teams has improved capacity of team members to analyze performance indicators, empowering them to develop local solutions and action plans. These forums have been critical in inculcating a culture of data use for decision making and have fostered collaboration amongst various departments within the family planning office to work towards a common goal of improved supply chain performance. The supply chain workforce has been strengthened with the support of a routine mentorship and on-the-job training program which has led managers to use data to better understand the needs of health facilities and provide appropriate support. In facilities where routine mentorship and on-the-job training has been conducted regularly there is improved supply chain performance with every visit. 89% increase in number of accurate stock cards * *matching physical stock The customer-focused, and data centric approach ensured that stakeholders have become more comfortable with analyzing and using data to proactively identify problems and determine solutions. Equipping staff throughout the system with the right tools and standard operating procedures has improved accountability and coordination at all levels. Better planning and the use of data for managing inventory and distribution has resulted in reduced stock imbalances and better availability at resupply points and SDPs. Most importantly, the work done over the last two years has elevated the importance of supply chain management within the family planning program and has provided the evidence needed to convince the central and local governments to increase investment and focus in strengthening family planning supply chain systems. Many of the lessons learned in the project districts, especially with regards to the use of data to guide distribution and resupply and the implementation of other supply chain management best practices, is now influencing and changing the policies and procedures at the national level. In addition, provincial and district stakeholders have recognized the value of adopting these interventions and have committed resources to scale up the interventions in 25 additional districts. Data visibility and use has improved by equipping users with user friendly tools that allow tracking of key supply chain performance indicators. Capacity building and on-the-job training with a strong emphasis on strengthening stock keeping recording and reporting has significantly improved data quality for decision making. 2018-2019 FEBRUARY 2018 FEBRUARY 2016 NOVEMBER 2015 APRIL 2016 to JANUARY 2018 Baseline assessment. Identify bottlenecks and needs Design system strengthening solutions Scale up to other districts Impact evaluation; identify successes for scale up Implement, monitor and make course correction if needed A DATA CENTRIC APPROACH TO DRIVING SUPPLY CHAIN EFFICIENCY IN INDONESIA HERY FIRDAUS ⚫ BETHANY SAAD ⚫ SARAH ANDERSSON ⚫ NURFADLIAH ⚫ OMAR BALSARA JSI RESEARCH & TRAINING INSTITUTE, INC. www.jsi.com/mychoiceindonesia jsi.idfp@gmail.com

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