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CLICK TO ADD TITLE. The 5th Global Health Supply Chain Summit November 14 -16, 2012 Kigali, Rwanda. Optimization of Benin’s Vaccine Logistics System Philippe Jaillard Hamadou Modibo Dicko. [SPEAKERS NAMES]. [DATE]. Introduction & Context.

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  1. CLICK TO ADD TITLE The 5th Global Health Supply Chain Summit November 14 -16, 2012Kigali, Rwanda Optimization of Benin’s Vaccine Logistics System Philippe Jaillard Hamadou Modibo Dicko [SPEAKERS NAMES] [DATE]

  2. 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 • Etatsgénéraux 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

  3. LOGIVAC a joint AMP and WHO project supporting health logistics professionalization in Africa Demonstration Sites Develop innovative model logistics systems; Serve as demonstration site for students; Evaluate impact of using certified logisticians on immunization program performance 4 Reference Center Consultingservices Training • Establish a first regional logistics reference center in Benin with a sustainable business model. .Expand to second location (Eastern/Southern Africa) thereafter • 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 • Develop a professional network of logistics experts that provide consulting services on health and vaccines logistics 1 2 3 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 5 3

  4. Optimization of Benin’s EPI Supplychain:a combinaison of method and tools; a collaborative process CCEM (PATH) EVM (WHO, UNICEF) HERMES (Vaccine Modeling Initiative) Optimized SC system* *: we are aware that there might be other confounding factors that facilitate this optimization process Key issue: ensuring the successfully implementation and country ownership! • 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 • EVM (Effective Vaccine Management) • assess the quality of the vaccine management system • EVM assessment report • EVM improvement plan (EVM-IP) • HERMES (Highly Extensive Resource for Modeling the Supply chain) • Virtual laboratory, can help in re-designing the supply chain • Measure vaccine ava • ilability and supply chain cost Transport system evaluation National cold room assessment Workshop 1 : identification of scenarii Optimization planning Workshop 2 : strategic orientations

  5. Results (1/4): Effective Vaccine Management (EVM) Assessment • NOTE: satisfactory score for an EVM is 80% Source: Benin’s EVM assessment 2012

  6. 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.

  7. 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

  8. Results (3a/4): Supply chain design Actual situation

  9. Results 3b/4 : Supply chain design options 1. Consolidation to zone level Status quo 3. 12 dept store + commune level removed 2. Actual + commune level removed

  10. Results (3c/4): HERMES – Vaccine availability Source: Benin’s HERMES result 2012

  11. 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)

  12. 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)

  13. 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)

  14. 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)

  15. 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) • Acquisition of solar equipment (in replacement of Kerosene ones) • Professionalization of health logistics (to properly handle change implementation) • Optimization of resources (Integration in some segment of the SC) • Equipment management system (LMIS, CC rehabilitation and maintenance plans) • Transport management system • Development of health logistics • EVM Improvement plan (vaccine management) • Investment plan for the logistics system

  16. EVM + HERMES Pilot in Benin Next steps towards the implementation plan

  17. 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…) • Global partnership (PAG) • Potential resistance due to change management • 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)

  18. 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

  19. Thank you www.logivac.org www.amp-vaccinology.org

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