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1. CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia Seeking the Transformative in Supply Chains for Public Health: Informed Push as a Case Study [SPEAKERS NAMES] [DATE]

2. Ellen T. Tompsett Sr. Programme Officer, Reducing Stockouts

3. Addressing challenges of data capture and trained HR

4. Producing dramatic results – Zimbabwe & Mozambique

5. Dramatic results – Nigeria and Senegal

6. Zimbabwe Alan Bornbusch Public Health Adviser

7. DTTU – The Basics Product availability > 95% Facility coverage > 98% DTTU team calculates consumption and stock on hand; tops up to maximum stock level Truck loaded with products; quantities based on previous quarter consumption data Truck drives with stock to facility

8. Cost effectiveness

9. Cost Drivers

10. Scalability

11. Sustainability

12. Mozambique Wendy Prosser Program Manager

13. Dedicated Logistics System (DLS) streamlines vaccine distribution Provincial Storage 1. Leave provincial level with: - medical supplies - equipment, parts - information • 3. Return to provincial level office: • input data • analyze information • address problems • prepare for next trip District Storage Health Centers • 2. Site visit (in coordination with district level): • - record & stock inventory • - service equipment • - supportive supervision • - collect data Level jumping * Task shifting * Data use * Optimized transport loops * Supportive supervision

14. DLS is more cost-effective and efficient than diffused distribution DLS province in Mozambique Non-DLS province in Mozambique 17% more cost-effective 21% more efficient Pilot resulted in 93% coverage rate for all childhood vaccines $5.03 - - - - - - - - Cost per child vaccinated - - - - - - - $6.07 $1.18 - - - - - - - - Cost per dose delivered - - - - - - - $1.50 27% 10% 20% 27% 48% 54% 8% 16% 17%

15. Process to sustainability and to scale 2015 ??? 2011: Operating in four provinces 2006: Expansion to one more province 2002: One province

16. Root causes of the challenges to reach sustainability Implementation Issues Funding Leadership Environmental Factors Lack of dedicated and accessible funding stream Insufficient capacity and motivation to use data Budget shortages (fuel, per diems, vehicle and cold chain maintenance and repairs) Lack of alignment with national priorities Insufficient commitment to consistent implementation Inconsistent Implementation of DLS Poor Vaccine Supply Chain Performance Insufficient personnel for fully implementing DLS Insufficient use of data for decision-making Lack of dedicated and available vehicles Poor quality of data collected at health centers Insufficiently trained & managed distribution team Poorly managed vehicle fleets and maintenance systems Human Resources Data Transport

17. SenegalLeah HasselbackProject Director

18. Orders Informed Push Model Proceedsrecovery Productretrieval Delivery Difficulties encountered Pull flow with orders Informed Push Model: push flow without orders Regional Supply Pharmacy Regional Supply Pharmacy 3PL • Poor forecasting of needs • Cash flow problems • Etc. • Retrieve products with own means (e.g., rental, taxi) • Payment for quantities consumed (not quantities delivered) • Margins maintained Information District District • Systematic delivery to restore stock levels • Order-delivery form signed with proceeds to recover and quantity of delivered products SDP SDP

19. Scalability and Sustainability 6-month pilot in 2 districts. Expansion to cover the regions of Dakar (12/12), Kaolack (1/13), and Thiès (4/13). Saint-Louis managed by PNA. Expansion to the regions of Diourbel, Fatik, Kaffrine, Matam, Louga. Full integration of the model in the health system. All regions managed by the PNA. August 2013 – July 2014 August 2014 – July 2015 August 2015 – July 2016 2012 – July 2013 Expansion to the regions of Tambacounda, Ziguinchor, Sechiou, Kolda, Kedougou. Scaling Adopted as national FP strategy and MoH requested national expansion. Decision for PNA to sustain the system. Explore the integration of other products, PNA management test, sustainability planning. 1367 SDPs 1000 SDPs 559 SDPs PNA takes over management of Dakar, Kaolack Thiès. Sustaining Geographic Coverage Regioncovered by IPM IPM managed by the PNA

20. Costs & Sustainability Cost Recovery Model Open Questions 3PLs in rural regions? PNA to manage 3PLs? Cost of PNA management? Cost of integrating other products? Other finance sources: program fees, high margin products, line in state budget, donors Cost-effectiveness analysis of the IPM • Total estimated annual costs at scale for family planning: $500,000 • Total expected annual costs recovered at scale: $1,040,000 • Division of Reproductive Health and Child Survival to commit 50% of cost recovery ($520,000) to IPM logistics costs

21. NigeriaEmmanuel Ogwuche

22. Direct Delivery and Information Capture (DDIC) Model Logistics data available for decision making Increased product availability Visibility in the supply chain Health workers focused on providing services

23. Scalability Improved Commodity Availability in Ebonyi • Scaled from 61 to 204 health facilities in 4 runs in Ebonyi • Scaled from 79 to 116 health facilities in 2 runs in Bauchi. Will reach 165 HF’s in November 2013 • In 2014 will scale up to 2 additional states and Federal Capital Territory

24. Cost-Effectiveness Study 2014 • Questions • Can the DDIC effectively ensure the delivery of commodities to facilities, as well as effectively capture key commodity availability information? • Is the DDIC system affordable? • Strategy • Data Quality Audit • Costing survey to include average cost effectiveness: • Total annual costs • Total annual operating costs • Compare multiple distribution models in Nigeria including DDIC • Compare across states and within states

25. Country Ownership/Sustainability Engagement with Nigeria government at all levels Use of public sector personnel as DDIC Team Leaders Collaborative efforts with various agencies in the country Integrating commodity distribution for different health programs