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CLICK TO ADD TITLE. The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia. HERMES Computational Simulation Modeling to Improve Vaccine Supply Chain Operations in Two West African Countries: Niger and Benin Bryan A. Norman. [SPEAKERS NAMES]. [DATE].

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  1. CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia HERMES Computational Simulation Modeling to Improve Vaccine Supply Chain Operations in Two West African Countries: Niger and Benin Bryan A. Norman [SPEAKERS NAMES] [DATE]

  2. HERMES Team Tina-Marie Assi, PhD Former Co-Coordinator Diana L. Connor, MPH Co-Coordinator Leslie E. Mueller, BS Analyst Michelle M. Schmitz, BA Analyst Shawn T. Brown, PhD Technical Lead Bryan A. Norman, PhD Industrial Engineering Rachel B. Slayton, PhD Former Co-Coordinator Leila A. Haidari, BS Analyst Jayant Rajgopal, PhD Industrial Engineering Angela R. Wateska, MPH Co-Coordinator Brigid E. Cakouros, MPH Senior Analyst Veena Karir, PharmD, MS Senior Analyst Sheng-I Chen, PhD Industrial Engineering Proma Paul, MHS Senior Analyst Joel S. Welling, PhD Developer Bruce Y. Lee, MD, MBA Scientific Lead Erin G. Claypool, PhD Industrial Engineering Jim Leonard Developer Roslyn J. Phillips, MPH Senior Analyst Yu-Ting Weng, MS Developer

  3. Overview • HERMES Overview • Examples of In-Country Work • Sample studies • Summary and Discussion For more information visit- http://hermes.psc.edu

  4. Modeling Is Widely Used Air and Space Travel and Exploration Finance and Investment Transportation Sports Natural Resource and Energy Exploration Military/Defense For more information visit- http://hermes.psc.edu

  5. HERMES Vision For more information visit- http://hermes.psc.edu

  6. HERMES can address… • Impact of introducing new technology • e.g., vaccines, storage, and monitoring • Characteristics of vaccines and other technologies • e.g., vaccine vial size, vaccine thermostability, cold device capacity • Configuration and operations of the supply chain • e.g., storage, shipping frequency, personnel, ordering policy • Effects of differing conditions/circumstances • e.g., power outages, delays, inclement weather, limited access • Investment or allocation of resources • e.g., adding refrigerators vs. increasing transport frequency • Optimizing vaccine delivery • e.g., minimize cost, cost per outcome, maximize immunizations

  7. Discrete Event Simulation For more information visit- http://hermes.psc.edu

  8. Service Delivery Location

  9. Steps to Model Supply Chains • Identify purpose of simulation • Questions to address • Perspective of user • Determine level of detail required in the simulation model • Less detail to address general, simpler questions • More detail to address more complex questions For more information visit- http://hermes.psc.edu

  10. Steps to Model Supply Chains • Gather and input supply chain data into HERMES • Evaluate the data that is available. • Less data  less detailed simulation model • More data  more detailed simulation model • Decision maker can directly run HERMES on any laptop computer For more information visit- http://hermes.psc.edu

  11. HERMES GUI • Simplifies • Data input • Running models • Evaluating different scenarios • Identifying bottlenecks • Seeking Beta testers for the HERMES GUI for early 2014 For more information visit- http://hermes.psc.edu

  12. Overview • HERMES Overview • Examples of In-Country Work • Sample studies • Summary and Discussion For more information visit- http://hermes.psc.edu

  13. Examples of In-Country Work For more information visit- http://hermes.psc.edu

  14. Overview • HERMES Overview • Examples of In-Country Work • Sample studies • Summary and Discussion For more information visit- http://hermes.psc.edu

  15. Niger Supply Chain Serum Institute Sanofi Aventis Central Store Regional Store Regional Store Regional Store Regional Store 1 Month Regional Store Regional Store Regional Store 42 District Stores (Chest Refrigerators and Freezers) 1 Month 600+ Clinics (Small Refrigerators and/or Freezers) 600+ Clinics For more information visit- http://hermes.psc.edu

  16. Vaccine Availability Vaccine Availability (%) Vaccine Availability (%) Vaccine Availability (%) Vaccine Availability (%)

  17. For more information visit- http://hermes.psc.edu

  18. Truck Capacity Utilization 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size

  19. Storage Capacity Utilization 10-dose measles vaccine vial size 5-dose measles vaccine vial size 2-dose measles vaccine vial size 1-dose measles vaccine vial size

  20. Vaccine Availability by Vaccine

  21. Cost per Dose by Arrival Rate

  22. Optimal Vial Size

  23. Benin: The Problem 1 http://www.who.int/immunization_monitoring/data/ben.pdf- 2011 Government and WHO-UNICEF estimate. • The Benin supply chain may not be effectively getting vaccines to the population. • At least 15% of children in Benin are not receiving full vaccinations (as measured by estimated DTP3 coverage).1 • Impending new vaccine introduction (e.g., rotavirus vaccine) may exacerbate this problem. • The Benin vaccine supply chain may also cost more to operate than it should (not completely efficient). For more information visit- http://hermes.psc.edu

  24. Benin: Objectives • Evaluate the current Benin vaccine supply chain: • Identify vulnerabilities (bottlenecks) • Calculate operating costs (storage, transport, labor, and building) • Assess Benin vaccine supply chain’s ability to handle new vaccine introduction. • Identify an alternate, more efficient vaccine supply chain design. • Establish a blueprint for redesign. • Build a business case to change the system. • Determine if costs could be lowered and coverage increased from the current system.

  25. Approach: HERMES Modeling Each Scenario Data on Benin Vaccine Supply Chain • 2010 Cold Chain Equipment Management (CCEM) assessment • Pilot 2012 EVM+HERMES • 2008 Comprehensive Multiyear Plan (cMYP) • Personal communications with Benin Ministry of Health (MoH), WHO, UNICEF, Project OPTIMIZE, and other key stakeholders Detailed Simulation Model of the Benin Vaccine Supply Chain Run Simulation Measure Vaccine Availability Measure Operating Costs Measure Capital Expenditure Make Additions to Relieve Bottlenecks Run Simulation Measure Vaccine Availability Measure Operating Costs For more information visit- http://hermes.psc.edu

  26. Current System: Not Completely Effective or Efficient Vaccine availability:93% (71% after rotavirus introduction) Total annual operating costs:$1,113,954 ($1,117,494 after rotavirus introduction) Logistics cost per dose: $0.23($0.26 after rotavirus introduction) * Current Bottlenecks: Storage at National Store and transport between all levels

  27. Which Redesign is the Best Option?

  28. Capital Expenditures Required to Achieve Each Design Alternative that will Accommodate Rotavirus Introduction

  29. ZS + Truck Loops: Lowest Capital Expenditures and Operating Costs

  30. ZS + Truck Loops: Lowest Logistics Cost per Dose Administered

  31. ZS+Truck Loops: Over Half a Million USD in Cost Savings after 5 Years

  32. Synergy of Two Changes Creates Savings

  33. Conclusions • Zone Sanitaire plus 4 x 4 Truck Loops at Lowest Level is clear choice. • Lower capital expenditures • Lower operating costs • After four years over half-million in cost savings • Combination of Zone Sanitaire and Truck Loops leads to a synergistic effect. For more information visit- http://hermes.psc.edu

  34. Overview • HERMES Overview • Examples of In-Country Work • Sample studies • Summary and Discussion For more information visit- http://hermes.psc.edu

  35. Summary and Discussion • HERMES can rapidly create a simulation model of any supply chain • Serve as a virtual laboratory to help a wide variety of vaccine decision makers answer any number of questions • Already implemented in multiple countries For more information visit- http://hermes.psc.edu

  36. Looking To The Future • Over the next ten years most GAVI countries are expanding their vaccines • MenAfriVac®, Rotavirus, PCV-13, others • Many new vaccines are relatively large • Even more burden on the vaccine cold chain • Higher coverage rate targets for current and new vaccines • Cost effective distribution is critical to achieve coverage targets For more information visit- http://hermes.psc.edu

  37. Acknowledgements • Funded by the Bill and Melinda Gates Foundation and the U.S. National Institutes of Health • Valued collaborators include: World Health Organization (WHO), UNICEF, PATH, Agencie de Medecine Preventive (AMP) For more information visit- http://hermes.psc.edu

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