[P1] Assessing routine health information system performance during the tenth outbreak of ebola virus disease (2018- 2020) in the Democratic Republic of the Congo: a qualitative study in North Kivu (8)
The Democratic Republic of Congo (DRC) has implemented reforms of its national routine health information system (RHIS) to improve timeliness, completeness, and use of quality data. Like other components of the health system, the RHIS can be affected by outbreaks, including Ebola Virus Disease (EVD), and undermine efforts to strengthen RHIS. We assessed the functioning of the RHIS during the tenth EVD outbreak which affected the Nord Kivu province between 2018 and 2020 to identify opportunities for improvement.
[P2] Direct and integrated last mile distribution of vaccines and program commodities to health facilities serviced by EPSS Hawassa Hub in Ethiopia (18)
Freight in Time (FiT) is an East African 3 and 4PL Logistics service provider with extensive experience in humanitarian logistics in the region. Since June 2020, Freight in Time’s Ethiopia branch, on request from the Ethiopian Pharmaceuticals Supply Services (EPSS) and with funding of the Global Fund, in PPP with EPSS is implementing a groundbreaking solution for optimized distribution of program commodities from EPSS’s districts Hub in Hawassa to 285 of the 504 Health Facilities under the Hub’s catchment. The pilot project is designed to prove that Public Private Partnerships are a mechanism to successfully address existing challenges to the last mile supply chain and enable EPSS to potentially replicate and scale the solution across the rest of the country with private sector service providers. The baseline assessment conducted at the beginning of the project in July and August 2020 revealed the following main challenges I. Poor supply chain data visibility due to: Ø Inadequate record keeping Ø Poor data quality Ø Lack of trained personnel for preparation of reports II. Low product availability and challenges to product quality at health facility level III. Sub-optimal fleet management.
[P3] Mapping procurement bottlenecks and establishing a national coordination mechanism to ensure sustainable financing for vaccine procurement: A case study on Cameroon (22)
Persistent procurement challenges in Cameroon result in central-level stock-outs and supply chain disruptions, yet the procurement process remained unclear. In 2020, the Clinton Health Access Initiative (CHAI) mapped the procurement processes for traditional and co-financed vaccinesin Cameroon1, and is currently supporting Cameroon to test key recommendations. These include the establishment of a Technical Working Group for Vaccine Financing and Procurement (GTFAV) and request for immunization funds in tranches, for easier approval and timely fund disbursement. These interventions have begun to yield positive results including improved coordination among procurement stakeholders and more improvement in the timeliness of fund disbursement for procurement of co-financed vaccines. As of July 2022, the Government of Cameroon has paid 84% of the funds required for procurement of co-financed vaccines for 2022 and is on track to make its full contribution by December 2022. This is a remarkable development that has been recognized by Gavi and is a great step in ensuring sustainability of Cameroon’s immunization activities after transitioning from Gavi support between 2027 and 2030.
[P4] A hotline to improve the availability, quality, and use of family planning logistics data to ensure product safety at the last mile (37)
Contraceptive products are of paramount importance in the national health care system in Niger – they must be available, affordable, accessible, of good quality, and rationally used. • The continued availability of quality contraceptive products at all levels of the health system requires that all stakeholders have full control over the various stages of the supply chain. • In 2019, an evaluation of the supply chain in Niger showed shortcomings with quantification practices that were attributable to the weak capacity of certain actors, especially at health facility level. • In addition, the technical committees for coordinating the management of health commodities, during their supervision visits, noted several shortcomings in the management of medicines. – These included irregularities in the updating of stock monitoring tools, the poor quality/completeness/timeliness of the integrated LMIS reports, and the failure to comply with good storage practices. • To address these shortcomings, the Global Health Supply Chain – Technical Assistance Francophone Task Order (GHSC-TA Francophone TO) project aims to support the DPH/MT technically and financially in the implementation of an:
[P5] Resilient commodities transportation system: Coping with cyclones, COVID-19 and armed conflict in Mozambique (45)
If a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. In Mozambique occurrence of severe weather and violent extremism, threaten the ability of the ability of the system perform uninterrupted distribution of medicines to the last mile. USAID and the Ministry of health of Mozambique through the Central Medical Stores partnered to implement an outsourced last mile distribution of medicines program. This program demonstrated to be an effective tool to ensure that the supply chain could cope and adapt with the occurrence of extreme weather and violent extremism.
[P6] Optimal pharmaceutical replenishment policy: the case of health centers in Addis Ababa (46)
Supply chain management and logistics are critical activities in the pharmaceutical sector. It has become essential for healthcare facilities to fulfill the demands of patients carrying different kinds of pharmaceutical products to improve customer service while lowering relevant costs (Jarrett, 1998; Ryu et al., 2013). Inventory management aims to determine a replenishment policy that informs when and how much to order and maintain an appropriate stock level, thus optimizing different tradeoffs such as carrying and re-order costs (Jalali and Nieuwenhuyse, 2015). Logistics services comprise physical activities (e.g., transport, storage) and non-physical activities. To balance logistics costs, those non-physical activities like decision-making and information systems play an essential role (Lakshmi, 2017). Even if massive amounts of data are archived manually and electronically in Ethiopia, their use in decision-making is limited. Given pharmaceutical high cost and perishability, the study is required to assist inventory managers in developing optimal inventory management policies. In this regard, operational research offers a wide range of methodologies that can help and significantly improve the operations of health facilities. It also overcomes the complexity of other inventory models (Jalali and Nieuwenhuyse, 2015). This study seeks to evaluate the current replenishment policy, review inventory models, and propose optimal replenishment methods.
[P7] Medicine Wastage: An assessment of post implementation of electronic logistics management information system at Levy Mwanawasa University Teaching Hospital (47)
The wastage of medicines has been a perpetual problem at Levy Mwanawasa University Teaching Hospital (LMUTH) for the past three decades. The wastage has been mainly in form of disposal of expired medicines. The electronic Logistics Management Information System (eLMIS) has been implemented since 2015, in anticipation to revolutionary reduce wastage and enhance cost-effective system of health data management that ensures greater commodity security and better health outcomes for the people for the consumers. Hence, this research assessed whether the eLMIS has been effective to reduce the wastage of medicines between 2014 and 2018 at Levy Mwanawasa University Teaching Hospital in Lusaka in District of Zambia.
[P8] End-to-end supply chain resilience: A case study of Nigeria’s COVID-19 pandemic experience (48)
With the occurrence of several health systems disruptions, however, agile supply chain systems are, continue to be faced with an amplification effect emanating from these disruptions. Following the emergence and impact of the SARS COVID 19 Virus in Nigeria, despite the rapid and successful rollout of the Covid-19 vaccines, the Nigeria immunization supply chain experienced a ripple effect that impacted its structural dynamics and performance which had the potential to pivot the country’s pandemic recovery and threaten the previous gains made with the immunization and Primary Health Care supply chain systems. This paper highlights the steps and mechanisms adopted by the country to achieve resilience, regain operational capacity, and improve efficiency following disruptions emanating from SARS-CoV-2.
[P9] Strengthening Uganda’s national cold chain inventory data system (61)
Vaccine cold chains are the backbone of immunization systems. Ensuring cold chain equipment remains functional is key to achieving equitable, accessible, and effective delivery of life-saving vaccines. An up-to-date cold chain equipment (CCE) inventory is crucial to the effective management and overall functionality of the cold chain. For many countries, paper-based systems have been used for CCE inventory management. These inventories are sporadically updated, costly to complete, and data sets are often incomplete or fraught with inconsistencies and data quality issues. Furthermore, the simple fact that most CCE are equipment that require maintenance and face functionality issues means that point in time snapshots of inventories become quickly outdated. Uganda’s National Program for Immunization (UNEPI) and National Medical Store (NMS) piloted and scaled a digital solution to update and manage CCE across the country. This system, called the Cold Chain Information System (CCIS), is built on the ODK-X software platform. The application allows users from national supervisors to district cold chain technicians to review, update, and share key CCE data via Android devices. The system functions “offline”, allowing user the ability to log and save data when out of wifi aor cellular service range. Once back in network service areas, users are able to sync data to centralized servers and databases. The app is designed to collect data across several important areas: updating the CCE inventory, capturing maintenance and repair logs (including spare parts), and collecting CCE temperature data. Data on these three areas are used by national managers and DCCTs to (a) ensure cold chain equipment in Uganda remain functional and (b) provide insights to support data analysis for CCE procurement planning. Both which are critical for Uganda to have a feasible National Cold Chain Rehabilitation plan that ensures the country achieve its sustainable goals in immunization.
[P10] Strengthened supply chain systems through establishment of county health products and technologies units (72)
Kenya now has 47 established county-level health products and technologies units (HPTUs), which aim to ensure reliable, resilient, and responsive health supply chain (SC) systems. These HPTUs were derived from the National Health Products and Technologies (HPT) SC Strategy (2020-2025), which seeks to provide management and oversight of all SC activities within the county. Through continuous process improvement, the HPTUs identify SC problems, develop solutions, and implement best practice interventions. Without HPTUs, SC responsibilities are scattered across programs or remain unassigned and unfulfilled. A properly staffed and supported HPTU ensures that resources and time are dedicated to coordinating and completing SC activities.
[P11] Enhancing commodity accountability to advocate for resource allocation: A case study of Kirinyaga county (73)
LMIS is an important and critical unit in every health system structure. The health facilities today face numerous challenges including incomplete and inaccurate data on commodity data, late deliveries to facilities, high rates of stock-outs of essential medicines and losses through expiries and thus leading to low resource allocation. The ideal scenario for improved service delivery especially in low resource setting would be availability of commodities and real-time or near real-time stock data management data to provide quick responses especially due to shortages. The use of excel spreadsheets by health facilities to report on consumption and stock on hand has had a huge impact on improving the visibility of data for key commodities in Kirinyaga county. These excel sheets are filled out by the facilities and sent to the sub-county manager, who compiles the data for all the facilities and delivers it to the county commodity in charge for decision making and advocacy in terms of resource allocation with the county executives. The data from this tool has been useful in proper forecasting and quantification of essential commodities, as well as in demonstrating commodity visibility and making decisions on supply chain interventions such as redistribution. Most importantly, because the tool includes a cost for each commodity, the county has used the data to increase the budgetary allocation to pharmaceuticals based on forecasted consumption. This tool’s future is to be integrated into a mobile application to provide real-time or near-real-time data visibility.
[P12] Risk evaluation and management of the malaria commodities supply chain in Kajiado County, Kenya (74)
An analysis was conducted to examine risk evaluation and management involved in the malaria commodities supply chain (SC) in Kajiado West Sub-County, Kenya. In Kenya, it is estimated that 3.5 million cases and 10,700 deaths are related to malaria each year (WHO, 2021). Kajiado County experiences malaria outbreaks due to annual changes in climate conditions. Despite great efforts to prevent and control malaria, stockout of malaria supplies in Kajiado County is a significant challenge for the healthcare system. Kajiado County Health Products and Technologies Unit (HPTU), in collaboration with USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) Afya Ugavi, provided both technical and logistical support to evaluate supply chain (SC) management of rapid diagnostic kits (RDTs), insecticide- treated nets (ITNs), antimalarial drugs, and other critical health commodities that aid in the prevention and treatment of malaria. A field survey was employed to evaluate risks and implementation strategies of malaria commodities in Kajiado West sub-county SC on June 8, 2021. Out of 35 health facilities in Kajiado West sub-County, eight were selected to investigate the management strategies of malaria commodities. The selected health facilities were in regions that had experienced a malaria outbreak in the previous year. The findings indicated that two facilities had above-average (54%) commodity management, while the remaining six facilities had below-average commodity management scores. Additionally, half of the facilities lacked human resource capacity while most had a low level of financial management programs. All the facilities adhered to best practices of malaria case management, however, most of the facilities had inadequate malaria commodities inventory and storage. Data management capacities were average among the facilities while the availability of appropriate documentation was generally low. Even though healthcare workers had appropriate training on the management of malaria, the lack of adequate malaria commodities appeared to be a major factor contributing to the inability to control and prevent malaria in the region. Therefore, routine, and standardized risk evaluation and management should be undertaken to ensure SC commodity security.
[P13] Improving the availability of health commodities through supportive supervision: A case study from Vihiga County, Kenya (77)
Poor human resource capacity and service delivery limit access to essential health technologies— including medicines—in low- and middle-income countries. The lack of adequate supportive supervision contributes to this suboptimal performance. By identifying service delivery gaps and providing onsite mentoring to health workers, supportive supervision not only builds the capacity of health workers but also affords program managers the information needed to address systemic challenges. In contrast to the traditional inspective approach to supervision—which tends to be punitive—supportive supervision focuses on joint problem solving, mentoring and provision of required resources. Supportive supervision ultimately improves healthcare workers’ performance, quality of service delivery and facilitates uninterrupted access to medicines and other health technologies, thereby improving population health. Based on the above premise, the Health Products and Technologies Unit (HPTU) of the Department of Health, Vihiga County, Kenya—established in June 2021 with support from USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project—embarked on an initiative to strengthen supportive supervision as part of the county’s overall goal of improving access to health products and technologies (HPTs), including medicines. Prior to the introduction of this initiative in January 2020, the county had limited visibility into the health facility’s performance resulting in poor decision-making by program managers. A baseline assessment by the county supportive supervision team in 69 public health facilities revealed shortage of health products and unexplained losses resulting in poor health service delivery. Specifically, the mean scores of health facilities on key indicators of the supply chain performance were low and as follows: resolution of previous action points 46.75%; storage of health products 68.72%; inventory management 42.67%; availability and use of commodity data MIS tools 74.40%; verification of commodity data 65.56%; availability of guidelines and job aids for commodity management 36.65%; accountability of HPTs 58.58%; composite (final) score 56.19%.
[P14] Bottom-up Innovations: System of auditable pharmaceutical transactions, and services for supply chain, proper use of medicines, and delivering health services in Ethiopia. (79)
One-third of the global population does not have regular access to medicines; this number is even greater in many low-income countries, such as Ethiopia. Ethiopia’s challenges with health care access can be attributed to gaps in the health system and supply chain such as poor deployment of human resources; poor management of and planning for commodities, leading to high wastage rates and low availability of medicines; lack of transparency of transactions preventing the tracking of medicine theft; and under resourced service delivery systems to give proper care to patients. To address these gaps, the Ministry of Health (MOH) in collaboration with the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC- PSM) project in Ethiopia, and with support from the US President’s Malaria Initiative (PMI) has designed and implemented an innovative system, Auditable Pharmaceutical Transaction and Services (APTS). APTS is a data-driven package of interventions focused on five “result areas” that will improve access to medicines: efficient budget utilization, transparent and accountable transactions, effective workforce development and deployment, reliable information for decision making (on product, financial value, and dispensary service delivery) and improved customer satisfaction. To fully implement APTS, GHSC-PSM worked with MOH and partners from January 2017 to October 2020 to enact legislation; develop guides, training materials and recording tools; deploy pharmacy staff and accountants; renovate pharmacy premises; support stock transfer; and monitor implementation. Due to Ethiopia’s extraordinarily diverse topography and climatic conditions, epidemiology of diseases (such as malaria) varies by geographical region and months, adding a layer of nuance to APTS implementation. GHSC-PSM has supported 263 hospitals (238 general and 25 specialized) from FY17 to FY22 to implement APTS. By taking qualitative and quantitative information from over four years of implementation, GHSC-PSM evaluated the impact of APTS.
[P15] Re-imagining Last Mile Distribution of health commodities for equity and resiliency in Nigeria (5)
Following a series of mass protests across Nigeria against Police brutality that occurred in October 2020; popularly referred to as “End SARS’ which eventually turned violent, the Calabar Axial Warehouse; one of the 4 Axial Warehouses in Nigeria managed by Akesis health at that period, are used as hubs for the distribution of USAID/Global Fund HIV and Malaria public health products including HIV Antiretroviral Drugs and reagents to health facilities in 24 states of Nigeria on behalf of Chemonics International for the GHSC-PSM project. The Calabar Axial warehouse was looted and vandalized by some hoodlums during this ‘End SARS’ unrest. This development was a major threat to the disruption of the bi-monthly Last Mile Distribution (LMD) of the ARVs and other drugs scheduled for November 2020 from this particular axial warehouse. An onsite visit assessment revealed the vandalized warehouse could not be used for the November LMD operations.