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The 5th Global Health Supply Chain Summit

November 14 -16, 2012 Kigali, Rwanda  

NGO Social Responsibility Model for Commodity Delivery

Leah Hasselback

Lessons  Learned  from  Expanding  a  Supply  Chain  Redesign  in  Mozambique  

 

4  

Project  History  

•  5-­‐year  supply  chain  redesign  pilot  project  implemented  in  Cabo  Delgado  province  (Dedicated  Logistics  System)  

•  Old:  Collection-­‐based,  ad  hoc  approach  

•  New:  Vendor  managed  inventory  with  level  jumping  

•  Includes  supportive  supervision  and  information  system  

•  Conducted  impact  evaluation  in  Cabo  Delgado,  using  neighboring  Niassa  province  as  a  comparison  

Mozambique  

Cabo Delgado Niassa

Dedicated  Logistics  System  Monthly  Activities  

District Storage

Provincial Store

Health Centers

1.  Leave  provincial  level  with:  

       -­‐  medical  supplies  -­‐  energy  

       -­‐  equipment,  parts          -­‐  information  

2.    Site  visit  (in  coordination  with  district  level):  -­‐  record  &  stock  inventory  -­‐  service  equipment  -­‐  supportive  supervision  -­‐  collect  data    

3.    Return  to  provincial  level  ofQice:  -­‐   input  data  -­‐   analyze  information  -­‐   address  problems  -­‐   prepare  for  next  trip  

14%

28%

12%

46%

Niassa

18%

12%

9%

61%

Cabo Delgado

Transport

Personnel

Cold  Chain

Vaccines  &  Supplies

Dedicated  Logistics  System  Results  The  Forest  

6  

Indicator   Baseline   Result  

Coverage  Rates  (DPT-­‐Hep  B3)   68%   95%  

Vaccine  stock  outs   80%   1%  

Cold  chain  functioning   ~40%   96%  

DPT1-­‐3  Dropout  Rate   12%   3.8%  

Trust  in  the  public  health  system  

91%  visited    in  last  month  despite:  •  47%  of  families  living  over  two  hours  away;    

•  85%  of  them  having  to  walk  to  get  there;  and  

•  most  common  reason  for  vaccination  failure  being  “place  of  immunization  too  far.”  

The  Dedicated  Logistics  System  (Cabo  Delgado)  is  more  cost-­‐effective  and  efQicient.  

What  do  you  do  after  a  successful  pilot?  

A  new  approach  to  achieve  impact,  sustainability,  &  scale:  

–  Outsourcing  activities  à  In  house  operations  with  technical  assistance  

–  External  resources  à  Mix  of  internal  and  external  resources  for  funding  and  transportation  

–  NGO  staff  closely  coordinating  with  government  à  All  government  staff  closely  coordinating  with  the  NGO  

Successful  Pilot  

Evidence  of  impact  &  cost  effectiveness  

How  do  we  achieve  impact,  

sustainability,  &  scale?  

Challenges  in  the  New  Approach  The  Swamp  

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0%  

10%  

20%  

30%  

40%  

50%  

60%  

70%  

80%  

90%  

100%  

Cabo  Delgado   Niassa   Gaza   Maputo  

Irregularities  in  DLS  Implementation  by  Province  and  their  Causes  

Transport   Funding   Human  Resources   Combination  of  more  than  one  cause  

Note:  In  Niassa,  35%  of  irregularities  were  caused  by  transport.  

Three  Challenges  in  the  In  House  Approach  

•  Funding  –  Funds  allocated  and  available  but  no  cash  in  hand  –  Not  enough  time  in  1  month  to  carry  out  activities  and  secure  funding  on  time  for  the  next  month’s  distributions  

–  Interim  solution:  direct  funding  from  VillageReach  for  some  costs  

•  Transportation  –  Vehicles  not  available  because  of  lack  of  planning,  management,  maintenance  

–  InsufQicient  quantity  of  vehicles  available  –  Interim  solution:  provision  of  some  vehicles  for  distribution  

•  Human  Resources  –  Distributions  interrupted  as  staff  are  called  back  for  other  activities  

Rethinking  Expansion  Approaches  

We   know   that   we   can   be   more   efQicient   with   a  redesigned  supply  chain,  but…    How   do   we   combine   the   best   of   outsourcing   and   in  house  operations  to  achieve  impact,  sustainability,  and  scale?  

Hybrid  Approaches  

Challenge   Outsource   In  House  

Funding   Local  fund  agent   Funds  monitoring  Requisitioning  Reporting  

Transportation   Outsource  vehicle  use   Technician  carries  out  distributions  Manage  performance  of  transport  provider  

Human  Resources   Applying  private  sector  best  practices  Performance  based  pay  Professionalization  of  the  Qield  coordinator  

Government  staff  

Travel  Tips  

•  In  designing  supply  chains,  start  at  the  last  mile  –  Build  systems  to  work  with  the  available  capacity  –  The  last  mile  of  distribution  is  the  Qirst  mile  of  information  

•  Focus  on  building  shared  interest  –  Allows  for  bringing  in  new  partners,  such  as  the  private  sector    

–  Drives  scale  and  sustainability  •  Only  travel  uncovers  the  unexpected  challenges!  

www.villagereach.org    

 Leah  Hasselback  

Mozambique  Country  Director  leah.hasselback@villagereach.org  

Tel:  +258  827324196      

Av.  25  de  Setembro,  1123-­‐11º.  E  Maputo,  Mozambique  Tel:  +258  21326446    Fax:  +258  21326448  

 

Thank  You