Public Health Lessons for restoration of supply chain - PowerPoint Presentation

Slide1

Public Health Lessons for restoration of supply chain

during a pandemic in India:

Anemia Mukt BharatDr Manish PantChief, Health & DevelopmentUNDP India

Slide2

Vaccines

Iron Folic Acid

Existing Public Health Supply Chain

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Vaccine Logistics System in the Country

Basis of vaccine supply: Distribution of vaccines from upper nodes to the lower nodes are supplied based on any of the following:Monthly targets

Stock outsLow stocks

Large quantity of stocks receivedProximity to State/District storeLow supply from ManufacturerDivisional Vaccine StoreSub-centers/Session sites

Beneficiaries

State vaccine store

Regional Vaccine Store

District Store

CHC/PHC

GMSDs (Only national buffer)

Government procures vaccines from manufacturer

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IFA Supply Chain: State Level

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Vaccine Supply Chain Management (SCM) Challenges

A Complex Six-Level Vaccine Supply Chain

Lack of

real-time visibilityNo visibility of storage temperaturesShort shelf life, long supply chainNon-standard record-keeping Mismatch in demand and supply

1

2

3

5

National store/

Manufacturer

State Store

Divisional

Store

District

Store

Taluk/Block

PHC/CHC

Limited infrastructure

Lack of transparency

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Vaccines have a short shelf life as compared to drugsVaccine supply chain has a long pipeline There is a constant requirement to prevent stock out or vaccine expiry

Temperature monitoring for vaccine storage very important (2-8C)In the absence of information, It is difficult to hold system functionaries responsible for lack of performance.

Vaccine Supply Chain Management (SCM) Challenges

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IFA Supply Chain Management (SCM) Challenges

Lack of

Written SOPs and guidelines for handling products

Staff not trained on SCMInadequate stock management at warehouse – stock outsWeak data for estimation, forecasting and consumption Non-uniform procurement & distribution cycles12

3

5

tte

Store

Divisional

Store

District

Store

Taluk/Block

PHC/CHC

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Human Resource

Technology

Operational Protocols

Electronic Vaccine Intelligence Network (eVIN)Managing Vaccine Supply Chain in India

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How It Works

eVIN

Cloud Server

MYeVIN

App

eVIN Dashboard

Temperature Logger

eVIN

Mobile App

Health worker enters:

- issues

- receipts

- stock counts

- discards

- orders

Health worker/ manager gets:

- real-time stock views

- alerts on low stock/expiry

- optimal order recommendations

- delivery status

- temperature alarms

- SOP reminders

- general announcements

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Strong Human Resource Network

National team

State Team

Regional OfficersDistrict Managers

Continuous feedback

for health workers and officials in the network

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Big data architecture

gives

actionable analytics for efficient supply managementEnables optimal decisions to ensure stock distribution & availability

TemperaturesensorsNational MoHFW

Central stores

State/Regional Stores

District Stores

Primary Health Centers

eVIN

Support

Connecting First Through The Last Mile – In Real Time

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Enhanced Accountability & Transparency

Real Time dashboard and analytics

at every level

Latest Stock Position Storage Temperature Tracking Geo-Mapped Health CentersDistrict MapsFacility level dashboard

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COVID-19 Impact on Public Health Supply Chains

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Upstream Supply Chain Of Medical Commodities: Challenges

Supply chains of raw material for medical commodities are disruptedMapping of upstream suppliers is very useful to plan and forecast availability of essential medical products using big data and artificial intelligenceUNDP is collaborating with Ministry of Commerce on this initiative. In addition, its very useful also to use existing supply chain systems to track COVID-19 commodities 

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WAREHOUSE MANGEMENT

DISRUPTED DISTRIBUTION

REDUCED

CONSUMPTION

ORDER MANAGEMENT

Low consumption has adverse affect on inventory with risks - stock expiry and quality breach.

Making it difficult to forecast for the next cycle

Lead time vary substantially during pandemic - robust MIS needed for online indentation and tracking

Stock-Outs can increase at the last mile facilities – school, Sub Centers, PHC

Downstream Supply Chain Of Medical Commodities: Challenges

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Tracking COVID-19 supplies through eVIN

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Addressing Supply Chains Under Health System

Lessons Learnt from eVIN Implementation

Diffuse Accountability

Building Flexibility in the SCM systemMultiple Levels of Supply ChainLack of HR Capacity

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Interaction of Supply Chain with Health System Elements

Health System FinancingeVIN Financing (Vaccine)

Supply Chain Financing

Health Product Supply ChainForecastingProcurementWarehousingDistributionHealth Information SystemsHMISeVIN (Vaccine)eAushadhi (Medicines)Coverage, Quality, Efficiency, EquityPopulation - BeneficiariesGovernanceProduct Registration, Procurement, Quality Health Workforce – Supply Chain ManagersAdapted from: Prashant Yadav.  http://dx.doi.org/10.4161/23288604.2014.968005

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HEALTH SYSTEM CHALLENGE: eVIN Learning

Accountability in Supply Chain ManagementCHALLENGEPoor stock visibility

Fragmented accountability for poor stock managementNo clear role definition between State – District – Health centers on governance and responsibilityLast mile health worker often held responsible for stock out

eVIN IMPACTReal time dashboard at all levelsOrder Management system allows for auto-indent generation at lower store before stock outDiscrepancy reports on stock management

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HEALTH SYSTEM CHALLENGE: eVIN Learning

Building flexibility in existing SCM system

CHALLENGESetting up a digital SCM platform at scale uniformly across the country Getting buy-in from public health staff at all levels on implementing a digital SCMBuilding flexibility, innovation and resilience in the SCM platform

eVIN IMPACTA flexible platform in place – can be rapidly adapted to be able to track COVID-related medical commoditiesAn easy to use user-interface and a strong team of mentors at district level ensure greater ownership by least mile workers.

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HEALTH SYSTEM CHALLENGE: eVIN Learning

Multi Level Supply ChainCHALLENGEStock requirement calculated for every level based on population

Variable lead times for distributionMore levels lead to more complexity Small variations in demand at last mile leads to large variations in procurement order at national level- BULL WHIP EFFECT

eVIN IMPACTOptimized stock inventory pipeline management is now possible Distribution frequencies can be optimized and better plannedMoving to consumption-based procurement all levelsLower level demands can now be predicted using big-data analytics algorithms in eVIN

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HEALTH SYSTEM CHALLENGE: eVIN Learning

Lack of HR Capacity and Incentives

CHALLENGELast mile staff are usually midwives or other workers with no skills on stock managementVaccine stock management is not incentivized - no clear goals and outputsNo back up support to store-managers

eVIN IMPACTDistrict level vaccine manager is part of eVIN– support systemS/he is critical for supporting all vaccine handlers in the district and ensuring efficient distribution of vaccinesOnline trouble shooting system in place to resolve field queriesProvision of mobile is big incentive to vaccine handlers at last-mile

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Structured and organized emphasis on People, Process and Technology can overcome major challenges.

Dedicated human resource providing mentoring and support to last mile worker

Standardized uniform processes for forecasting, estimation, distribution and warehousing Effective use of eVIN model for capturing last mile data and flowcasting analytics for decision making. PeopleProcessTechnologyRecommendations: Summary

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Thank You!

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eVINIndiawww.in.undp.org/evin