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The 6th Global Health Supply Chain Summit

November 18 -20, 2013Addis Ababa, Ethiopia 

Coca-Cola and Ghana Health Service learning from each other

David Sarley BMGF

“If Coke can deliver to every village, surely we can learn from them to improve public health supply chains”

Actually, although Coca-Cola are not delivering to every village, we can learn from them but we need to translate commercial best practices to public health settings.RED meets REDCoca-Cola: RED = Right Execution DailyGhana Health Service: RED = Reach Every DistrictThis work was undertake by Accenture Development Partners in collaboration with Coca-Cola and Ghana Health Service and funded by the Bill and Melinda Gates Foundation

© 2013

The Cold Chain Uptime project translated Coca-Cola’s capabilities in cooler maintenance into a maintenance model for GHS’ cold chain

Coca-Cola CapabilitiesGHS’ Aspirations

Reduce frequency of equipment break downReduce the fault to repair time

Cold Chain Inventory Analysis

Preventative Maintenance ModelPilot and Evaluation of Maintenance Model Business Case for National Roll OutPhase One DeliverablesCold Chain Uptime Objectives© 2013

Ghana Health Services’ cold chain inventory is not functioning, and the high number of models make it difficult to maintain effectively

Key FindingsImplications

123

4

51 out of every 4 units is not functioning11% of the inventory does not have a recorded functioning statusHealth facilities are forced to cope with a cold chain that has a large volume of non-functioning equipmentLimited data keeping practices implicate the ability to make effective decisionsProcurement compliance is relatively well maintainedAn inventory with limited make/model standardisation is expensive to maintain because of increased spare parts required and reduced technician productivityAn aging inventory results in higher total cost of ownership because of frequent breakdowns and expensive repairs99% of inventory is purpose made for vaccine related useThere are over 80 different models of cold chain equipment41% of the inventory is over 10 years old © 2013

Coca-Cola’s model has been highly successful, as they maintain a large inventory with minimal staff and downtime

Critical Success FactorsFocus on preventative maintenance increases equipment availability

Coca-Cola delegates accountability to enforce uptime of coolersTraining of maintenance, supervision personnel and users reduces need for corrective maintenance and downtimeCoca-Cola’s cooler uptime percentage is 99.3%

Coca-Cola

StatisticsNational equipment inventory 15,600No. of cooler models10No. of national technicians26No. of coolers per technician~ 600Average daily cooler visits per technician4

No. of times cooler serviced per year

2

Annual

c

ooler

services target

per technician

1,200

Current equipment

not functioning

~0.6%

© 2013

The maintenance model developed for GHS requires fundamental changes to their operations and ways of working

Regional technicians

exclusively responsible for cold chain equipmentDaily routes scheduled for targeted equipment servicesDocumented maintenance activities to

Track performanceObtain necessary approvals

Generate reports for data driven decision makingRegional spare parts available when required123

4Key Components of Proposed Preventative Maintenance Model © 2013

We tested the feasibility and practicality of the maintenance model through a five-week pilot in the Volta region

Reasonable number of units that can be serviced in a dayInventory data accuracyFault correction response and repair timesObserved impacts and benefits of preventative maintenance

The key measurements of the pilot wereWhat is different about GHS’ operating environment?What resources are required to perform and manage equipment servicing?

Can the response and fault repair times be improved? What will it cost to deliver the maintenance model?

The pilot aimed to answer the following questionsPilot Districts:AdakluAktasi SouthCentral TonguHo MunicipalSouth DayiVolta Region, Ghana© 2013Included several districts without Coca-Cola

The outcomes of the pilot allowed us to refine the maintenance model, develop metrics and gain further insight into challenges in the field

Insight from Pilot

Lack of spare parts availability was a key issue in non-functioning equipment, as there is no dedicated funding for spare parts Common faults could be resolved through purchase of cheap parts (e.g. digital thermometers), or better installation of partsOver 50% of inventory data was incorrectFacility staff reported that 50% of units waited over a year to be repairedOver 95% of units never been serviced

Over 60% of units do not have stable electricity supply

Key Metrics for MaintenanceNo. of units technician should service per day2-4 unitsTarget timescale for all equipment to be serviced6 months Average time for servicing1.1 hrsTravel time per day

3.25 hrs

Distance travelled before overnight stay is cost-efficient

80km

Number of units a technician should be responsible

for

(based on health facility density)

150-350 units

Pilot Outcomes and Implications

© 2013

From our work on the cold chain, we have developed five key lessons learned

Funding for spare parts

1A stable supply of spare parts is required to maintain equipment – currently there is no specific funding of spare partsFacilities purchase parts from the local market which break easily

Data

collection2Accurate data needs to be captured and analysed to make future cold chain decisions, e.g. maps required for route planning, lifecycle costs of different models, cold chain uptime ratesOrganisation alignment3Clear roles and responsibilities are required to enable accountability, as often multiple departments at the national and regional level are involved in distribution and maintenance

Power stabilisers

4

Power

stabilisers

are required to protect expensive equipment from damage, e.g.

A TCW 3000 was damaged from a possible lightning strike and rendered useless until repaired four months later

Training for all levels

5

Training is required across all areas, from equipment installation and usage to maintenance processes and technical repair

Training is also required for support staff, e.g. in data entry

© 2013

To fully embed the maintenance model, we are developing a cold chain inventory database and planning for national rollout

Complete

Cold Chain UptimeDevelopment of preventative maintenance modelPilot in 1 regionImplementation of CCEI Module and Asset Tagging

Tag all cold chain equipment inventory assets and clean data

Implement Cold Chain Equipment Inventory (CCEI) tool, which integrates to the District Health Information System (DHIMS)Joint implementation by ADP, GHS, UNICEF and PATHNational Rollout of Preventative Maintenance ModelDevelop spare parts management processEquip and train all regional technicians and support staff in technical and maintenance procedures Monitor rollout in-field Use GAVI HSS fundsOn going support from local Coca-Cola bottlerJune 2013Nov 2013Feb 2014

In Progress

Planned

© 2013

Coca-Cola and GHS partnered in this phase by sharing experiences and challenges and working together in the field during the pilot, putting the maintenance model in action

Coca-Cola and GHS refrigeration technicians (Maxwell and Livingstone) sharing preventative maintenance techniques.John Dadzie and Joejo Acquah discussing common challenges of maintaining refrigeration equipment.

Recording the vaccine fridge details on the technician’s daily accomplishment form.Livingstone and Maxwell geared up to perform preventative maintenance.

© 2013

Photo Credit: Rita Bulusu Accenture