TechNet-21 - Forum

  1. John Lloyd
  2. Supply chain and logistics
  3. Sunday, 26 November 2017

IAPHL are debating the agenda for their next Webinar. Some are suggesting a focus on aspects of logistics integration for CD and NCD programs. For me, this is the 'Elephant-in-the-room' of future distribution strategy for country health pogrammes. Incorporating the distribution of vaccines and the fast-growing category of medicines that require cooling (i.e. insulin) and CT storage would have much to discuss, including the following three strategic issues:

1. Defining and achieving high efficiency distribution by:

  • requiring that every national list of medicines contains the secondary packed volume of each generic and name-brand medicine so that cooled storage capacity can be correctly anticipated at time of tender;
  • requiring that every medicine procured declares storage conditions (temperature range, humidity, sensitivity to light radiation) to ensure availability of required conditions of transport and storage;
  • assessing in the country context whether the stages of transport in distribution can be more efficiently handled by active-refrigerated vehicles or passive-cooled insulated cold boxes/packaging;
  • employing back-loading practices to bring sealed sharps boxes containing used syringes to central disposal hubs.

2. Optimizing the distribution network by:

  • minimizing the number of stages of transport and storage at which products are handled and repacked for onward distribution;
  • exploiting the current state-of-the-art energy management technologies in the design of new warehousing and for transport. As autonomy of electric vehicles now reaches 400 kms, take advantage of greater efficiency of electric vehicles, lower maintenance and cost reduction by solar-grid linked electricity management;
  • using IT applications to maximise efficiency of supply trips and vehicle loading and also to provide GPS tracking and temperature monitoring with remote alarms.

3. Calm the fears of 'silo' programme logistics officials and support them by:

  • using IT and communications technologies to maintain the control functions (distributing specific groups of vaccines or medicines) entirely in their hands via computer applications;
  • offering freedom of access to vehicles and warehousing for PH officials to ‘control quality’ by inspection and routine review meetings with the distribution central management;
  • as plans are laid for transition to integrated distribution, build time and progressive implementation stage by stage to allow time to build confidence. If outsourcing is introduced or expanded, allow for contract supervision and quality monitoring.

Join the IAPHL debate and add your thoughts to theirs? 

Lloyd John

26 Novmber 2017


Accepted Answer Pending Moderation

John's proposal is one that can enable a big step forward. Indeed in many countries intergration of drugs other than vaccines is already a reality because most programs use their country's Central Medical Store for storing and distributing drugs up to regional or district levels; and from there districts and health posts respectively take over the transport and distribution again in an integrated manner. What is problematic in many countries though is the reluctance of immunization programs to join the leading pack of the race. This should then be the subject of the discussion with the different points suggested by John including one, which is very important and that is the idea to use IT and communications to make immunization managers feel they still remain "in control" of what is happening to "their" vaccines!

  1. more than a month ago
  2. Supply chain and logistics
  3. # 1
Accepted Answer Pending Moderation

The focus on the supply chain for the EPI quite naturally rests on the special considerations of the cold chain. Should any other project wish to share the cold aspects of the EPI supply chain for products such as oxytocin and insulin, then they should follow the same guidelines created and used by the EPI. John expresses this clearly and correctly.

While products such as oxytocin and insulin have a great need for cold chain technologies, the EPI supply chain has other significant aspects which are even more important for a large number of other projects. Data, allowing for end-to-end control of the supply chain, and tracking the financial flows, are far superior within the EPI than in most other public sector medical supply chains.

Many projects would benefit if they were able to integrate into the EPI systems. However it must be said that while the EPI has a superior supply chain system, it is woefully dated and appears to be stuck in a process that is decades old. Looking at how the private sector now operates supply chains, indicates that significant improvements, enabling managers all along the supply chain, are overdue.

Rather than discuss integration of current medical supply systems it may be more beneficial for both the EPI and projects, such as NCD, to jointly design a future modern supply chain, taking into account the individual and combined needs of all.

  1. more than a month ago
  2. Supply chain and logistics
  3. # 2
Accepted Answer Pending Moderation

The question of integrating supply systems has been raised a few times already, and was on the agenda of the Copenhagen TechNet Meeting, which took place -  in 2003, if I remember correctly. At that time I presented a paper (please see attached copy). Now Umit correctly points out that, often, there is a certain resistance or fear of "handing over the cold chain" by Immunization Programme  Managers. This concern was already voiced in 2003, and I coined it in my presentation at the TechNet Meeing, "Who is taking over who?". 

Another point is that integration of supply systems, in many cases, is already partially done, because ordering/tendering is done by the Medical Stores; and storage at the central and regional level is handled by medical stores, leaving distribution from regional stores to district stores and health center stores to be done by the immunization programme. This is explained with details in my paper. The role performed by the Medical Stores brings me to present another argument for integrating the supply systems. The Medical Stores, particularly in Africa, are managed by professionals, i.e. by pharmacists, called Technical Officers with  3-4 years of education in pharmacy. I have extensive experience of cooperating with these people from working in essential drugs programmes in Zimbabwe, Zambia, and Mozambique. The pharma techs are indeed very good in logistics, having to handle a substantial number of supply items in the Essential Drugs Programmes that can amount to 500-600 items for regional hospitals and district hospitals, and 150 for health centers, i.e. 4-5 times more items than the number found in an immunization programme. The logistics of the essential drugs programmes are dealt with in the "Yellow Bible" edited by Management Sciences for Health, Boston, and more up- to- date by the excellent software programme mSupply, available free of charge for non-comercial users. The manual of the mSupply describes very clearly the problems in a supply system and how to handle them.

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  1. more than a month ago
  2. Supply chain and logistics
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