TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Modibo Dicko
  2. Supply chain and logistics
  3. Wednesday, 24 February 2016

Dear Supply Chain Managers and Friends,

A few days ago, I conducted a supervisory visit to a health post in Senegal to check the implementation of the "Informed Push Model" project (IPM), which I have lead since last August, and which has been distributing family planning products (9 to 11 products depending on Regions) to all public health service delivery points (SDPs) across the country since 2013. Starting in October 2015, we added 17 United Nations Life Saving Commodities for maternal and child health as well as seven products from HIV/AIDS, malaria, and tuberculosis public health programs. We also added vaccines in the region of Saint-Louis to continue the legacy of the former Project Optimize.

Within IPM, we are focused on the health post pharmacy store, and its manager. So I went with my team and visited the depot of a rural health post in the District and Region of Fatick. The visit took nearly three hours, and as when my team and I were leaving—as I was already crossing the gate—I remembered; vaccines! Immunization. The vaccine fridge. I stopped abruptly, turned back and looked for the head nurse in order to take a look in the fridge.

When I came back to the car, while the other team members were chatting, I was silently remembering my 17-year WHO experience, during which I had visited hundreds of centers and health posts in Africa, Asia, Europe, and even the Pacific Islands. I was interested only in the vaccines, the fridges, vaccination syringes and their destruction after use. I do not remember ever once going to check the pharmacy store that received, stored and managed medicines and other health products for all other healthcare services provided in health centers and health posts, including contraceptives for family planning! How was this possible? How could I have been wearing blinders for 17 years that only let me see immunization, vaccines, syringes and nothing else?

I felt ashamed of myself!

I imagined the poor nurses someday receiving "supervisory-monitoring-evaluation" teams from immunization programs; the next day, those from family planning programs; two days later, those of the malaria programs…then those from the HIV/ AIDS; then those from the tuberculosis program, then IMCI, then neglected tropical diseases, etc., etc.! And each of those teams was coming with its own requirements, its own data tables to fill, stressing its own deadlines, requiring the clinical staff attend its own training programs.

And I was ashamed of the health system!

How can we work in such a fragmented manner, each of us with own blinders, each of us in his/her own silo? And will it continue with every new global initiative?

However, there is a glimmer of hope:

  1. During the rest of my supervisory visits, I checked fridges in four other health posts; they all contained products other than vaccines! What was a “crime de lèse-majesté” some time ago, now seems to be accepted as quite normal. This should encourage us to open our eyes. (See the WHO-UNICEF joint statement on integrating cold chain: http://www.unicef.org/health/files/EPI_cold_chain_WHO_UNICEF_joint_statement_A4_rev2_5-14-15_(3).pdf)
  2. In Ouidah, Benin, the Regional Public Health Institute trains "health logisticians" (LogiVac). But are we sure that when the trainees go back home, they do not become logisticians of particular programs?
  3. I recently saw a UNICEF post publication that was called "Essential Health and Immunization Commodity Specialist '!

Then I smiled as I was remembering two things:

  • The first one is the series of 27 training modules prepared by WHO in 1984, which I came across when I joined WHO in 1995: it was called “Logistics and Cold Chain for Primary Health Care”! In addition to vaccines it covered contraceptives, essential drugs, malaria supplies and ORS.
  • The second is a phrase I read in an article written by Lee Weng Choy in “The Nation” on 16 September 2004 in Bangkok, Thailand: “The dreaming of what is to come is seemingly what is to come back!

Those of us working in health supply chains must remember to look back often in order to carry forward with us the good things of the past and use them to build the foundation of the future. As George Orwell once said: “He who controls the past, controls the future.” We must think across programs, holistically. Even if the supply chains we work in are not integrated, we owe it to our clients and patients and fellow health care workers to be integrated in our thinking and in our actions. Integration starts with each of us.

Good morning, good day, good evening depending on where you are!

Modibo

Dakar

Patrick Lydon Accepted Answer

Thanks for sharing this great story from the field Modibo. It reminded me of a post Chris (Wright) shared a few months back about the story of when he was sitting with an EPI Manager discussing support for better visibility and analysis of immunization supply chain data. When asked if data was also collected on the other non-EPI commodities (that we know are often stored in the cold chain) the EPI team seemed surprised by the question: “those aren’t our commodities” the program logistician explained. While it’s true they are not EPI commodities, they are occupying space in the cold chain in many countries at service levels. More and more pharmaceuticals are being developed that require some level of temperature control. And the volumes for products like Oxytocin or anti-venoms are orders of magnitude larger than the combined set of recommended EPI vaccines. The strain on the cold chain at health facility level will only increase. It’s high time EPI moves in the direction of supply chain convergence with other health commodity supply chains.

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  2. Supply chain and logistics
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