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[DATE][SPEAKERS NAMES]

The 5th Global Health Supply Chain Summit

November 14 -16, 2012Kigali, Rwanda

 

Optimization of Benin’s Vaccine Logistics SystemPhilippe Jaillard

Hamadou Modibo Dicko

Introduction & Context

Weak logistics affects Benin national immunization program (NIP)Inadequate storage capacity, vaccines and supplies stockouts, lack of dedicated, skilled human resources

delay introduction of new vaccines and immunization missed opportunities

Expansion of NIP–Pending new vaccines introductions: MenA, Rota, HPV, measles 2nd dose, –Broader target population (12-24 months, adolescents, adults)–Adaptation of new technologies and supply chain strategies

Ministry of Health engaged to optimize its vaccines' logistics system–Etats généraux de la vaccination (June 2012)–Technical and financial supports from partners –LOGIVAC project implemented in Benin–Existing evidences and data : 2008 NIP review, 2010 cold chain inventory

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LOGIVAC a joint AMP and WHO project supporting health logistics professionalization in Africa

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Demonstration Sites

Develop innovative model logistics systems;

Serve as demonstration site for students;

Evaluate impact of using certified logisticians on immunization program performance

Reference Center

Training Consultingservices

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• Establish a first regional logistics reference center in Benin with a sustainable business model. .Expand to second location (Eastern/Southern Africa) thereafter

• Develop and implement tailored pre-service and in-service training that provides professional certifications and meets the demands of existing and future health & vaccines supply chains

• Develop a professional network of logistics experts that provide consulting services on health and vaccines logistics

LOGIVAC Consortium of partners (public organizations and private companies) Promote the reference center / tools / project results; Support recognition of a common professional qualification for health supply chain manager; Generate and disseminate vaccine supply chain knowledge

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Optimization of Benin’s EPI Supply chain:a combinaison of method and tools; a collaborative process

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EVM (WHO, UNICEF) CCEM (PATH) HERMES (Vaccine

Modeling Initiative)Optimized

SC system**: we are aware that there might be other confounding factors that facilitate this optimization process

Key issue: ensuring the successfully implementation and country ownership!

CCEM (Cold Chain Equipment Management) assess the quantity and functionality of cold chain equipment •Dynamic inventory system that is continuously updated by the national level

EVM (Effective Vaccine Management)assess the quality of the vaccine management system•EVM assessment report•EVM improvement plan (EVM-IP)

HERMES (Highly Extensive Resource for Modeling the Supply chain) Virtual laboratory, can help in re-designing the supply chain •Measure vaccine availability and supply chain cost

Transport system evaluation

National cold room assessment

Workshop 1 : identification of

scenariiWorkshop 2 :

strategic orientationsOptimization

planning

Results (1/4): Effective Vaccine Management (EVM) Assessment

• NOTE: satisfactory score for an EVM is 80%

Source: Benin’s EVM assessment 2012

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# Criteria

Levels

National Department Regional/relais

Lowest distribution level (Commune)

Service delivery point

1 Vaccine arrival/receving 58% Non applicable

2 Storage temperature 41% 75% 95% 70% 77%

3 Storage capacity 33% 55% 28% 70% 69%

4Buildings, equipment & transport 67% 79% 70% 67% 78%

5 Maintenance 50% 55% 59% 63% 54%

6 Stock management 72% 79% 74% 61% 59%

7 Distribution 64% 31% 32% 57% 69%

8 Vaccine management 68% 81% 57% 62% 80%

9 Information system 78% 89% 100% 61%Non applicable

Results (2/4): CCEM – Equipment source of energy and age (SDP only)

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Many fridges rely on

Kerosene (expensive).

Many fridges are amortized and

need replacement

> 50% older than 10 years.

Results (2b/4): CCEM – Option for reduction of operational cost

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Replace absorption fridges >10 years (n=379) with:- Ice lined refrigerators where possible- Solar direct drive refrigerator where no power is available

Capital cost : 258 728 USDSaving on operational costs : 180 000 USD/year

*Présentement le réfrigérateur 410 EK refrigerators est utilisé dans les sites qui ont >8 heures d’electricité par jour

Results (3a/4): Supply chain design Actual situation

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Results 3b/4 : Supply chain design options

Status quo

1. Consolidation to zone level

2. Actual + commune

level removed

3. 12 dept store + commune

level removed

Results (3c/4): HERMES – Vaccine availability

Source: Benin’s HERMES result 2012

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Actual system

Scenario 1: consolidation to Health

zone

Scenario 2: Acutal system

without the communes

(LDL)

Scenario 3: 12 departments and

without the communes (LDL)

Vaccine availability 93% 94% 96% 99%

With Rota virus 71% 64% 91% 93%

Added capacity+ Rota Virus 100% 100% 100% 100%

4 loops-Added capacity+ Rota Virus

99% 99% 99% 100%

6 loops-Added capacity+ Rota Virus

99% 99% 99% 100%

10 loops-Added capacity+ Rota Virus

99% 99% 99% 100%

Results (3d/4): HERMES – For Each Scenario, Capital Expenditures to Achieve and Annual Operating Costs

Source : The Business Case for Vaccine Supply Chain Redesign in the Republic of BeninEVM+HERMES Analysis: Consolidating Communes to Zone Sanitaire plus Implementing a 4x4 Truck Loop

Delivery System to the Health Centers is the Dominant Scenario Bruce Y. Lee, et all (unpublished data)

Results (3e/4): HERMES – Logistics cost estimations

Source : The Business Case for Vaccine Supply Chain Redesign in the Republic of BeninEVM+HERMES Analysis: Consolidating Communes to Zone Sanitaire plus Implementing a 4x4 Truck Loop

Delivery System to the Health Centers is the Dominant Scenario; Bruce Y. Lee, et all (unpublished data)

Logistics Cost per Dose Administered for each Scenario after Rotavirus Introduction and with Capacity Added

Results (3f/4): HERMES – Logistics cost estimations

Source : The Business Case for Vaccine Supply Chain Redesign in the Republic of BeninEVM+HERMES Analysis: Consolidating Communes to Zone Sanitaire plus Implementing a 4x4 Truck Loop

Delivery System to the Health Centers is the Dominant Scenario; Bruce Y. Lee, et all (unpublished data)

Cumulative Cost Savings over time from Implementing Redesign vs. Simply Augmenting Capacity of Current System*

Results (3f/4): HERMES – Vaccines logistics costs

Source : The Business Case for Vaccine Supply Chain Redesign in the Republic of BeninEVM+HERMES Analysis: Consolidating Communes to Zone Sanitaire plus Implementing a 4x4 Truck Loop

Delivery System to the Health Centers is the Dominant Scenario Bruce Y. Lee, et all (unpublished data)

• Scenario 1 : Consolidating Commune level to zone level• Capital cost : 234 087 USD• Logistics Cost per dose : 0,19 USD (with truck loop)• Saving cost (cumulative):

– after 3 years : 322 953 USD – After 5 years : 504 255 USD

• Dominant scenario, choosen by MoH

Results (4/4): Conclusion from the 2nd optimization workshop

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Strategic Orientations

• Changing the EPI’s supply chain design (reduction of # of storage points)

• Acquisition of solar equipment (in replacement of Kerosene ones)

• Professionalization of health logistics (to properly handle change implementation)

• Optimization of resources (Integration in some segment of the SC)

Global Optimization Plan

• Equipment management system (LMIS, CC rehabilitation and maintenance plans)

• Transport management system

• Development of health logistics

• EVM Improvement plan (vaccine management)

• Investment plan for the logistics system

EVM + HERMES Pilot in Benin Next steps towards the implementation plan

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Lessons learned and conclusion

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• Strong involvement within MoH • High level cadres • NIP director and team• other directorates within

MoH (equipment, pharmacy…)

• Global partnership (PAG)

• Potential resistance due to change management

• Country willingness to make strategic change in NIP Logistics system

• Country’s ability to mobilize fund• Assessment and modeling :

USD 35 000 (without HR)• Optimization plan

• Strong technical supports from partners

• Implication of MoH agents• Available and Skilled

• A valid inventory (< 2 years old)

Application and scale upLessons learnt

Contribution to EVM+HERMES in Benin

• VMI : Bruce Y. Lee, MD, MBA, Shawn T. Brown, PhD, Diana L. Connor, MPH and Angela R. Wateska, MPH, Bryan A. Norman, PhD and Jayant Rajgopal, PhD, Brigid E. Cakouros, MPH, Sheng-I Chen, PhD, Erin G. Claypool, PhD, Leila A. Haidari, BS, Veena Karir, PharmD, Jim Leonard, Leslie E. Mueller, BS, Proma Paul, MHS, Rosyln Phillips, MPH, Michelle M. Schmitz, BA, Joel S. Welling, PhD, Yu-Ting Weng, MS

• AMP: Benjamin Schreiber, Philippe Jaillard, Hamadou Dicko, Melanie Avella, Caroline LeBrun, Alfred Da Silva

• UNICEF: Dmitri Davydov, Terry Hart, Flavia Guidetti, Bibata Pare, Hortence Kossou

• Bill and Melinda Gates Foundation: Raja Rao, Skye Gilbert, James Cheyne• PATH/Optimize: Mercy Mvundura, Sophie Newland, Modibo Dicko• OMS : Aristide Sossou• Ministry of Health in Benin : Ndeye Bassabi, Justin Sossou, Justin Djidonou

LOGIVAC – a project of AMP and WHO

Thank you

www.logivac.orgwww.amp-vaccinology.org