Health & Humanitarian - The Supply Chain Review , Issue 4, Sep. 2017 by Pamela Steele Associates Ltd

HEALTH & HUMANITARIAN The Supply Chain Review

Issue 4 September 2017 Produced by PSA Ltd

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Contents

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EDITOR IN CHIEF Pamela Steele Sara A. Khan Editorial Team Susana Cunha

PROFESSIONALISATION CORNER with Gloria Modupe Omatie Chukwumah Honouring Achievement in Health Supply Chain at the Ministry of Health, Nigeria

PSA Training Programs â&#x20AC;&#x201C; in Nairobi, Bangkok and Dubai Supply Chain Leadership: A Case of Rajasthan, India SIAPS - Defeating Malaria through Pharmaceutical Systems Strengthening

IMPACT Team Network - transforming supply chains through data Cash Transfer Programming Fritz/CILT(UK) updates their Certification Programmes

Editor’s Note The past decades have seen dramatic progress in global health as health has become a key priority for international stakeholders. We can only be pleased that this heightened priority for health has remained at the heart of many, no matter what circumstances the world has been faced with. Strong partnerships in global health have been formed and stakeholders have been aligned towards a common goal, especially for public health, namely the Sustainable Development Goal (SDG) 3 to “ensure good health and well-being for all”. Although much progress has been made, it is evident that progress needs to be accelerated to meet SDG targets by 2030, focusing not just on individual diseases or health emergencies, but also paying attention to sustainable health systems in times of stability. Increased focus on people, process, policies, finance and governance may remove the constraints that block access to quality health services for many. Thus, a need to take a holistic approach to improvements in health systems is required, so that solutions can be found that both support and strengthen a resilient health system. Many would claim that they are, in fact, strengthening a health system by providing tools and implementing global strategies with incountry partners. However, this is often mere support for the health system as it comes in disorganised solutions to the country with no real impact on lasting change. The focus should

instead be on developing in-country capacity through localized solutions that meets countryspecific needs for health system strengthening. We need to move away from the assumption that tools and strategies built on ‘one-size fits all’ will lead to sustainability and most importantly, country ownership. PSA understands the need to provide effective, sustainable and country-led solutions for the global health sector. Although, we focus on supply chain capacity development for low- and middle-income countries, we see the health supply chain as an integral part in the overall health system strengthening. Capacity development for individuals and governments is at the heart of what we do and the basis of our day-to-day work. In this issue, we have highlighted stories that touch on some of the key indicators for a wellfunctioning supply chain. The people aspect in the supply chain sector is brought to you by talking to Pharm. Gloria Chukwumah. As we look at processes and policies for public health supply chain, we bring you the case of Rajasthan in India. For improvements in systems, SIAPS shares their in-country success story. The achievements are many and, as part of the sector, we are proud to share some of them with our friends and partners through this issue. We hope that you will enjoy reading the issue!

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PROFESSIONALISATION CORNER A conversation with Gloria Modupe Omatie Chukwumah Gloria Chukwumah is the Director & Head of Department for Food & Drug Services at the Federal Ministry of Health in Nigeria. She is a pharmacist by profession and has had a long and successful career in the public health sector. Gloria was recently awarded the â&#x20AC;&#x153;Outstanding Achievement in Supply Chain Management 2017â&#x20AC;? award through the African Women in Supply Chain Leadership Initiative.

s a seasoned pharmacist and supply chain specialist, Gloria Chukwumah has had an accomplished career in public health and governance. Prior to Gloria’s long career within the public health sector beginning as a pharmacist, she had always been troubled by the high maternal and neonatal mortality in Nigeria. “I have always had a deepseated passion for the vulnerable population, especially women and children”. So, she aimed for positions that had a strong chance to influence and sway decisions that would help improve the lives of the most vulnerable in the country. Gloria was committed to the cause of public health with the expectation that the deplorable conditions of women and children can be improved, period. At the same time, she also wanted to make significant improvements to the overall health conditions for the broader public, who often had very limited healthcare resources.

Africa has afforded me the opportunity to fly through these changes from the cock-pit.”

Put women in the SCM cock-pit!

The passion fuelling the journey Gloria’s journey into health supply chain started in 2008 after an intensive training sponsored by USAID. “Getting full knowledge of the intricacies behind each step of the value chain enervated me to apply myself actively, to ensure I contribute towards improving public health and supply chain.” She became the founder and first National Coordinator of the “National Product Supply

Chain

Management

Programme,

NPSCMP” in Nigeria and emphasizes that; “it has been an honor leading this charge towards [supply chain] integration. Having been the first National Coordinator of the biggest Supply Chain Integration Programme in sub Saharan

Gloria’s thoughts on being a female leader in the field of heath supply chain who drives the change from the cockpit? Gloria recognizes that being a leader in the field of health supply chain has afforded her the opportunity to make an impact in an area that has a far-reaching domino effect across various parts of Nigeria and even beyond. However, she points to the fact that although this feeling is pleasing, health supply chain leadership is still a maledominated field, as the case with other sectors in Nigeria.

“…health supply chain leadership is still a male dominated field Gloria encourages women to grow in supply chain so that they move from being mere influencers to the ‘powers’ in the public health, to

actually becoming the ‘powers’ themselves. “The sector’s workforce is already dominated by women, who need to be sensitized and motivated further to ensure they attain positions that will provide them a platform to make critical evidence based unbiased decisions.” Gloria mentions that there are still cultural norms in Nigeria that are preventing young women from entering a career in Supply Chain. She adds that: “The cultural norms in Nigeria program woman to have a sub-par mentality especially as it relates to men and taking on leadership positions. Therefore, there has to be a rigorous mentality shift to make women realize that they can respectfully compete even for positions that are culturally viewed as professions suitable for men only.” Nonetheless, the health supply chain sector is changing by trying to create greater gender balance and Gloria is proud and humbled to be on the “vanguard of this change”.

Looking towards the future… After working in the public health sector for so many years, Gloria realises that the public health supply chain in Nigeria is still plagued with numerous pitfalls. Such challenges especially include lack of political buy-in often due to unawareness of how important the supply chain is. She still sees gender discrimination, lack of coordination, poor quantification, stock outs, lack of commodity availability and poor patient access to mention few across the country. “The National Product Supply Chain Management Programme (NPSCMP)” of the Federal Ministry Health, Nigeria is trying to change all of that with Gloria at the helm. Through the NPSCMP, Supply Chain Processes are currently being integrated using already established models that are scaled up to accommodate hitherto parallel systems. Gloria points to the fact that, along with

Gloria Chukwumah with the Honourable Minister of Health, Nigeria, Prof. Isaac Adewole at the awards ceremony on July 25, 2017

processes, technology and human resources are equally important factors for a well-

functioning health supply chain - both areas that have become a priority for the country. Gloria is hopeful for the future; “In reality, supply chain strengthening is a continuous process and I must say that with the current influx of women in key health leadership positions and the set-up of efficient systems using the right kind of skilled personnel; improvements are gradually more evident in the public health supply chain in Nigeria.” PSA would like to thank Gloria for taking the time to speak with us and we wish her well as she continues her journey in public health.

Photo © PSA and FreeImages

Honouring Achievement in Health Supply Chain at the Ministry of Health, Nigeria

amela Steele Associates (PSA) proudly recognized the outstanding achievements in supply chain leadership by Ms Gloria Chukwumah, Director & Head of Department, Food & Drug Services, Federal Ministry of Health, Nigeria at an award ceremony at the offices of the Honourable Minister of Health, Professor Isaac Adewole in Abuja, Nigeria. This was the launch of an annual award meant to give visibility to the achievements of Women in Supply Chain Leadership by PSA.

expanding its scope of impact at both national and state level in Nigeria.

Gloria Chukwumah is the first to be awarded the “Outstanding Achievement as an African Woman in Supply Chain Leadership” award. As a seasoned public health, industrial pharmacist and supply chain specialist, Ms Chukwumah has an accomplished career of strong leadership and governance, which has seen her department

Ms Chukwumah’s outstanding achievements in Supply Chain include, among many, that she is:

The Honourable Minister of Health, Prof. Isaac Adewole congratulated the awardee describing Ms Chukwumah as: “an outstanding person, a gogetter, formidable manager, very aggressive and unrelenting in her efforts to achieve her targets.” He added that “her leadership style has led to the improvement in the health supply chain management in the country.”

1. The founding National Coordinator of the National Product Supply Chain Management Programme, NPSCMP.

The Hon. Minister of Health, Prof. Isaac Adewole, with Pamela Steele, CEO, PSA, Pharmacist Gloria O. Chukwumah and Akut Stephen, National Representative for PSA in Abuja, Nigeria

2. The first National Coordinator of the Nigeria Supply Chain Integration ProjectNSCIP. 3. The initiator for the LMCU Project – Logistics Management Coordinating Units – a project to empower state Directors of Pharmaceutical Services (DPS) to take charge of all matters related to Public Health pharmaceutical services in the states.

collaboration in this ceremony and for welcoming PSA to their offices, emphasizing that; “I am humbled to celebrate the achievements of African woman in supply chain leadership such as Ms Chukwumah, who has achieved such great things in this field where not many women have made their mark yet”. PSA recognises Ms Chukwumah’s extraordinary passion, drive for results and pioneering works in the advancement of Pharmaceutical Services in the public health sector, through her knowledge of international procurement & supply chain management. In addition to this distinction, PSA has awarded two organisations for Outstanding Achievement in Supply Chain; Sudan’s National Medical Supplies Fund (NMSF) for “Transformation of Central Medical Stores,” and Kenya’s Medical Supplies Authority (KEMSA) for “Development of Supply Chain Knowledge through South-South Exchange.”

Pamela Steele, Founder and CEO of PSA, thanked the Ministry of Health, Nigeria for their

Through this annual award, PSA looks forward to recognizing the outstanding individuals and organisations in the supply chain sector making notable achievement each year.

PSA Training Programs Pamela Steele Associates Ltd. (PSA) invites global health supply chain professionals to the 3rd edition of Health Supply Chain Training in English and French in Nairobi, Kenya. This year, we will also launch the Human Resources for Health Supply Chain Management, which has been highly sought after. Health Supply Chain Management: 20 - 24 November, 2017 Gestion de la chaîne d’approvisionnement de la santé publique: 20 – 24 novembre 2017 Human Resources for Health Supply Chain Management: 27 November - 1 December, 2017 PSA Skills Profile

Who Should Attend?

As part of the training, participants will be given complementary access to the Health Supply Chain Skills Profile (Competency Assessment). The Skills Profile is an online questionnaire that measures technical, management and leadership competencies covering six key areas of health supply chain work, as set out in the People that Deliver (PtD) Health Supply Chain Competency Framework for Managers and Leaders. The resulting personal feedback report provides three scorecards that profile your technical, management and leadership competencies.

The courses are targeted at people who are responsible for planning, procuring, distributing or monitoring health program supplies. Specific positions may include: • • • • •

Pharmacy managers Warehouse in-charge Health programme managers Staff of Central Medical Stores Technical assistance providers

For more information and registration, contact Yukabeth Otieno at info@pamsteele.co.uk or visit www.pamsteele.co.uk

Supply Chain Leadership: A Case of Rajasthan, India by Sanjay Saha in collaboration with UNICEF Supply Division

The following case describes the establishment of a centralized procurement agency in the state of Rajasthan. The agency has led to the makeover of the supply chain workforce and helped to ensure 70 million people access to essential medicines.

developed by the RHSDP, and helped to create a fully sustainable and enabling environment for supply chain functions.

Successes

Evolution of the Rajasthan Medical Services Corporation Rajasthan initially embarked on its journey towards ‘Access to Essential Medicines for All’ in 2006, when the government began to open medicines stores providing essential medicines at a cheaper rate than available at private medicine vendors. However, the decentralised nature of procurement and a weak supply chain in the state led to unavailability of medicines in the government stores. The State of Rajasthan then began the health systems strengthening project, ‘The Rajasthan Health Systems Developing Project (RHSDP).’ Running from 2006 to 2011, supported and funded by the World Bank, the RHSDP had a substantial impact and led to a large improvement in healthcare indicators in the state. However, access to medicines remained a problem due to decentralised procurement mechanisms. Following the success of RHSDP, the state of Rajasthan established a ‘Free Medicines Scheme’ in 2011. To help achieve this, a centralised agency, Rajasthan Medical Services Corporation (RMSC), was established in May 2011 to manage the overall procurement and supply chain of health commodities under this scheme. The state adopted a collaborative approach to manage the supply chain in the state and all important stakeholders were involved in decision-making. The RMSC took over the supply chain in the state using the resources which were already strengthened and

The first initiative of the RMSC was to develop a specialized supply chain workforce. This was managed through collaboration with the Department of Medical Health and Services (DMHS), where the central and district level professionals were recruited and managed by RMSC and the other staff below the district levels are managed by DMHS. The supply chain in the state of Rajasthan is now managed by 3000-4000 personnel working at various levels. There are dedicated staff at the centre for procurement, logistics, quality assurance, IT, finance and other related functions. The government has also positioned staff at the district level (at each of the 40 District Warehouses) and at each Drug Distribution Centre (more than 3,000) to help with drug dispensing and managing the drug inventory. All new personnel had clear job roles and responsibilities with adequate training. A new web-based application named Eaushadhi is deployed to help manage the inventory, order management and data management. E-aushadhi simplifies data collection and retrieval, which is used to aid annual forecasting of drugs required. This addresses earlier challenges of difficulty in forecasting accurately from the manual system previously used. Furthermore, to manage this software, IT officers have been positioned at most of the service delivery points, and

wherever an IT officer is not present, the pharmacist is trained to manage the system. The mandate for RMSC is to ensure that all the products on the Essential Drugs List reach the service delivery points for dispensing at the right quantity, quality, price and time. To make the operations sustainable, RMSC levies a 5% operations fee on the total procurement budget from the Government of Rajasthan, it processes annually. In 2011 the RMSC started supplying around 200 essential medicines, which has now increased to more than 600. The state has seen a tremendous improvement in both supply chain and health indicators in the last 6 years from when the supply chain structure was strengthened by the government.

Challenges The remote nature of Rajasthan state made it challenging to roll out the system initially. Rajasthan is the largest state in the country in size and has one of Indiaâ&#x20AC;&#x2122;s most difficult terrains â&#x20AC;&#x201C; 60% of the area of the state is comprised of the Thar Desert. This meant that making all the systems and guidance available took more time than expected. The corporation also faced

difficulties in sourcing personnel with suitable technical expertise. This was remedied by retaining staff from the RHSDP, getting others deputed from the Department of Health and Family Welfare, and then training staff based on their job responsibilities.

Lessons Learned The RMSC helped to establish an enabling environment for supply chain functions. One of the main reasons of the continued success of the system is the availability of the adequate workforce at each level. This highlights the importance of hiring appropriate staff with sufficient technical expertise. The case of Rajasthan also indicates the benefits of a centralized procurement agency to procure medicines in bulk and at lower prices. For the full case study, please contact Adebayo Adekola, UNICEF Supply Division at aadekola@unicef.org . Photo ÂŠ Sanjay Saha, Freeimages, DepositPhotos

SIAPS Defeating Malaria through Pharmaceutical Systems Strengthening By the SIAPS Program

A technician tests a child for malaria at a health center in Kinshasa, DRC.

Between 2000 and 2015, great strides have been made in fighting malaria. According to the World Health Organization’s World Malaria Report (2015), the disease’s mortality rate declined by 48% globally and the number of new malaria cases fell by 18%.

espite impressive gains in malaria intervention coverage, 212 million people were still infected and 429,000 died in 2015, with the majority being children under the age of 5 in Sub-Saharan Africa. As the world’s population grows, more people will be living in areas where malaria is a persistent threat, which will further strain the health care delivery system. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, implemented by Management Sciences for Health, recently published the results of its activities in eight countries (Angola, Burundi, the Democratic Republic of the Congo (DRC), Ethiopia, Kenya, Guinea, Mali, and South Sudan) to control malaria. Defeating Malaria through Pharmaceutical Systems Strengthening summarizes interventions that support the prevention and treatment of malaria. With funding from the US President’s Malaria Initiative (PMI) and based on PMI’s priorities, SIAPS provided assistance to strengthen pharmaceutical governance, build the capacity of local organizations and individuals, and improve pharmaceutical management information systems to better manage and improve the availability of malaria products. SIAPS also strengthens financing strategies and mechanisms to improve access to malaria products and ensure the quality of pharmaceutical services for malaria patients, thereby improving health outcomes and reducing malaria mortality and morbidity. Kalume Tutu, the DRC Ministry of Health National Director for the Directorate of Families and Specific Groups, explains that “When we think of systems strengthening, we don’t just

look at whether products, like bed nets or antimalarials, are available. It’s before the product even arrives that the hard work is done— preparing sound procurement and distribution plans, identifying the need, and developing the guidelines. That’s where we find that the system has been strengthened.” A persistent challenge in every country where SIAPS provided technical assistance is the lack of reliable supply chain data and poorly-defined supply chain operating procedures. In DRC, SIAPS helped revamp the supply chain of antimalarial commodities by establishing national- and regional-level coordination committees. At the provincial level, these committees were essential in optimizing the distribution of products by collecting and reviewing the stock status of anti-malarials across all partner organizations in the province. The committees also developed a mechanism to mitigate potential stock-outs in one facility by redistributing identified overstock in other facilities. The report also highlights the necessity to promote appropriate recommendations for standard treatment guidelines (STGs). STGs outline recommendations for providers to prevent, diagnose, and treat malaria, thereby ensuring that patients receive the most effective treatment possible.

Antimalarial medicines are tracked and stored at a central storage facility in Juba, South Sudan.

The Central Equatoria State warehouse manager stocking shelves at a storage facility in Juba, South Sudan

In Guinea, the Ebola epidemic forced health workers to reform standard treatment protocols to effectively treat malaria patients while minimizing their potential exposure to Ebola. Maria Walusimbi, a physician and a consultant for SIAPS Guinea, explains, “If you think about trying to increase health worker capacity, we can add new practitioners, but then they get on the job, the treatment guidelines are either nonexistent or out of date. If we can have one document with all the treatment protocols in one place, it will be an important step forward.” To address this issue, Guinean authorities requested that SIAPS review treatment standards and develop a revision process that emphasized stakeholder engagement and ownership. The development of these new

STGs and their approval in 2015 was a significant step toward coordinated supply planning of malaria commodities. These are two of the many achievements SIAPS has made in-country to defeat malaria. The support SIAPS provided to malaria control programs, regulatory authorities, and health care providers will help countries to maintain effective interventions to support the prevention and treatment of malaria. For more information, please read the full report: http://bit.ly/2uGdIxb Photo © Aubrey Clark, SIAPS

About SIAPS | The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program works to ensure access to quality pharmaceutical products and effective pharmaceutical services through systemsstrengthening approaches to achieve positive and lasting health outcomes. SIAPS is funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health. For more information, visit www.SIAPSprogram.org.

The case of Nandi County, Kenya

IMPACT Team Network transforming supply chains through data by Eric Wakaria, inSupply, JSI continuous improvements become a key focus for this approach. Ensuring that data is understood and used appropriately is also at the nexus of the IMPACT Team network. Through monthly meetings, the IMPACT teams focus on data analysis, support for root cause analysis, action planning, use of IT tools, and measuring the ongoing progress. In Nandi County, Kenya, the Nandi Commodity Security Technical Working Group implemented the IMPACT Team

aunched in June 2016, the IMPACT Team Network is a structured approach for using data and management best practices through a network of connected teams of supply chain leaders who work together to achieve a common goal, share experiences and, together, influence the local public health supply chain. Supported by inSupply, JSI, the IMPACT Team network was implemented in 10 counties in Kenya. The IMPACT Team network approach aims to empower teams with quality improvement skills to make changes in the supply chain, while ensuring there are champions and change agents to help the teams continue their momentum in moving forward. Thus, sustainability and

approach with the focus of reducing stock-out of tracer family planning commodities.

avoid wastage in the facilities that were overstocked.

The IMPACT Team in Nandi County was implemented from June 2016 to February 2017. Within the implementation period, the Nandi IMPACT team was able to reduce stock-outs to zero for three straight months, from September 2016 through November 2016 for all FP products. This was through the use of an indicator tracking tool that helped the county to visualize the stock-out rates and stock status at the various sub counties. Due to the presence of accurate stocks data, the county was able to develop a redistribution plan that saw the

The county has continued to implement the IMPACT Team approach after transition of the approach from JSI to the county. The team has been able to successfully conduct quantification of family product commodities for Nandi County. The 10 counties in Kenya are continuing their work with the IMPACT Team Network and it has become evident that county leadership, like in Nandi County, are eager to learn and apply data analytics. However, continuous support and mentorship is needed for the IMPACT Teams to sustain the momentum.

excess stock moved to facilities that were stocked out. This has not only helped reduce stock-out, but also helped the county Photo ÂŠ Depositphotos

inSupply Consulting Services is a supply chain consulting firm based in East Africa, transforming the lives of people and communities by designing solutions drawn from proven commercial sector methodologies and adapted for the local context.

Cash Transfer Programming Fritz/CILT(UK) updates their Certification Programmes by Dorothea Carvalho, CILT

In 2016, the then UN General Secretary Ban Ki-moon called for cash transfer programmes to become the ‘preferred and default method’ of aid. The increasing trend to transfer cash to people in need rather than in-kind commodities allows the recipients of aid to decide on their own what to do with the money. According to recent research from the Centre for Global Development, cash should be thought of as the “first best response to crisis” as a recent study found that 20% more people could be helped at no additional cost if people received cash.

To reflect these changes in the way aid is delivered The Chartered Institute of Logistics and Transport’s “Humanitarian Logistics Certification Programme” has been updated to provide quality training for humanitarian logisticians in cash transfer programming which is not to be found elsewhere. Funded by USAID and working with Fritz Institute, based in California, CILT’s newly updated programmes in “Certification in Humanitarian Logistics” and “Certification in Humanitarian Supply Chain Management” offer development of the new knowledge and skills needed by the humanitarian logistics professionals. What makes the CILT programme so unique is that it is designed by the humanitarian sector for the sector. The programme is delivered entirely online and learners have the support of one-to-one expert coaches. The Certification in Humanitarian Logistics (CHL) teaches the base principles of logistics and supply chain operations in the humanitarian context to increase the

proficiency and expertise of humanitarian logisticians working at an operational level. There is now a completely new unit in this qualification on Cash Transfer Programming (CTP). The Certification in Humanitarian Supply Chain Management (CHSCM) is aimed at humanitarian logisticians who are engaged in planning, resourcing and managing the supply chain and the implementation of supply chain strategy. The units on CTP in both programmes can also be studied as stand-alone awards. In updating the programmes to include Cash Transfer Programming as a modality, the CILT has demonstrated that the Certification Programme remains as relevant and current as it was when it was first launched in 2006. For more information, visit the Humanitarian Logistics Certification Programme website: www.hlcertification.org. Questions? Contact Karianne.keatings@ciltuk.org.uk

PSA is not a partner in delivering the programmes offered by CILT. Please enquire directly with CILT for more information.

Health & Humanitarian