Health & Humanitarian, The Supply Chain Review, Issue 2, Aug 2016 by Pamela Steele Associates Ltd

HEALTH & HUMANITARIAN T h e

S u p p l y

C h a i n

R e v i e w

Issue 2 August 2016

Produced by PSA in conjuction with the Oxford University Internship Programme

HEALTH & HUMANITARIAN The Supply Chain Review

Photo Â© 02Freeimage.com

HEALTH AND HUMANITARIAN The Supply Chain Review EDITOR IN CHIEF Pamela Steele Sara Khan EDITORIAL TEAM Charles Dennis Yeonjoo La Ariane Laurent-Smith HOW TO REACH US

Pamela Steele Associates Ltd.

Prama House, 267 Banbury Road, Oxford, OX2 7HT, UK PHONE NUMBER +44 (0) 1865 339 370 WEBSITE www.pamsteele.co.uk

Contents Editorial

4 Professionalisation Corner: A conversation with Sean Barton

PSA Training Courses in Kenya from November 21, 2016

VillageReach: The role of data in improving vaccinedelivery in Benin

UPS: Private partnership with the humanitarian sector aids Nepal earthquake relief effort

LMI: Implementing ERP systems in Kenya

The SCMS Project: Global supply chain project for people living with HIV/AIDS promotes country ownership

EDITORIAL As we work on this second issue of ‘Health and Humanitarian’, we became aware of the pessimism that surrounds logistical reform in the field of public health and humanitarian aid. Calls for logistical reform are far from rare. Every year numerous papers are being published on this issue and many conference recommendations are being passed. Yet outside of these areas, it is all too easy to assume that these will be shouted into the ether and not have any impact. Bureaucratic issues continue to stand in the way of effective reform, and refusing to tolerate inefficiency when its consequences are so lethal is a key part of the work of all agencies in this field. However, this ‘conference-fatigue’ threatens to obscure the bold work taken by many organisations that do not receive the recognition that they deserve. Often these changes lead to substantial, rapid improvements in various fields. Even where they do not, they ought to be encouraged and praised for the spirit of innovation they demonstrate. This is why we decided to highlight and celebrate coun-

try-based achievements in this area for the second issue of our magazine. It is easy to think of structural reform as of secondary importance, as a laudable objective that must take a back seat to getting aid to the people who so desperately need it. Yet without the former, we cannot hope to achieve the latter. This turned out to be true last year, as seen in UPS’ role in providing aid during last year’s Nepal earthquake. It is also evidence by VillageReach’s effort to improve vaccine delivery in Benin using data. Another example that corroborates this is the Supply Chain Management System in Africa which has enhanced the delivery of HIV/AIDS-related medicines. Moreover, LMI has shown how private-sector capacity can be utilised to to better supply life-sustaining medicines in Kenya. These successes ought not to distract from the need for further changes, but increase our confidence that they can be achieved.

We are proud and honoured to have received so many submissions from such seasoned professionals, working in both the private and public sectors. In particular, we are very grateful to Mr Sean Barton for sharing his experiences of supply chain reform over several decades, and how the industry must adapt to encourage gender equality.

This publication remains a cooperative effort involving current students of the University of Oxford and Pamela Steele Associates Ltd. The editors would like to say how touched we have been by the warmth of the supply chain professionals we have spoken to, as well as their enthusiasm in introducing us to this vital area of work.

PSA Microinterns from Oxford University, Yeonjoo La, Ariane Laurent Smith and Charlie Dennis from the June 2016 batch

Photo ÂŠ PSA

PROFFESIONALIZATION CORNER A conversation with Sean Barton Sean Barton is an experienced supply chain professional, both in public and private sectors. He previously worked for a global consultancy firm, Computer Sciences Corporation (CSC), before joining the humanitarian sector. He worked for Oxfam GB for over eight years, becoming their Head of Humanitarian Supply Chain and Logistics and he is now a consultant for a number of organisations including PSA Ltd.

The road to humanitarian work One could never describe Sean’s career path as typical, as is the case for many a humanitarian professional. Though he has recently finished nearly a decade at Oxfam, he has made forays into not only commercial and public health supply chain management, but also chauffeuring and working for the local council. Yet even before his degree in International Politics and History, he was aware he wanted to break out of the UK: “To be frank, describing myself as a young man, I think I was interested in excitement and travel and adventure, and I wanted to do things that were helpful.”

“It would be wrong to form an impression of me as some sort of giving person, I think it was largely because I like Tarzan films and … Zulu wars and that kind of thing.” Yet even if his motivations were basic, Sean still worked for the Sudanese government as a teacher of English as a Foreign Language for two years, followed by another two in Morocco. After a year in Reunion Island and a Master’s Degree in African Studies at the University of Edinburgh, a defining moment in his relationship with supply chain occurred. While a student, he was offered a job with Band Aid in Ethiopia. Musing why someone with a Master’s degree in History would be more qualified than an Ethiopian, he turned it down as a result, but when he did it made him realise how much he wanted it. “I didn’t want to go just because I was a known quantity … I wanted a skill, I wanted to say I’m here because I’m actually better than any available Ethiopians.” This is what led to him studying further for a Masters in Supply Chain at Cranfield, which in turn led him to commercial and military logistics jobs.

“I often used to describe my job to people as the Oxfam goalkeeper. We had attackers, we had midfield, we had defence, but finally if it was all over and they were running towards the goal, it was just me” Although Sean’s first role at the famous aid agency saw him managing team of first phase responders, after only two years he was promoted to become Head of Humanitarian Supply and Logistics. Largely based in either Oxford or occasionally in Brussels or Geneva, but also a lot of field engagement in countries as diverse as the Philippines and the Ivory Coast. “I often used to describe my job to people as the Oxfam goalkeeper. We had attackers, we had midfield, we had defence, but finally if it was all over and they were running towards the goal, it was just me.” Though he describes it as the “Best job I ever had”, Sean admits to burning out, having seen many disturbing things during his time at Oxfam and experiencing “an increased sense of frustration in how the humanitarian world was going.”

What makes a successful supply chain logistician? Although Sean is clearly committed to humanitarian work, he stresses that he does not have what he calls the “activist mind-set” of some others in the industry. “I know what I want to do, I know what I want to achieve. If it’s not going to help me achieve what I want I want to achieve, I don’t pay any attention to it.” In the humanitarian sector particularly, this seems to be a vital characteristic. In the commercial sector, there is more of a case to be made for always keeping an eye open for other opportunities. In the field, though, you have no time. As Sean states, “you didn’t have time to do your own job … It’s a constant sense of crisis management.” Yet for all the challenges of always being on the back foot, it creates a sense of confidence in the importance of your work. “You’ll never be bored [...] You’ll never get back on the plane and think was it worth it? You know it was worth it.” “That said, I think that might have been a feeling rather than the reality.” People said that he was very organised, but Sean uses the analogy of a swan looking calm and cerebral. “Actually, beneath the surface, my feet were paddling.” In many ways, therefore, a successful humanitarian logistician must be seen to be the one in control, to be calm and confident while others worry about their particular job. This is often means that it’s your job to break “up fights between staffers and employees,” or to step forward to road blocks.

“Commercial sector supply chain management doesn’t work that well in humanitarian contexts … because there isn’t really a supply chain… in a conflict zone or a drought or a famine.”

Commercial and Humanitarian Interplay Despite his CV comprising both commercial and humanitarian supply chain work, Sean told us that this combination is extremely rare. “I’ve never met [commercial supply chain logisticians] in the field. Where there are no trucks [...] no fuel [...] commercial supply chain professionals ... haven’t had enough experience of that utter collapse, which means when it happens they’re going through the emotional churn for the first time.” “Commercial sector supply chain management doesn’t work that well in humanitarian contexts … because there isn’t really a supply chain… in a conflict zone or a drought or a famine.” Even professionals with experience in military logistics struggle in this field, as they have to come to terms with an environment where their orders are not obeyed without question. As Sean phrases it, “I spent my entire life telling people what to do and then them not doing it.” The main problem for humanitarian supply chain professions is that, “In NGOs, logistics is undervalued [...] we don’t plan with logistics, neither strategically nor operationally.”

Examples such as program teams asking logistics to bridge impassable rivers with almost no notice are symptoms of an understandable desire to provide aid to those who need it without wasting time thinking of the big picture. “This is a cultural thing, because the humanitarian sector used to be very amateur. So logistics ended up being the [job of the] gofer, the doer. The more thinking, cerebral types, would decide what we needed to do and logistics would just sweep up. And unfortunately that still resonates now.” “In the commercial sector, if the supply chain director of Tesco” [raises a problem] “nobody questions him or her, it’s just the way it is.” A way of avoiding this would be a widespread professionalizing of the humanitarian sector. However, Sean is not entirely in favour of this either. This is firstly because the salaries are so low that it makes young people spending their early career there nearly impossible, a dilemma not helped by the commercial sector’s tendency to dismiss humanitarian experience as nearly irrelevant. More importantly, however, such professionalization can lead to a greater focus on careerism and diminish attention paid to those who actually need aid.

Instead of institutional change, reform will come naturally with time. “It is almost a generational thing. The leaders of the NGO movement in their fifties are people who were doing their fieldwork back in the 1980s. So they still reflect that slightly amateur approach to logistics. Some of the younger people that I’ve worked with are less like that. “ “One of the things that would make the biggest difference would be for logisticians to be trained in soft skills. Persuasion, networking, negotiating, bargaining.” “Instead of just flipping out because of the decision, it’s [about] finding soft skills and working out how we can make this work.” Sometimes this means learning how to say no. “Logisticians are very task focussed. A lot of them will try and get stuff across the river. What they should really do is press the red light and say ‘Program stopped’.” However, it is also learning how to say no diplomatically. “Some [logisticians] are very abrupt. They are people in a hurry, who can’t get everything done and are working seven days a week. We’ve been talking about this for ten years and it goes on and on and on.”

Gender in supply chain and logistics Sean is working with PSA and the Women’s Institute for Supply-Chain Excellence In International Humanitarian Logistics, also known as WISE, studying the effects of gender in supply chain logistics. This has partly been because of the differences he encountered between how people treated him and others, the same difference he was suspicious of when turning down work in Ethiopia early in his career. There are many advantages to being a white man in the field, Sean said “A white, grey haired guy is approaching, might be an important person, let’s give him some deference we’re not going to give to a young black woman for example.” Sean was keen to emphasise the benefits of having female logisticians on teams, saying that they often have good soft skills such as negotiation or bargaining, as well as being more communicative, calmer and less confrontational. “They tend not to get involved in ego sparring and also they’re incredibly hard workers.” He highlighted the difficulties of working in the field, where the culture might be very different than the head office, and the dangers might be more significant for women.

One example he gave was in Afghanistan, where female European aid workers are “top targets” for the Taliban. Furthermore, there is also a strong element of recruiting people who look like you. “Field workers are under stress, so the old adage about how you recruit yourself unless you’ve been trained in recruiting applies.” Sean was adamant that cultural issues should not prevent women from participating in leadership positions, if they want to. He noted the weight of paternalism, and how male domination pervades everything. “I don’t think I’ve come across a female logistician in a position of authority in the country of her birth in any event that’s just happened” “Most of the really excellent logisticians [I’ve] met have been women. They absolutely have got that soft skills thing. They’re hard as nails, they’re very tough, but you wouldn’t know it. “

As Sean continues his work with PSA, we are glad to have Sean’s expertise in the office and would like to thank him for taking the time to talk to us.

Photo © Sean Barton and Freeimage.com

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VillageReach The role of data in improving vaccine delivery in Benin Nora Phillips - Associate, Health Systems, VillageReach Emmanuelle Assy - Monitoring and Evaluation Technical Advisor, AMP

VillageReach has supported the Agence de Médecine Préventive (AMP) in their work to pilot and scale Logivac, an informed push distribution system for immunization commodities, over the past year and a half in Benin. Starting as a pilot in a single health zone in 2014, this system will be deployed in approximately one-third of the 34 health zones nationwide under the name Logivac+ by July 2016. VillageReach has worked with AMP to

aid them in adapting and deploying OpenLMIS, which is locally called the Systeme Informatisé d’Information Logistique (SIIL), by collecting data and providing the information needed to improve the informed push system. Over the past weeks, VillageReach and AMP have been working to determine program needs and ensure that SIIL is up-to-date as Logivac+ moves to scale. The informed push system for health products is based on the same

principle. Logisticians fill up their truck (often called a “mobile warehouse”) with quantities of medicines or vaccines they predict the health centres will need based on historical and/or population data. Then, they head out and visit each health centre, physically count the available stock, remove any products that have expired or gone bad, and fill the shelves or refrigerators back up so that the health centre can meet demand until the next visit. Throughout the distribution, the logistician also assists health agents in logistics-related activities, passing along best practice supply chain management lessons to health workers. In reality, the informed push system for vaccines (and other medical commodities) is a little more complicated than described above. While the idea of a vaccine vending machine is not a new concept, it’s not available yet. So, how does the logistician know how much of each product to deliver? Where does the information system fit in? What data is used to determine the quantities needed? What if the quantity required is greater or less than what will fit in the vaccine fridge?

Overstocking can lead to losses of expensive, lifesaving products, while understocking results in unmet needs for critical health services. For vaccines in particular the ideal stock amount can be determined using population data. Using this data helps estimate the number of children that a specific health centre should vaccinate each month; this calculated amount is called the Ideal Stock Amount, or ISA. In some cases, however, population estimates may not accurately represent the number of children who actually come to the health center to be vaccinated each month. During the initial pilot phase of the Logivac+ project in Benin, some health centres used up to three times the quantity of vaccines predicted by their ISA. This can happen for a few reasons. Firstly, the census data used for the population estimates may not be extremely accurate. Secondly, and perhaps more importantly, just because administrators draw lines on maps and assign people to certain health centres to estimate populations doesn’t mean those people will actually go to that health centre. The health centres in the Benin example are close to the border with the country of Togo; for people living in that region of Togo, the most convenient health centre may be just across the very porous border in Benin, causing higher-than-estimated consumption of vaccines at that facility. Another theory is that service quality impacts demand. Mothers and caregivers often prefer to bring their children to the health facilities they know and which from their experience are likely to have vaccines in stock, and avoid those which carry what they perceive to be low-quality product. The ultimate goal of the Logivac+ informed push system, and consequently of OpenLMIS, is to increase the availability of high-quality vaccines at the last mile, so the intervention itself could impact demand for vaccinations.

With an information system like OpenLMIS, the logistician can overcome challenges like these to ensure that each health centre can meet the actual demand for vaccines. The Logivac+ system is designed not only to ensure that enough vaccines are available to meet demand, but also that those vaccines are stored in the right conditions to remain potent and effective for longer. As a platform, OpenLMIS is mobile and works offline, so the logistician is able to enter data about real consumption and losses they observe while they arein the storeroom of a health facility, typically without internet connectivity, rather than relying on paper reports sent to a district office. These calculations are done automatically in real time, so they canquickly and easily assess whether the actual demand the health centre experienced in the past month corresponds with the estimated ISA. Using that information, they can make a rapid, informed decision to distribute the right amount of commodities, based on the most current data. However, Logivac+ is still in the process of being scaled nationally in Benin.

Current national policy for vaccine distribution is based fully on a push system where quantities to be delivered are determined mainly by a population-based ISA instead of real-time consumption data. This type of system, while adequate, can result in misleading data for delivery indicators, further demonstrating the need for a system like OpenLMIS. By empowering logisticians to make informed decisions about the quantities they should deliver through an electronic information system, data quality is improved and verified, and logisticians are able to make informed, justified decisions. In Benin, OpenLMIS collects critical supply chain data at the “last mile” of healthcare, where data visibility and accuracy is most important, providing a solid evidence base which informs decision makers on future national policies as well as supporting the data needs of Logivac+. When the data used for supply chain decisions matches the actual demand at the health center level, the “right” indicators will drive the distribution system, ensuring more children have access to the vaccines they need, when they need them.

Photo © VillageReach and Freeimage.com

Photo ÂŠ Freeimage.com

UPS Private partnership with the humanitarian sector aids Nepal earthquake relief effort Submitted by UPS A magnitude 7.8 earthquake struck central Nepal on April 25, 2015 causing widespread destruction and affecting more than 6.6 million people in the region. The nationâ&#x20AC;&#x2122;s capital, Kathmandu, and the surrounding rural areas suffered substantial destruction to critical infrastructure, including roads, water supply, and communications networks. The quake was the worst to hit the country in over eighty years and aid needed to be delivered as efficiently as possible.

Over 14,000 cubic metres of relief items were facilitated by the Logistics Cluster through the airport for 94

The UPS Foundation, the philanthropic arm of UPSÂŽ, immediately committed an initial $500,000 in funding and in-kind support for relief efforts in Nepal. It later increased its commitment to $800,000. In addition to providing funding for relief organisations to purchase and distribute relief supplies, The UPS Foundation also worked with its humanitarian partner agencies to assess the immediate needs in the area and how UPS could assist them. Through the Logistics Emergency Team (LET) partnership, led by the World Food Programme and the United Nations Logistics Cluster, the UPS Foundation was able to help address and overcome several obstacles in the effort to deliver life-saving relief items across the affected areas. Through the Logistics Cluster network, UPS coordinated with a UPS agent based in Nepal to secure a 250 sq. ft. warehouse space and forklift operators to assist at the local airport to transfer incoming supplies from the tarmac to be palletized for distribution. Over 14,000 cubic metres of relief items were facilitated by the Logistics Cluster through the airport for 94 organisations. Additionally, UPS worked with its partners to assess transportation capabilities and provide transportation services to move supplies from Kolkata, India and from the International Humanitarian City in Dubai to Kathmandu, Nepal. During the emergency response process, UPS used its logistics experience and expertise to overcome several challenges.

Logistics Challenge 1: Distributing supplies to a damaged airport

Not long after the news of the earthquake hit, the UPS Foundation was in motion to send immediate aid to Nepal â&#x20AC;&#x201C; a Boeing 747 aircraft was booked, flight dates were confirmed, and pricing agreements were in place. Only a few hours later, UPS was informed that the main airport outside of Kathmandu, Tribhuwan International Airport, was damaged and could not accommodate large aircrafts. To address this challenge, UPS immediately started looking for other options and came up with a solution- use a smaller, military grade aircraft to deliver supplies. This aircraft, an Ilyushin-76, was the only other available plane suitable to meet the stringent landing requirements at the small Nepali airport. Since the new aircraft could only hold a fraction of the supplies of the original Boeing, the UPS Foundation committed to support the in-kind transport of three shipments instead of one.

Logistics Challenge 2: Navigating permitting and scheduling requirements

One of the primary challenges faced was obtaining the proper overflight and landing permits for the aircraft. Due to strict government regulations, the IL-76 aircraft was required to make a technical stop in New Delhi, India before taking off again for Nepal. Then after getting approval in India additional permitting was needed before landing in Kathmandu. In New Delhi, the permit request process required going through a series of governmental agencies for approval. First the request went to the Ministry of Civil Aviation (MOCA) asking for permission then the request moved on to the Director General of Civil Aviation, which will grant you, based on provided documentation, a permit to fly over or into the country. The flight request was then circulated internally to the Ministry of Intelligence, the Home Ministry and various offices. Once our slots were cleared, all permit documentation was forwarded to the Bureau of Civil Aviation

Landing in Kathmandu was just as demanding. UPS air operations advised that we could obtain the New Delhi permits at a later time; however, UNHCR insisted on having that permission first as it would make it easier for them to obtain the landing slot in Kathmandu. Yet another challenge was that UNHRD could not accept handover of the cargo to UPS until both landing slots in New Delhi and Kathmandu were confirmed. We reached a solution by committing to returning the cargo back to the IHC warehouses in less than 48 hours if the flight did not depart. With that commitment, UNHRD agreed to handover the cargo to UPS trucks in order for us to meet the flight cut-off at the airport. One day prior to the scheduled flight departure we received an urgent call from UNHCR informing us that the planned landing slots in Kathmandu were still unconfirmed. Since the cargo contained sensitive medical equipment, all cargo had to be offloaded and stored immediately in a temperature-controlled warehouse. Confirmation for the new landing slot came in two hours before the planned departure time and cargo was reloaded and the shipments were delivered successfully the following afternoon.

UPS learnt from this initial experience and the subsequent flights to Nepal went more smoothly and more according to plan.

Logistics Challenge 3: Managing the unexpcted Having already completed two successful shipments, the third shipment was expected to go off without a hitch. The Kathmandu landing slots had been obtained two days prior to the flight. However, for the third flight, UPS was informed that they had lost the planned landing slot for New Delhi and that this would delay their arrival in Nepal by two hours. In response, the UPS team immediately reached out to, UNHCR, to inform them about the delay. However, the teams in Nepal asked for them to stick to the planned time or risk jeopardizing landing approvals in Kathmandu. Ultimately, there was no choice but to order the operator to take off.

Lessons Learned In this crisis, UPS used its logistics experience to overcome many challenges in delivering critical aid to those affected by the quake in Nepal. From this case study, it is clear that a thorough and coordinated effort among many different parties – private sector, government and nongovernmental organizations – is needed in order to be successful. It requires a public-private partnership where all parties are communicating with one another and where lessons learned are applied to future efforts to expedite the delivery of relief supplies.

Further complicating the shipment, as UPS was dealing with the landing slot changes, they found out that the approval that was secured for the UNHCR shipments had the wrong operator name on it. Luckily, the Kathmandu operations supervisor was not concerned about having a different operator name as long as the actual delivery was the same and belonged to UNHCR. To make things more difficult, an imminent shift change was upcoming at the Kathmandu airport in few hours. The on-site supervisor asked that UNHCR personnel brief the second shift to ensure there would be no lapse in coverage to unload the cargo upon arrival. UNHCR personnel agreed and stayed in Kathmandu airport to complete the task. The flight operator was notified that the issues were under control and they agreed to take off. In the end, the flight captain contacted flight towers in New Delhi and Kathmandu and we were able to secure the green light to arrive using the new landing permits for Kathmandu.

Photo © UPS & Freeimages.com

LMI

Implementing ERP Systems in Kenya

Taylor Wilkerson, LMI Global Health Clinton De Souza, Imperial Health Sciences

With approximately 1.6 million people living with HIV/AIDS in Kenya, ensuring a secure and sustainable supply of medications and diagnostic tests is a matter of life and death. In 2009, the Kenya Medical Supplies Authority (KEMSA) sought to streamline and enhance a supply chain process using private-sector partners. The goal of this supply chain process: to deliver life-sustaining rapid test kits (RTKs) to 4,500 sites throughout Kenya. Public health supply chain managers are often hesitant to partner with commercial providers, relying on a preference for in-house operations to deliver

health products. Yet, the private sector offers capability and flexibility that can be essential for meeting supply chain requirements and supporting public health goals. Partnership with the private sector helped KEMSA overcome the challenges it faced in distributing RTKs in Kenya.

Challenge #1: The need for an ERP system Initially, there was no enterprise resource planning (ERP) system in place. Since Kenyans needed the lifesaving RTKs as quickly as possible, there was no time to stop the supply chain and implement an ERP system. Instead, manual processes and strict controls were implemented while simultaneously getting an industry-standard SAP system up and running.

location as well as providing consistent, standardized, and cost-effective service. This proactive system reduced costs, simplified the invoicing process and made overall supply chain improvements, all while reassuring the client that it could meet demands.

Challenge #3: Effectively managing 3PL vendors One such manual process was the change from bimonthly scheduling for 1,000 delivery sites, which was previously accomplished through an Excel spreadsheet requiring each line item to be entered manually. This left significant room for error and wasted staff resources, especially when clients would submit updated schedules without notice. To solve this problem, a hard deadline was put in place for receipt of schedules with additional costs for second and third rounds of scheduling built in. Soon, behaviour at distribution sites changed, driving discipline and improvement. With this data, staff resources were better allocated for the implementation of the SAP ERP system.

Valid proof of delivery documentation was required to reimburse the third-party logistics (3PL) vendors sending hundreds of shipments of RTKs each month, but the 3PL vendors often failed to submit that documentation. The growing backlog delayed processing payments again a streamlined administrative process was needed. Ties were severed with 3PL vendors that couldn’t comply and others were brought in to participate in the improvement process. The following steps led to a more robust way to manage the remaining 3PL vendors: - six driver trainings with more than 200 drivers in a 3-month period - service-level agreements (SLAs) - SLA review meetings to foster common goals and understanding - regular 3PL vendor evaluations

Challenge #2: Moving from reactive to proactive With an ERP system in place, the focus was now on client grievances—a perceived disconnect in the ability of the local service providers (LSPs) to execute deliveries and a lack of transparency in the operations. Real-time information and metrics of LSP performance provided the information needed for a proactive approach for handling supply chain disruptions. Data gathered included ontime delivery percentages, driver qualifications, adherence to vehicle maintenance procedures and client feedback. These metrics allow reviews of complaints to take corrective action, build capability matrices and routings per

The Outcome: A more robust supply chain in Kenya After overcoming these challenges, LSPs reported average staff and business growth of more than eighty percent, moving from about a hundred employees to over six hundred But this growth is sustainable beyond development programmes—it increased commerce and the capacity of the local sector, thereby creating a more competitive market. Finally, the LSPs and 3PL vendors are now well trained and experienced in handling pharmaceutical commodities so they are available to deliver lifesaving medical supplies in Kenya efficiently and effectively. Photo © LMI and Freeimage.com

THE SCMS PROJECT Global supply chain project for people living with HIV/AIDS promotes country ownership, strengthens health systems Submitted by the SCMS Project The Supply Chain Management System (SCMS) project, funded by USAID and the Presidentâ&#x20AC;&#x2122;s Emergency Plan for AIDS Relief (PEPFAR), has worked for the last ten years to develop cost-effective, reliable, secure and sustainable supply chains for people living with HIV/AIDS in developing countries. The projectâ&#x20AC;&#x2122;s goal was to make real and lasting progress toward achieving universal access to treatment by bringing down the cost of medications and other health supplies, and strengthening supply chains in-country. Today 5.7 million people in developing countries receive direct lifesaving antiretroviral treatment as part of this project. SCMS procures 70% of all ARVs directly funded by PEPFAR.

Following are some of the key successes of the SCMS Project: · Delivered $2.4 billion of life-saving commodities, including antiretrovirals, essential medicines and laboratory commodities · Directly procured a majority of the lifesaving antiretroviral drugs used to treat 5.7 million people in developing countries · Negotiated a dramatic drop in the cost of drugs to treat a single HIV/AIDS patient to around $110 per year ·

Saved hundreds of millions of dollars through the procurement of generic antiretrovirals

· Delivered 239 million HIV tests to high-prevalence countries, so that millions of people around the world could know their status ·

Saved more than $176 million in shipping costs over the last ten years

· Supported governments and local partners in 25 countries to build capacity and country ownership of supply chain management

SCMS’ success can be attributed to its approach of aggressively scaling up treatment access, promoting country ownership and investing in sustainable country health systems. In Nigeria, for example, SCMS managed a joint effort of PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Government of Nigeria to unify seventeen HIV/AIDS supply chains into one program. This public-private partnership initiative was driven by the USAID Mission and designed to encourage government ownership and leadership of the HIV/ AIDS supply chain at the state level, while keeping associated risks at a minimum. The HIV/AIDS Supply Chain Unification Initiative started in July 2012 through a phased approach in five states. By July 2014, it was successfully completed in 36 states and the Federal Capital Territory. This initiative has improved the overall efficiency of the supply chain by reducing stockouts from 25% to less than 9% and by delivering to more than 6,500 health facilities in less than two years. Today 700,000 HIV-positive people in Nigeria are on treatment, compared with less than 70,000 in 2006, a great achievement.

Through the Nigeria HIV/AIDS Supply Chain Unification Project, SCMS has covered 36 states and the Federal Capital Territory with last-mile deliveries of more than $158 million of HIV/AIDS commodities, reaching more than 7,000 health facilities through more than 49,000 deliveries, as of May 2015.

Today 5.7 million people in developing countries receive direct lifesaving antiretroviral treatment as part of this project.

In Ethiopia, the health system in 2005 struggled with inadequate pharmaceutical supply, poor storage conditions, and weak stock management causing high levels of waste and stockouts. To reach Ethiopia’s universal access goals, SCMS worked with the Pharmaceuticals Fund and Supply Agency (PFSA) to significantly increase warehousing and distribution infrastructure. Together PFSA and SCMS designed and outfitted 10 central and regional warehouses, trained more than 6,000 health staff in supply chain management, and developed and implemented a system for ordering and delivering commodities to more than 1,000 sites (up from 170 in 2006). These efforts, combined with systems strengthening technical assistance and an integrated approach similar to the work SCMS did in Nigeria produced significant results. A 2013 survey of 42 facilities showed that 95% of ARV drugs were available. The commodity wastage rate is less than 2%, and there are virtually no stockouts. The country has experienced no ART interruption since 2006. Close to 300,000 HIV-positive people are currently on treatment, compared with 24,400 in 2006, before the reforms were implemented.

These are but two of the many in-country successes SCMS has produced. To learn more the multi-country achievements of the program, please access their online report “10 Years of Supporting PEPFAR through Stronger Public Health Supply Chains: A Report on SCMS Contributions to PEPFAR Results.” You can find it in French here. The report helps to summarize a decade of operating the largest public health supply chain in the world on behalf of the US government, and how it helped the global community get closer to reaching the goal of achieving an AIDSfree generation.

Health & Humanitarian Supply Chain Summit 2016 Joining forces to strenghten supply chains in East Africa

The Health & Humanitarian Supply Chain Summit took place at the Boma in Nairobi, Kenya on July 8th, 2016. This unprecedented event was hosted by Pamela Steele Associates (PSA) Ltd and sponsored by UPS, PSA and FIT. The objective of the Summit was to explore the current challenges in health and humanitarian supply chain in the East Africa and to share updates and insights from the different stakeholders involved with supply chain in the region and particularly Kenya. This was also an opportunity to promote professionalization of supply chain practitioners and provide attendees with a networking venue.

Nearly 80 people attended the Summit representing sectors such as public health, private sector, NGOâ&#x20AC;&#x2122;s and academics. The participants and speakers were welcomed by PSA Founder and CEO, Pamela Awuor Steele. Ms Steele emphasized the importance of breaking down silos and sharing knowledge and experiences with each other in order to have stronger and more resilient health supply chains. To support and strengthen this development in supply chains in Kenya and beyond, PSA has recently opened an office in Nairobi. The Summit included numerous speakers from the health and humanitarian supply chain sector including KEMSA, Kenya Red Cross and John Snow Inc. The private sector and academia was also well-represented with Kenyatta University, UPS, DHL, Kuehne Foundation and Changamka Microhealth. To discuss professionalization in supply chain and among health logisticians, Dr Andrew Brown presented on behalf of the International Association for Public Health Logisticians, IAPHL. Dr Brown was also the facilitator for the various sessions throughout the event.

The Summit in the eyes of the Participants PSA received only positive feedback throughout the event. These are just a few comments made by the participants on the Summit: “The presentations were so relevant, the issues were contemporary, the organization was excellent!” “I wish to thank and congratulate you for the wonderful professional meet you organized. I must admit that I am yet to see such a successful and organized meeting of top professionals in Kenya. Please keep up” “Have more of the same, especially in East Africa” “The additional reading resources provided will be useful for both professionals and academia”

“Words into Action” The Health and Humanitarian Supply Chain Summit 2016 gave health supply chains in Kenya and East Africa a tremendous boost. As PSA Founder and CEO, Pamela Steele highlighted, the Summit was not meant to be a single event, but a starting point for the work that must be done to mitigate issues in supply chain once and for all. At the end of the one-day Summit: • Participants were challenged to consider the needs in health supply chain in Kenya and see where they could contribute • Continued networking was encouraged with PSA undertaking to provide opportunities for more networking events in the future • PSA has volunteered to champion an IAPHL country Chapter in Kenya with participants to expect an e-mail regarding this in the coming weeks. This will provide a platform to share and exchange ideas and to contact each other • The sessions from the summit have been recorded and PSA has prepared a resource page allowing individuals to view the presentations and to share the links with those unable to make the Summit.

Photo © PSA

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