Transcript of 1 Informed Design: Supply Chain Costing for Policy Decision Making Cost-Effectiveness of Vaccine...
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- 1 Informed Design: Supply Chain Costing for Policy Decision
Making Cost-Effectiveness of Vaccine Supply Chains in Mozambique
USAID | DELIVER PROJECT Critical Issues Series Washington DC, July
30, 2012 Leah Hasselback
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- 2 2 Why do supply chain costing? Costs of getting commodities
to health facilities is often overlooked or unknown Knowledge of
operating costs and cost drivers should be used to make decisions
about: Supply chain design Implementation Performance Advocate for
funding supply chain Align pricing policies with actual costs
Improve efficiency and effectiveness of the supply chain
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- 3 3 Project History 5-year supply chain redesign pilot project
implemented in Cabo Delgado province (Dedicated Logistics System)
Old: Collection-based, ad hoc system New: Delivery-based, vendor
managed inventory with level skipping Included supportive
supervision and information system Conducted impact evaluation in
Cabo Delgado, using neighboring Niassa province as a comparison
Mozambique Cabo Delgado Niassa Nampula
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- 4 Impressive resultsbut at what cost? 4 IndicatorBaselineResult
Coverage Rates (DPT-Hep B3)68%95% Vaccine stock outs80%1% Cold
chain functioning~40%96% DPT1-3 Dropout Rate12%3.8% Trust in the
public health system 91% visited in last month despite : 47% of
families living over two hours away; 85% of them having to walk to
get there ; and most common reason for vaccination failure being
place of immunization too far.
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- 5 Cost Study Objective Compare the costs of vaccine logistics
in the pilot province and a control province. Challenges Haphazard
nature of supply chain in Niassa. Wide variety of activities,
participants, frequency, and costs. Lack of cost records.
Sufficient recall. Methodology Excel-based cost model Transport,
personnel, cold chain, vaccine & supplies Immunization portion
only Niassa as comparison province Niassa 10% random sample using
PPS 10 health centers in 8 districts Surveys at health centers,
districts, and province & national transport & maintenance
staff Total 42 surveys
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- 6 Description of Logistics System Assessed Cabo Delgado Project
system Active logistic delivery system Vaccines reliably delivered
to health facilities each month Niassa Mixed & inconsistent
Collection & distribution Varies by location & month
Mozambique
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- 7 Cabo Delgado: Dedicated Logistics System 7 District Storage
Provincial Store Health Centers Outreach Teams 4. Field coordinator
office - input data - analyze information - prepare for next trip -
training 1. Leave with: - medical supplies - propane - equipment,
parts - knowledge 2. Site visit: - record & stock inventory -
service equipment - collect data - supportive supervision 3. Return
with: - data
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- 8 Niassa: Old System
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- 9 Results Characteristic / ComparisonNiassaCabo Delgado
Difference Niassa Cabo Delgado Absolute Costs
Population1,178,1171,632,809-454,692 Total Vaccine Logistics Costs
(1 yr)$266,563.04$305,418.80-$38,855.76 Transport$ 35,968.39 (14%)$
55,234.48 (18%)-$19,266.09 (-4%) Personnel$75,482.23 (28%)$
35,376.00 (12%)+$40,106.23 (16%) Cold Chain$31,306.42
(12%)$27.191.82 (9%)+$4,114.60 (3%) Vaccines &
Supplies$123,806.00 (46%)$187,616.51 (61%)-$63,810.51 (15%) Costs
Controlling for Population Differences Population of Children
U5179,892303,007-123,115 Total Cost Per Child U5 (1
yr)$1.48$1.08$0.40 Relative Cost-Effectiveness DPT3 2008 Coverage
Rate among children aged 24-35 months 70%95.4%-25.4% Total Cost Per
Child Receiving DPT-Hep B3 (1 yr) $6.07$5.03$1.04 Relative
Cost-Efficiency Number of Vaccine Doses Delivered (1 yr)
498,624889,152-390,528 Total Cost Per Dose of Vaccine Delivered
$1.50$1.18$0.32
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- 10 Results: Breakdown of Costs Conclusion: The Dedicated
Logistics System (Cabo Delgado) is more cost- effective and
efficient, which leads to government savings.
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- 11 Using the Results Results were used to advocate for
expanding the Dedicated Logistics System to other provinces,
building on 15 months of advocacy with impact results. 3 months
later expansion approved by the Minister of Health. Today 4 of
Mozambiques 10 provinces implement the Dedicated Logistics System,
which now extends to over 445 health centers.
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- 12 Thank You www.villagereach.org Leah Hasselback Mozambique
Country Director leah@villagereach.org Tel: +258 827324196 Av. 25
de Setembro, 1123-11. E Maputo, Mozambique Tel: +258 21326446 Fax:
+258 21326448