Immunisation Supply Chain Strategies - UNICEF · PDF fileImmunisation Supply Chain Strategies...

Immunisation Supply Chain Strategies

2014 Vaccine Manufacturer ConsultationCopenhagen, 9 October 2014

Session Topics

• Why do immunisation supply chains matter?

• GAVI Alliance immunisation supply chain strategy

• UNICEF supply chain strengthening with governments

• Current activities in Zambia, Nigeria, DRC

• ViVa visibility for vaccines

• Discussion

Immunisation supply chain risk will increase due

to higher volumes, doses and vaccine cost

Increasing number

of doses2

Increase in stock keeping units

per year for GAVI vaccines4

Growing volume (cm³) to

vaccinate per child1

28070

Introduction of more

expensive vaccines3

2010

Vx mix3

2020

Vx mix

(price 2013)3

$0.8$4.1

2010 2020Supply chain requirements

~4x

~2x

~6x

~5x

Note: All figures relate to GAVI-funded vaccines

1. UNICEF Supply 2012 Financial report, WHO data for Pneumo and Rota vaccines, and HPV (only for girls); 2. 2010: GAVI Shipment Data; 2020; GAVI SDF Forecast; Including volume for GAVI future graduated countries; 3. Comparison based on 2013 Price; 2020 Vaccines include: Rota, Pneumo; HPV; 2010' vaccines include:YF, Measles, DPT, OPV (UNICEF SD); 4. GAVI Background SDF Information; 2010": estimates based on 2009 data; 2020: estimates based on 2013 forecast

Vaccine introduction status and tentative plan for

Eastern & Southern Africa region: 2014-2018

CountryPe

nta

Pneu

mo

Rota

MSD

MR/

MM

R

HepB

birth

HPV

IPV YF Men

A

Angola 2006 2013 2014 2017 0 2017 2017 2015 1999 0 4

Burundi 2005 2011 2013 2013 2017 2017 2015 2015 2017 2016 6

Botswana 2009 0 0 2011 0 2000 0 2015 0 0 1

Comoros 2009 2016 2016 2015 2018 2018 2016 2015 0 0 7

Eritrea 2008 2015 2014 2012 2015 2020 2018 2015 2020 2018 5

Ethiopia 2007 2011 2013 2018 0 2018 2016 2015 2018 5

Kenya 2001 2011 2013 2013 2015 2017 2014 2015 2000 2017 5

Lesotho 2008 2014 2015 2013 0 2015 2011 2015 0 0 4

Madagascar 2008 2012 2014 2018 0 2018 2018 2015 0 0 5

Mozambique 2009 2013 2015 2015 2018 2018 2017 2015 0 0 6

Malawi 2002 2011 2012 2015 2016 2021 2015 2015 0 0 4

Namibia 2009 2014 2014 2015 0 2012 0 2015 0 0 4

Rwanda 2002 2009 2012 2014 2014 2018 2014 2015 2016 2017 7

Somalia 2013 2016 2018 0 0 0 0 2015 0 0 3

Mozambique 2009 2013 2015 2015 2018 2018 2017 2015 0 0 3

South Sudan 2014 2016 2018 2018 0 0 0 2015 2016 0 6

Swaziland 2010 0 0 2008 0 0 0 2015 0 0 1

U R of Tanzania 2009 2013 2013 2014 2014 2018 2014 2015 0 0 5

Uganda 2002 2013 2016 2016 0 2017 2015 2015 2020 2016 6

Zambia 2004 2013 2012 2013 2015 2019 2015 2015 0 0 3

Zimbabwe 2008 2012 2014 2015 2015 2019 2014 2015 0 0 5

95

Updated date:

Aug 2014Tentative year of vaccine introduction

Numb

er of

vacci

ne

intro

ducti

on pl

an

2014

-201

8

Total

On average country immunisation supply chains do

not meet WHO standards today

1. EVM (Effective Vaccine Management) Assessments – Average score of Principal, Sub-National, Local District and Service Point Level; Source: EVM assessment for 57 GAVI countries, WHO

20% 24%38%

28%16% 19% 17%

30%37%

80% 77%62%

73%85% 81% 83%

70%63%

Distribution Information

systems

Buildings

and

equipment

Storage

capacity

Temperature

monitoring

Stock

management

MaintenancePre-

shipment &

vaccine

arrival

Vaccine

management

Reaching standard

Not reaching standard

% of countries that reach 80% target on

relevant supply chain WHO standards1

0%

20%

40%

60%

80%

100%E1: Arrivage/Réception vaccin

E2: Température

E3: Capacité de stockage

E4: Bâtiments, équipement, transport

E5: MaintenanceE6: Gestion de stock

E7: Distribution

E8: Gestion des vaccins

E9: SIG, fonctions d'appui

Scores de critères

Cible % Maximum % Moyenne % Minimum % Etendu: Entier Niveau: Dépôt central (1) n: 1

0%

20%

40%

60%

80%


E2: Température




E7: Distribution



Scores de critères

Cible % Maximum % Moyenne % Minimum % Etendu: Entier Niveau: Dépôt intermédiaire (1) n: 3

0%

20%

40%

60%

80%


E2: Température




E7: Distribution



Scores de critères

Cible % Maximum % Moyenne % Minimum % Etendu: Entier Niveau: Dernier niveau de distribution n: 17

0%

20%

40%

60%

80%


E2: Température




E7: Distribution



Scores de critères

Cible % Maximum % Moyenne % Minimum % Etendu: Entier Niveau: Point de prestation n: 12

Central level Regional level

District level Service Delivery level

Session Topics

• Background and problem statement





• Discussion

Consultations with PPC

and board members

The strategy was developed in a collaborative process

with Alliance partners

Private sector / other

partners

Consulted on strategy

with ~35 private sector

and other partners

Presentation at World

Vaccine Congress

Review of strategy in

eight Steering Committee

workshops

Alliance

Taskforce

Countries

Baseline analysis drawing

on discussion with 25

country level experts

Surveyed >25 EPI

managers

Presentations at regional

EPI managers meetings

Direct consultations

Global health community

67 members actively

involved through working

groups

Presentation at workshops

and conferences

http://www.gavialliance.org/about/partners/who/

http://www.gavialliance.org/about/partners/who/

http://www.gavialliance.org/about/partners/unicef/

http://www.gavialliance.org/about/partners/unicef/

http://www.gavialliance.org/about/partners/bmgf/

http://www.gavialliance.org/about/partners/bmgf/

The task of moving vaccines and immunisation

products to beneficiaries involves many challenes:

Evidence points to issues in seven areas:

• Limitations in supply chain system design

• Insufficient and misallocated human resources

• Ineffective use of data for management

• Weak distribution systems

• Inadequate budget and distribution systems

• Deficient cold chain equipment

• Increasing volume and value

Priorities

and

Initiatives

Change

Objectives

Vision 2020

The resulting strategy framework builds on a number of

critical priorities and initiatives

1. Currently EVMSource: GAVI Alliance Task Force

• Use resources efficiently

Immunisation supply chains provide potent vaccines efficiently to all

Save children's lives and protect people's health by

increasing access to immunisation in poor countries

• Maintain vaccine potency

• Ensure availability of right

vaccines and supplies

1 2

System Design & Optimisation

Distribution

& Transport

People &

Practices

Cold Chain

Equipment

Data for

Management

Alliance-wide theory of change

Implementation

mechanisms

Funding

mechanisms

Technical

assistance

Roles &

responsibilities

Policy changes

and guidance

In-country

change

process

Implementation roadmap Budget

Managing change in countries will build upon

existing mechanisms

CSOs PartnersPrivate

sector

Support & Funding

Donors

2. Country supply chain

plan

3. Grant application(HSS /NVI)

4. IRC and High level

panel review

5. Implemen-tation of impro-

vement plan

6. Monitoring & evaluation

Partners aligned to

promote and support

implementation

Supply chain management

dashboard to support

monitoring

Increased support for applications.

Improved guidelines to strengthen

link with improvement plans

Improvement plan based

on assessments and tools

Right supply

chain expertise

on IRC and high

level panel

1. Country change team

Country-led team to

manage implementation;

supply chain manager is

key participant

Session Topics






• Discussion

Support government initiatives with short term

targeted support

In such cases the goal is to work closely with UNICEF country offices

and governments to strengthen and optimize key segments of supply

chains for targeted products to reduce costs, stock-outs, wastage,

improve performance –

- and help achieve results in Results Areas:

1 (Health), 2 HIV/AIDS), 3 (WASH), 4 (Nutrition), 5 (Education)

DEF

INIT

ION

OF

NEE

D

BU

DG

ETIN

G &

P

LAN

NIN

G

PR

OC

UR

EMEN

T

DEL

IVER

Y &

C

LEA

RA

NC

E

INSP

ECTI

ON

WA

REH

OU

SIN

GD

ISTR

IBU

TIO

N,

& R

EOR

DER

UTI

LIZA

TIO

N B

Y EN

D U

SER

MO

NIT

OR

ING

&

EVA

LUA

TIO

N

Funding & Policies

Investments & Infrastructure

Systems & Data

People & Practices

Sustainable National Supply Chains

DEF

INIT

ION

OF

NEE

D

BU

DG

ETIN

G &

P

LAN

NIN

G

PR

OC

UR

EMEN

T

DEL

IVER

Y &

C

LEA

RA

NC

E

INSP

ECTI

ON

WA

REH

OU

SIN

GD

ISTR

IBU

TIO

N,

& R

EOR

DER

UTI

LIZA

TIO

N

BY

EN

D U

SER

MO

NIT

OR

ING

&

EV

ALU

ATI

ON

Support government initiatives to achieve long term

results

What does success look like in 2017?

Increased number of countries implementing national supply chain systems strengthening/capacity

development strategies, led by government and aligned with national strategic health plans

Strong networks created with increased collaboration, sharing

and co-ordination in supply chain activities at global, regional and

country level

Global Learning Centre

is recognized as a platform for supply chain resources and

learning

> 20 Government supply chains strengthened and optimized for

targeted products

Increased use of supply chain data to support decision making,

from determination of need through to delivery to the last

mile

Success in 2017

Phase 1 Phase 2 Phase 3 Phase 4

Monitoring and Evaluation

Results of SC assessments and improvement plans

published

SC assessments and improvement plans

Accepted govtrequests come to pre-defined end

objectives

Courses available and delivered in GLC

Product specific SC performance monitoring

Ad

voca

cy /

Co

mm

un

icat

ion

Too

ls a

nd

Gu

idan

ce

Skills/Learning & Development

Global networking and

collaboration

Comms tools for creating internal and external awareness

Advocacy for increased SC

engagement in ICCs & NTWGs

Advocacy for SC collaboration and

co-ordination.

Integratedcampaign guidance

SC analysis and management toolkits

Project management

Technical assistanceand training of COs

and partners

WIM training

Guidance for adopting innovative technologies

National SC strategies

Enhanced CO VISION

WH module

Conceptual development of CD strategies

Knowledge sharing portal / platform

Distribution and transportation

guidance

In-country champions for effective supply chains

Landscape analysis of

existing SC tools

SCM essentials and reference materials

Quality assurance and CAPA in SCs

SCM partnerships

Designing SC improvement

plans

Project engagement progress reporting

SC standards and KPIs

South-to-SourhexchangecEVM

Session Topics






• Discussion

• National Supply Chain Strategy developed by MoH and partners and endorsed by Minister of Health; aligned with the National Strategic Health Plan

• Govt and partners are implementing supply chain strengthening initiatives that support the national strategy under the 8 strategic pillars:

Quantification and Product Selection

Quality Assurance and Rational Use

ProcurementCommodity Security , financing and

resources mobilization and M&E

LogisticsHuman Resources for Health in

Supply Chain

Information System Public Private Partnerships

Implementing a National Supply Chain

Strategy in Zambia

Context

Scope

LMIS: Microsoft Dynamics Navision warehouse module in Nigeria

Currently warehouse management at national level in Nigeria does not provide real time, accurate data.

The high volume of incoming and outgoing stock necessitates the need for an integrated, robust LMIS system for all levels of warehouse management in Nigeria

The deployment of Microsoft Dynamics Navision 2013 will be limited to:

1 Central Store6 Zonal Stores37 State Stores (36 states and FCT)

The system includes the modules:

Vaccine RequisitionsVaccine IssuanceStock Movement Stock Location Transfers Stock Level ManagementStock Expiry Date Tracking Audit & Inspection

Warehouse Module Structure

Objectives

Increase vaccine supply chain visibility and improve stock management and communication between the supply chain tiers.

Transfer the ownership to the government after installation, training, etc to ensure sustainable use and maintenance of the system.

Decentralisation of international vaccine

shipments to reduce bottlenecks

632 million doses

Data: UNICEF Supply Division 2013

111 million doses

Problems observed today:

• High frequency of international shipments to the capital airports

• Large cold room capacity required

Potential solutions:

• Support the decentralization of international shipments and destination points to provincial international airports

• Contribute to analyse the benefits of a decentralised distribution network

• Contribute to capacity development of human resources at multiple levels

Session Topics






• Discussion

25

ViVa is a stock monitoring projection and early

warning / advocacy tool

ViVa enables identification and communication of

potential upcoming vaccine supply constraints

weeks

doses

3 months alert

ViVa evaluation of pilot phase:

success criteria and result of feedback survey

Criteria of success

1 Visual Aspect: Is the graphics acceptable?

2 Usability: Is the tool user friendly?

3Frequency of use as monitoring tool: How frequently was the tool used as monitoring tool?

4Frequency of use as advocacy tool: How frequently was the tool used as advocacy tool?

5Utility of the tool as monitoring tool: How useful was the tool as monitoring tool?

6Utility of the tool as advocacy tool: How useful was the tool as advocacy tool?

7Stock level information requirement update: How difficult it is to provide the information required?

8 Frequency of stock level update requirement: Is the frequency adequate?

PILOT PHASE

Feedback survey result / CommentsScore Comments

4 84% Very appropriate – 5% Extremely appropriate

3.9 68% Very easy – 11% Extremely appropriate

Frequency not assessed in the feedback survey; but slides extracted from ViVa used during monthly CCIA meetings in DRC and Niger

4.2 68% Very useful – 26% Extremely useful

4.3 53% Very useful - 37% Extremely useful

Not assessed in the feedback survey; but weekly stock level were provided at 85%.

The Supply Chain Ends Here

Session Topics






• Discussion

Immunisation Supply Chain Strategies - UNICEF · PDF fileImmunisation Supply Chain Strategies...

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