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The 5th Global Health Supply Chain Summit
Managing Supply Chain Risk in Complex and
Difficult Situtations: A Practioner’s
Perspective Dr. T U Wushe
[SPEAKERS NAMES]
November
14 -16, 2012[DATE]
Kigali, Rwanda
Agenda
• Introduction- Setting, Supply Disruptions & Justification of
the presentation
• Defining Difficult Environment
• Difficult Situations and Health Supply Chain Management
• The Zimbabwe Case 2000-2009 Case study
• Conclusions and Recommendation
Introduction
Setting
• WHO target of 10.5 lives saved every day
• Drugs availability at facility level is the MOST important
element
• Unreliable or Supply Chain disruptions is a key barrier
Therefore the supply chain is a mission critical element of a
health program (Shawkey 2000)
Supply Chain Disruptions/causes
Supply Chain disruptions causes
• Stock outs
• Poor Quality products
• Damaged product
• Leakages
Examples Include
• Normal Disruptions- fuel, vehicle breakdown, labour
issues, global shortages
• Complex and Difficult environment- Civil strife, Political
interferences, temporal closure of facilities, cross purpose
goals and objectives
Defining Difficult Environments
• No universally accepted definition
• Torres and Anderson (2004, p.5-6) propose a difficult
states taxonomy along the following categories:
– State collapse: the central state ceases to function
– Loss of territorial control: contested or partial loss of
authority
– Low administrative capacity
– Political instability
– Neo-patrimonial politics, or clientism
– Conflict
– Repressive government
– Difficult Partnership countries
– Low income countries
Difficult Situations & Health Supply Chain
Management
• Influenced by the Health Systems strengthening
framework
Options
- Humanitarian: Saving lives
- Developmental: Strengthening public systems
In practice it is a continuum and the position of operation
forms a foundation for building Public Health supply chains
Characteristics of a Health Supply Chain
in Complex Environment
• Lack/Poor infrastructure
• Multiple and at times Dysfunctional supply chains lacking
coordination and oversight
• Lack of equity in drug availability
• Poor and inadequate logistics information system
• Poor management capacity
• Expired drugs, surpluses and stock outs
• Weak institutions the government medical stores are just a
warehouse and not involved in the purchasing and supply
plans
• Displaced or weak country systems
Common Sources of and risks in Complex
Environments
• Stakeholder goal divergence. Government, civil society
and donors
• Poor ICT knowledge and resources in government
• Dysfunctional competition for channel members and staff
• Low level of commitment by government employees
• Secondment positions in government creating
dysfunctional working relationships
• Vertical programs, TB, Malaria etc.
• Reduced/limited access to rural health facilities
• Political grandstanding
• Protests/lawlessness/ illegal road blocks and hijackings
The Zimbabwe 1999 – 2009 Case study
• Transformed from one best in sub sahara health sysytems
to one of the worst.
• Findings
- Complex relationship matrix with partners leading to aid
adjustments causing an adjustment vicious circle
- No longer meet its public health obligation to almost 100%
donor reliant
- Critical shortage and stock outs
- Deterioration of infrastructure
- Skills flight to neighboring countries, NGOs & Funded
vertical programs
The Supply Chains
• The Delivery Team Top Up, (DTTU) based on a pull system.
This is funded by GOZ, USAID and DFID.
• The ARV supply system funded by USAID.
• Cold Chain supply system
• NGO led supply network.
• NatPharm Distribution System which is based on a pull
system
• The Zimbabwe Informed Push system
In my 2010 study Products that were allocated and distributed from
the central medical stores had a higher product availability rate that
those that were ordered by health facility level staff.
How did Zimbabwe Manage its Risks
• Stock outs of Commodities – The DTTU integrated
logistics system
• In 2003 DTTU was approved, piloted and rolled out
country-wide.
• Reporting increased from 30% to 100% and stock outs
reduced from 40% to less than 5%.
• CPR rate one of the highest in Sub-Saharan Africa at 65%
• 2007 – Medicines delivery systems ground t a halt
• More products were subsequently added to DTTU in
2007, 2009 and 2011.
Resilient People
Risk Management Strategies
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Postponement
Strategic Stocks
Buffer Stocks
Flexible Supply Base
Dynamic Demand Management
Robust Transportation
Capacity Building
Capacity Building
Challenges of Implementation
• Cost vs. Benefits
• Strategic Fit
• Capacity
Conclusions
• Build robust and resilient supply chains that less
vulnerable to disruptions- contingency planning
• Understand the context first then structure SCRM system
• Design and Application of SCRM is a process based on
action more than theory
• SCRM in difficult and complex environment is a SCM sun
discipline requires more practitioner and academic
research
The right product at the right place and in
time
With the Right Attitude It is Possible
The Reality Check
• “The problems of VICTORY are more agreeable than
those of defeat but they are not less difficult”
(Sir Winston Churchill 11.11.42)
• I acknowledge that doing well in difficult and complex
environment comes with its own set of challenges.
Therefore supply chain managers should always be
ready to seize the current opportunity and organise on the
fly to deliver undisputed value to clients.
• SCRM is a contact sport. Be ready to play the game.