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Interim Approach (IA) For
Health Commodities Distribution
BY
Minnnie Sirtor Bowier
JSI / USAID|DELIVER PROJECT
February 2015
Presentation Outline
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Overview of Liberia
Background - IA
Objectives - IA
Key components
Impact of Ebola
Achievements
Challenges
SIERRA LEON
Over view of Liberia
• Population of approx. 4 million
• Currently has the 1st African female president
• Has one of the largest rain forest and 2 seasons (dry and
raining)
• Experienced 14 years civil unrest (1989 – 2003)
• Maternal mortality stands at 1,072/100,000 live births
• 5% of the population are women of reproductive age
• Unmet need for family planning is 31%
Over view of Liberia cont’d
Amidst
ALL this:
:
Background / History of the Interim Approach (IA)
• Serious challenge with implementation of the SCMP
– Accountability for commodities
– Commodity security
– Data availability for decision making, etc
• Led to concerns by partners and donor agencies
• The MoHSW formed a Supply Chain Task Force led
by Minister Tolbert Nyenswah
• The task force appointed a technical committee
which developed a concept paper on IA
Health Commodity Supply Chain Flow Chart
Central Warehouse
County Depots
HF
HF
Client
County Depots
Client
HF
Client
Client
HF
Client
What is the Interim Approach (IA)?
• IA is a modified top-up commodities distribution
system in which a team of HCWs determine
quantities and supply commodities based on physical
inventory at facility and develop logistics data report
• OBJECTIVES OF INTERIM APPROACH (IA)
• Ensuring commodity security
• Accountability & transparency
• Reporting / availability of data for decision making
Interim Approach Rounds
• June 2013: Interim Approach adopted by MOHSW
• July/August 2013: pilot distribution conducted
• October 2013: first round of distribution began
• February 2014: 2nd Round distribution
• May 2014: 3rd Round distribution
• September - October 2014: 4th Round distribution
• February 2015: 5th Round distribution
How does distribution work under IA?
Interim Approach- Distribution options
Option 1
Separate
Data
Collection
and
Delivery
IA team visits HF, calculates consumption,
stock on hand and quantity to deliver,
returns to warehouse
Truck loaded with predetermined packs of
quantity to deliver
Truck drives with stock
to facility
Option 2
Combine data
collection
and delivery
– Mobile
Warehouse
Truck loaded with products;
quantities based on previous
quarter consumption data
Truck drives with stock to
facility
IA team calculates consumption
11 up to
and stock on hand; tops
maximum stock level
Impact of the Ebola Virus
What happened during the ebola outbreak?
• Things change more rapidly
• Killed about 3,935 persons including health workers
• Health facilities were closed
– Even when opened clients were afraid to visit
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Clients could not have access to FP commodities
Ebola Treatment Units (ETU) were later established
WHO recommended the NO TOUCH POLICY
People fled the country
Response Strategies
Distribution during the ebola outbreak
• Restoration of health services was and is emphasize
• Facilities had to be resupplied with commodities
• For resupply the IA was used but with all caution
• Health workers were trained to use Personal
Protective Equipment (PPE)
• Limited entry into facilities
• Use of PPE during commodity delivery
Results from the IA
• Consistent decline in stockout rates rounds 1-4 except for
depo provera that was stock out at the central level during
the fourth round
• High delivery coverage/reporting rates
• Greater visibility of data, including consumption data and
stock on hand/stock status
• Greater accountability: quantities issued match quantities
received
• Data verification exercise combined with EUV
• Capacity building of both central and county level staff
• Harmonization of distribution of other commodities with IA
Comparison of Stock Out Rates - All 5 Counties
21%
25%
Depo-Provera
18%
Male Condom
16%
63%
36%
65%
35%
Microgynon
76%
75%
72%
87%
17%
22%
Female Condom
7%
Microlut
15%
5%
84%
64%
16%
Cycle Beads
(IUD) or Copper T model
TCu380A
68%
57%
88%
79%
8%
4th Round
10%
3rd Round
62%
2nd Round
1st Round
91%
Montserrado
Delivery Coverage Across Distribution Rounds
4th Round
76%
3rd Round
99%
2nd Round
99%
1st Round
98%
Delivery coverage (4 Counties)
3rd & 4th Round Delivery Coverage
93%
4th Round
98%
3rd Round
Commodity Supply Chain Flow Chart
Central Warehouse
County Depots
HF
HF
Client
County Depots
Client
HF
Client
Client
HF
Client
Accountability in movement of products
LOFA
BONG
Product
Qty Issued
by NDS
(from
invoice)
Qty
Received
by Depot
Quantity
received
recorded on
Stock Card
Qty
Requested
on SBRR
Qty Issued
by NDS
(from
invoice)
Qty
Received
by Depot
Quantity
received
recorded on
Stock Card
0
0
0
0
189
0
0
0
14,800
7,200
7,200
7,200
12,177
7,200
7,200
7,200
407
410
410
410
424
420
420
420
346,700
336,000
336,000
336,000
-219,575
-
0
0
22,018
22,320
22,320
22,320
3,600
3,600
3,600
3,600
2,866
2,880
2,880
2,880
4,512
4,320
4,320
4,320
Qty
Requested
on SBRR
(IUD) or Copper T
Depo-provera
Jadelle
Male Condom
(3,000)
Microgynon
Microlut
Challenges
• Inadequate/weak human capacity, infrastructure and
data management at county level
• Poor accessibility to some health facilities due to bad
roads
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Challenges
• Inadequate supportive supervision on supply chain at
county level
• Facilities closure due to EVD epidemic impacted
coverage
• Changes in the distribution team members due to
competing priorities (Ebola Response) by the county
health team
• Thank you
• Questions?
NO
PRODUCT
NO
PROGRAM