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The 6th Global Health Supply Chain Summit
GAVI Alliance immunisation supply chain strategy
Daniel Thornton, GAVI Secretariat
[SPEAKERS NAMES]
[DATE]
November
18 - 20, 2013
Addis Ababa, Ethiopia
Overview
• Introduction to GAVI
• Issues with the immunisation supply chain
• Introduction to the strategy development process
• Next steps
GAVI Alliance: a public private
partnership
GAVI supports immunisation in the world’s
poorest countries
• Click to add text
Overview
• Introduction to GAVI
• Issues with the immunisation supply chain
• Introduction to the strategy development process
• Next steps
Immunisation supply chains: backbone of
national immunisation programmes
Manufacturer
Shipments
(air & sea)
Ordering
Forecasting
Vaccine
Arrival
Analysis
National Store
Reports
Sub-national
Stores
Records
Health Centers
Service Delivery
Waste
management
6
Value, volume and complexity have grown rapidly
Compare 1980s to 2010
Challenge of reaching effective vaccine
management standards
No country meets all
minimum standards
for all criteria, at all
levels of the supply
chain
A GAVI Alliance immunisation supply
chain strategy is required
• Recognition that stronger immunisation supply chains are
needed to achieve the GAVI Alliance mission
• Agreement that this topic requires more attention at all
levels in order to:
– improve the effectiveness and efficiency of immunisation
supply chains
– increase the resources for immunisation supply chains
– enhance collaboration across the Alliance (e.g.
WHO/UNICEF immunisation supply chain Hub)
– leverage expertise and knowledge from other health sectors
and the private sector
Overview
• Introduction to GAVI
• Issues with the immunisation supply chain
• Introduction to the strategy development process
• Next steps
GAVI Alliance immunisation supply chain
strategy timeline
Board
Taskforce
discusses
supply chain established
Q4
2012
Q1
2013
Cold chain work
transferred to
taskforce
Q2
2013
Q3
2013
Landscape analysis
findings
Presentation to
Board
Taskforce reset
Q4
2013
Q1
2014
Q2
2014
Framework
to PPC
SAGE discussion (1/2)
Q3
2014
Q4
2014
Strategy to
PPC
SAGE discussion (2/2)
GAVI
immunisation
supply chain
strategy
Phase 1: Landscape analysis
Phase 2: Consultations & framework developed
Phase 3: Strategy development
Phase 4: implementation planning
GAVI 20162020 strategy
EC
4 Mar
Board
SAGE PPC
1-3 Apr 5-6 May Jun 18-19
Identified challenges were prioritised into
four working groups
Data discrepancy country vs.
global
Global
Multiple signals of demand
received by manufacturers.
Limited opportunity to
reconcile
Identified challenges
Product specifications impact
SCM
Poor quality of short-term
country forecasts
Frequent updates of forecast
to manufacturers
Interface
Lack of total cost perspective
on portfolio and SC decision
Long lead times for approval
Timing of approval
Vaccine Products
Vx intro decisions and
scheduling are not robust
enough and change frequently
Last minute sharing of
procurement plan
Missed return on investment
from money on “Procurement
Accounts”
Delay of co-funding
Long lead-times and delays in
getting shipment clearance
Delivered products don’t match Lack of transparency into
preferred specification
shipment data
Incountry
Multiple levels of supply chain
holding inventories
Limited expertise to operate
and oversee SC processes
Insufficient or non-functional
cold chain equipment
Ad-hoc delivery schedules
Suboptimal cold chain
equipment selection
Poor equipment repair and
maintenance
Lack of SC processes / not
well implemented
Priority working groups for
approaching challenges
Insufficient transportation
resources
People and practices
Data for management
Cold chain strengthening
System optimisation
Limited transparency on
demand frequency, size and
location
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Priority working groups
•
People &
Practice
•
•
Data for
management
Cold chain
strengthening
System
optimisation
Support access for quality pre-service and in-service training
health supply chain training
Advocate for recognition of supply chain management as a
profession
Strengthen management structures and systems
•
•
Capture and share information about on-going projects
Identify gaps where funding should be targeted to help, and
encourage scale up of information systems identified as most
likely to succeed in range of countries
•
•
•
•
Define target specifications for better projects
Improve global guidance to countries
Set up feedback mechanisms for buyers and manufacturers.
Explore market shaping options
•
Support countries to streamline network designs in order to
increase their efficiency, agility and effectiveness.
Focus on transportation systems, synergies with private sectors
and other health commodity supply chains
•
14
Insufficient high performing human resource with
appropriate expertise at global and local levels
Causes
Challenge
Lack of
sufficient
expertise in
existing staff
Insufficient
high
performing HR
w/ appropriate
expertise at
global/ regional
level
Insufficient
overall number
of staff
Lack of proper
incentives and
performance
management
Insufficient
high
performing
human
resources with
appropriate
expertise
in countries
Who is managing the immunization supply chain in
Benin (2012) ?
“When you use a nurse or a physician as a logistician,
you lose the nurse or physician and you don't get a
good logistician!”
Dr. Saracino, former Minister of Health, Côte d'Ivoire
TFI members briefing, Harare, Oct.2006.
Source: AMP LogiVac Project
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Previous generation of GAVI health systems
funding had little focus on supply chain training
DRC
% of GAVI HSS funding dedicated to HR
training
Training funding dedicated to health
supply chain training
29% ($16.3m) dedicated to training
No health supply chain training
14% ($1.4m) dedicated to training
No health supply chain training
Ghana
Nigeria
23% ($10.3m) dedicated to training
~5% ($0.48m) of total training
$allocated to logistics
(at time of evaluation training hadn't
happened)
Of 3 countries, only Nigeria provides logistics training, and at time of
evaluation, training had not yet been implemented
Source: HSS Evaluations
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Significant barriers to implementation of new tools
and technology
Despite the promise of some existing tools and
new technologies...
Stock Management Tool (SMT), District Vaccine
Data Management Tool (DVD-MT)
 Microsoft Excel-based tools for monthly
reporting, developed by WHO
Vaccination Supplies Stock Mgmt (VSSM)
 Access based tool developed by WHO
 Supports warehouse management
 Used for central/large subnational stores
...systems improvements are often challenging
to implement in countries

Countries have a lack of choice and access to
information on potential solutions

Costs of licensing and contracting are high
• Country MoH have limited capacity to develop
contracts with information system providers

Cost and complexity of developing custom-made
software

Lack of connectivity, reliable electricity and
capacity to maintain systems at peripheral level
imply that typical commercial systems are often not
suitable

Lack of technical expertise at central levels needed
to run and maintain systems once they are acquired.
Open LMIS
 Freely available resources for electronic
logistics management information systems
and other tools
 Commercially available systems developed by
profit and non-profit organisations
Mobile Phones
and Networks
Cloud
Computing
Source:, Project Optimize: Information Systems Action Plan, Expert Interviews, Village Reach: The framework for open LMIS
17
There are four critical cold chain
equipment gaps at the facility level
~134,000
▪ Many facilities that should have cold chain equipment (based on
Unequipped
facilities
17%
Non-functional
equipment
17%
government plans) are not equipped today
– Nigeria: <20% of 11,500 target facilities currently equipped
▪ Much of equipment which does exist is non-functional or not
installed (e.g., due to poor maintenance)
▪ Significant portion of installed base is absorption, solar with battery,
Undesirable
technology
Acceptable, but
sub-optimal
technology
42%
or domestic refrigerators with significant issues:
– Expensive to run
– Unreliable
– Inadequate holdover
– Risk to efficacy of vaccines due to poor temperature control
(e.g., freezing, etc.)
▪ Smaller portion of installed base are ILRs and SDDs that:
– Do not meet facility needs (e.g., 50% of facilities need <15L
24%
capacity, but most too large)
– Are of some risk to efficacy of vaccines (risk freezing if user
does not pack refrigerators correctly)
1 Extrapolated data from 7 countries representing >50% of GAVI birth cohort
SOURCE: CCEM data; country data; WHO/NPHCDA
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Example of system optimisation from India:
milk run
Bhagalpur division
Bihar
INR 4200 per trip
INR 4200 per trip
INR 4200 per trip
INR 4200 per trip
• Presently each district books a private vehicle to source vaccines from divisional HQ at an average
cost of INR 4200
per trip
Baseline:
each
district pays average INR 4200 to book separate trips
• A round trip from Bhagalpur (milk run) will be ~300 km; even at a cost of INR 30 per km it will be
Solution:
only INR 9000round
per trip trip milk run reduces distance, saves ~INR 100,000
• (~$1500)
Translating into
annual saving of ~INR 1,00,000
peranyear
• A similar saving may be replicated in vaccine transportation from district HQ to PHCs
SOURCE: Public Health Foundation India
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Overview
• Introduction to GAVI
• Issues with the immunisation supply chain
• Introduction to the strategy development process
• Next steps
Next steps
• Continue to engage with countries, stakeholders,
experts, throughout this process
• Draw upon existing knowledge and expertise,
especially in the prioritised areas
–
–
–
–
People & practice
Cold chain strengthening
Data for management
System optimisation
• Launch request for expressions of interest to better
understand the landscape of existing service
providers and technical partners
Thank you