Transcript Slide 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
1
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
2
2
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
3
3
Mozambique
Cabo Delgado
Niassa
Nampula
Impressive results…but at what cost?
Indicator
Baseline
Result
Coverage Rates (DPT-Hep B3)
68%
95%
Vaccine stock outs
80%
1%
Cold chain functioning
~40%
96%
DPT1-3 Dropout Rate
12%
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.”
4
4
Cost Study
• Methodology
• Objective
– Excel-based cost model
– Compare the costs of
vaccine logistics in the
pilot province and a
control province.
• Transport, personnel, cold
chain, vaccine & supplies
• Immunization portion
only
• Challenges
– Niassa as comparison
province
– Niassa 10% random
sample using PPS
– Haphazard nature of
supply chain in Niassa.
– Wide variety of activities,
participants, frequency,
and costs.
– Lack of cost records.
– Sufficient recall.
• 10 health centers in 8
districts
• Surveys at health centers,
districts, and province &
national transport &
maintenance staff
• Total 42 surveys
5
Description of Logistics System Assessed
• Cabo Delgado
Mozambique
– Project system
– Active logistic delivery system
– Vaccines reliably delivered to
health facilities each month
• Niassa
– Mixed & inconsistent
– Collection & distribution
– Varies by location & month
6
Cabo Delgado: Dedicated Logistics System
1. Leave with:
- medical supplies
- propane
- equipment, parts
- knowledge
Provincial
Store
4. Field coordinator office
- input data
- analyze information
- prepare for next trip
- training
District
Storage
3. Return with:
- data
Health Centers
Outreach Teams
7
7
2. Site visit:
- record & stock inventory
- service equipment
- collect data
- supportive supervision
Niassa: Old System
DPS
Lichinga
Cuamba Regional
Desposito
DDS
Lichinga Cidade
US
Lichinga
US
Chiulugo
DDS
Lagos
US
Bandeze
DDS
Majune
US
Luambala
DDS
Mandimba
US
Lipúsia
8
DDS
Nipipe
DDS
Metarica
DDS
Cuamba
US
Cheia-Cheia
US
Namicunde
US
Mitucue
DDS
Mecanhelas
US
Coronga
US
Chissaua
Results
Characteristic / Comparison
Niassa
Cabo Delgado
Absolute Costs
Population
1,178,117
1,632,809
Total Vaccine Logistics Costs (1 yr) $266,563.04
$305,418.80
Transport
Personnel
Cold Chain
Vaccines & Supplies
$ 35,968.39 (14%)
$ 55,234.48 (18%)
$75,482.23 (28%)
$ 35,376.00 (12%)
$31,306.42 (12%)
$27.191.82 (9%)
$123,806.00 (46%)
$187,616.51 (61%)
Costs Controlling for Population Differences
Population of Children U5
179,892
303,007
Total Cost Per Child U5 (1 yr)
$1.48
$1.08
Relative Cost-Effectiveness
DPT3 2008 Coverage Rate among 70%
95.4%
children aged 24-35 months
Total Cost Per Child Receiving
$6.07
$5.03
DPT-Hep B3 (1 yr)
Relative Cost-Efficiency
Number of Vaccine Doses
498,624
889,152
Delivered (1 yr)
Total Cost Per Dose of Vaccine
$1.50
$1.18
Delivered
9
Difference
Niassa – Cabo Delgado
-454,692
-$38,855.76
-$19,266.09 (-4%)
+$40,106.23 (16%)
+$4,114.60 (3%)
-$63,810.51 (15%)
-123,115
$0.40
-25.4%
$1.04
-390,528
$0.32
Results: Breakdown of Costs
Cabo Delgado
Niassa
Transport
18%
14%
Personnel
61%
46%
12%
Cold Chain
9%
Vaccines &
Supplies
28%
12%
Conclusion: The Dedicated Logistics System (Cabo Delgado) is more costeffective and efficient, which leads to government savings.
10
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 Mozambique’s 10 provinces
implement the Dedicated Logistics System, which
now extends to over 445 health centers.
11
Thank You
www.villagereach.org
Leah Hasselback
Mozambique Country Director
[email protected]
Tel: +258 827324196
Av. 25 de Setembro, 1123-11º. E
Maputo, Mozambique
Tel: +258 21326446
Fax: +258 21326448
12