Transcript Nigeria Health Supply Chain: Strategy Workshop, April 16 2008

Nigeria Health Supply Chain
Strategy Workshop
Abuja, Nigeria
April 16-17, 2008
Nigeria Health Supply Chain Strategy
Workshop
•Context
•Activities Presentation/Executive Summary
• Enabling Environment
• Product Selection
• Quantification
• Procurement
• Inventory Control Procedures
• Warehousing & Storage
• Transport & Distribution
• Product Use
• LMIS
• Organizational Support
• Finance, Stakeholder/Donor Coordination
• Quality
•Prioritization Exercise
•Full Presentation (Includes Goals and Challenges)
Nigeria Health Supply Chain Strategy
Workshop
• Context
• Activities Presentation/Executive Summary
• Enabling Environment
• Product Selection
• Quantification
• Procurement
• Inventory Control Procedures
• Warehousing & Storage
• Transport & Distribution
• Product Use
• LMIS
• Organizational Support
• Finance, Stakeholder/Donor Coordination
• Quality
• Prioritization Exercise
• Full Presentation (Includes Goals and Challenges)
On April 16 & 17 of 2008, 70 stakeholders and
experts representing organizations from
across the Nigeria health supply chain…
• Axios
• Clinton Foundation
HIV/AIDS Initiative
• CHAN/Medipharm
• Crown Agents
• Catholic Relief Services
• EU-Prime
• European Union
• Family Health
International/Global
HIV/AIDS Initiative
Nigeria
• The Global Fund
• Harvard School of Public
Health AIDS Prevention
Initiative
• Federal Ministry of Health
• Food and Drug Services
Division
• Central Medical Stores
• Family Health Division
• National AIDS Control and
Prevention Program
• Public Health Department
• International Center for
AIDS Care and Treatment
Programs/Mailman School
of Public Health
• Institute of Human VirologyUniversity of Maryland
• John Snow Incorporated
• LIFESIGN
• Leadership Management &
Sustainability Program
• Making Medical Injections
Safer
• National Agency for Control
of AIDS
• Nigeria Indigenous Capacity
Building Project
• The Supply Chain
Management System
• Society for Family Health
• US Government
• Centers for Disease
Control and Prevention
• Department of Defense
• USAID
• UN Population Fund
… participated in a health supply chain strategy workshop
The Federal Ministry of Health strategic
objective…
“to strengthen the national health system such
that it would be able to provide effective,
efficient, quality, accessible, and affordable
health services that will improve the health
status of Nigerians through the achievement of
health-related Millennium Development Goals.”
… guided the proceedings
Workshop “activities” were intended to support
Federal Ministry of Health policy guidance and
strategies…
•
•
•
•
National Health Policy
National Drug Policy
National Essential Drugs Program
Other existing and planned policy
documents and guidelines
… and enable improved harmonization
Participants agreed on an overall workshop
goal…
“to develop a comprehensive supply chain
management system strategic plan that supports
national goals and is based on stakeholder needs,
drives SCMS, USAID|DELIVER PROJECT, and
JSI/Global Fund activities and which links to donor
and stakeholder planning processes.”
…as well as a set of workshop objectives
• Identify key themes that cut across supply
chain functions
• Develop supply chain goals and objectives
• Build consensus among stakeholders on a 3-5
year strategy
Breakout sessions were organized around 12
components of the health commodity logistics
cycle
Enabling Environment
1. Enabling Environment
Select
2. Product
Selection
Use
Procure
8. Product Use
Support
3. Quantification
4. Procurement
9. Logistics Management
Information System
10. Organizational Support
11. Financing and Donor /
Stakeholder Coordination
Distribute
Store
7. Transport and
Distribution
5. Inventory
Control
6. Warehousing and
Storage
Participants were asked to answer three
questions pertaining to each component area.
• What are your desired goals/objectives for health
sector supply chain management in Nigeria
pertaining to this component area?
• What are the challenges/gaps that exist that prevent
attainment of these goals/objectives?
• What activities should be undertaken to address
these gaps?
Participants also considered if and how their
answers would change across supply chains
• Avian Influenza
• OIs/STIs
• Laboratory equipment
• Malaria
• Essential drugs
• Reproductive health
• HIV/AIDS
• Tuberculosis
• Vaccines
• Test kits
• Blood Samples
• Others
Results of the workshop will inform supply
chain activities in 2008 and beyond
Next steps/way forward
•Proceedings document to be reviewed, revised and validated by
participants and other partners
•Narrative health logistics strategy to be drafted based upon
proceedings document
•SCMS, USAID|DELIVER, and JSI/Global Fund projects to guide
and develop annual work plans based upon this strategy
•Strategy document to be shared with stakeholders, donors and
other health supply chain implementers as means to inform and
harmonize national supply chain activities
•Document to be reviewed and updated on a regular basis to reflect
evolving needs and changing
12
Nigeria Health Supply Chain Strategy
Workshop
• Context
• Activities Presentation/Executive Summary
• Enabling Environment
• Product Selection
• Quantification
• Procurement
• Inventory Control Procedures
• Warehousing & Storage
• Transport & Distribution
• Product Use
• LMIS
• Organizational Support
• Finance, Stakeholder/Donor Coordination
• Quality
• Prioritization Exercise
• Full Presentation (Includes Goals and Challenges)
1. Enabling Environment: Opportunities & Activities
• Multi-stakeholder review of policies including:
•
•
•
•
Contraceptive Logistics Management System
Petroleum Trust Fund
Expanded Programme on Immunization
Global Fund Malaria Project
• Conduct capacity building and create
incentive systems for operators
• Improve supply chain awareness of relevant
personnel within the enabling environment
• Review current arrangements for customs
clearance and engage relevant authorities to
improve processes
1. Enabling Environment: Opportunities & Activities
(cont’d)
• Support exemption policies for free health services
• Support development of National Procurement
Policy
• Harmonize, integrate national supply chains
• Improve financial management and financial
system sustainability
• Make the National Health Insurance Scheme
accessible to all Nigerians
• Establish, institutionalize and strengthen the Drug
Revolving Funds at all levels of Government
2. Product Selection: Opportunities & Activities
• Strengthen institutions that are responsible
for product selection through:
• Training and capacity building
• Infrastructure enhancement
• Implement policy
• Develop user friendly tools for data capture
and analysis for decision-making
• Enable information dissemination, review and
feedback
• Assess prevailing product use data bases
3. Quantification: Opportunities & Activities
•
•
•
•
•
•
Provide training on quantification
Standardize tools
Monitor & supervise data collection
Develop data quality assurance checklists
Enable data feedback loops
Forecast needs at national level—conduct
national quantification
• Establish supply chain working group
meetings, provide updated quarterly reports
and review quarterly data
• Conduct training on quantification
4. Procurement: Opportunities & Activities
• Advocate for more funds allocation to health
commodities
• Improve the system for the release of those
funds within the Federal Ministry of Health and
between ministries
• Undertake inter-departmental advocacy within
ministries/government departments
concerning linkages between Finance,
Procurement and Program Performance
• Involve technical experts within the tender
board
• Develop/disseminate Procurement Policy
4. Procurement: Opportunities & Activities (cont’d)
• Build technical capacity of procurement personnel
• Advocate for consistency and continuity of
government policies
• Develop long term procurement plans
• Develop procurement standards
• Develop and disseminate standard operating
procedures (SOPs) for key procurement activities
(eg. customs clearance, ICBD)
• Establish National Drug Procurement Agency
• Develop clear job descriptions that will articulate
qualifications for procurement specialists
5. Inventory Control Procedures: Opportunities &
Activities
• Learn from existing supply chain systems
• Improve storage and distribution infrastructure
• Establish and enforce inventory management
standard operating procedures (SOPs)
• Provide training in inventory management
• Computerize inventory management at sites
• Harmonize, simplify and distribute data collection
tools
• Undertake limited, well-supervised task shifting of
inventory control activities where appropriate
• Establish procedures for disposal of expired
product
6. Warehousing and Storage: Opportunities and
Activities
• Publish and implement standard operating
procedures (SOPs) for inventory control and
warehouse management
• Undertake staff training in
•
•
•
•
Product awareness
Safety
Use of equipment
Others as appropriate
• Provide appropriate clothing and safety
equipment
• Renovate buildings and equipment, (e.g.
racking, air-conditioning)
6. Warehousing and Storage: Opportunities and
Activities (cont’d)
• Advocate for budget earmarking to support
ongoing sustainability of warehousing and the
institution of quality assurance measures
• Undertake appropriate disposal of expired and/or
used products and supplies
• Undertake pest control measures
• Establish/improve communications network
• Re-activate zonal warehouses
• Establish periodic warehousing and storage
practice supervision
• Emphasize that donor support should not end
once goods arrive in country
6. Warehousing and Storage: Opportunities and
Activities (cont’d)
• Implement warehouse management systems
• Implement appropriate packing and other
equipment
• Establish long term planning for warehousing
based on forecast and procurement planning
• Establish surge capacity for disease
outbreaks
• Disseminate the National Drug Policy and train
management and staff in its enforcement.
7. Transportation & Distribution: Opportunities &
Activities
• Explore Public/Private Partnership (PPP) and
outsourcing options
• Establish budgetary provisions for
transportation and distribution services
• Strengthen networking, at all levels in the
system, with specific timelines
• Government, at all levels, should improve the
transportation network
• Ensure sufficient buffer in the inventory
control system
7. Transportation & Distribution: Opportunities &
Activities (cont’d)
• Coordinate and harmonize transportation and
distribution activities
• Pre-qualify potential transportation and
distribution vendors
• Develop appropriate standard operating
procedures and/or guidelines for
transportation and distribution activities
• Develop and provide training program for
transportation and distribution companies
8. Product Use:
Opportunities & Activities
• Provide continuing education in product use
• Advocate for appropriate product use to policy
makers
• Sensitize product users (i.e. clinicians, patients,
technicians) to appropriate product use
• Employ, train and deploy staff knowledgeable in
appropriate product use
• Improve conditions of service
• Improve incentives for staff
• Improve product use understanding/capacity in rural
areas
26
8. Product Use:
Opportunities & Activities (cont’d)
• Disseminate Standard Treatment Guidelines
(STGs)
• Improve product labelling
• Advocate for appropriate product use to
appropriate authorities
• Make products available & affordable at the
lowest tier of service delivery
• Strengthen relevant information management
systems
27
9. LMIS: Opportunities & Activities
• Identify, access and utilize existing
information and communication technology
• Develop time-line for the provision of a data
reporting and feedback system
• Standardize, harmonize existing tools and
protocols
• Motivate and train staff in application use
• Provide supportive supervision of LMIS
development initiatives
• Advocate for the importance of LMIS in
broader supply chain strengthening
10. Organizational Support:
Opportunities & Activities
• Develop clear, written job descriptions
• Develop career progression schemes for
logistics professionals
• Provide supportive supervision to staff at all
levels
• Harmonize organizational support tools
• Encourage advocacy for the importance of
supply chain management functions from
senior leaders of organizations
10. Organizational Support:
Opportunities & Activities
(cont’d)
• Build incentive schemes including performance
based rewards where practicable:
o to support logistics training
o to encourage feedback & communication
o to increase access to and adoption of organizational
development tools & resources
o to enable positive reinforcement
o to allow for career development and enhancement through
regular annual performance reviews, promotions and awards
11. Finance/ Stakeholder Donor Coordination:
Opportunities & Activities
• Institute regular, supply chain-specific, stakeholder
coordination meetings
• Establish supply chain management coordination
technical committee comprising national private
sector, public sector and partner organizations
• Institute coordinated procurement planning
• Advocate to government officials for increased
funding for supply chain management
• Review and increase access to national health
insurance scheme
• Undertake social marketing as means to secure
increased subsidization of commodities
11. Finance/ Stakeholder Donor Coordination:
Opportunities & Activities (cont’d)
• Publish budgets, tenders, expenditures for
government and donor program initiatives
• Increase transparency, visibility to commodity
pricing and procurement practices
• Advocate for passage of The Health Act
• Increase community involvement in program design
• Advocate for review of the process of funds release
• Improve planning
• Explore public/private partnerships and outsourcing
to competent companies of appropriate supply chain
functions
12. Quality: Opportunities & Activities
• Develop national guidelines on supply chain
• Disseminate National Drugs Policy through
workshops, e-mail, hard copies, and other
media
• Develop and implement supply chain quality
monitoring tools
• Harmonize of vertical supply chains
• Improve storage conditions, (e.g. power
supply, cooling facilities, metal shelves,
pallets etc.)
12. Quality: Opportunities & Activities (cont’d)
• Sensitize, advocate at all levels for the
importance of supply chain management
• Develop human capacity plans for improving
quality to include hiring, continuous training,
and task shifting where appropriate
• Continue to strengthen of National Agency for
Food, Drug Administration and Control
(NAFDAC)
Nigeria Health Supply Chain Strategy
Workshop
• Context
• Activities Presentation/Executive Summary
• Enabling Environment
• Product Selection
• Quantification
• Procurement
• Inventory Control Procedures
• Warehousing & Storage
• Transport & Distribution
• Product Use
• LMIS
• Organizational Support
• Finance, Stakeholder/Donor Coordination
• Quality
• Prioritization Exercise
• Full Presentation (Includes Goals and Challenges)
A prioritization exercise indicated general
support for five categories of supply chain
strengthening
• National Quantification—Establishment of one national quantification; Improve
the coordination of commodity quantification and procurement planning
• Coordinated Supply chain(s)—Establishment of a supply chain management
coordination committee comprised of public sector, private sector and other
partners: Harmonize and standardize existing tools and protocols for logistics
management information; Explore the integration of certain supply chain
functions
• Information Sharing—Summarization, publication, dissemination of policies,
guidelines and other Federal Ministry of Health guidance
• Skills Development—Staff, human capacity development through specific
training and incentive schemes; Improve skills in quantifying national commodity
needs
• Public Private Distribution Partnership—Develop public-private partnerships
to improve the transportation and distribution of health commodities,
Nigeria Health Supply Chain Strategy
Workshop
• Context
• Activities Presentation/Executive Summary
• Enabling Environment
• Product Selection
• Quantification
• Procurement
• Inventory Control Procedures
• Warehousing & Storage
• Transport & Distribution
• Product Use
• LMIS
• Organizational Support
• Finance, Stakeholder/Donor Coordination
• Quality
• Prioritization Exercise
• Full Presentation (Includes Goals and Challenges)
1. Enabling Environment: Goals
A Supply Chain Management System that is
integrated, responsive, and supportive. That
allows optimal service delivery by making
medicines both accessible and affordable in a
transparent and expeditious manner.
1. Enabling Environment: Challenges
• Policies are unclear, redundant, contradictory
• Local manufacturers are not given the tools to
be globally competitive
• Inadequate political commitment
• Lack of strengthened essential drugs program
1. Enabling Environment: Opportunities & Activities
•Multi-stakeholder review of policies including:
o Contraceptive Logistics Management System
o Petroleum Trust Fund
o Expanded Program on Immunization
o Global Fund Malaria Project
•Conduct capacity building and create incentive
systems for operators
•Improve supply chain awareness of relevant
personnel within the enabling environment
•Review current arrangements for customs
clearance and engage relevant authorities to
improve processes
E1.Enabling Environment: Opportunities & Activities
(cont’d)
• Support exemption policies for free health services
• Support development of National Procurement
Policy
• Harmonize, integrate national supply chains
• Improve financial management and financial
system sustainability
• Make the National Health Insurance Scheme
accessible to all Nigerians
• Establish, institutionalize and strengthen the Drug
Revolving Funds at all levels of Government
2. Product Selection: Goals
• Products must satisfy the majority of health needs
of the patients of the area
• Products should be selected by their:
o
o
o
o
o
Efficiency
Effectiveness
Availability
Safety
Accessibility
• Systems and processes that are followed in the
selection of commodities for use by patients and
or clients
42
2. Product Selection: Challenges
• Government policies/ regulations which are unable to
ensure transparency in product selection
• Weak institutions and their incapacity to carry out
product selection in terms of: skills, etc.: this affects
product selection for health care projects
• Lack of appropriate data for decision making
• Inadequate finance
• Environment: which affects
o Selection of equipment
o Product selection
• Non existence of a budget line item for product selection
• Weak regulatory enforcement at all levels
43
2. Product Selection:
Opportunities & Activities
• Strengthen institutions that are responsible
for product selection through:
o Training and capacity building
o Infrastructure enhancement
• Implement policy
• Develop user friendly tools for data capture
and analysis for decision-making
• Enable information dissemination, review and
feedback
• Assess prevailing product use data bases
3. Quantification: Goals
National quantification based on data from
throughout the system:
•
•
•
•
•
•
•
Morbidity
Consumption data
Plans for scale (up or down)
Supply plans—manufacture & transport delays
Self-life of product
Buffer needs & storage concerns
Costing implications
45
3. Quantification: Goals (cont’d)
•
•
•
•
•
•
•
Achievement of “The Six Rights”
Well founded assumptions for forecasting
Quality and timely data
Use of data over time
Translation of data into procurement tools
Valid from patient level to national level
Strengthened quantification capacity at
SDP, regional depots, CMS and
procurement coordinator
• Regular updates
46
3. Quantification: Challenges
• Lack of dedicated staff
• Administration/management an added
responsibility on clinical staff
• Weak infrastructure to support an
automated/IT system
• Poor staff retention/motivation/supervision/
empowerment
• Poor community distribution networks
• Weak quantification skills
47
3. Quantification: Challenges (cont’d)
• Inefficient data collection and transfer
• Procurement decisions not informed by
quantification
• Weak monitoring and supervision
• Unequal access to tools
• Shifting context e.g. Policy, scale up,
prioritization, stock fluctuations
• Inefficient reporting
• Variable periodicity of data reporting
• Parallel reporting systems (product line and type eg.
Pharmacy vs. lab vs. clinic)
48
3. Quantification: Opportunities & Activities
•
•
•
•
•
•
Provide training on quantification
Standardize tools
Monitor & supervise data collection
Develop data quality assurance checklists
Enable data feedback loops
Forecast needs at national level—conduct
national quantification
• Establish supply chain working group
meetings, provide updated quarterly reports
and review quarterly data
• Conduct training on quantification
4. Procurement: Goal
• Efficient and timely procurement of priority
health commodities to meet program needs
50
4. Procurement: Challenges
• Inadequate government funding for
procurement of health commodities
• Difficulty of obtaining timely release of
allocated funds
• Poor awareness among departments in FMOH
and between ministries of the linkages
between finance, procurement and program
performance
• Technical experts are not consulted during
tenders
• Inconsistent/unclear policies for procurement
51
4. Procurement: Challenges (cont’d)
• Poor capacity of procurement personnel
• Government policies change frequently, especially
with change of government or ministers
• Lack of procurement planning process
• Lack of performance standards for procurement
services (government or outsourced)
• Lack of SOPs for key procurement activities
52
4. Procurement: Opportunities & Activities
• Advocate for more funds allocation to health
commodities
• Improve the system for the release of those
funds within the Federal Ministry of Health and
between ministries
• Undertake inter-departmental advocacy within
ministries/government departments
concerning linkages between Finance,
Procurement and Program Performance
• Involve technical experts within the tender
board
• Develop/disseminate Procurement Policy
4. Procurement: Opportunities & Activities (cont’d)
• Build technical capacity of procurement personnel
• Advocate for consistency and continuity of
government policies
• Develop long term procurement plans
• Develop procurement standards
• Develop and disseminate standard operating
procedures (SOPs) for key procurement activities
(eg. customs clearance, ICBD)
• Establish National Drug Procurement Agency
• Develop clear job descriptions that will articulate
qualifications for procurement specialists
5. Inventory Control Procedures : Goals
Allows for a national supply chain management
system that is:
•
•
•
•
•
•
•
•
•
Appropriate stock levels
Established inventory management procedures
Minimize waste
Avoid stock outs
Min and max
Reorder level
Minimize emergency orders
Inventory management collection tools
Efficient reporting system from and to facility levels
5. Inventory Control Procedures : Challenges
Allows for a national supply chain management
system that is:
•
•
•
•
•
•
•
•
Difficult and different data collection tools
Lack of data use culture
Lack of trained personnel
High turnover of staff
Lack or personnel
Lack of appropriate storage space and facilities
Lack of commodity security
Lack of harmonized inventory management control
tools
5. Inventory Control Procedures : Challenges
(cont’d)
Allows for a national supply chain management
system that is:
• Poor reporting
• No timely deliveries
• Poor distribution system
o non timeliness
difficult deliveries
o Damaged deliveries
• Damaged stock
5. Inventory Control Procedures: Opportunities &
Activities
• Learn from existing supply chain systems
• Improve storage and distribution infrastructure
• Establish and enforce inventory management
standard operating procedures (SOPs)
• Provide training in inventory management
• Computerize inventory management at sites
• Harmonize, simplify and distribute data collection
tools
• Undertake limited, well-supervised task shifting of
inventory control activities where appropriate
• Establish procedures for disposal of expired
product
6. Warehousing and Storage: Goals
Allows for a national supply chain management
system that maintains stock integrity and
security
6. Warehousing and Storage: Challenges
•Insufficient climate control for both cool and
cold storage
•Insufficient power supply
•Security and safety issues
•
•
•
•
•
Quarantine
Fire safety
Hazards
Leakage
Diversion of products
•Inadequate space
•Irrational use of space
6. Warehousing and Storage: Challenges (cont’d)
• Poor inventory control
• Improper packaging
• Insufficient inappropriate and untrained
human resources
• Physical access
• Inappropriate location
• Weak infrastructure and poor maintenance
• Lack of inventory management system
• Poor waste management/destruction
policy/processes and equipment
6. Warehousing and Storage: Challenges (cont’d)
• Weak visibility of product whereabouts
upstream within CMS
• Lack of linkages with other warehouses
Central- Regional- District, and
comprehensive with other parallel warehouse
systems.
• Weak product awareness
• High rate of staff attrition
6. Warehousing and Storage: Opportunities and
Activities
• Publish and implement standard operating
procedures (SOPs) for inventory control and
warehouse management
• Undertake staff training in
•
•
•
•
Product awareness
Safety
Use of equipment
Others as appropriate
• Provide appropriate clothing and safety
equipment
• Renovate buildings and equipment, (e.g.
racking, air-conditioning)
6. Warehousing and Storage: Opportunities and
Activities (cont’d)
• Advocate for budget earmarking to support
ongoing sustainability of warehousing and the
institution of quality assurance measures
• Undertake appropriate disposal of expired and/or
used products and supplies
• Undertake pest control measures
• Establish/improve communications network
• Re-activate zonal warehouses
• Establish periodic warehousing and storage
practice supervision
• Emphasize that donor support should not end
once goods arrive in country
6. Warehousing and Storage: Opportunities and
Activities (cont’d)
• Implement warehouse management systems
• Implement appropriate packing and other
equipment
• Establish long term planning for warehousing
based on forecast and procurement planning
• Establish surge capacity for disease
outbreaks
• Disseminate the National Drug Policy and train
management and staff in its enforcement.
7. Transportation & Distribution : Goals
Create and sustain a viable distribution network
which supports effective & efficient systems
which ensures timely delivery of supplies
Definitions:
• Distribution: The process of moving products from
the point of storage to the end user.
• Transportation: Movement of goods from one
place to another.
7. Transportation & Distribution: Challenges
• Insufficient delivery vehicles
• Lack of dedicated funds for distribution
• Ineffective flow of information from
requisitioning facilities to coordinating body
to central stores
• Lack of automated data management system
that link these bodies above
• Poor transport network
7. Transportation & Distribution: Challenges (cont’d)
• Lack of integrated distribution systems( ARVs,
lab commodities etc)
• Inexperienced transporters
• Over centralization of warehouses
• Poor monitoring of outsourced services
• Inadequate availability of vehicles with coldchain management capacity
7. Transportation & Distribution: Opportunities &
Activities
• Explore Public/Private Partnership (PPP) and
outsourcing options
• Establish budgetary provisions for
transportation and distribution services
• Strengthen networking, at all levels in the
system, with specific timelines
• Government, at all levels, should improve the
transportation network
• Ensure sufficient buffer in the inventory
control system
7. Transportation & Distribution: Opportunities &
Activities (cont’d)
• Coordinate and harmonize transportation and
distribution activities
• Pre-qualify potential transportation and
distribution vendors
• Develop appropriate standard operating
procedures and/or guidelines for
transportation and distribution activities
• Develop and provide training program for
transportation and distribution companies
8. Product Use:
Goals
• Appropriate and rational use of each product for its
intended purpose, supported by—
o Skilled healthcare provider
o Clear treatment guidelines and protocols
o Accessible and available supplies
o Appropriate product information
o Product acceptability in the community
o Effective data capture on usage
71
8. Product Use:
Challenges
• Provider knowledge and skills outdated
• Inappropriate use of task shifting
• Inadequate availability of skilled product users (i.e.
clinicians, patients, technicians)
• Non-availability of STGs in all health programs
• Poor legibility of product information
• Lack of product acceptability due to socio-cultural
factors
• Lack of easy access to the products due to cost,
distance, terrain, geography, transportation
• Lack of reliable record-keeping and data collection
72
8. Product Use:
Opportunities & Activities
• Provide continuing education in product use
• Advocate for appropriate product use to policy
makers
• Sensitize product users (i.e. clinicians, patients,
technicians) to appropriate product use
• Employ, train and deploy staff knowledgeable in
appropriate product use
• Improve conditions of service
• Improve incentives for staff
• Improve product use understanding/capacity in rural
areas
• Disseminate Standard Treatment Guidelines (STGs)
73
8. Product Use:
Opportunities & Activities (cont’d)
• Improve product labelling
• Advocate for appropriate product use to
appropriate authorities
• Make products available & affordable at the
lowest tier of service delivery
• Strengthen relevant information management
systems
74
9. LMIS: Goals
• Organize data in one (central) place
• Uniformity of tools
• Efficient flow of data throughout the system
75
9. LMIS: Challenges
•
•
•
•
•
•
•
•
•
•
•
Data quality issues
Unskilled personnel
Multiplicity of tools
Timeliness
Lack of data use
Lack of feedback
Inadequate funding
Inadequate infrastructure
Poor user friendliness of tools
Staff shortages/attrition
Lack of motivation
76
9. LMIS: Opportunities & Activities
• Identify, access and utilize existing
information and communication technology
• Develop time-line for the provision of a data
reporting and feedback system
• Standardize, harmonize existing tools and
protocols
• Motivate and train staff in application use
• Provide supportive supervision of LMIS
development initiatives
• Advocate for the importance of LMIS in
broader supply chain strengthening
10. Organizational Support:
Goals & Objectives
Goal:
• To equip and empower staff to deliver prompt and
efficient logistics services
Objectives:
• To maximize existing resources through
integration of functions across programs at all
levels (i.e. AI, HIV/AIDS, malaria)
78
10. Organizational Support:
Challenges
•
•
•
•
•
•
•
Lack of motivation
Inadequate staff capacity
Poor record keeping culture
No clear job descriptions
No clear SOP
Poor communication lines (up and down)
Lack of logistics tools (where there is no
money)
• Too many tools (where there are multiple
stakeholders)
79
10. Organizational Support:
Challenges (cont’d)
• Inadequate supervision
• Insufficient equipment, infrastructure (trolleys,
forklift, pallets, racks)
• Workload issue—staff wear several hats of
SDP
• Lack of personnel
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10. Organizational Support:
Opportunities & Activities
• Develop clear, written job descriptions
• Develop career progression schemes for
logistics professionals
• Provide supportive supervision to staff at all
levels
• Harmonize organizational support tools
• Encourage advocacy for the importance of
supply chain management functions from
senior leaders of organizations
10. Organizational Support:
Opportunities & Activities
(cont’d)
• Build incentive schemes including performance
based rewards where practicable:
o to support logistics training
o to increase access to and adoption of organizational
development tools & resources
o encourage feedback & communication
o to enable positive reinforcement
o to allow for career development and enhancement through
regular annual performance reviews, promotions and
awards
11. Finance/ Stakeholder Donor Coordination:
Goals
• Prudent, transparent, and efficient management of
funds
• Long-term sustainability of program
• Optimal resource allocation and release
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11. Finance/ Stakeholder Donor Coordination:
Challenges
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Parallel programs
Multiplicity of funding streams without coordination
Delay in release of funds
Inadequate and erratic nature of funding
Lack of accountability
Weak resource allocation
Top-down programming (inadequate awareness and
participation of communities
Conflicting priorities among partners/all tiers of government
Weak government ownership and coordination
Poor commitment of government to counterpart contributions
Inadequate understanding of the role of the different tiers of
government
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11. Finance/ Stakeholder Donor Coordination:
Opportunities & Activities
• Institute regular, supply chain-specific, stakeholder
coordination meetings
• Establish supply chain management coordination
technical committee comprising national private
sector, public sector and partner organizations
• Institute coordinated procurement planning
• Advocate to government officials for increased
funding for supply chain management
• Review and increase access to national health
insurance scheme
• Undertake social marketing as means to secure
increased subsidization of commodities
11. Finance/ Stakeholder Donor Coordination:
Opportunities & Activities (cont’d)
• Publish budgets, tenders, expenditures for
government and donor program initiatives
• Increase transparency, visibility to commodity pricing
and procurement practices
• Advocate for passage of The Health Act
• Increase community involvement in program design
• Advocate for review of the process of funds release
• Improve planning
• Explore public/private partnerships and outsourcing
to competent companies of appropriate supply chain
functions
12. Quality: Goals
• Supply chain performance should guarantee
commodity security at service delivery points
• All supply chain processes should adhere to
standard best practices/SOPs
• Logistic system should ensure availability of
quality products which conform to regulatory
standard
• Effective implementation of Supply Chain
Strategy in National Drugs Policy
12. Quality: Challenges
• No Supply Chain guidelines
• Poor dissemination and poor implementation of
Supply Chain Strategies in National Drugs Policy
• Insufficient quality monitoring tool as relates to
Supply Chain (ie. No standardized quality
monitoring tool)
• Vertical Supply Chain across bard
• Infrastructure problems particularly related to
power
• Inadequate capacity building skills in supply chain
(Central Medical Stores etc.)
12. Quality: Opportunities & Activities
• Develop national guidelines on supply chain
• Disseminate National Drugs Policy through
workshops, e-mail, hard copies, and other
media
• Develop and implement supply chain quality
monitoring tools
• Harmonize of vertical supply chains
• Improve storage conditions, (e.g. power
supply, cooling facilities, metal shelves,
pallets etc.)
12. Quality: Opportunities & Activities (cont’d)
• Sensitize, advocate at all levels for the
importance of supply chain management
• Develop human capacity plans for improving
quality to include hiring, continuous training,
and task shifting where appropriate
• Continue to strengthen of National Agency for
Food, Drug Administration and Control
(NAFDAC)