Transcript Overview of JSI`s DELIVER Proposal

Strategic Decentralization:
Centralizing Logistics
Paula Nersesian, RN, MPH
No product? No program.
Commodity Security
• Know commodity requirements
• Plan the necessary financial resources to
meet those requirements
• Procure the commodities needed - or have
them procured
• Reliably deliver the commodities to
customers
The Logistics Cycle
The Supply Chain
Supply Chain Objectives
• The right goods
• In the right quantities
• In the right condition
• Delivered to the right place
• At the right time
• For the right cost
Health Sector Reform
• Decentralization
• Integration
• Cost Recovery
• Privatization
Logistics in HSR Settings
• Integration in Mali and Nepal
– Both improvements and harm to LMIS
• Privatization in the Philippines
– Stockouts and problems with private carrier
contracts
Logistics in HSR Settings
• Cost recovery in Mali
– Donated condoms expired
• Decentralization in the Philippines and
Mexico
– Some regions didn’t order contraceptives
or didn’t order enough to meet demand
Advantages and
Disadvantages to
Decentralizing Logistics
Functions
Serving Customers
+ Service delivery based on local needs
- Reduced control over prescribing practices
Product Selection
+ Selection based on local needs
- Selection based on non-medical criteria
- Reduced influence on:
– Treatment guidelines
– Products for priority essential services
– Priority of preventative products
Forecasting and Procurement
+ Quantification based on local requirements
- Greatly increased prices
- Increased:
– Forecasting labor
– Forecasting error
– Procurement complexity
Inventory Management
+ Local control over reordering decisions
+ Local control of shipping schedules
- Impossible to rationally allocate scarce
products
- Local resources (e.g., staff and transport)
may be unavailable
Information, Money, People, Quality
- LMIS may be lost or folded into the HMIS
- Local financial resources may be
inadequate
- Local staff may be absent, or lacking
necessary skills
- Commodity quality control difficult if
procurement decentralized
Lessons Learned
from Commercial Sector
• Eliminate intermediate levels in the supply
chain
• Include a strong LMIS
• Increase supply chain “agility”
• Centralize and automate supply chain
management
Planning for
Decentralization
Planning for Decentralization
Centralize:
• Logistics System Functions
• Drug Registration
• Standard Treatment Guidelines
• Health Professional Licensing
Kenya: STI kits
Avoid decentralization of
these logistics functions
• Specification and Enforcement of EDL
• Product Selection and Essential Service
Package specification
• Bulk and international purchasing
• Rationing for scarce essential products
• Quality assurance for all products
• Logistics Management Information Systems
Conclusions
• Decentralize decision making only if you can
provide district managers with the resources
to execute those decisions
• Begin with a detailed, indicator-based
logistics system assessment
• Examine critical planning assumptions
critically (e.g., funding, personnel availability,
organizational constraints, time frames)
Conclusions
• Develop a detailed logistics decentralization
plan for all aspects of the logistics cycle
• Be prepared to change it
• Strengthen/protect the LMIS at all costs
• Ensure that logistics training to support
decentralization is competency-based and is
accompanied by periodic follow-up
• Supervision is critical, and should include
logistics oversight