PSM of Kits Atieno Ojoo Unicef Supply Division

Purpose of kits Simply product delivery logistics Simply product delivery logistics –Transport (Weight, height, length, palletization) –Storage and warehousing Ease of use (Self instructive, no assembly of parts) Ease of use (Self instructive, no assembly of parts) Assumption that kit contents are the right ones for the intervention Assumption that kit contents are the right ones for the intervention –Population characteristics –Problem prevalence, likely morbidity –Level of skills of providers Usually designed for acute phase Usually designed for acute phase Protracted phase-Set packing specific to situations Protracted phase-Set packing specific to situations

Procurement & Supply chain management Product Selection Quality Assurance Supplier Selection Distribution Forecasting Product Procurement Rational Use Receipt and Storage Procure ment Needs identified Govts CSOs

Supply System context PROGRAMME: product selection, standard setting, quantification of needs. PROGRAMME: product selection, standard setting, quantification of needs. FINANCING: clarify budgets and funds FINANCING: clarify budgets and funds LEGISLATIVE/REGULATORY: check status of product registration, marketing authorisation, national procurement laws LEGISLATIVE/REGULATORY: check status of product registration, marketing authorisation, national procurement laws COMMERCIAL/TRADE: customs duty, patents, licenses COMMERCIAL/TRADE: customs duty, patents, licenses

Supply System Organisation TENDER MANAGEMENT: supplier prequalification, bid evaluation, adjudication, Contracting. TENDER MANAGEMENT: supplier prequalification, bid evaluation, adjudication, Contracting. QUALITY ASSURANCE: pre and post quality control, supplier performance QUALITY ASSURANCE: pre and post quality control, supplier performance LOGISTICS: port clearance/receipt from suppliers, transportation, Storage, distribution. LOGISTICS: port clearance/receipt from suppliers, transportation, Storage, distribution. MANAGEMENT INFORMATION SYSTEMS: data and information control, feedback/action MANAGEMENT INFORMATION SYSTEMS: data and information control, feedback/action

Important considerations What is required in acute phase of emergency? What is required in acute phase of emergency? –Save lives, prevent harm, stabilize the situation, mitigate against risks that could lead to harm in the future, What is required in the protracted/recovery phase What is required in the protracted/recovery phase –Assessment of future needs, modified version of routine care Content of kits-evidence, consensus, reflects real need Content of kits-evidence, consensus, reflects real need Language, naming of kits (universal, no confusion, relate to contents as much as possible), ease of identification for tracking & tracing Language, naming of kits (universal, no confusion, relate to contents as much as possible), ease of identification for tracking & tracing Compromise: some items may have to be left out or made to be ordered after an assessment is done Compromise: some items may have to be left out or made to be ordered after an assessment is done Transport; weight, height, length, Palettization (number of kits that can fit on a standard palette) Transport; weight, height, length, Palettization (number of kits that can fit on a standard palette) Kits do not replace routine healthcare provision Kits do not replace routine healthcare provision Political and social sensitivity Political and social sensitivity

Selection of contents Global level leadership and commitment-WHO stamp important Global level leadership and commitment-WHO stamp important Evidence-base;Standard Treatment protocols- WHO Evidence-base;Standard Treatment protocols- WHO Agreed assumptions based on experience Agreed assumptions based on experience Injectable medicines require professional health worker use e.g.MgSO4 Injectable medicines require professional health worker use e.g.MgSO4 Single item per intervention; this allows HCW to concentrate on making the right intervention decisions, rather than choosing between interventions. Oxytocin Vs Misoprostol Single item per intervention; this allows HCW to concentrate on making the right intervention decisions, rather than choosing between interventions. Oxytocin Vs Misoprostol Usability: ease of use Usability: ease of use Volume and weight of product Volume and weight of product Protective devices for health workers Protective devices for health workers No duplication with existing kits No duplication with existing kits Lifecycle of product- scenarios where a product is likely to become obsolete, change in treatment protocols e.g. MgSO4 Lifecycle of product- scenarios where a product is likely to become obsolete, change in treatment protocols e.g. MgSO4 Product stability; choose longer shelf life formulation, avoid cold storage products Product stability; choose longer shelf life formulation, avoid cold storage products Storage requirements for components Storage requirements for components Patents, regulatory concerns Patents, regulatory concerns

Kit design Several complete basic units within a kit Several complete basic units within a kit –Bundle products that need to be used together –Do not mix external use and internal use products –Separate consumables from equipment and reusables Sub kits with different contents Sub kits with different contents Supplementary kits Supplementary kits –Higher level of skills required –Higher level of health services Shelf life of kit dependent on product with shortest shelf life. Shelf life of kit dependent on product with shortest shelf life.

Forecasting & procurement Morbidity based Morbidity based –Population based-Use prevalence information –Information from previous crises –standard, universal protocols Prequalification of suppliers & products Prequalification of suppliers & products Procurement by generic name Procurement by generic name Competitive procurement process (public procurement principles) Competitive procurement process (public procurement principles) Responsibilities for Quality assurance Responsibilities for Quality assurance Customs clearance Customs clearance Financing the kits Financing the kits

Kit assembly One stop packing One stop packing –Procurement of kit contents –All products in a kit available at one place –Challenge with products that have to be in multiple kits Quality assurance Quality assurance Procurement, packing and distribution lead times Procurement, packing and distribution lead times Compliance with international guidelines for quality, packaging, labeling Compliance with international guidelines for quality, packaging, labeling

Warehousing, transport How much to stock & where to locate stocks How much to stock & where to locate stocks –Work with other emergency logistics –Stocks with suppliers of kits? Include in the package of supplies in the logistics cluster for immediate response Include in the package of supplies in the logistics cluster for immediate response Pre-agreements with logistics agents, other international agencies Pre-agreements with logistics agents, other international agencies Shipping, flights, ground transportation Shipping, flights, ground transportation Stock rotation, managing expiries Stock rotation, managing expiries

cost Procurement of kit items Procurement of kit items Kit packing Kit packing Storage, inventory management Storage, inventory management Distribution and logistics Distribution and logistics Other transaction costs Other transaction costs Cost of wastage Cost of wastage Cost of destruction of unusable kits Cost of destruction of unusable kits

IN-COUNTRY LOGISTICS Supply Chain AssessmentPlanning Good Clearance Procurement Warehousing and Inventory Management Shipping Inland Transport and Distribution Supply Tracking and Evaluation

Receiving & checking supplies Storing supplies in locations Authorising delivery Shipping supplies (FIFO/FEFO) Store Receipt Stock CardWayBill Daily Warehouse Operations Documents Notifying losses damages when receiving Monitoring Inventory Control Performance Notifying losses damages during storage & transport Monitoring & Control The Inventory database is updated for each transaction and reports generated regularly and upon request Inventory Database Receipt Acknowledgement WayBill Receipt Physical Count (IMAT) Claim ref: Book G Property Survey Board Loss/Adj.Report Disposal Report Processes Dispatch Request Authorising HUMANRESOURCESHUMANRESOURCES M&E: SUPPLIES ALSO MOVE ON PAPER Sample

Function Scheme Logistical Services Logistical Services Logistical Services Logistical Services Technical support Technical support Procurement & Contracting Procurement & Contracting Quality Asurance Quality Asurance Technical support Technical support Procurement & Contracting Procurement & Contracting Quality Assurance Quality Assurance Warehouse Country Partners Normative Crisis area Suppliers Normative Management and Support Services Suppliers