CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November , 2012 Kigali, Rwanda NGO Social Responsibility Model for Commodity Delivery Leah Hasselback

Lessons Learned from Expanding a Supply Chain Redesign in Mozambique

4 Project History 5-year supply chain redesign pilot project implemented in Cabo Delgado province (Dedicated Logistics System) Old: Collection-based, ad hoc approach New: Vendor managed inventory with level jumping Includes supportive supervision and information system Conducted impact evaluation in Cabo Delgado, using neighboring Niassa province as a comparison Mozambique Cabo Delgado Niassa

Dedicated Logistics System Monthly Activities District Storage Provincial Store Health Centers 1. Leave provincial level with: - medical supplies - energy - equipment, parts - information 2. Site visit (in coordination with district level): - record & stock inventory - service equipment - supportive supervision - collect data 3. Return to provincial level office: - input data - analyze information - address problems - prepare for next trip

Dedicated Logistics System Results The Forest 6 IndicatorBaselineResult Coverage Rates (DPT-Hep B3)68%95% Vaccine stock outs80%1% Cold chain functioning~40%96% DPT1-3 Dropout Rate12%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.” The Dedicated Logistics System (Cabo Delgado) is more cost-effective and efficient.

What do you do after a successful pilot? A new approach to achieve impact, sustainability, & scale: –Outsourcing activities  In house operations with technical assistance –External resources  Mix of internal and external resources for funding and transportation –NGO staff closely coordinating with government  All government staff closely coordinating with the NGO Successful Pilot Evidence of impact & cost effectiveness How do we achieve impact, sustainability, & scale?

Challenges in the New Approach The Swamp Note: In Niassa, 35% of irregularities were caused by transport.

Three Challenges in the In House Approach Funding –Funds allocated and available but no cash in hand –Not enough time in 1 month to carry out activities and secure funding on time for the next month’s distributions –Interim solution: direct funding from VillageReach for some costs Transportation –Vehicles not available because of lack of planning, management, maintenance –Insufficient quantity of vehicles available –Interim solution: provision of some vehicles for distribution Human Resources –Distributions interrupted as staff are called back for other activities

Rethinking Expansion Approaches We know that we can be more efficient with a redesigned supply chain, but… How do we combine the best of outsourcing and in house operations to achieve impact, sustainability, and scale?

Hybrid Approaches ChallengeOutsourceIn House FundingLocal fund agentFunds monitoring Requisitioning Reporting TransportationOutsource vehicle useTechnician carries out distributions Manage performance of transport provider Human ResourcesApplying private sector best practices Performance based pay Professionalization of the field coordinator Government staff

Travel Tips In designing supply chains, start at the last mile –Build systems to work with the available capacity –The last mile of distribution is the first mile of information Focus on building shared interest –Allows for bringing in new partners, such as the private sector –Drives scale and sustainability Only travel uncovers the unexpected challenges!

Leah Hasselback Mozambique Country Director Tel: Av. 25 de Setembro, º. E Maputo, Mozambique Tel: Fax: Thank You