CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November , 2012 Kigali, Rwanda Outsourcing vaccine supply chains: The Western Cape Experience Michelle Arnot

Contents Introduction & background Review Approach Results: Management & Operational Improvements Lessons learnt

Introduction & background

Review Approach Collection of qualitative information from key stakeholders regarding historical context, background and rationale for the outsourcing decision as well as operational insights Effective Vaccine Management Assessment (WHO tool utilised) at a sample of sites throughout the province Temperature Monitoring (WHO Protocol adapted to WC context) along the supply chain

Results : Management Vaccine store no longer compliant with new pharmaceutical standards Historical context Internal options: lack of technical expertise, additional infrastructure investment required Biovac: technical expertise and state of the art facilities Decision-making process Phased approach which was scaled up SLA: Pressured to finalize. Unchanged from Partnership based on collaboration & sharing of information Process and implementation Initial plan: electronic reporting on vaccine stocks, orders, deliveries, charges Reports and monitoring Mediocre quality services – but this view was tainted by recent stock outs, slow ordering system (Logis), fees still charged to sub-depots, equipment failures Client perspectives

Results : Operations Storage & deliveries Orders & Payments Economic analysis

Storage & deliveries: EVM Assessment

Storage & deliveries: Temperature Control

Orders & payments : Stock levels Stock levels –contractual 3 month stock level required –Stockouts at facility level were widespread when Biovac did not maintain sufficient stocks Biovac utilized a push system based on forecasts determined at a national level which did not reflect the facility demographic

Orders & payments: Variability of orders

Orders & payments : Facility Stock levels

The impact of the new schedule… Click to add text

Outsourcing Costs

Improvements since the review Distribution: Fixed delivery schedule implemented Minimization of sub-depots and resupply points through decentralization Operating Procedures: SOPs developed for all aspects of cold chain and vaccine management Vaccine management: Collaborative forecasting EVM utilized as management tool/routine monitoring Drug Supply Management training for all staff involved with vaccines Improved ordering system with reduced lead times

Improvements since the review… Contract Management: Revision of contract to include an early warning system, penalty clauses, improved cold chain standards, emergency orders and management oversight Temperature control: Implementation of electronic loggers and SMS alerts Modification of temperature charts to include logger alarm status, causes of temperature deviations and follow up actions, monthly review by supervisors Storage capacity: Decentralization of distribution in rural districts Systematic replacement of all absorption fridges

Lessons learnt: Outsourcing of a critical supply chain function like vaccines requires collaboration and a partnership approach Communication has been key in making improvements An understanding of Biovac’s operations and their challenges is important when planning Inventory costs (and associated risks of holding stock) can be reduced by outsourcing if –the distribution system is decentralised –lead times are reduced by an efficient ordering system –appropriate checks and supervision is in place

Acknowledgements Western Cape Government: Health Project Optimize: Michel Zaffran & Patrick Lydon Collaborative Centre for Cold Chain Management: Ticky Raubenheimer