1. CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November 14 -16, 2012 Kigali, Rwanda Supply Chain Performance Approaches in Global Health Jennifer Chavez

2. Objectives of Presentation Understand how metrics can improve health product availability and support public health programs/improve health outcomes Present and compare two examples of performance measurement systems in global health –WHO collaboration for HIV, malaria and TB –USAID | DELIVER PROJECT Moving forward: What other areas do we need to consider when applying metrics in different contexts

3. Why Measure Supply Chain Performance? Improve public health supply chain performance Use data to identify and explore root causes of challenges Assess and improve management of logistics functions at all levels of the system Inform and modify investments in supply chain strengthening Provide framework for local organizations to conduct routine performance monitoring capacity and maintain performance in the absence of external assistance

4. CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] Two Examples of Supply Chain Metrics Widely Used in Public Health

5. World Health Organization indicators for Procurement and Supply Management System Purpose –To harmonize country reporting requirements for increased transparency, productivity and efficiency of programs –To track performance of National Procurement & Supply Management (PSM) systems –To set early warning indicators of stockouts and overstocking –To alert managers to areas requiring technical support –Provide opportunities for collaboration across sectors and stakeholders including procurement stakeholders to improve national distribution system Strengthen data quality assurance and regular data reporting Audience –Procurement and supply management managers –Donors

6. WHO PSM indicators: Background Collaboration between 2005-2008 –Various Donors –Desk review, initial selection, field testing, refinement Focus –Core PSM indicators Although, relevant for all national drug programs, donors and institutions focused on ARVs, TB and malaria –Harmonized indicators Highlight most critical problems Avoid duplication of effort

7. Metrics I IndicatorsMeasures Product Selection % of commodities in National/WHO Standard Treatment Guidelines Prescription and rational use % of ARV & TB patients treated in line with treatment guidelines % of initiating ARV patients treated in line with treatment guidelines Quantification and forecasting % products received vs. planned to receive % of available quantity for consumption that is used Procurement Prices and Delivery Time Ratio between median price of products and international median reference value % of orders delivered in full and on time per supplier % of orders to be cleared from port that were cleared before the deadline Average # of days between arrival at port and date of clearance from port Purple represents early stockout warning indicators

8. Metrics II Indicators Inventory Control % of treatment sites submitting inventory control reports on time % of treatment sites placing orders while the stock in hand was below minimum stock levels Availability % of treatment sites that had a stock out at all during a define period % of available items at each treatment site % of treatment sites that had a stock out of a particular product during a defined period Average duration of stockouts at i) each and ii) all treatment sites Quality Assurance % of product batches meeting QC standards Distribution% of treatment sites receiving orders in full and on time Loss% of quantities of each product loss per total quantities available

9. Application of PSM Metrics WHO: Falls under the general M&E framework WHEN: Most metrics are measured periodically; others triggered by SC event FROM WHERE: Many metrics require collection from multiple peripheral points e.g., health centers, through typical reporting process SO WHAT: All metrics have targets and signal action in the event targets are not achieved –Understanding root causes of deviation –Initiation of steps to address root cause –Early warning stockout metrics

10. USAID | DELIVER PROJECT Supply Chain Performance Measures Background –Standard industry metrics, –Applicable across programs and countries Audience Supply chain managers, donors and project implementers, government logistics management units Purpose –Monitor system performance –Provide routine feedback –Improve program management –Improve system performance at all levels of the supply chain –Report results and determine impact INCREASE PRODUCT AVAILABILITY FOR IMPROVED HEALTH OUTCOMES

11. Performance Measures SCM Performance Measures Matrix by Function (USAID | DELIVER PROJECT)

12. Some examples of Indicators Inventory Management/LMIS/Customer Response QUALITY: Stockout rate RESPONSE TIME: Order lead time order placed to received COST/FINANCIAL: Value of unusable stock due to expiration/damage PRODUCTIVITY: Facility reporting rates Distribution/Transport QUALITY: On-time arrivals: % shipments arriving as scheduled RESPONSE TIME: Average delivery time from dispatch to destination COST/FINANCIAL: Average transportation cost per km/m 3 /kg of product PRODUCTIVITY: Container capacity utilization per vehicle

13. Metric Count

14. Lessons Learned about developing Supply Chain Metrics Past experience shows that setting up performance monitoring systems in public health is a long process requiring commitment and a desire to harmonize by all partners Requires building and incentivizing a culture to routinely collect, report, and use data up and down stream Aim is to institutionalize performance measurement capacity but governments face major human and financial resource constraints

15. Measures Must Evolve as Supply Chains Mature Investments work to strengthen supply chain management capacity and help supply chains systems evolve Overall indicators of performance must be applied and monitored to ensure performance is maintained or improved by investments

16. Measures Can Help Determine Enablers Although investments focus on strengthening the supply chain, these supply chain operate within a wider context Supply chain performance is affected by many things, many of which are not under the control of supply chain managers Further research is needed to help identify enablers and constraints and areas where direct investments have impact

17. Must select metrics that serve both donor and country purposes How can we measure sustainability, ownership and capacity of MOHs to manage different Supply Chain functions? Need to find identify the key factors to be measured. What are the true triggers of performance? “All that can be measured is not necessarily worth measuring” (Einstein) What other supply chain functions should be monitored and evaluated? What other measures exemplify performance? Questions for Consideration

18. Questions for Consideration (continued) Is there a quality bias or is quality just a good basis for harmonizing standards? How do we differentiate the “early stock out warning” indicators from the other measures of performance? How do we determine the most practical indicators for supply chain performance in a setting and maintain measure of standardized indicators without becoming overwhelmed by number of measures required? How do we measure the implications of supply chain performance on general public health?

19. Thank you.