1. CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia District Level Capacity: The Achilles Heel of Vaccine Supply Chains in Mozambique Wendy Prosser VillageReach

2. Dream vs. Reality Dream

3. Dream vs. Reality Reality

4. Decentralization in the Mozambique health system Policy District level responsibility for distribution of vaccines to health centers District level funding for distribution activities Practice Capacity gaps in health logistics Poor performing supply chains Lack of product availability at service delivery points Lack of reliable funding

5. Quantitative and qualitative evidence gathered from the district level 53 districts in Mozambique Surveys with 114 staff in government health facilities –Pharmacy –EPI –Management

6. Districts displayed some positive practices 98% demonstrated good understanding of how to collect data and place orders 91% include logistics in supervisions at health centers 91% regularly perform inventories 84% update stock records

7. Study results also indicate capacity gaps at the district level Limited human resources –Few personnel dedicated to logistics activities Ineffectual technical capacity –Only 6% of pharmacy staff and 12% of EPI staff scored well on basic logistics concept quiz Insufficient financial resources –Only 8% of EPI district programs report they have a budget for distribution Inadequate infrastructure capacity –19% of all closed vehicles were unavailable/non-functioning –Average of 38 days for a broken vehicle to be repaired

8. Typical recommendations are unrealistic to address the immediate challenges Improve district infrastructure Budget support for logistics tasks Technical capacity for performing logistics activities Supportive supervision to improve technical capacity More research to define the optimal quantities of time, personnel, transport, and funds needed at district level

9. Alternative and innovative short-term solutions should be explored Targeted capacity building Task shifting to reduce burden on health care workers Logistics system redesign Creating logistics management units Outsourcing distribution activities

10. Efforts are already being focused on these solutions Modeling exercise in Benin for system redesign Informed push model for family planning commodities in Senegal Outsourcing distribution in many countries Capacity building at each level of the supply chain

11. If we truly want to reach the final 20% of children, we have to think differently and creatively to address the challenges to supply chains at all distribution levels.

12. Thank you Program information also available at www.villagereach.org