Last Mile Health (LMH) is a non-governmental organization partnering with rural communities and the Liberian government to advance healthcare in remote communities. In this workshop, members of a joint research team from LMH and Northwestern University will discuss the use of logistics models and mapping technologies in the deployment of community healthcare workers and their supervisor in Rivercess, Liberia. Developing a realistic and actionable transportation network map in remote Liberia has been a large focus of the project. LMH has invested a significant amount in developing meaningful maps of the region, both in terms of having people on the ground collecting data and then turning this into a digital map with GIS. The workshop will focus on (a) how to set up a process to create these maps and (b) how to leverage these maps to make better decisions with logistics models. These achievements in Rivercess offer lessons—as well as questions—for institutions concerned with the development of modeling systems for logistics, operations, and workforce management. Among the most important lessons relates to the value of multidisciplinary problem solving. The Rivercess case highlights that bringing together field practitioners and engineers—“boots on the ground” and operations research modelers—can create optimal solutions for specific contexts.

• Karen Smilowitz, Northwestern University, Professor of Industrial Engineering and Management Sciences
• Ross Feehan, Last Mile Health, Supply Chain, Logistics, and Operations Officer
• Mallika Raghavan, Last Mile Health, Community Health Systems Workforce Manager

Many countries have ambitious goals for their public health supply chains in terms of coverage, access, cost and sustainability. Rapid achievement of those goals often requires a coordinated set of interventions across several areas - such as data visibility, performance management, distribution processes and infrastructure, operating model (including use of the private sector), and staff mindsets and capabilities. Maximizing sustainability can ultimately imply integrating across previously siloed supply chains to realize logistics efficiencies and to reduce management burden for both supply chain staff and health care workers.

In this workshop we first outline how a transformative set of interventions drove rapid, sustained performance increases in Nigeria's vaccine supply chain, resulting in a sustained doubling of the number of district stores with adequate stock of all vaccines and a significant reduction in stockouts at facility level. We then outline the vision, approach and progress to date toward the larger transformational goal of national integration across multiple health commodity supply chains (HIV/AIDS, malaria, TB, vaccines, family and reproductive health) for Nigeria.

• Tania Holt, McKinsey & Company, Associate Principal
• Mureji Fatunde, McKinsey & Company, Senior Delivery Analyst
• Michael Fleming, McKinsey & Company, Practice Expert
• Patrick Githendu, The Global Fund to Fight AIDs Tuberculosis and Malaria, Senior Project Manager, Supply Chain

The health supply chain is often the weakest link in achieving global health equity, with all health programs dependent on a functional system for maximum results (e.g. improving maternal health, reducing child mortality, combating HIV/AIDS, malaria). The status of the supply chain workforce in resource constrained countries is in marked contrast to their status in high income environments, where supply chain management is recognized as a key strategic function, instrumental to institutional success. The People that Deliver (PtD) Initiative is a global partnership of organisations established in 2011, with a strong interest in health supply chain management. Over recent years the Initiative has been using a coordinated multi-organizational approach to address HR for SCM issues and has developed extensive experience in the process.

This interactive presentation session highlights the importance of a strong workforce for health and humanitarian supply chains and explains a systematic approach to HR for SCM through the five HR Building Blocks; 1) Engaged Stakeholders, 2) Optimise Policies & plans, 3) Workforce Development, 4) Increase Performance and Staff Retention and 5) Professionalization of SCM. PtD (www.peoplethatdeliver.org) will present their stepped approach to systematically assess HR for SCM capacity development in country contexts, highlight Namibia as a case study and provide supporting tools and guidance that may aid interventions made by others in their country contexts. This stepped approach to country-based change will particularly benefit managers and leaders responsible for the development of health and humanitarian supply chains in low and middle income environments.

• Andrew Brown, People That Deliver Initiative, Executive Manager
• Abre Van Buuren, Imperial Health Sciences, Training Manager - Africa Supply Chain Academy

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Gavi’s 2016-2020 strategy identifies weak supply chains as one of the critical bottlenecks to achieving its coverage and equity goals. Current immunisation supply chains struggle in part due to insufficient managers and workers with appropriate skills, recognition, resources and authority. Supply chain managers have often not received sufficient training, and there is a lack of structure to allow for effective performance management and sharing of good practices. Without strong management and well trained staff, weaknesses in the systems that are intended to make potent vaccines available where they’re needed go unaddressed. Whilst significant training and development for personnel in the immunisation supply chain has been focused on technical skill development, there has been little focus placed on developing the professional competencies needed at the higher level executive level. As a global distribution and logistics organisation, UPS has built robust and agile supply chain primarily through the development of its people. It has, above other organisations, a particular emphasis on professional development focused through the term ‘constructive dissatisfaction’, empowering its leaders to continually strive for performance excellence.

UPS has partnered with Gavi to transfer its approach to training supply chain leaders to senior executives within the Ministries of Health in Gavi supported countries by creating a Strategic Training for Executives Program (STEP). This session will focus on the development of this innovative public-private partnership, the identifying and creating a shared-value vision, the opportunities in engaging with country stakeholders and developing a scalable partnership that seeks to engage the private sector in advocating for the professionalization of supply chain managers in Gavi-supported countries.

• Kevin Etter, UPS Foundation/GAVI, Executive on Loan to GAVI, The Vaccine Alliance
• Esther Ndichu, UPS, Director, Humanitarian Supply Chain
• Moz Siddiqui, GAVI- The Vaccine Alliance, Manager, Innovative Finance and Private Sector Partnerships

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Building an effective supply chain requires the active monitoring of resources and an accurate forecast of demand, a notable challenge in remote locations. When communities are able to effectively communicate their needs, supply chains can be best positioned to help. Using examples from your own experience, we’ll explore how human-centered design methods can yield effective and sustainable communication and distribution channels by cultivating empathy for end users. We’ll practice strategies that can be used to engage all levels in the active creation of an improved system, and you’ll sketch your own system map to understand the flow of data, people, and supplies in order to identify opportunities to integrate with and capitalize upon existing workflows.

• Dianna Kane, Medic Mobile, Senior Designer

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The Bill and Melinda Gates Foundation plans to launch an African Resource Center (ARC) for Supply Chain in 2016. The ARC for Supply Chain is dedicated to connecting and mobilizing public and private actors, talent, and capital to work with countries to transform their public and private healthcare supply chains, with an initial focus on francophone Africa. This workshop will include short presentations (20 minutes) and a group discussion and debrief: (40 minutes). The presentations will set the initial stage for discussion. It is hoped that the majority of the workshop will be dedicated to a group discussion on Togo. Presentations will be given in either French and English with translation provided.

• Hervé d'Almeida, Togo Ministry of Health / Centrale d'Achat des Medicaments Essentiels et Generiques de Togo (CAMEG), Program Director/Directeur des Projets et Programmes de Sante
• Steven Harsono, William Davidson Institute at the University of Michigan, Senior Advisor & Senior Manager, Healthcare Supply Chain
• David Sarley, Bill & Melinda Gates Foundation, Senior Program Officer, Vaccine and Integrated Delivery
• Trip Allport, 3 Degrees Ventures, Founder & Owner
• Maeve Magner, Independent Supply Chain Consultant

2014 marked the largest outbreak of Ebola in recorded history. Public health systems were overwhelmed in providing supplies to treat patients and protect workers. Emergency logistics capacity was assembled by various organizations to fill the gap. Effective heath crisis response combines well-developed logistics and public health systems with well-designed emergency logistics strategies. In this workshop, Dr. Dorbor and Ms. Bruck, medical and logistics experts directly involved in the Ebola response, will reflect on their experiences and consider how to improve logistics in future health crises by involving participants in discussion.

• Michal Bruck, Avenir Analytics, International Projects Manager
• James Dorbor Jallah, Government of Liberia, former Deputy Incident Manager for Support Services at the National Ebola Command Center

Effective drug regimens for people living with HIV has shifted the focus of patient care from a highly medical approach to one demanding intensive collaboration between medical and non-medical providers. A Tiered Care model will soon be published by the WHO defining four key elements reflecting the new reality: Service Intensity, Service Frequency, Health Worker Cadre, and Service Location. [1] Successful realization of the new model of care will require an effective supply chain and limited resources in the affected contexts will demand efficiency. At the centre of the model are the people who rely on its successful implementation to live healthy lives.

This workshop highlights two supply chain elements of the Tiered Care model where activities and research are either underway or have been completed : (1) How to represent and engage the patient community in the development of Supply Chain solutions, and (2) How to develop a reform agenda to respond to the complex and expansive scope of the Supply Chain challenges.

Representing the Patient Reality
Médecins sans Frontières (MSF) began the Stop Stock Out project in 2014 in reaction to a disturbing patient reality caused by inefficient HIV supply chains. The project has a three tiered approach: collecting baseline data on the frequency and length of stock ruptures for critical HIV medications, empowering the patient through community engagement, and gap filling of critical medications in the event of stock ruptures. The broader objectives of this project are to establish standard indicators to measure the success of the supply chain from the patient perspective as well as to foster solution development at the grass roots level.

Methodology for Reform
Improving a measured patient reality requires a comprehensive reform agenda with a clear definition of accountability. Placing national governments accountable requires that sustainable solutions need to be in line with political capacity or otherwise in tandem with political reform. A reform agenda that takes these concepts into account is presented in the article: “Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform”. [2] It is hoped that by accepting this agenda as a starting point, patient realities and global health support structures will start moving in the right direction.

Conclusion
At the end of the presentations it is hoped that the participants will engage in discussion on the development of pragmatic supply chain solutions including the best methods of collaboration on a complex and multifaceted challenge impeding the global response to the HIV epidemic.

• Mark McCaul, Médecins Sans Frontiéres, Supply Chain Officer - Southern Africa & India
• Sue Tafeni, Stop Stock Outs, Registered Nurse

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Increasing evidence shows that every 1 USD invested in disaster preparedness saves 7 dollars in disaster aftermath. However, only 1% of international aid is spent to minimise disaster impact (UNDP, 2015). One reason may be the lack of a unified understanding of preparedness. One the one hand, organizations seem to have a very fragmented approach without common language or tools. On the other, research focuses mainly on one aspect - prepositioning of goods. Based on a recent study the workshop leaders provoke discussion on what constitutes logistics preparedness, on gaps identified in the study, and on how applied research can support organizations in developing and improving their preparedness.

• Luk Van Wassenhove, INSEAD, Academic Director, Humanitarian Research Group
• Marianne Jahre, Department of Strategy and Logistics, BI Norwegian Business School, Professor

With two-thirds of the world’s HIV/AIDs cases – and 3 new infections occurring every minute – public health systems in Africa are under enormous strain. In this workshop we discuss logistical and other issues related to HIV response and public health systems in Africa. We present a framework for HIV prevention and treatment planning: determining the right program for the right place at the right time. We discuss logistical issues related to program implementation (for example, determining needed facilities, personnel and supplies to support scale up of antiretroviral treatment), and identify ways in which programs in practice may fall short of planned programs. Barriers to full program implementation include not only logistical challenges, but also economic, social, political and cultural factors. We conclude with discussion of the broader issues of competing public health priorities and opportunities for better integration of health systems.

• Margaret Brandeau, Stanford University, Coleman F. Fung Professor in the School of Engineering and a Professor of Medicine (by Courtesy)

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In Q1 2016, the APICS SCC - the world’s largest unbiased nonprofit supply chain organization - will launch a special focus forum (SFF) for strengthening global health and humanitarian supply chains. The forum will provide a platform for private and public sector participants to collaboratively develop solutions to address some of the most pervasive challenges impacting health and humanitarian supply chains. The vision is to leverage global private sector best practice in Supply Chain and share this with SC professionals from LMI countries (both public & private sectors) to improve SC performance. Solutions will be founded in leading practices that have been successfully applied by private sector participants representing a variety of sectors, but customized to accommodate the local context with insights from public sector participants.

During this interactive workshop the Forum Sponsor (APICS SCC), Chair (Imperial Health Sciences) and Program Manager (PwC) will present its current vision and charter of the SFF, and participants will be able to discuss and give feedback on the proposed initiatives and identify challenges where the SFF might focus near-term engagement.

• Fernanda Debellian, APICS SCC, Regional Director for Central and South America
• Clinton de Souza, Imperial Health Sciences, Director - Public Health
• Shabana Farooqi, PricewaterhouseCoopers (PwC), Director
• Chandresh (Chan) Harjivan, PricewaterhouseCoopers (PwC), Partner

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While great strides have been made to improve commodity availability upstream at lower prices, issues with in-country supply chains often result in high stock outages and waste at facilities. Vertical programme structures, and siloes in logistics organisations can mitigate against both strategic and tactical improvements, due to the lack of a coherent vision of what is currently happening, as well as fragmented governance to take corrective action.

Leveraging leading practice from complex supply chain businesses in the private sector, the Gates Foundation sought to establish a blueprint for an operating model (the visibility and analytics network (VAN)) that would help to coordinate the activities of multiple organizations that are involved in funding or delivering public health programs and governing public health systems. The starting point for the blueprint was the concept of a shared service that would have visibility to data from the end to end supply chain, and be staffed by dedicated supply chain specialists. The shared service would achieve economies of scale, and skill, and establish an organisation that can act as the leader and co-ordinator of integrated continuous improvement. The design effort between 2014/15 involved over 25 organisations in global health.

The workshop will explain the design process and the key features of the blueprint, and will showcase South African examples of technologies and operating models that beginning to deliver the benefits of a VAN at provincial and national level. We will conclude with a discussion on the VAN concept and guidance on using the outputs developed by the project.

• Ed Llewellyn, Accenture Development Partnerships, Africa Lead
• Karin Turner, Broadreach Healthcare , Director of Business Development
• Rob Botha, Imperial Health Sciences, Public Health Consultant
• John Vorster, Mezzanineware , COO
• Gavin Steel, South African National Department of Health, Chief Director

Health and humanitarian supply chains can be very complex, with demand that is seasonal or uncertain; sourcing of products that can be local, regional, or international; or with decisions that interact across the supply chain. Decision-support tools can be developed to assist in aggregating information, analyzing decisions, or understand the trade-offs between different elements. In this workshop we describe three such tools, which perform the following functions:

1. geographic assignment of healthcare personnel in Mozambique
2. developing a comprehensive global strategy for cholera prevention and control (as part of the part of the efforts of the Coalition for Cholera Prevention and Control (CCPC))
3. quantitative analysis of design strategies and key tradeoffs in developing a breastmilk supply chain network around Cape Town in South Africa.

These tools have been created in collaboration with entities including the Bill and Melinda Gates Foundation, the Mozambique Ministry of Health, and the Task Force for Global Health. Each will be discussed with participation from the audience, along with ideas for future decision-support tools in the health or humanitarian sectors.

• Julie Swann, Georgia Institute of Technology, Harold R. and Mary Anne Nash Professor, School of Industrial and Systems Engineering; Co-director, Center for Health & Humanitarian Systems
• Pinar Keskinocak, Georgia Institute of Technology, William W. George Chair, School of Industrial and Systems Engineering; Associate Director of Research for the Health Systems Institute; Co-director, Center for Health & Humanitarian Systems

Strong, private-sector, supply chain partners with the capability and capacity to meet partnership expectations can be difficult to find. A strong partnership can mean better availability, higher efficiency, and a more robust supply chain. When looking to partner with supply chain organizations, we look for partners who can both deliver on basic operations, and also offer insight about the market.

This workshop will highlight two organizations who have approached partnerships in a different way. Experiences will be shared from Procter and Gamble (P&G), and Philips Health Services; both highlighting examples of in-country partner development. Each organization will present for 15 minutes (30 minutes total) and the remaining 30 minutes will invite workshop discussion.

• Martin Ewert, Bill & Melinda Gates Foundation, Supply Chain Specialist (Sub Sahara)
• Grace Waiharo, Phillips Healthcare Services, Ltd, Head of Operations

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The distribution of pharmaceutical and medical device products to non-premium primary health care facilities in Africa carries additional risks that are due to the infantile structures, requiring additional risk management from a company in order to avoid stock outs and unnecessary high end consumer prices, compared to the average income available. Whereas in the 1st world certain stability can be ensured, the African reality is a different one, requiring solutions that accommodate this African reality. A simple copy and paste approach of 1st world solutions would lead to failure, constant stock outs and investment loss. In this workshop, we discuss the process of mapping the inefficiencies that lead to non-consistent product supply and high end consumer costs in the non-premium private primary health care sector. We will also present a model/framework to overcome inefficiencies and that ensures a consistent product supply, by eliminating margins along the distribution chain, enabling a lower end consumer price.

• York Zucchi, 0712, Founder and CEO
• Anke Schaffranek, Lioness Consulting, Strategic Advisor

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