To simplify the concept, take a bunch of Legos where each one represents different components of the supply chain—transport, fuel, health centers, cold chain, vaccines, per diem, transport loops, and, of course, the logistician. Putting those components together in one way may cost $0.42 per dose per child vaccinated and would result in an 80% availability of vaccines at the health center, which is what the HERMES model can show. Changing those components by possibly adding a transport loop or moving the cold chain equipment may result in a cost of $0.28 per dose per child vaccinated with availability increasing to 95%. The HERMES model can easily change those scenarios to find those efficiencies—almost as easily as changing around pieces of Legos but with much better insight into the actual performance of the system design.
This workshop was the first step of putting the concept of modeling into practice in Mozambique. The local team got to work with the user-friendly interface of the HERMES tool to build their own supply chains. I could see the light bulbs going off in people’s heads as they figured out how to add in a vehicle in one place, a refrigerator somewhere else, and introduce new vaccines to their supply chains. This local team is now building up their capacity to run different computer simulated models and use those models for actionable results in the on-the-ground supply chain to find efficiencies and cost savings.
A few key themes resounded during the week-long workshop:
- The power of “crazy ideas.” The team was able to think about those out-of-the-box, “crazy ideas” of supply chain design because there are no actual costs to experimenting with transport loops or different delivery intervals when using a computer simulation. Improvement comes from change–thinking and doing things differently, as the MOH Immunization Program manager pointed out; modeling provides a way to do that.
- Improving the performance of the vaccine supply chain is a priority. All participants were concerned about improving the supply chain, sharing new approaches they have been involved with directly or have heard about, and bringing up areas that need more attention like outreach efforts and wastage rates. This initial pilot focused on two provinces, but there was a general consensus that a modeling exercise would be even more beneficial at the national level.
- Tools are available to help improve the supply chain. The HERMES tool is one of many ways of looking at the supply chain. The participants agreed that results of any HERMES model must be analyzed within the realistic context and with information from other sources, such as health services data.
- Technology and knowledge transfer is part of the process. This was a first introduction to the concept of modeling and actually running the model. No one became an expert by the end of the workshop, but each person is developing their modeling skills and ability to ask important questions to improve the functioning of the supply chain.
It was great to see the local team running models and debating the different options for the Mozambique vaccine supply chain. Of course, this is only the first step of changing and improving the system. More modeling needs to be done to test out those “crazy ideas”, and the different decision makers need to decide which ideas are truly “crazy” and which ones can actually improve the supply chain and ensure more children are vaccinated and stay healthy.
About the Author: As Program Manager, Wendy Prosser is responsible for the design, implementation, and monitoring and evaluation of health system program for VillageReach in Mozambique. Efforts in Mozambique seek to streamline vaccine logistics with an improved logistics management information system and transport services. Wendy has over a decade of global health experience in program development and management, research and analysis, capacity building, and behavior change communications. This experience has taken her to Mozambique, Malawi, Angola, Kenya, and South Africa in various public health settings, starting with Peace Corps in Cape Verde. Wendy holds a MPA in International Development and Global Health from the University of Washington.