Insights into the GHSCS Prize for Supply Chain Excellence in Global Health in Low- and Middle Income Countries
Out of five global health supply chain interventions nominated, the Dedicated Logistics System in Mozambique was selected as the winner of the Prize for Supply Chain Excellence in Global Health in Low- and Middle Income Countries, presented at the 2015 Global Health Supply Chain Conference in Dakar, Senegal, November 2015.
The judging was based on impact measurements and outputs, how the intervention was designed, partner organizations, challenges, and key achievements. One of the main factors influencing the selection of the DLS was the demonstrated commitment from the government and particularly the DPSs to this new approach to supply chain management.
The fact that a Ministry of Health representative was on stage to accept the award and describe the DLS was a very important factor in the decision. This award recognizes that the Ministry of Health is engaged and dedicated to improved performance of the vaccine supply chain, willing to question the status quo, and able to drive decisions based on evidence to ensure vaccines are available to all children in Mozambique. The DLS is an excellent example of “Next-generation” immunization supply chains that will serve as evidence for the global community’s increased focus on and prioritization of system design as a key component of improved immunization supply chains.
The following summary highlights the key aspects of the DLS, along with additional judging criteria and insights into why the DLS was selected as the winner.
For more than a decade, VillageReach has been engaged with community and governmental partners on the ground in Mozambique to redesign the supply chain model through the Dedicated Logistics System, or DLS for vaccines and related supplies. The DLS is an example of a Next Generation immunization supply chain. It is an informed push model that applies a comprehensive strategy that includes:
1. A simplified, streamlined distribution process involving re-assignment of tasks, level jumping and optimized delivery routes
2. An open source information management system, OpenLMIS (locally referred to as SELV) provides real time data for more accurate data collection and utilization
3. The introduction of a Field Coordinator role who delivers vaccines and supplies, repairs equipment, collects and reports data, and provides active and ongoing supportive supervision and training, allowing frontline health workers to focus on patient care
The DLS introduced new efficiencies to Mozambique’s vaccine supply chain resulting in significant increases in
• fully vaccinated children
• dramatic reduction in stock-outs,
• reduced government operating costs, and
• increased the use of data to drive action with SELV
In 2010, VillageReach launched a national expansion of the DLS, currently serving more than 400 health centers and a population of over 6 million. The DLS operates as a cost-share model and is now provincial government-run and managed. VillageReach currently provides technical assistance to provincial Ministry of Health authorities to support implementations and operations of the DLS in four provinces, including Cabo Delgado, Niassa, Gaza, and Maputo, with a fifth province soon to be added.
Decisions on the original design of the DLS were informed by assessment of the supply chain to identify the most critical gaps—lack of information availability, effective data utilization, human resources, and logistics processes. The initial deployments provided evidence to convince stakeholders in other provinces to adopt the model. Now with nearly half the country running the DLS (5 out of 10 provinces), peer-to-peer learning and advocacy have been instrumental in engaging national level stakeholders.
The DLS model allows for flexibility as provinces can adjust to fit their needs. New technologies like HERMES modeling tools have proven to be incredibly valuable in advocating for and demonstrating the benefit of system change. Listening to the concerns of DPS and MoH partners, and using these tools, VillageReach was able to show how the system could be adjusted in order to meet the logistics challenges across the country. Most importantly, with this evidence DPS and MoH partners are now willing to question the status quo and drive for efficiencies in the supply chain by introducing new approaches to management and system design.
It is important to note that change is difficult, and it takes time. There are many dependencies attached to political will for change. In the effort to drive system design changes and to convince stakeholders, the biggest challenge wasn’t proving that the system worked, but stakeholder’s perceived inability to question the status quo. The DLS represented changes at every point in the supply chain, addressing multiple aspects of the systems. For the DLS to scale, a slow but steady practice of building evidence, along with relationships with the DPS and Ministry of Health, lead to changes in management practices and will eventually lead to ownership at the country level.
The biggest achievement of the DLS is the demonstrated interest at the national level to consider and prioritize supply chain system changes. Yes, the DLS presents a successful, more efficient vaccine supply chain. And yes, this has generated interest and support from others through peer-to-peer learning, which has led to further expansion. But most important is the leadership and provincial government support for a new way of thinking about and managing the supply chain. As Mozambique moves through this “pipeline” of change at scale, it will serve as powerful evidence to the global community on the importance of a comprehensive approach to supply chain redesign (and the willingness to adopt new models) in order to improve immunization, and ultimately reach more children with quality vaccines.
Additional Award Criteria and Insights
When the summit organizers presented the finalists for the award, they provided some additional insight into criteria for the decision. To win, the intervention would have to demonstrate short-term impact, which the DLS clearly has done using results from the initial pilot evaluation as well as on-going monitoring of an improved performance of the supply chain. Stakeholder buy-in was another criteria, also demonstrated by the DLS with government participation in the management approach to the system. The award judges were also looking for rigor in the design of the system, also demonstrated by evidence-based decision making for system design of the DLS. And finally, the scalability criteria is clearly seen as the DLS has moved from one province to four with a fifth coming on-line now. Additionally, components of the DLS are being adopted in other provinces, such as OpenLMIS in Zambezia and a system redesign approach in all provinces as new vaccines are introduced.
The honor and prestige of the award is accompanied by a $2,000 USD prize that will continue to support the project.