Equitable Access to Medicines, Vaccines and Technologies

Equitable Access to Medicines, Vaccines and Technologies

The Essential Need To Improve Supply Of Live-Saving Medicines And Vaccines

The Public Health Supply Chain (PHSC) provides a reliable supply of commodities, and thus more people are likely to use health services. However, Low- and Middle-income countries (LMIC) still experience essential medicine and vaccine stockouts that cause interruptions to health services, leading to missed opportunities to protect people from diseases and epidemics.

20 million children worldwide – more than 1 in 10 – missed out on lifesaving vaccines such as measles, diphtheria and tetanus in 2018, according to new data from WHO and UNICEF Press Release.

GaneshAID collaborates with national and international stakeholders to address the main challenges of in-country efficient supply chains:

  • Limited effect of supply chain interventions because the risks are unmitigated and systemic root causes are not identified and addressed in the health system. 
  • Lack of leadership and ownership, ineffective coordination, and oversight of supply chain systems: limited strategic vision, no supply chain strategy, inappropriate investments, donor- or implementor-driven intervention with poor articulation with national health priorities.
  • Insufficient accurate and reliable data for decision making, leading to poor visibility of stock availability with the risk of health services disruption, waste or loss of commodities.
  • Unsatisfactory human resources for service delivery and supply chain management: heavy workload for supply chain staff, shortage of skilled personnel or limited skills, high turnover and low retention. The most frequent intervention to address HR challenges is short term in-service training of staff but this cannot address the issue.

Identifying Root Causes 

Limited effect of supply chain interventions

We support innovative approaches to focus systematically on root causes analysis and not only symptoms in health systems. We support mechanism to shape sustainable and evidence-based solutions for building resilient health supply chain systems.

Lack of leadership and ownership

We strengthen country ownership and governance structures capacity to prioritize, coordinate and be accountable within supply chain activities. 

  • Conducting national health supply chain assessments.
  • Formulating costed supply chain strategies and operational plans.
  • Establishing/strengthening effective governance structures for accountability, alignment, and coordination
  • Managing health supply chain activities for proper disease-prevention, diagnostics, and treatment of all communities.

Fragmented accountability of health supply chain across in-country stakeholders is a impedement to ensure availability of medicines and vaccines up to the last miles.

Insufficient accurate and reliable data for decision making

We help country determining and implementing mechanisms to support the collection of key supply chain data required for decision making. 

  • Capacity building to capture and report consumption data, fostering health programs integration.
  • Optimizing digital technology for logistics management information systems (LMIS) from central up to facility levels. We focus on
    • Mobilizing resources for increased electronic systems coverage,
    • Building trust in the benefits of digital transformation among health workers, and
    • Advancing expertise and skills needed for effective use of digital supply chain and logistics technologies.
  • Increasing visibility on the performance of supply chain systems including:
    • Quality: stock-out rates, order refill rates, buffer stock levels.
    • Response times: by order turnaround times, on time delivery and fill rates.
    • Efficiency and economy: ratio of transport cost to value of products and total delivery costs

Unsatisfactory Human Resources for service delivery and supply chain management

  • Advocating towards in-country decision makers for:
    • Establishing human resources for health supply chain positions within the public system: supply chain managers, logisticians, cold chain officers, warehouse keeper, etc. This includes a clear career path.
    • Attracting/Hiring/Retaining health supply chain professionals in the public system.
    • Integrating systems to reduce heavy overload of medical doctors, pharmacists, nurses, and midwives who should be fully dedicated to healthcare activities.
    • Investing in pre-service public health supply chain curricula, preparing for next generation of supply chain professionals.
    • Innovating competency-based in-service trainings that embed performance support within the workplace, including supportive supervision, mentoring and coaching.
  • Conducting Human Resources for supply chain management assessment.
  • Formulating Human Resources for supply chain strategic plans.
  • Conducting training needs assessment.
  • Developing costed training master plans.
  • Instructional designing health supply chain training programs.
  • Delivering training courses: in-person, virtual, e-learning, and m-learning.

Our Responses

National Logistics Working Groups – NLWG

Since 2015, GaneshAID team has been supporting health supply chain leadership and coordination through National Logistics Working Groups. An article published in The Vaccines describes the situation of the NLWG and provides good practices on NLWG across the world.

Likewise, to support more people establishing and reinforcing NLWG, our expert was the Subject matter expert of the e-learning module available on UNICEF/AGORA LMS.

HR4SCM rapid diagnostics for action and Training Needs Assessments

GaneshAID’s experts supported various countries to assess the situation of human resources for supply chain management. The Human Resource for Supply Chain Management Theory of Change Rapid Diagnostic Tool generated key evidence and relevant information about the in-country health and immunization supply chain workforce.

Consultation of stakeholders and partners demonstrated a common acknowledgement that a continuous supply of quality, safe, effective and affordable medicines and vaccines is one of the building blocks of well-functioning health systems. Consequently, a properly functioning supply chain is a critical part of ensuring commodity security—when every person can access quality essential health supplies when needed. However, the rapid diagnostic revealed that the strategic vision of health supply chain should be clarified and based on best practices and international standards.

A major factor in building a strong supply chain is the capacity of countries to efficiently and effectively manage it. An established supply chain and logistics governance and leadership structure within the Ministry of Health would be key to properly organize, monitor, and support all supply chain operations, as well as coordinate stakeholders to prioritize investment in the health supply chain. In the same idea, building the competencies of supply chain professionals is vital to the health supply chain in Vietnam. A robust supply chain requires trained and competent staff to manage and execute operations with the purpose of meeting health system demands. The skills needed to manage the health supply chain in Vietnam include Strategy and Design; Forecasting and Supply Planning; Procurement; Warehouse and Distribution Management, Data Management, PHSC Workforce Development; and Governance. Considering the critical role that skilled and competent staff play in managing supply chains, the country should invest in the training and professionalization of local health supply chain leaders and staff. Their tasks include managing logistics data, conducting product quantifications and forecasts, procuring products, using data management software and system, planning the distribution, distributing products, managing PHSC staff, monitoring and evaluation and coordinating stakeholder supply chain decision-making.

The Human Resource for Supply Chain Management Theory of Change Rapid Diagnostic Tool and Training Needs Analysis has exposed positive factors (Strengths and Opportunities) and negative factors (Weaknesses and Threats) at the country level, and thus the need for action in this key area as part of the overall health and immunization planning to ensure the sustainability of efforts by the government and partners.

The training needs analysis reveals that there are critical needs to enhance the competency of the current health workforce dedicated to supply chain. These critical needs are the basis for developing training modules/programs on public health supply chain with a modular approach. A training strategy is developed to address the needs of existing staff who are performing the tasks related to supply chain and the needs of the future generation of supply chain professionals in the system.

Continuous advocacy towards government and partners in this area will be key to ensure that the five recommendations will be included in the country’s health policies and plans, and especially the Human resources for health strategy.

A coordinated, strategic planning effort will enable countries to design a strong and resilient supply chain system with robust planning, management, and coordination structures and available skilled workforce.

Health supply chain strategy development

GaneshAID’s experts supports countries developing public health supply chain strategies to guide prioritization of issues. The analysis of the Supply chain system at country level is the foundation of the strategic plan development process. It is an ongoing process for monitoring and evaluating the progress and improvements of the healthcare supply chain system, its operational functions and management. It is mainly crucial to monitor and assess periodically the situation of the healthcare supply chain in a context of rapid changes and reforms of the healthcare sector.

In a country, the analysis of the situation of the healthcare supply chain relies on previous assessments, reports and consultations of all stakeholders involved in the healthcare supply chain. Likewise, SWOT analysis helps determine a diagnostic in terms of Internal environment (Strengths and Weaknesses) and External environment (Opportunities and Threats). Recommendations are then prioritized for integration and standardization of processes, elimination of inefficiencies.

Supporting Vaccines potency through the GAVI CCEOP

Strong and efficient supply chains – equipped with reliable cold chain equipment (CCE) – are vital to helping countries increase immunisation coverage and equity, reaching children with lifesaving vaccines and protecting them against deadly diseases. To ensure that vaccines are widely available and remain cold, safe and effective throughout the entire supply chain, each country’s immunisation programme needs access to high-performing and well-maintained cold chain equipment.

Such cold chain equipment, when available at the required cold chain points-in-country, will increase vaccine availability, potency, and safety. This will help to improve immunisation coverage. Some older technologies have high operating costs and/or poor temperature control that can lead to vaccine wastage if vaccines are exposed to very high or freezing temperatures. To support countries in improving their cold chains, Gavi, the Vaccine Alliance established the Cold Chain Equipment Optimisation Platform (CCEOP) in January 2016.

Access the CCEOP Technology Guide (as of Feb. 2020)

The CCEOP is a financial facility through which Gavi jointly invests with countries in the purchase, deployment, and installation of higher-performing cold chain equipment.

GaneshAID provides experts to pre-Review the Gavi Cold Chain Equipment Optimization Platform (CCEOP) Applications from developing countries. Our experts are assigned to assess the quality and soundness of the country’s proposals to the Gavi CCEOP to ensure that applicants have fulfilled all Gavi requirements and received recommendations to take appropriate action -based on the “Pre-Review” assessment – in advance to the Independent Review Committee (IRC). There are Fifty-Five (55) Gavi-supported countries that are eligible for the CCEOP support. From 2016 to 2020, 19 countries were reviewed and received recommendations prior to the IRC.

The COVID-19 pandemic is affecting all aspects of immunization programmes, including the supply chain. One of the measures to control the pandemic is vaccinating vulnerable people against COVID-19. Several COVID-19 vaccines are already available for deployment whilst others are in the advance phases of development and will be deployed as soon as they are approved by the market authorities. However, as many countries have only enough cold chain space to store their routine vaccine supply, additional cold chain capacity may be required to successfully manage the vaccine and implement vaccination campaigns.

Gavi has established a mechanism to support the Advance Market Commitment (AMC) Group participating countries to ensure successful COVAX deployment by addressing cold chain gaps. An Alliance pre-review process, jointly led by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) cold chain experts (hereby referred to as the “Alliance PR Team”), is necessary to ensure that country proposals satisfactorily meet the requirements set forth by the Gavi COVAX Facility and are therefore eligible for approval by Gavi’s Independent Review Committee. The pre-review activities are organized and coordinated by the WHO Secretariat, in collaboration with the Gavi Secretariat.

Our CEO joined the team of experts to pre-review the quality, exhaustivity and rationale of Countries’ application to the Gavi COVAX CCE facility.

“I am so proud to support WHO and countries  in this tremendous initiative. This will enable all countries to equitably access COVID-19 vaccines and address cold chain storage capacity gaps”

Dorothy Leab, GaneshAID CEO    

COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator. The ACT Accelerator is a ground-breaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.

Watch “COVAX: Ensuring global equitable access to COVID-19 vaccines”