CD implementation Step 5

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Create a Logistics and Supply Chain Plan and Prepare for Implementation

Objectives

  • Develop a logistics and supply chain plan that is informed by detailed assessments.
  • Contract third party logistics management company, where needed, or ideally fit into an existing government supply chain management division (i.e, Medical Stores Division).

Outputs

  • Transport and storage plan.
  • Tracking and other logistics tools designed and in place.
  • Contracts for third party logistics suppliers in place.

Activities

  • Convene a coordination committee meeting.
  • Plan the supply chain—transport routes, storage points, distribution points for all channels, to the lowest point possible.
  • Plan and conduct a risk assessment of the supply chain; the outputs should inform risk mitigation measures in the final plan.
  • Develop a documented logistics and supply chain plan.
  • Share the documented plan widely.
  • Call for third party logistics suppliers, where needed.
  • Assess submissions and award third party logistics supplier contracts.
Guidance
  • Develop a logistics and supply chain plan that integrates the needs of all the CD channels planned, because there may be important opportunities for synergy and economizing.
  • Undertake a risk assessment of the supply chain to inform the development of a robust logistics plan. Refer to the VectorWorks document, Preventing, identifying and mitigating the impact of fraud, theft and diversion of insecticide treated nets,  as it includes more detailed guidance on how to conduct such an assessment and how to use the results to develop the logistics plan.
  • Include the following aspects in the logistics and supply chain plan:
    • A plan of the distribution network showing distribution points, storage points, and transport routes.
      • Plan these aspects in discussions with personnel familiar with different areas of the country, transport challenges, and store availability and quality.
      • You may need to make store assessment visits to verify store appropriateness and plan to upgrade security and conditions, if needed.
    • Storage requirements, including guidance on security measures, which may vary by level, provide example images to illustrate good practice approaches, and storage conditions.
      • Storage conditions must be—
        • Dry.
        • Rodent free.
        • Secure.
        • Large enough for good storage practices that support accurate store recordkeeping and allow accurate visual stock checks.
    • Resupply plans linked to the micro-quantification  plan, detailing approaches to trigger resupply, such as stock thresholds, and the options for mechanics of resupply. Resupply is a critical issue in CD with supply bottlenecks and service point stockouts a frequent challenge.
      • Appropriate resupply approaches may vary within the country. Including the options available in this plan avoids dictating approaches that may be too stringent for districts, where one standard approach may not be appropriate.
      • Districts may need budgets for resupply to help avoid ITNs bottlenecking in district stores, but with distribution points stocked out.
      • Resupply may be a combination of push and pull mechanisms, depending on the channel and context.
    • Integrate the initial distribution, storage, and resupply plans across CD channels in areas with more than one channel.
    • Reverse logistics plans, if appropriate (see channel specific guidance on school-based distribution).
    • Document expectations around the use of and contracting of third party logistics providers. Include information on timelines that call for applications, review of applications, and templates for contracts. This section should include guidance on how the stringency of requirements for third party logistics suppliers may change at the lowest levels.
      • Robust contracts with third party logistics suppliers are a crucial part of reducing opportunities for fraud, theft, and diversion of ITNs. For additional guidance, see the VectorWorks document, Preventing, identifying and mitigating fraud, theft and diversion in the ITN supply chain.
    • Detail the tracking requirements and documentation, including clear guidance on expectations and document examples in the annex.
      • Ensure the tracking and reporting documentation is simple and clear and only includes need-to-know information. Avoid expanding documents, particularly reporting documents, by including nice-to-know information. Incorrect, incomplete, or untimely documentation, and reporting is a major problem in ITN supply and reporting. Keeping documentation simple is one way to address this challenge.
      • Use any existing standard country documentation, as much as possible.
      • Documents should include—
        • Logistics tracking tools; existing country formats are probably available.
          • Waybill.
          • Stock/store card.
        • Distribution recording and reporting tools:
          • Include a section for ITN in the ANC/EPI register to avoid having a separate register.
          • Distribution register for school-based and community-based distribution.
          • Distribution summary forms for school-based and community-based distribution.
          • Include in the monthly health facility reporting forms a section for the number of ITNs distributed to avoid a separate summary reporting system.
    • Details of accountability plans, including plans for supervision, spot-checks on stores, etc. (see Step 6).
    • Highlight the role of health facilities because in many CD models they play a logistics role in other CD channels—potentially as storage points and/or in supporting reporting.
    • Initial distribution and resupply plans should cover ITNs but, also, support materials needed; such as tracking tools, reporting tools, and sometimes coupons.

Channel specific guidance

Health facility-based distribution
  • Logistics for this channel have the best opportunity to link into existing transport, storage, and distribution systems. Tracking documentation, distribution, and resupply and reporting should primarily use the existing tools and systems.
  • Resupply is the greatest challenge. This aspect may require parallel systems to be set up and additional budgets provided, because no other commodities of a similar bulk are distributed routinely within the health system, so resupply systems with adequate volume capacity are not already established. Partly because of this, resupply is a serious challenge in ANC and EPI distributions and is a weakness of many countries health facility–based distributions. Reliable resupply is more likely if-
    • Systems are designed with inputs from the district- and distribution-level personnel who understand the challenges and opportunities.
    • A single standard system is not dictated, but options are described to districts that can adopt the most appropriate system for their context and needs.
    • Clearly identified budget lines for districts resupply needs.
    • Performance for stock management is regularly reviewed, and reasons for weaknesses and opportunities for improvement, are discussed at review meetings, from district level up.
  • Some countries have used a voucher system for health facility–based distribution; where a voucher is given to the target group at the ANC or EPI visit that can be redeemed at a local outlet for an ITN (perhaps with a contributory sum of money required from the recipient). Voucher systems, therefore, have very different logistics needs:
    • The focus on initial distribution and resupply to health facilities is on vouchers. As a far less bulky item, this means distribution costs are far lower and resupply can be done with other health facility documentary supplies.
    • Close engagement with the private sector is required to ensure all communities have access to participating outlets. Close discussions should be maintained to monitor and—if necessary—work to improve continued stock availability at these participating outlets.
  • To streamline logistics management across the overall ITN distribution strategy, it is important to develop a resupply plan that supports all distribution mechanisms. ITNs do not need to be compartmentalized for different distribution schemes. One stock of ITNs can be held at the health facility and drawn on, as needed, for various methods of distribution.
  • The VectorWorks document,Guide to Health Facility-based Distribution of Insecticide-treated Nets, provides more detail on these issues.
Community-based distribution
  • Logistics for this channel probably links closely to health facilities. It is possible to work outside the health facility network, if necessary, but linking to the health facility network brings opportunities for synergies and efficiencies.
  • To streamline logistics management across the overall ITN distribution strategy, it is important to develop a resupply plan that supports all distribution mechanisms. ITNs do not need to be compartmentalized for different distribution schemes. One stock of ITNs can be held at the health facility and be drawn on, as needed, for various methods of distribution.
  • Health facility–based distribution is probably in place throughout the country, so in areas where community-based distribution is added, the logistics plans should be identical up to the health facility level. If ITNs are not stored at health facilities, additional logistics planning is needed.
  • Key points to plan are where coupon redemption points will be (i.e., where a household member can redeem their coupon for an ITN) and where resupply storage hubs will be.
    • Redemption points may be health facilities that also store ITNs for distribution through ANC and EPI clinics; or, they may be smaller points at the community level, such as volunteer’s houses, if health facilities are insufficient.
    • Storage hubs should be at health facilities if this network is sufficiently functional. If it is impossible to use health facilities, then look for other storage hubs—in schools, local organizations, or other.
  • Options for distribution to community level redemption points include—
    • Pull: community representatives visit health facilities for stocks.
    • Push: health facility representatives, or local transporters hired by them (e.g., a local person using a bicycle) deliver stock to community distribution points.
  • Most redemption points are unlikely to have sufficient space to store more than a few bales of ITNs. Where redemption points are in a community member’s house, this will be particularly true. Two bales of ITNs may be the average amount held at a redemption point.
  • Setting a solid threshold that indicates the need for restocking is vital to preventing stockouts at the community level. Planners should choose a minimum quantity threshold for resupply (such as 10 ITNs, or the average number distributed in one month) to ensure that enough nets will be available to cover the demand between reorder and delivery. Minimum thresholds (the number of months’ worth of nets to trigger resupply) will depend on the size of the storage space, the catchment area’s population, and accessibility (which affects the frequency of resupply). Similarly, base the setting of maximum stock levels (such as three months) on the consumption rate, storage capacity, and estimated frequency of resupply.
  • Quantification should have considered the likelihood of a higher initial demand than is expected by the system. Planners should remember this and be prepared for more frequent resupply requests, at least initially. It may also be worth considering increasing initial stock levels before the rainy season, for two reasons:
    • Redemption rates may peak during the rainy season, or as the rainy season approaches.
    • Mobility may be particularly poor during the rainy season in some areas, making it difficult to resupply a community.

The VectorWorks document, Guide to Community-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

School based distribution
  • Most often, school-based distributions are done once per year. This means the distribution and resupply plans will differ considerably from the on-going health facility and community channels.
  • Consult sub-national education personnel about the transport plan; they will have information on the accessibility of different schools.
  • For distribution of ITNs through schools, through advanced planning of transport routes is important to improve adherence to schedules. Given the reach of schools into communities, transport is often a cumbersome task with some schools accessible only by boat, bicycle, or foot. It may be most practical to assign a specific transport agent (a local NGO, large project, or transport provider).
  • Transport plans (and associated training) must ensure deliveries are during working hours.
  • Most schools should have sufficient internal storage space for the ITNs.
  • To reduce opportunities for theft, distribution of ITNs to target groups should take place no more than 1–2 days after arrival of ITNs at the school.
  • Where storage is a problem; it may be necessary to support schools in finding alternative storage sites, or provide funds to allow schools to improve conditions—including security—of the areas designated for storage.
  • Storage may also be a problem at the district level, and planners may need to consider hiring storage locations if government sites are insufficient. Careful review of storage requirements and availability should be part of the micro-planning process.
  • The VectorWorks document, Guide to School-based Distribution of Insecticide-treated Nets, provides more detail on these issues.

Examples

Resources

(Health facilities should use country standard forms for distribution and summary reporting.)

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