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System wide issues in supply chain management: the example of UNICEF
In this video Musonda Kasonde describes ways in which those working in supply chain management can support the wider health system development.
CLAUDIA TORREALBA: Hello, Musonda. It is a pleasure to have you here to discuss on supply chain management and health systems strengthening.
MUSONDA KASONDE: Hello, Claudia. I’m very happy to be here to discuss this important topic with you.
CLAUDIA TORREALBA: So for starting the conversation, can you describe how supply chain management contributes to health system strengthening?
MUSONDA KASONDE: Well, as you will be very aware, health programs are becoming more complex. More products are available, which increase procurement, transport, and storage requirements. And more partners work in public health. The image on the screen shows the various parallel supply chains that exist in a particular country, across different health commodities. So a strong supply chain management and supply chain managers are necessary to ensure that supplies can move through the system to reach the people that need them and achieve the program objectives.
CLAUDIA TORREALBA: So considering that, how does UNICEF incorporate broader health systems issues into their supply chain management strategy?
MUSONDA KASONDE: UNICEF’s work in strengthening national supply chain systems is embedded in the broader frameworks of country health strategies. For example, we work with countries to develop comprehensive national supply chain strategies that support their existing health strategies and health development plans. Our work in supply chain management is focused on key health areas including immunisation, nutrition, and HIV, with the understanding that where there are no supplies, there are rarely results for children.
CLAUDIA TORREALBA: So what do you think are the core functions required for effective supply chain management? Does this change in different programs, for example, immunisation or nutrition supplies?
MUSONDA KASONDE: UNICEF looks at the supply chain holistically, as a set of supply chain operations, like budgeting and planning, procurement, delivery and clearance, warehousing and distribution. We’ve also recognised that well-managed supply chains require supply chain enablers, like highly skilled staff, data flow, and sufficient financial resources. These core operations and enablers do not change for different programs. What changes from program to program are the commodities and any specific considerations for procuring, storing, distributing, and using that commodity. For example, for immunisation programs, we have to consider culture and requirements for vaccines, whilst for MNCH essential medicines being used at the community level, we have to consider the packaging and ease of use for community health workers.
For the nutrition program, we consider the bulk in volumes of RUTF for storage and distribution. So the specificities of each program do vary, but the core supply chain operations and enablers remain the same for all.
CLAUDIA TORREALBA: Now that we have to looked into the specificities of certain programs, how does UNICEF support countries to strengthen national supply change in the context of health system strengthening? What does this entail in practice? And how would a country kickstart this process?
MUSONDA KASONDE: Yes, our support to countries is through capacity development approaches that aim to strengthen supply chain maturity and the long-term sustainability of supply chain systems. The first step to mobilise action, is to identify and convene key stakeholders around the table to start the conversation. It’s so important to align the key actors, governments, donors, and implementing partners around the common agenda and define that shared vision for the supply chain. UNICEF then encourages countries to develop a national supply chain strategy that clearly defines a national vision and direction that articulates the strategic initiatives that will be put in place to realise that vision collectively and the theory of change.
We’ve developed a process guide for strengthening public health supply chains that is a useful resource to guide this process and is among the resources that are found in this course. To give you a practical example of Nigeria, which has a comprehensive national supply chain strengthening program, which the country office and the regional office and supply division have been instrumental in driving forward with governmental partners. UNICEF Nigeria, for example, is now recognised as a key supply chain partner and has placed great effort in convening partners around a common agenda.
In doing so, they supported the Federal Ministry of Health and the National Primary Health Care Development Agency to develop, and now, implement, a primary health care supply chain revitalisation strategy, which is very much in line with the primary health care development plan and the government’s commitment to universal health coverage for its 200 million citizens. The supply chain strategy is essentially targeted at moving the availability of essential health commodities by strengthening the country’s supply chain system for PHC commodities. This also aims to harmonise existing supply chain structures and enhance strategic collaboration.
CLAUDIA TORREALBA: Thank you. So now, how can countries measures the performance of supply chain initiatives and actual contribution to health systems improvements?
MUSONDA KASONDE: Yes, this is a very important question. And we put a lot of thought into how we would measure the impact of our own efforts and investments. UNICEF– we then have developed a supply chain maturity model to support governments to define where they were in terms of supply chain maturity, to help them recognise where they needed to go, to have a mature supply chain, and to measure supply chain and health system improvements. The maturity model looks at each area of the supply chain along each of the supply chain operations and enablers that I mentioned earlier and helps countries to quantify where they are along each of these areas.
But, more importantly, it helps countries to identify the characteristics and requirements of mature systems and to guide the supply chain strengthening efforts. We’ve applied this tool on a number of occasions with several countries as a self-assessment exercise, and found that it really helps to identify strengths and gaps very quickly. It, then, creates a common framework for talking about where additional resources need to be spent. It has also been useful in terms of monitoring the effectiveness of our own work. For example, we’ve been working in the area of supply chain human resource capacity development. And with the maturity scorecard, we can see that these efforts have had a tangible impact when a country progresses from one maturity level to another.
CLAUDIA TORREALBA: And finally, how do we ensure the ongoing governance and coordination efforts?
MUSONDA KASONDE: Yes. Another key issue for sustainability. A strong governance structure for oversight and coordination to steer implementation of the supply chain strategy is critical for success. The national logistics working group, or the supply chain technical committee as it’s often called, or the equivalent coordinating body in each country plays a key role here. UNICEF and the WHO in particular, view this as a key priority and are providing technical support to countries to establish and strengthen these groups. Sierra Leone is a good example, where in 2017, with the support of UNICEF, the government, the Ministry of Health established a national logistics working group to oversee and coordinate all activities related to immunisation supply chain management.
The national logistics working group in Sierra Leone is now a key element of the national EPI strategy that works towards ensuring the availability of effective vaccines for children and adults at all levels of the system. It has helped the government to identify priorities, to strengthen immunisation supply chain management, to coordinate government and partner support in these areas, but also to provide evidence-based recommendations to senior management in the Ministry of Health, to donors, and implementing partners, for decision making.
CLAUDIA TORREALBA: Thank you very much, Musonda. This is all very useful to understand better how supply chain management contributes to health system strengthening.
MUSONDA KASONDE: Thank you very much, Claudia. It was great to talk to you.
Musonda Kasonde describes a number of ways in which those working in supply chain management can work to making those actions support the wider health system development. We like the idea of the maturity model. There are a number of maturity models available, most of which originated within industry supply chain research. One simple way to think about maturity is one that is pictured in this document which described three phases of development: the ad hoc phase, the organised phase and finally the integrated phase. For learning more about how UNICEF strengthen public supply chains through the adoption of the maturity model, you can access an overview of UNICEF’s maturity model below.
In the comments below suggest what phase the supply chain system might be in your work context? What do you think are the priority actions to move it towards an integrated system?
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