The goal of the eZICS project is the development and pilot testing of a rational, sustainable, transparent and scalable supply chain management system that will improve access to essential drugs at the point of service delivery

Monze, Mweene

Ward, Peter M.

English

Warwick Research Archives Portal Repository

Stockout Eliminator:the objectives and design of the eZICStechnical solution in ZambiaPeter WardMweene MonzeAgenda• Project partners• Context• Brief history of eZICS– “enhanced Zambian Inventory Control System”• Solution objectives• Expected outcomes• Technical design overview• ConclusionseZICS project partners• Zambian Ministry of Health• Medical Stores Ltd• Crown Agents• World Bank• Prof. Gallien’s Research Group– London Business School, MIT, UMichigan• Pfizer• IBMContext• Mobile telecoms growing dramatically in sub-Saharan Africa– Phones and other handheld devices the predominant user interface• Previous projects have successfully showed this can be harnessed for healthcare supply chains, for example:– SMS for Life pilot, Tanzania, and subsequent rollouts– RapidSMS-based projects– cStock, Malawi• Ongoing need for Ministries of Health to demonstrate good governance with Donor-funded drugsBrief history• Prof. Jeremie Gallien has covered the earlier history of the project• In late 2010 I was asked to engage because of my SMS for Life experience in Tanzania• The project team held a design workshop in Lusaka and agreed a way forward• I arranged for IBM to contribute the technical solution– Mweene Monze is the technical genius behind it• We anticipate starting the Zambian pilot soonSolution objectives• Improved:– Public health through enhanced access to medicines– Financial planning and governance through reduction in inventory costs, expired stock and accountability for health products– Drug procurement decisions from data-driven forecasts• By:– Providing a means for health facility staff to report drug stock and usage information in real time– Using this information plus historical trends and other factors as input to new algorithms1 which determine the stock reorder quantity for each drug month by month• Therefore having all drugs always available at every health facility– As long as there is sufficient stock in the central stores– Otherwise share the stock equitably between health facilities requesting it1. Algorithms developed by Prof. Gallien’s research group and IBMExpected outcomes• Lower warehouse staff workload through automated order entry– Also reduced error rate since no manual data entry• No need for health facility staff to calculate and place orders themselves– Also no need for MSL staff to check orders– But manual adjustments are permitted when required• Historical patient demand data becomes visible– Opportunity to feed into procurement and budget planning processes• Real-time visibility of stock availability and transportation data– Potential to contribute to logistics performance reportingSynchronizing supply and demand Integrating customer forecasts and demand to plan logistics requirements Participation in customer’s Sales & Operations Planning processSupply ChainSuppliersManufacturers SellPlan Source DeliverMakeCustomerChannelsHealth FacilitiesDistribution CentersFlows:  Product, Process, Information, Cash & Capital ManagementServiceMulti-source orders and fulfillment Ability to track purchase orders through their entire lifecycle Knowledge of total pipeline supplier inventoryIntegration with manufacturer’s systems Access to order commitments & delivery schedules  Visibility into order production statusMonitoring shipment status• Monitor shipment status throughout pipeline with proactive event notification • Improved ability to identify short and over  shipmentsMultiple channels / touch points• Single source dashboard to view overall performance• Tracking from order to delivery • Knowledge of total pipeline customer inventory Post Sales Service Efficiently process returns Manage Spare Parts Inventories Visibility to entire reverse logistics processesSupply chain operational and visibility modelThe eZICS operational platform (IBM SCO/P) is built upon the industry standard Supply Chain Operations Reference (SCOR) model (See http://supply-chain.org), which baselines supply chain processes, metrics, resources and best practices.Conceptual overviewA simple information gathering, processing and analytics model provides end-to-end visibility of the pharmaceutical supply chain, from suppliers through distribution centres to end-users. The concept was developed collaboratively by the Gallien Research Group and IBM.· Governance· Procurement· Planning· Analytics· Receipts· Storage· Packing· DispatchHQ· Receipts· Issues· Transfers· Orders· Audits· Returns· SupplementalsRegional / Local HFVirtual Private Network (VPN) over WAN/LAN/Web/Mobile Network153462SecondaryDistributionPrimaryDistribution· Receipts· Storage· Packing· DispatchNational DCRegional DCSupplier /ManufacturerEnterprise Service BusApplication / Information Integration ServicesDelivery ChannelsFixed WorkstationMobile WorkstationStationary / Mobile UsersBusiness ServicesData Sinks / SourcesProcurement Specialist Forecasting SpecialistShipment Specialist District PharmacistPoint-of-Care PharmacistPerformance ManagerAuthentication & AuthorisationInventory Tracking• Product Issues• Product Receipts• Stock ManagementInventory Control• Demand Forecasting• Shipment Optimisation• Scenario PlanningPerformance Management• Performance Dashboard (KPIs) • Product / Stock Reporting• Logistics ReportingResource• Product• Facility• Schedule• ScenarioWarehouse ControllerMobile DeviceRich Client Services• Offline Operations • Asynchronous MessagingInfrastructure Services• Virtual Private Network • Web Access ServicesTransaction• Order• Shipment• Issue• Receipt• StatusData Warehouse• Dashboard• HistoryCentral Warehouse• Product• Facility• Order• Shipment• VehicleSolution architectureImplementation of the concept leverages a broad spectrum of world-leading IBM mobility, integration, analytics, forecasting and optimisation technologies to deliver a sophisticated and robust pharmaceutical supply chain operations planning platform.What does it look like?Solution brief (for more information)Conclusions• The eZICS technical solution meets genuine validated requirements in innovative ways• It improves the ordering process without requiring changes to warehouse management or distribution• It is ready to pilot in Zambia• It is available to customise and deploy elsewhereThank you!Peter WardMweene MonzeBackup slidesDistribution challenges Accessibility of essential drugs at the health facility level remains a bottleneck to health service delivery in Zambia, where health facilities face difficulties in accessing drugs in appropriate quantities because of inadequate drug distribution capabilities. The key distribution challenges include: Demand forecasting: Reliance on simple monthly consumption averages as a predictors of future demand. Delivery lead time forecasting:  Failure to anticipate predictable changes in delivery lead-times, for example for health facilities that are cut-off by flooding during the rainy season.  Allocation of scarce stock:  Adhoc and sometimes irrational allocation of stock across health facilities when inventory on hand is not sufficient to cover all requirements.  Demographic variations: Factors such as age, education, mortality rate, gender and employment distributions need to be considered since they impact the forecast and vary greatly across health facilities. Disease incidence: The forecast is influenced by the frequency and severity of specific illnesses which vary during the year as seasons change. Procurement pipeline: Due to disparate sources of funding, procurement cycles are largely unpredictable. The current manual drug distribution system determines demand forecasts and shipment schedules without adequately accounting for all these factors.  A major consequence of these shortcomings is avoidable deaths due to downstream drug stock-out situations which can last over multiple months, as well as wastage due to over-supply of drugs to health facilities that do not need them in such quantities.eZICS goals The goal of the eZICS project is the development and pilot testing of a rational, sustainable, transparent and scalable supply chain management system that will improve access to essential drugs at the point of service delivery. Key objectives include: Sustainability and country-ownership: the development, operation and maintenance of this system should involve the reliance on, and/or development of, local technical knowledge and expertise. Fairness and rationality: shipments to health centers should be determined according to a scientific method which minimizes country-wide unmet drug needs of patients at all times and under all scenarios of inventory availability, storage capacity and all other relevant practical constraints while ensuring higher equity across different health facilities and regions.  Transparency: the system should support the collection and monitoring of all critical performance data such as unmet demand/service level and drug expiry on a continuous basis as part of regular operations, make that data available to selected key stakeholders, and also support accurate tracking of public assets. Knowledge sharing: any knowledge generated as part of this initiative that is of potential value to other health systems and countries should be publicly disseminated. The current manual drug distribution system determines demand forecasts and shipment schedules without adequately accounting for all these factors.  A major consequence of this shortcoming is avoidable deaths due to downstream drug stock-out situations which sometimes last over multiple months.Solution architecture The eZICS solution delivers IBM mobile, integration, analytics, forecasting and optimisation capabilities in a package that is designed to be rapidly deployed and cost-effectively supported in Zambia and other countries in Africa. The solution architecture consists of these core functional components: Demand Forecasting: SPSS Statistics and SPSS Forecasting are used to generate sophisticated drug demand forecasts that take into account forecast complicating factors like lead time, seasonal and demographic variances. Shipment Optimisation: This function exploits ILOG Optimisation Decision Manager Enterprise (ODME) which supports scenario comparison to enable informed trade-offs between alternative solutions and conflicting goals. ODME embeds sophisticated optimization engines that are used to create the optimised shipment schedules for the eZICS distribution scenarios.  Mobility: IBM Worklight serves as the host platform for the custom-built eZICS inventory management application, and its mobile device management functions are used to support over-the-air distribution of applications, data and configurations.  Integration: WebSphere Message Broker (ESB) and WebSphere MQ (connectivity) provide the application and data integration capabilities for all the system components, including the existing warehouse control system. WebSphere MQ Telemetry Transfer provides a reliable, efficient publish-subscribe messaging channel for the thousands of connected mobile devices. Data Warehouse: The warehousing function leverages the InfoSphere Warehouse Pack for Supply Chain Insight whosecomponents include a physical data model and sample data mart structures built on DB2 and InfoSphere Data Warehouse. Business Analytics: Reporting and analytics also leverages sample Cognos BI reports that are packaged with InfoSphereWarehouse Pack for Supply Chain Insight. Custom data synchronisation have been developed to support offline operations at remote health facilities that are not connected to the mobile grid; these capabilities support local offline capture of inventory transactions, for subsequent synchronisation to the data centre at HQ via surrogate mobile devices. A custom Java component has also been developed to generate the lead time forecasts in a suitable format for the shipment optimisation algorithm.MSL ‐ Zambia’s central medical stores• Created in 1976• Semi‐autonomous Parastatal• Mandated to store anddistribute medicines, medicalsupplies & health equipment• Shareholders MoFNP & MoH• MSL regulated by the PRA• Upholds good warehousing anddistribution practices• 1998 – Outsourced as a management lease contract• 2004 – Management contract awarded to Crown Agents• Now effectively a PPP offering services to both public and private sectorsChallenges faced• Political challenges – many stakeholders• Culture shift – perceived loss of control, “District Approval”• Piloting – necessity & difficulty of stock pots• M&E – whole sub-project to ensure benefits/effects are measured• Complexity beyond the basic functionality – substitutions, pack sizes, etc• Roll-out challenges – mobile devices to 2000 locations• Training• Mobile devices - loss/damage/replacement• Dealing with no signal – standard operating proceduresLessons learned• Clear business case• Early stakeholder Buy-in at all levels• Map all processes• Spend time on exceptions (not just standard flows)• Clearly define requirements• Fully evaluate hardware, devices, OS options – Total Cost of Lifetime Ownership, familiarity, supportability locally• Fully plan and budget for M&E, roll-out, and all other associated activities, not just development and implementation• Cost the system for full roll-out in advance of commitment to pilot • Include maintenance (software, hardware and mobile devices)• Define standard operating procedures with new system

Stockout eliminator : the objectives and design of the eZICS technical solution in Zambia

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Stockout eliminator : the objectives and design of the eZICS technical solution in Zambia

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