Health Systems Strengthening: Ensuring Effective Health Supply Chains (Round 19)
In 2015, the Sustainable Development Goals (SDG) were adopted by countries focused on 17 critical goals to ensure a “better world with no one left behind” by 2030. SDG 3 represents health and focuses on ensuring healthy lives and promoting well-being at all ages. It includes ambitious goals to end preventable deaths of newborns and children under 5 years of age, end the epidemics of AIDS, tuberculosis, and malaria, ensure universal access to reproductive health care services, and achieve universal health coverage and access to safe, effective, quality and affordable essential medicines and vaccines for all.
The health supply chain is comprised of people, processes, policies, technology and resources to ensure the right products reach the right place in the right condition. When effective, the supply chain is “the backbone” for access to safe and effective health products, and supports the goals of eliminating AIDS, TB and malaria, ending childhood vaccine-preventable deaths, and ensuring universal access to reproductive health services. An efficient supply chain also safeguards the significant financial investments on the procurement of health products by donors and country governments - estimates on donor-financed health products alone range from $7 - 10 billion dollars per year procured for low- and middle-income countries (LMIC).
Yet, public health supply chains are often sub-optimal and unable to support achievement of the broader health goals of a country, due to a combination of failures relating to people, processes, technology or resources. The recent UN Commission on Life Saving Commodities focused on increasing access to 13 critical medicines and health products that often fail to reach the women and children with significant implications on the health and well-being of both. Insufficient supply at the locations most needed was identified as one of the common barriers to access. The UN Commission noted that addressing barriers and ensuring access could save up to 6 million lives over five years and contribute to reductions in maternal mortality rates and under-5 deaths.
Recognizing the need for innovation to tackle these supply chain barriers, the Gates Foundation and the U.S. Agency for International Development (USAID) have collaborated to issue this joint call for innovative and potentially transformative solutions with the potential to overcome key roadblocks to more effective supply chains in low- and middle-income countries.
As noted, supply chains are an essential component supporting LMIC health systems in achieving the SDG goals and ensuring healthy lives for all. Some of the key challenges we see include:
- Last mile availability: Challenges in infrastructure (e.g. inadequate roads, electrification, etc.), people (e.g., lack of necessary competencies and accountability), and processes (e.g., existence and implementation of SOPs) create barriers at the “last mile” and limit access to essential health products for health system clients and patients.
- First mile data: Multiple barriers limit efficient collection and reporting of critical health supply chain data at the health clinic or community level (i.e. the “first mile” of data flow). These include limitations in scalable tools and platforms that efficiently capture and transmit data in a way that meets the full requirements of local systems; overburdened staff with heavy data reporting burdens; and poor quality control of reported data.
- Data driven performance management at all levels: Even where data is “unlocked” from paper tools—meaning that that data and information becomes accessible to other staff within and outside of the facility — weaknesses remain in how data is analyzed and used. Integration and analysis of data from multiple sources, particularly consumption data, and triangulation of data remains challenging; data are rarely used in a systematic way to inform decision- and policy-making.
- Supply chain system design: Traditional LMIC public health supply chain designs often result in lack of supply chain efficiency, agility, resilience and responsiveness, as well as problems of execution. These weaknesses can produce unintended consequences that may impede achievement of public health goals, for example through increased expiries, increased costs, and/or lower availability at dispensing points.
- Governance and accountability: The formal and informal incentives in public health supply chain systems, and the workforce that manage and operate them, can be misaligned to public health goals at multiple levels (from warehouse and clinic staff to policy makers). This “political economy” of the supply chain can lead to inaction, poor decision making, or rent-seeking behaviors that hamper the effective and efficient management of supply chain systems.
- Sustainable human capacity: Years of investment in training and capacity building for supply chain management have, in many countries, failed to produce national systems that effectively or efficiently operate their supply chains without external support. Public health supply chains often face difficulties in developing, attracting, and retaining staff with the required supply chain competencies. Further, many countries lack mechanisms to produce a workforce that is able and available to meet the needs of the public health supply chain and similar supply chain needs of other industries.
- Resource mobilization and supply chain operations financing: Sufficient funds are not allocated for or expended on critical supply chain operations, including distribution (e.g. vehicle maintenance, fuel, per diems, etc.), information collection, monitoring, and performance improvement. Information on the actual costs to operate the supply chain are rarely known or visible within the public sector.
What we are looking for:
The Foundation and USAID seek proposals that address challenges in effective health supply chains that are daring in premise, and clearly different from the approaches currently under investigation or employed. The solutions submitted to this topic could focus on an integrated health supply chain, or they could focus specifically on immunization and/or family planning supply chains and their respective programmatic goals. They must have the potential to be scaled up or reproduced in multiple settings. We encourage solutions that translate leading and best practices and solutions developed by the private sector (e.g. outside of health), as well as academic research and findings, to LMICs in a way that support their public health goals.
Proposals must provide a strong rationale for the work proposed, demonstrating a clear understanding of country context and needs, and present a defined hypothesis and associated plan for how the idea would be tested or validated. Proposed ideas must ultimately be translatable to practical interventions accessible in resource-limited settings.
A few examples of work that would be considered for funding:
- Distribution and delivery technologies & approaches
- Novel approaches, technologies and tools that enable effective and efficient delivery of health products to the last mile (this may include all health products or a focus on specific product groups).
- Supply chain design tools or processes that will optimize the supply chain for achievement of public health goals.
- New channels and designs to access and deliver health products
- Unique and innovative uses of other channels (beyond the standard public sector channels, e.g. private distributors, retail pharmacies, other retail services, social enterprises, etc.) to deliver health products, including to underserved population segments.
- Utilization of other sectors, such as agriculture (e.g. flower exporters or other agricultural export) or fast-moving consumer goods (e.g. food including ice cream, beauty care, etc.) to improve access to essential health products and supply chain efficiencies.
- Visibility and analytics
- Innovative solutions to establish and maintain end-to-end supply chain visibility, including data capture, reporting, and use at all levels.
- Approaches, tools or technologies that can support data analysis and data-driven decisions and actions to improve supply chain performance.
- Improve governance and accountability
- Systems or frameworks that will better align public health supply chain incentives (at the individual, organizational or systemic level) with public health goals.
- Technological or system innovations that will reduce corruption, wastage and leakage in the supply chain.
- Sustainable capacity within a country
- Innovative means for developing or accessing local supply chain technical and managerial capacity that will be sustained within the local institutions and/or systems, including through partnerships with the private sector.
- New systems and mechanisms for improving staff motivation and human resource performance management within the supply chain.
- Financing and costing
- Tools and methodologies to increase insight into costing and budgeting for supply chain operations.
- Approaches and solutions to help LMICs determine a balanced/optimized costing and financing model for supply chains that manage free, donor-provided health products and/or cost-recovery products; especially models that address actual supply chain operations costs and optimize pricing for achievement of health system goals.
- Innovative mobile technologies, tools, mechanisms and approaches to ensure funds are available and expended for supply chain operations and to overcome public financial management challenges, such as delayed public fund transfers and low liquidity in countries.
We will not consider funding for:
- Proposals that do not directly address at least one of the challenges described above;
- Proposals without a clearly-articulated objective or an objective that cannot be easily assessed for quality, efficiency and/or effectiveness;
- Preclinical or clinical research: proposals for vaccine or medicine administration or delivery devices; proposals aimed at improving vaccine or medicine stability or formulation; proposals involving animal models or human subjects in clinical trials;
- Approaches that represent incremental improvements to current activities or conventional solutions, or iterative solutions;
- Approaches that are not applicable in low- and middle-income country settings;
- Approaches for which proof of concept cannot be demonstrated within the funding levels described for this call;
- New solutions that do not have the potential to be used widely or scaled-up, or are only relevant to a single geography or context.
- Proposals that do not describe or outline the innovation’s down-stream effects on the supply system or consider innovation in the context of the broader health and routine immunization system or local landscape capacity;
- Proposals based upon, or that rely solely on, an SMS platform for sending reminders or communication; and
- Proposals that can only be applied to individual manufacturers' products or specific product improvement initiatives.
For more information, please consult the following links:
- Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform. Prashant Yadav. Health Systems & Reform Vol. 1, Iss. 2,2015. http://www.tandfonline.com/doi/full/10.4161/23288604.2014.968005
- GAVI Alliance Immunisation Supply Chain Strategy; Report to the Board. http://www.gavi.org/about/governance/gavi-board/minutes/2014/18-june/presentations/05---gavi-alliance-immunisation-supply-chain-strategy/
- UN Sustainable Development Goal 3: http://www.un.org/sustainabledevelopment/health/
- People that Deliver. Healthcare Supply Chains in Developing Countries https://peoplethatdeliver.org/ptd/resources/research-materials