HERMES Vaccine Supply Chain Modeling: Senegal and Benin

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1 HERMES Vaccine Supply Chain Modeling: Senegal and Benin Bruce Y. Lee, MD, MBA Associate Professor University of Pittsburgh

2 HERMES Team Tina-Marie Assi, PhD Former Co-Coordinator Diana L. Connor, MPH Co-Coordinator Leslie E. Mueller, BS Analyst Michelle M. Schmitz, BA Analyst Shawn T. Brown, PhD Technical Lead Leila A. Haidari, BS Analyst Bryan A. Norman, PhD Industrial Engineering Rachel B. Slayton, PhD Former Co-Coordinator Brigid E. Cakouros, MPH Senior Analyst Veena Karir, PharmD, MS Senior Analyst Jayant Rajgopal, PhD Industrial Engineering Angela R. Wateska, MPH Co-Coordinator Sheng-I Chen, PhD Industrial Engineering Bruce Y. Lee, MD, MBA Scientific Lead Proma Paul, MHS Senior Analyst Joel S. Welling, PhD Developer Erin G. Claypool, PhD Industrial Engineering Jim Leonard Developer Roslyn J. Phillips, MPH Senior Analyst Yu-Ting Weng, MS Developer February 28,

3 HERMES Vision Data on Supply Chain Structure, Storage Locations, Transport, Capacities, Personnel, etc. Standard input deck Create a freely available and userfriendly software tool for decision makers to generate an interactive simulation model of any supply chain (= a virtual laboratory). Economic Metrics Discrete event Simulation model of supply chain Supply chain performance metrics Total Costs Unit Costs Cost Drivers

4 HERMES Can Address Impact of introducing new technology e.g., vaccines, storage, and monitoring Characteristics of vaccines and other technologies e.g., vaccine vial size, vaccine thermostability, cold device capacity Configuration and operations of the supply chain e.g., storage, shipping frequency, personnel, ordering policy Effects of differing conditions/circumstances e.g., power outages, delays, inclement weather, limited access Investment or allocation of resources e.g., adding refrigerators vs. increasing transport frequency Optimizing vaccine delivery e.g., minimize cost, cost per outcome, maximize immunizations

5 Discrete Event Simulation Each Storage Facility Refrigerator Next Level 1 Higher Level Transport Each vaccine vial = entity Each diluent vial = entity Refrigerator Refrigerator Freezer Capacity Temperature range Probability of failure or delay Next Level 2 Next Level 3

6 Service Delivery Location An example of the possible devices available at any location Refrigerator Higher Level Vaccine carrier Health care worker: 1. opens vaccine vial and reconstitutes with diluent (if required) 2. administers vaccine to client Client arrival based on health system or census/birth data If the correct vaccine is Available = successful immunization Not available = missed immunization opportunity Example of outputs Open vial wastage = unused doses in opened vials Medical Waste vaccine availability = clients successfully immunized all clients arriving

7 HERMES Locations

8 Senegal

9 Senegal: Scenarios Explained 1. (PRA) System with the Optimize project of moving warehouses (from the regional pharmacy to the health posts in Saint Louis) 2. (PRA) System with the Optimize project of moving warehouses (from the regional pharmacy to the health posts in Saint Louis) WITH a 25% security stock at the district level 3. (PRA) Distribution system from the regional to the district level 4. (PNA) Transport from the national to districts (bypassing regions) 5. (PNA) Transport from the national to the office of the regional medical officer

10 Senegal: Vaccine Availability and Costs Vaccine Availability Logistics Cost per Dose Scenario 1: Moving Warehouse 36% 99% $0,53 $0,29 $0.20 Scenario 2: Moving Warehouse with buffer stocks 37% 99% $0,53 $0,29 Scenario 3: PRA deliver to Districts in loops 43% 97% $0,45 $0,30 Current EPI Scenario 4: Region removed: Monthly Scenario 5: Old Supply chain with rented truck 78% 29% 89% 97% $0,55 $0,56 $0,30 $0,31 With Rota and PCV 89% Baseline 29% 0% 20% 40% 60% 80% 100% $0,33 $0,54 $0.23 $- $0,20 $0,40 $0,60 November 28, Bill & Melinda Gates Foundation 10

11 Benin

12 Benin: Objectives Evaluate the current Benin vaccine supply chain: Identify vulnerabilities (bottlenecks) Calculate operating costs (storage, transport, labor, and building) Assess Benin vaccine supply chain s ability to handle new vaccine introduction. Identify an alternate, more efficient vaccine supply chain design. Establish a blueprint for redesign. Build a business case to change the system. Determine if costs could be lowered and coverage increased from the current system.

13 Benin: Modeling of Each Scenario Data on Benin Vaccine Supply Chain 2010 Cold Chain Equipment Management (CCEM) assessment completed in 2012 Pilot 2012 EVM+HERMES 2008 Comprehensive Multiyear Plan (cmyp) Personal communications with Benin Ministry of Health (MoH), WHO, UNICEF, Project Optimize, and other key stakeholders Detailed Simulation Model of the Benin Vaccine Supply Chain Run Simulation Measure Vaccine Availability Measure Operating Costs Measure Capital Expenditure Make Investments to Relieve Bottlenecks Run Simulation Measure Vaccine Availability Measure Operating Costs

14 Benin: Redesign Options Zone Sanitaire (ZS) Removing Commune Level Consolidating existing 80 Communes into 34 Zone Sanitaire Stores Motorbikes pick up from Zones point to point or 4x4 trucks deliver to health centers in loops Removing Commune Level with and without addition of 5 Department Stores Motorbikes pick up from Departments point to point or 4x4 trucks deliver to health centers in loops

15 Benin: Visualizations of Redesign Current System Zone Sanitare Removing Communes

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17 Capital Expenditures to Achieve Scenario ($US Millions) Benin: Redesign Results Capital Expenditures and Operating Costs Dominant Scenario ,05 1,10 1,15 1,20 1,25 1,30 1,35 1,40 1,45 Total Operating Costs ($US Millions) Baseline, motorcycle no loops Baseline, 10 HC per loop Zone Sanitaire, motorcycle no loops Removing Commune Level motorcycle no loops Zone Sanitaire, 10 HC per loop Removing Commune Level 10 HC per loop Removing Commune Level + 5 New Departments, motorcycle no loops Removing Commune Level + 5 New Departments, 10 HC per loop

18 Cumulative Cost Savings over Current Augmented System Benin: Cumulative Cost Savings $ $ Zone Sanitaire: Motorcycles, no loops $ $ $ Initial Capital Expenditure Zone Sanitaire with Truck Loops Removing Commune Level with Truck Loops $ Removing Commune Level + 5 New Departments with Truck Loops $ Simply augmenting capacity of Current System $0 -$ Year 4x4 Truck Loops at the lowest level with each loop serving 10 Health Centers

19 Conclusion HERMES can rapidly create a simulation model of any supply chain Serve as a virtual laboratory to help a wide variety of vaccine decision makers answer any number of questions Re-design of vaccine supply chains could improve effectiveness and/or efficiency. Benin and Senegal provided important lessons learned for in-country implementation.