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CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia Coca-Cola and Ghana Health.

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Presentation on theme: "CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia Coca-Cola and Ghana Health."— Presentation transcript:

1 CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 6th Global Health Supply Chain Summit November 18 -20, 2013 Addis Ababa, Ethiopia Coca-Cola and Ghana Health Service learning from each other David Sarley BMGF

2 If Coke can deliver to every village, surely we can learn from them to improve public health supply chains Actually, although Coca-Cola are not delivering to every village, we can learn from them but we need to translate commercial best practices to public health settings. RED meets RED Coca-Cola: RED = Right Execution Daily Ghana Health Service: RED = Reach Every District This work was undertake by Accenture Development Partners in collaboration with Coca-Cola and Ghana Health Service and funded by the Bill and Melinda Gates Foundation © 2013

3 The Cold Chain Uptime project translated Coca- Colas capabilities in cooler maintenance into a maintenance model for GHS cold chain Coca-Cola Capabilities GHS Aspirations Reduce frequency of equipment break down Reduce the fault to repair time Cold Chain Inventory Analysis Preventative Maintenance Model Pilot and Evaluation of Maintenance Model Business Case for National Roll Out Phase One Deliverables Cold Chain Uptime Objectives © 2013

4 Ghana Health Services cold chain inventory is not functioning, and the high number of models make it difficult to maintain effectively Key FindingsImplications 1 2 3 4 5 1 out of every 4 units is not functioning 11% of the inventory does not have a recorded functioning status Health facilities are forced to cope with a cold chain that has a large volume of non-functioning equipment Limited data keeping practices implicate the ability to make effective decisions Procurement compliance is relatively well maintained An inventory with limited make/model standardisation is expensive to maintain because of increased spare parts required and reduced technician productivity An aging inventory results in higher total cost of ownership because of frequent breakdowns and expensive repairs 99% of inventory is purpose made for vaccine related use There are over 80 different models of cold chain equipment 41% of the inventory is over 10 years old © 2013

5 Coca-Colas model has been highly successful, as they maintain a large inventory with minimal staff and downtime Critical Success Factors Focus on preventative maintenance increases equipment availability Coca-Cola delegates accountability to enforce uptime of coolers Training of maintenance, supervision personnel and users reduces need for corrective maintenance and downtime Coca-Colas cooler uptime percentage is 99.3% Coca-Cola Statistics National equipment inventory15,600 No. of cooler models10 No. of national technicians26 No. of coolers per technician~ 600 Average daily cooler visits per technician4 No. of times cooler serviced per year2 Annual cooler services target per technician 1,200 Current equipment not functioning~0.6% © 2013

6 The maintenance model developed for GHS requires fundamental changes to their operations and ways of working Regional technicians exclusively responsible for cold chain equipment Daily routes scheduled for targeted equipment services Documented maintenance activities to Track performance Obtain necessary approvals Generate reports for data driven decision making Regional spare parts available when required 1 2 3 4 Key Components of Proposed Preventative Maintenance Model © 2013

7 We tested the feasibility and practicality of the maintenance model through a five-week pilot in the Volta region Reasonable number of units that can be serviced in a day Inventory data accuracy Fault correction response and repair times Observed impacts and benefits of preventative maintenance The key measurements of the pilot were What is different about GHS operating environment? What resources are required to perform and manage equipment servicing? Can the response and fault repair times be improved? What will it cost to deliver the maintenance model? The pilot aimed to answer the following questions Pilot Districts: 1.Adaklu 2.Aktasi South 3.Central Tongu 4.Ho Municipal 5.South Dayi Volta Region, Ghana © 2013 Included several districts without Coca-Cola

8 The outcomes of the pilot allowed us to refine the maintenance model, develop metrics and gain further insight into challenges in the field Insight from Pilot Lack of spare parts availability was a key issue in non-functioning equipment, as there is no dedicated funding for spare parts Common faults could be resolved through purchase of cheap parts (e.g. digital thermometers), or better installation of parts Over 50% of inventory data was incorrect Facility staff reported that 50% of units waited over a year to be repaired Over 95% of units never been serviced Over 60% of units do not have stable electricity supply Key Metrics for Maintenance No. of units technician should service per day 2-4 units Target timescale for all equipment to be serviced 6 months Average time for servicing1.1 hrs Travel time per day3.25 hrs Distance travelled before overnight stay is cost-efficient 80km Number of units a technician should be responsible for (based on health facility density) 150-350 units Pilot Outcomes and Implications © 2013

9 From our work on the cold chain, we have developed five key lessons learned Funding for spare parts 1 A stable supply of spare parts is required to maintain equipment – currently there is no specific funding of spare parts Facilities purchase parts from the local market which break easily Data collection 2 Accurate data needs to be captured and analysed to make future cold chain decisions, e.g. maps required for route planning, lifecycle costs of different models, cold chain uptime rates Organisation alignment 3 Clear roles and responsibilities are required to enable accountability, as often multiple departments at the national and regional level are involved in distribution and maintenance Power stabilisers 4 Power stabilisers are required to protect expensive equipment from damage, e.g. A TCW 3000 was damaged from a possible lightning strike and rendered useless until repaired four months later Training for all levels 5 Training is required across all areas, from equipment installation and usage to maintenance processes and technical repair Training is also required for support staff, e.g. in data entry © 2013

10 To fully embed the maintenance model, we are developing a cold chain inventory database and planning for national rollout Complete Cold Chain Uptime Development of preventative maintenance model Pilot in 1 region Implementation of CCEI Module and Asset Tagging Tag all cold chain equipment inventory assets and clean data Implement Cold Chain Equipment Inventory (CCEI) tool, which integrates to the District Health Information System (DHIMS) Joint implementation by ADP, GHS, UNICEF and PATH National Rollout of Preventative Maintenance Model Develop spare parts management process Equip and train all regional technicians and support staff in technical and maintenance procedures Monitor rollout in-field Use GAVI HSS funds On going support from local Coca-Cola bottler June 2013Nov 2013 Feb 2014 In Progress Planned © 2013

11 Coca-Cola and GHS partnered in this phase by sharing experiences and challenges and working together in the field during the pilot, putting the maintenance model in action Coca-Cola and GHS refrigeration technicians (Maxwell and Livingstone) sharing preventative maintenance techniques. John Dadzie and Joejo Acquah discussing common challenges of maintaining refrigeration equipment. Recording the vaccine fridge details on the technicians daily accomplishment form. Livingstone and Maxwell geared up to perform preventative maintenance. © 2013 Photo Credit: Rita Bulusu Accenture


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