1. Interim Approach (IA) For Health Commodities Distribution BY Minnnie Sirtor Bowier JSI / USAID|DELIVER PROJECT February 2015

2. Presentation Outline Overview of Liberia Background - IA Objectives - IA Key components Impact of Ebola Achievements Challenges

3. SIERRA LEON GUINEA IVORY COAST ALANTIC OCEAN

4. Over view of Liberia Population of approx. 4 million Currently has the 1 st African female president Has one of the largest rain forest and 2 seasons (dry and raining) Experienced 14 years civil unrest (1989 – 2003) Maternal mortality stands at 1,072/100,000 live births 5% of the population are women of reproductive age Unmet need for family planning is 31%

5. Over view of Liberia cont’d : It is a Country that has a 10 yrs National Supply Chain Master Plan (SCMP ) One of the countries hard hit by the ebola epidemic in March 2014 to present Amidst ALL this:

6. Background / History of the Interim Approach (IA) Serious challenge with implementation of the SCMP –Accountability for commodities –Commodity security –Data availability for decision making, etc Led to concerns by partners and donor agencies The MoHSW formed a Supply Chain Task Force led by Minister Tolbert Nyenswah The task force appointed a technical committee which developed a concept paper on IA

7. Health Commodity Supply Chain Flow Chart Central Warehouse County Depots Client HF Client

8. What is the Interim Approach (IA)? IA is a modified top-up commodities distribution system in which a team of HCWs determine quantities and supply commodities based on physical inventory at facility and develop logistics data report OBJECTIVES OF INTERIM APPROACH (IA) Ensuring commodity security Accountability & transparency Reporting / availability of data for decision making

9. Interim Approach Rounds June 2013: Interim Approach adopted by MOHSW July/August 2013: pilot distribution conducted October 2013: first round of distribution began February 2014: 2 nd Round distribution May 2014: 3 rd Round distribution September - October 2014: 4 th Round distribution February 2015: 5 th Round distribution

10. How does distribution work under IA?

11. 11 Interim Approach- Distribution options Truck loaded with products; quantities based on previous quarter consumption data Truck drives with stock to facility IA team calculates consumption and stock on hand; tops up to maximum stock level Option 1 Separate Data Collection and Delivery Option 2 Combine data collection and delivery – Mobile Warehouse Truck loaded with pre- determined packs of quantity to deliver Truck drives with stock to facility IA team visits HF, calculates consumption, stock on hand and quantity to deliver, returns to warehouse

12. Impact of the Ebola Virus What happened during the ebola outbreak? Things change more rapidly Killed about 3,935 persons including health workers Health facilities were closed –Even when opened clients were afraid to visit Clients could not have access to FP commodities Ebola Treatment Units (ETU) were later established WHO recommended the NO TOUCH POLICY People fled the country

13. Health workers are at the front line

14. Response Strategies Temperature Check Frequent Hand Washing No Touching

15. Distribution during the ebola outbreak Restoration of health services was and is emphasize Facilities had to be resupplied with commodities For resupply the IA was used but with all caution Health workers were trained to use Personal Protective Equipment (PPE) Limited entry into facilities Use of PPE during commodity delivery

16. Results from the IA Consistent decline in stockout rates rounds 1-4 except for depo provera that was stock out at the central level during the fourth round High delivery coverage/reporting rates Greater visibility of data, including consumption data and stock on hand/stock status Greater accountability: quantities issued match quantities received Data verification exercise combined with EUV Capacity building of both central and county level staff Harmonization of distribution of other commodities with IA

18. Montserrado

19. Delivery coverage (4 Counties)

20. Commodity Supply Chain Flow Chart Central Warehouse County Depots Client HF Client

21. Accountability in movement of products Product BONG LOFA Qty Requested on SBRR Qty Issued by NDS (from invoice) Qty Received by Depot Quantity received recorded on Stock Card Qty Requested on SBRR Qty Issued by NDS (from invoice) Qty Received by Depot Quantity received recorded on Stock Card (IUD) or Copper T 0000189000 Depo-provera 14,8007,200 12,1777,200 Jadelle 407410 424420 Male Condom (3,000) 346,700336,000 -219,575-00 Microgynon 22,01822,320 3,600 Microlut 2,8662,880 4,5124,320

22. Challenges Inadequate/weak human capacity, infrastructure and data management at county level Poor accessibility to some health facilities due to bad roads 22

23. Challenges Inadequate supportive supervision on supply chain at county level Facilities closure due to EVD epidemic impacted coverage Changes in the distribution team members due to competing priorities (Ebola Response) by the county health team

24. Thank you Questions? NO PRODUCT NO PROGRAM NO PRODUCT NO PROGRAM