Challenges of the Last Mile
Supply chain management assessments carried out by i+solutions in South Kivu, DRC, highlighted multiple logistical challenges in making medicines and SRH commodities available to patients at Health Facility (HF) level. The last mile of the supply chain is the part between the Pharmacy of the Health Zone (HZ) and the storage of the HF. It is the most fragile part of the supply chain, due to
- Geographical complexity and poor road infrastructure
- Safety concerns
- Transportation breaks down
- High transport cost combined with limited financial means of HFs to pick up products at the HZ
- Poor availability and use of supply chain reporting and requisition tools
In the DRC, the traditional model of distribution of health products at the last mile is the pull model. This is how that works: a HF quantifies its needs, completes a requisition, sends it to the pharmaceutical depot of the HZ and picks up the products at the HZ pharmacy. Reporting of logistic information, quantification of monthly needs and transportation of products are the responsibility of the HF.
This model has several disadvantages:
- Inefficiencies in last mile distribution, resulting in high transport costs between the HF and the HZ.
- Delayed and low-quality logistic information
- Limited visibility and ownership over the last mile distribution process by HZ staff, resulting in stock outs, excess stocks, expired products and redeployments.
- Precious time of the head nurse is spent on logistics that should be used to take care of providing services to clients and patients and managing the Health Facility.
Our solution
i+solutions and the DRC Ministry of Health conducted a pilot in the HZ of Katana, South Kivu, to assess the impact of distribution based on the Informed Push Model (IPM) on the above shortcomings. All 18 HFs and 2 hospitals of Katana, providing health care to a population of 241.000, were included in this pilot. The Health Zone Walungu, which is comparable to Katana, was used as a control HZ.
① From pick-up by the HF (pull) to delivery by the HZ (push)
Instead of individual HFs picking up their products at the HZ pharmacy, the HZ manages the transportation, dividing the delivery into several transport rounds, providing products to three to four HFs most efficiently situated along that round. Family planning commodities for these HFs were bundled into one transport. Transportation is carried out by a private motor taxi, contracted by the HZ. (Fig. 1) The taxi transports the medicines to the HFs along the routes. (Fig. 2)
② From HF driven to HZ and Community driven
Instead of the head nurse of the HF preparing stock reporting, requisitions and submitting these timely to the HZ, we installed IPM Focal Points (IPM-FP)1 that cooperate with the head nurse of the HF in stock-taking, reporting of stock and consumption data, and preparation of requisitions. Monthly reporting and requisitions are delivered timely by the IPM-FP to the HZ. Based on the information provided, the HZ staff confirms the quantities to be supplied and arranges the transport, assisted again by the IPM-FP. The IPM-FP manages the physical transportation of products from the HZ pharmacy to the HF.
Impact through Results
The introduction of Informed Push led to a more efficient and effective logistic system, contributing to improved responsiveness and quality of the health system, leading to the following results:
a. Reduction of stock outs and expiries
The availability of family planning commodities improved drastically during the IPM pilot. At the beginning of the pilot 80% of all health facilities experienced a stock out of at least 1 of the Family Planning methods, whereas at the end of the pilot, only 10% of the health facilities experienced a stock out.
The number of facilities experiencing expired goods also reduced significantly by 75%.
b. Transportation cost dropped
Transportation cost for family planning commodities dropped dramatically with almost 75% from $ 20 to $ 5,4 per HF per month. (Fig. 3)
A few months after the start of the pilot, also a selective number of essential medicines were bundled with the family planning commodities. Transportation cost for these medicines also reduced by approximately 60%.
