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[DATE][SPEAKERS NAMES]

The 6th Global Health Supply Chain Summit

November 18 -20, 2013Addis Ababa, Ethiopia

A Quality Management Approach to Performance Improvement – Botswana CMS

Tom Brown

Background

• 2009 – CMS Botswana was suffering from poor service levels, lack of trust and transparency and high profile corruption cases

• MoH Botswana approached PEPFAR to provide an interim management team for a period of three years to deal with problems and improve performance

• CMS was to be transitioned to a parastatal, as per an existing Cabinet Directive

• GoB accepted SCMS proposal of 6 expatriate managers (4 Crown Agents, 2 Imperial Health Sciences)

• The team was expected to manage the transition to a parastatal and hand over to a counterpart team after three years

Vision for the Botswana CMS Transformation Project

• “….the final outcome will be an efficient operation run by skilled Ministry of Health (MoH)-hired managers with the expertise and independence to maintain best-practices and a strong well-motivated workforce….”

• “…the project aspires to provide the Government of Botswana with a medical supply chain which will be the benchmark for sub-Saharan Africa.”

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Vision for the Botswana CMS Transformation Project

• “….the final outcome will be an efficient operation run by skilled Ministry of Health (MoH)-hired managers with the expertise and independence to maintain best-practices and a strong well-motivated workforce….”

• “…the project aspires to provide the Government of Botswana with a medical supply chain which will be the benchmark for sub-Saharan Africa.”

What is a Quality Management System?

A QMS refers to what the organization does to manage its processes, or activities in order that the products or services that it produces meet the objectives it has set itself, satisfying the customer's quality requirements,

Focus on efficiency and effectiveness

Clear responsibilities for doing what, when, by who, how, why and where.

Quality Management Systems – ISO 9001:2008 standard

Process of QMS development

• Phase 1 – Preparation (early 2010)

– Management Commitment

– Baseline survey

– Communication

– Overall objectives

• Phase 2 - developing the QMS components (2010-2012)

– Process development

– Setting sub objectives and performance framework including management review

– Training (1,200+ interventions) & audits (25)

• Certification (2012)

– Documentary audit

– Physical audit, findings, corrective action, certification (Nov 2012)

Examples of process changes/interventions implemented

Observed Problem Tested Solutions (examples)

Low availability of pharmaceuticals at CMS

Flexible inbound systems implemented – 2 year contracts, fixed price & LT, variable quantity

High expiry of pharmaceuticals at CMS

Information exchange:CMS – supplierCMS – customerCustomer - CMS

Impact on Performance

2010 (April) 2013 (November)

Vital Drug Availability % (220 products)

55% 85%

Expiry % (of budget) 7.8% 1%

Next Phase

• Performance problems remained in warehousing and distribution functions due to lack of control over some key processes (transport management, buildings maintenance, HR management)

• GoB decided in December 2012 that risk could be better managed by outsourcing warehousing and distribution services to a competent provider

• SLA in place with contractual KPIs (OTIF the major one). CMS will move from managing operations to managing a contract– Project has included scoping, tendering, evaluation & negotiation.

Contract expected to start mid December, 3 year duration

– Risk identification and mitigation has been a key element of the process (eg use of partners, introduction of IT)

Final Thoughts

• Presented an example of how a QM approach can be used to improve performance

• The QM approach has supported the organic way in which the whole project has developed– transformation of CMS from within government structures is

now developing into a partially outsourced operation– GoB is also piloting other new supply chain solutions such

as providing NCD drugs through private pharmacies

• Approach is now one of risk analysis and looking for options which help GoB manage risk better

• Several PPPs are woven into this story!