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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The 6th Global Health Supply Chain Summit

November 18 -20, 2013Addis Ababa, Ethiopia

Coca-Cola and Ghana Health Service learning from each otherDavid Sarley BMGF

“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

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The Cold Chain Uptime project translated Coca-Cola’s 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

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Ghana Health Services’ cold chain inventory is not functioning, and the high number of models make it difficult to maintain effectively

Key Findings Implications

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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

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Coca-Cola’s 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-Cola’s cooler uptime percentage is 99.3%

Coca-Cola Statistics

National equipment inventory 15,600

No. of cooler models 10

No. of national technicians 26

No. of coolers per technician ~ 600

Average daily cooler visits per technician 4

No. of times cooler serviced per year 2

Annual cooler services target per technician

1,200

Current equipment not functioning ~0.6%

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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

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Key Components of Proposed Preventative Maintenance Model

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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

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Included several districts without Coca-Cola

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 servicing 1.1 hrs

Travel time per day 3.25 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

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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

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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 2013 Nov 2013 Feb 2014

In Progress

Planned

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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 technician’s daily accomplishment form.

Livingstone and Maxwell geared up to perform preventative maintenance.

© 2013 Photo Credit: Rita Bulusu Accenture