Bill & Melinda Gates Foundation

The Power of Crazy Ideas

November 26, 2013

I spent last week at the Global Health Supply Chain Summit in Ethiopia, mingling and mixing with logisticians, academics, private sector distribution experts, and ministry of health representatives, all talking about the important and complicated process of getting health products to the people who need them.

 It’s time to take those innovative ideas from other sectors and apply them to global health supply chains.Global conferences like this are important as they give an opportunity to think critically about what I fondly refer to as “crazy ideas” – those ideas that upon first reflection seem absolutely impossible. But then, as the details get worked out and testing of different approaches and concepts produce positive results and an evidence-base in different sectors, those “crazy ideas” are no longer crazy but are innovative, revolutionary, and are simply new ideas applied in new ways. It’s like the common thinking at one point that smallpox could not be eradicated (accomplished in 1980). Or that treatment for HIV wasn’t possible in Africa (more than 7 million people were on treatment in Africa in 2012). So now it’s time to take those innovative ideas from other sectors and apply them to global health supply chains.

Many innovative approaches to improving health supply chains were presented at this conference, many of them drawing from experiences from other sectors with technologies that can be adapted to the new context of the public health supply chain. A few that caught my attention:

  • Shipment prioritization simulation improves forecasting of drugs and optimizes distribution quantities by taking into account the seasonality that effects the demand for the product. For example, with this analysis, sufficient stock of malaria treatment is available at the health centers before the rainy season when the risk of malaria dramatically increases and not just after the rains have passed.
  • An informed push model panel, organized by the Reproductive Health Supplies Coalition, presented distribution models that regularly visits health centers to collect consumption data and deliver the required stock. This is being implemented in Senegal with family planning commodities and in Mozambique with vaccines.
  • System redesign to reduce the levels of distribution could improve the efficiency and cost-effectiveness of these systems. As Prashant Yadav pointed out in his opening keynote address, multi-layered distribution systems that typically follow administrative structures add layers to the already weak information flow, additional steps to distribution, and create more opportunities for missteps. It’s a call for reducing the number of tiers of the distribution system when it is appropriate and effective.
  • GAVI Alliance is developing their supply chain strategy, moving towards an end-to-end approach, much like what you find in the private sector. An end-to-end approach can provide visibility of information up and down the supply chain, greater coordination, and improved predictability of demand between the tiers of the distribution system.
 The next critical step will be to continue these conversations at the country level, where many of these approaches would need to be implemented to actually effect change.It is great to be a part of this conversation at the global level to think critically about innovative approaches to improve supply chain management. The next critical step will be to continue these conversations at the country level, where many of these approaches would need to be implemented to actually effect change. Change cannot be made, however, without the political will and leadership from the ministries of health. And this will only happen through sharing the evidence base, continuing the conversation while recognizing these changes are not easy but they are possible, and finally, through advocacy for the fact that these ideas may not actually be crazy after all.
 
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