Assessing “First Mile” Supply Chain Factors Affecting Timeliness of School-Based Deworming Interventions: Supply and Logistics Performance Indicators

Abstract

BackgroundBetween 2007 and 2012, Children Without Worms (CWW) oversaw the Johnson & Johnson (J&J) donation of Vermox (mebendazole) for treatment of school-age children to control soil-transmitted helminthiasis (STH). To identify factors associated with on-time, delayed, or missed mass drug administration (MDA) interventions, and explore possible indicators for supply chain performance for drug donation programs, we reviewed program data for the 14 STH-endemic countries CWW supported during 2007–2012.MethodologyData from drug applications, shipping records, and annual treatment reports were tracked using Microsoft Excel. Qualitative data from interviews with key personnel were used to provide additional context on the causes of delayed or missed MDAs. Four possible contributory factors to delayed or missed MDAs were considered: production, shipping, customs clearance, and miscellaneous in-country issues. Coverage rates were calculated by dividing the number of treatments administered by the number of children targeted during the MDA.Principal FindingsOf the approved requests for 78 MDAs, 54 MDAs (69%) were successfully implemented during or before the scheduled month. Ten MDAs (13%) were classified as delayed; seven of these were delayed by one month or less. An additional 14 MDAs (18%) were classified as missed. For the 64 on-time or delayed MDAs, the mean coverage was approximately 88%.Conclusions and SignificanceTo continue to assess the supply chain processes and identify areas for improvement, we identified four indicators or metrics for supply chain performance that can be applied across all neglected tropical disease (NTD) drug donation programs: (1) donor having available inventory to satisfy the country request for donation; (2) donor shipping the approved number of doses; (3) shipment arriving at the Central Medical Stores one month in advance of the scheduled MDA date; and (4) country programs implementing the MDA as scheduled.

Improving Timeliness in the Neglected Tropical Diseases Preventive Chemotherapy Donation Supply Chain through Information Sharing: A Retrospective Empirical Analysis

“…Such upstream processes have been noted as potentially impacting delivery timeliness by the WHO HQ-such as the fairly significant time taken for the regions to review applications-and further incorporation of these processes in NTDeliver may benefit the end-to-end NTD supply chain [7].…”

“…This focus is justified by the considerable volume of medicines, the unique nature of this supply chain that includes WHO involvement, the importance of PC to achieve NTD targets, and accessibility of data through NTDeliver. There are opportunities to improve processes across the supply chain but the focus of this research will be on the segment from application to delivery to central medical stores, also referred to by partners as the "first mile" [7]. We chose to focus on the first mile due to the WHO drive to improve on-time delivery to central medical stores, the accessibility of relevant data, and opportunity to leverage information sharing among the many partners involved in this segment.…”

“…Sometimes delivery targets may lag as much as 40% below the WHO target for 80% of all shipments to be delivered at least one month before the planned MDA date [6]. Delivery delays result in waste, increased program costs, and delayed or even completely missed MDAs, leaving individuals susceptible to NTD infections [7].…”

“…This limitation may be an indicator that performance measurement and management systems have not been widely developed and systematically implemented as part of the overall humanitarian supply chain strategy [15]. Only Korpoc’s 2015 research on the impact of the NTD “first mile” processes (the segment of the NTD supply chain covering up to delivery to central medical stores) on MDA timeliness acknowledges this area of NTD supply chain performance measurement by identifying the need for performance indicators and outlining suggested metrics [7]. Furthermore, the recent COVID-19 pandemic has raised the profile both of the criticality of publicly sharing timely data in the global health domai n and the topic of assuring robust supply chains to meet global health goals [16–21].…”

Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study

“…Strengthening of commodity supply chains has often been limited to HIV, tuberculosis, malaria or other priority programmes 28–30. For NTDs, studies on availability and access have mainly focused on those that are amenable to mass drug administration, and those mostly rely on large donation programmes 31 32. In the era of universal health coverage, access to quality-assured medicines and diagnostics for VL must be enhanced, particularly for the eastern Africa region.…”