Nutrition Supply Chain Workshop

KENYA Experience

Presented by:

Dr Patrick Amoth

Head, Division of Family Health

Ministry of Health, Kenya

21st June 2016

OVERVIEW OF KENYA NUTRITION SITUATION

30.3

35.3

26

19.9

16.1

11

5.6 6.74

0

5

10

15

20

25

30

35

40

2003 2008 2014

% c

hild

ren

Trends of under nutrition in Kenya(KDHS 2003-2014)

Stunting Underweight Wasting

•Reduction in stunting from 35.3% to 26%, however huge disparities exist

among counties, with some rates exceeding 40%

•MDG target for underweight (11%) achieved.

•According to the Global Nutrition Report 2015, Only 1 country—Kenya—is

on course for all five WHA undernutrition targets.

Nutrition Situation,

February 2015

Nutrition Situation, August

2015

Nutrition Situation, February

2016

OVERVIEW OF KENYA NUTRITION SITUATION –SURVEYS ASSESSING LEVELS OF ACUTE MALNUTRITION

Distribution of SAM Caseloads for Arid and semi arid land counties and urban informal settlements

DATE SAM

Feb 2016 46,040

AUG 2015 51,012

TREATMENT OF SEVERE ACUTE MALNUTRITION

Therapeutic milks – F75 & F100

Ready to Use Therapeutic Food (Plumpy Nut)

ReSoMal

• Each severely malnourished child

requires about 150 sachets of Ready

to Use therapeutic foods until full

recovery

• Each year over 56,000 children living

in Arid and Semi Arid Counties of

Kenya are severely malnourished and

require treatment plus a further

12,000 from the 2 refugee camps and

12,000 in the urban informal

settlements

• In 2015 about 82,000 cartons of

Ready To use Therapeutic foods was

required costing about USD 4.6M

excluding transport

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

2012 2013 2014 2015

Valu

e (

US

D)

Year

Ready To Use Therapeutic Foods (2012 – 2015)

TREATMENT OF ACUTE MALNUTRITION

It costs 130$ to treat One

(1) Severely

malnourished child

RUTF costs approx.

52USD/ treatment plus

programme costs

PREVIOUS NUTRITION SUPPLY CHAIN DISTRIBUTION SYSTEM IN KENYA

UNICEF store

National level

UNICEF Supply

and logistic unit

County and Sub-

county stores

County & Sub

county level

CNO/DNO/CHMT/

SCHMT

Storeman/

Commodity officers

Health facilities

Officer in

charge/nurse

Outreach

sites

Request

Flow of RUTF

UNICEF Supply

division-

Copenhagen

Contra-

ceptives and

RH

equipment

STI

DrugsEssential

Drugs

Vaccines

and

Vitamin A

TB/Leprosy

Blood

Safety

Reagents

(inc. HIV

tests)

D

F

I

D

K

f

W

UNICEF

J

I

C

A

GOK, WB/

IDA

Source of

funds for

commodities

Commodity

Type(colour coded) MOH

Equip-

ment

Point of first

warehousingKEMSA Central Warehouse

KEMSA

Regional

Depots

Organization

responsible

for delivery to

district levels

KEMSA and KEMSA Regional Depots

(essential drugs, malaria drugs,

consumable supplies)

Procurement

Agent/BodyCrown

Agents

Government

of Kenya

GOK

GTZ(procurement

implementation

unit)

JSI/DELIVER/KEMSA Logistics

Management Unit (contraceptives,

condoms, STI kits, HIV test kits, TB

drugs, RH equipment etc)

E

U

K

f

W

UNICEF

KEPI Cold

Store

KEPI(vaccines

and

vitamin A)

Malaria

U

S

A

I

D

U

S

A

I

D

U

N

F

P

A

E

U

R

O

P

A

Condoms

for STI/

HIV/AIDS

prevention

C

I

D

A

U

N

F

P

A

US

Gov

C

D

C

NPHLS store

MEDS(to Mission

facilities)

Private

Drug

Source

G

D

F

Government

NGO/Private

Bilateral Donor

Multilateral Donor

World Bank Loan

Organization Key

Japanese

Private

Company

W

H

O

G

A

V

I

S

I

D

A

NLTP(TB/

Leprosy

drugs

Commodity Logistics System in Kenya (as of April 2004)Constructed and produced by Steve Kinzett, JSI/Kenya - please communicate

any inaccuracies to skinzett@cb.jsikenya.com or telephone 2727210

Anti-

Retro

Virals

(ARVs)

Labor-

atory

supp-

lies

Global

Fund for

AIDS, TB

and Malaria

The

"Consortium"

(Crown Agents,

GTZ, JSI and

KEMSA)

B

T

C

MEDS

D

A

N

I

D

A

Mainly District level staff: DPHO, DPHN, DTLP, DASCO, DPHO, etc or staff from the Health Centres,

Dispensaries come up and collect from the District level

MEDS

Provincial and

District

Hospital

Laboratory

Staff

Organization

responsible for

delivery to sub-

district levels

K

N

C

V

MSF

MSF

KENYA’S HEALTH FACILITIES MAPPING

Overview of Current Project

• Supply of nutritional commodities is

currently done via parallel logistic

chains by various donors and

stakeholders.

• These parallel systems make it difficult

to coordinate and manage the nutrition

program supply chains since they

require parallel reporting and parallel

logistics systems.

• Objective of the project is to to asses

the Parallel Nutrition Logistics Chains

for Integration into the GoK National

SCM System.

• The assessment focused on RUTF,

RUSF, F-75 and F-100 commodities.

The parallel chains assessed included

UNICEF, WFP and KEMSA.

• The assessment focused on the

activities within the supply chain

functions which include planning,

sourcing, storage, distribution,

monitoring and evaluation.

Supply Chain Gaps Supply Chain Recommendations

Deliver

Source

Store

Plan

M&E

• Lack of planning tools

• Inconsistent Reporting

• Poor Data Quality

• Weaknesses in DHIS

• Lack of ICT and

Infrastructure

• Develop Standardized Reporting Tools

• Investment in ICT Infrastructure

• Development of a Resource Mobilization

Strategy

• Lobbying for a blanket Commodity Exemptions

for Nutritional Commodities

• Rehabilitating and Upgrading of Existing Stores

• Design of Suitable Storage Structure

• Provision of Buffer Stocks

• Integration into the National Government

Supply Chain

• Provision of Continuous Training

• Resource Constraints

• Processing of Tax

Exemption Certificates

• Delays of

Customs

Clearance

System

• Poor Storage

Structures

• Weaknesses in

Inventory Management

• Limited Storage Space

• Poor Storage Conditions

• Secondary Distribution of

RUTF

• Lack of Distribution Tools

• Staff Absenteeism

• Poor Road

Infrastructure

• Unscheduled

Deliveries

• Lack of Training

• Lack of

Resources

• Understaffing

Cross Cutting Challenges

• Devolution

• Programme Ownership

• Staff Turnover

• Sale of Nutritional Commodities

Cross Cutting Recommendations

• County Government involvement

• Capacity Building

• Community Engagement and

Sensitization

• Branding and Serialization

Supply Chain Functions

Project Phases

Assessing the parallel

nutritional supply chains

and identifying the

bottlenecks within the

system.

Developed an integration

roadmap that entails the

activities, roles of

stakeholders, KPIs to guide

the implementation process.

Piloting the

integration model to

evaluate its

feasibility and

generate lessons

learnt

Assessment of Parallel Nutrition Logistics Chains for Integration into the GoK National SCM System

2013 - 2014

Phase 1: Assessment Phase 2: Integration Design Phase 3: Pilot

Why Need for integration of system

• Too many parallel nutrition supply chains by

DPs.

• Opportunity to optimize parallel supply chain

systems

Also consider:

• Increased risk of losses

• Poor supply chain management

• Supplies component is a Nutrition Sector

priority: need for better planning and resource

management

• RUTF is on the essential supplies list

KEY BENEFITS OF INTEGRATION

12

• Direct delivery of nutritional commodities to health facilities

• Increased collaboration in forecasting and quantification of needs

• Dedicated warehousing and distribution partner

• Continuous flow of commodities from Mombasa (port) to satellite facilities

(no supply chain breaks)

• Commodity tracking information system

• Trained personnel

• Increased accountability

13

Capacity BuildingFull Integration

The roll out of the integrated supply chain to other counties

will occur after the successful completion of the pilot

project. The full integration will require the following

initiatives for its successful implementation.

Roll out of integrated supply chain

in the country

Standardized reporting tools

Steering committee / Coordinating

entity to guide the implementation

Establishment of funding

mechanism

Establishment of project

management office for

implementation

Capacity Building

This will address the downstream supply chain bottlenecks to have a fully

integrated supply chain model. It will involve training of targeted personnel

from the entities involved in the integration process equipping them to

effectively participate in the integration process. The focus of the training

will be on integrated supply chain management. The approach to undertake

capacity building will involve:

Identify

Audience

Needs

Assessment

Content

Development

Capacity

Development

Scale Up

Identifying the targeted personnel and

stakeholders to be trained in supply chain

management

Conducting a high level analysis of the capacity

gaps of identified personnel and stakeholders

To include order processing, forecasting,

inventory management, stores management,

reporting, M&E, etc.

Use of various approaches to build capacity for

targeted individuals. The trained individuals are

expected to cascade the knowledge to other

personnel and stakeholders

Develop a Capacity Development Scale-Up

Strategy for the country

• Direct delivery of nutritional commodities to health facilities and Commodity tracking information system

• Dedicated warehousing and distribution partner – KEMSA

• Trained personnel and Increased accountability

• Continuous flow of commodities from Mombasa (port) to satellite

facilities (no supply chain breaks)

• Increased collaboration in forecasting and quantification of needs

Stakeholders

NUTRITION SUPPLY CHAIN INTEGRATION

Anticipated Benefits of the Integrated Supply Chain

PLANNED SUPPLY CHAIN DISTRIBUTION SYSTEM –

CURRENTLY UNDER SCALE UP

KEMSA stores

National/

Regional level

KEMSA/MOH

logistic team

County and Sub-

county stores

County & Sub

county level level

CNO/DNO/CHMT/

SCHMT

Storeman/

Commodity officers

Health facilities

Officer in

charge/nurse

Outreach

sites (>600)

Request

Flow of RUTF

UNICEF Supply

division-

Copenhagen

UNICEF

Kenya

ORDER REQUEST SYSTEM

16

• Current nutrition reporting structure maintained

• Standardized reporting templates – KEMSA have specific reporting tools for

nutrition

Sub-County

Request

Orders Health Facilities

(nutrition@kemsa.co.ke)

KEMSA Warehouse

in Nairobi

CNC / CHMT to provide

quality assurance

DNOPhysical

Reports

MoH

Analyzed

data

Direct supply of nutritional commodities by KEMSA

Approved D-

List

TOWARDS COUNTRY OWNED COUNTRY LED SUSTAINABLE

NUTRITION SUPPLY CHAIN SYSTEM

Assessment of Parallel Nutrition supply chains

Project Piloting

Deploy resources/build capacity to address gaps

Lessons learnt & Road map for scaling up

Ownership/

country

leadershipAdded

value

through

enhanced

M&E

Process of Nutrition Supply Chain Integration

Logistics Management Information System

LMIS- web

based system.

Self-service ordering

platform.

• Online ordering

• Order tracking

• Consumption data

Reporting

Nutrition Commodity Steering Committee

Nutrition

Interagency

Coordinating

Committee

Review and endorse supply chain

integration roadmap

Provide overall direction to the project, monitor

and control progress of the project at a strategic

level

Monitor Project deliverables

Make decisions on any amendments to the

project including; scope of work and project

timelines

Assume ownership and accountability for final

deliverables in order to realize project benefits

Provide continuous feedback to stakeholders

Make required project decisions in a timely

basis

Provide leadership in the initial stages of

nutrition supply chain integration

Main Roles and Responsibilities

WAY FORWARD ON INTEGRATION PROCESS

• Enhance M&E as a way to significantly increase transparency in the supply chain and enable a quicker response to fluctuations in demand – focus on capacity of county teams

• Support the scale up LMIS to facilitate ease in order management including order placement and reporting

• MoH, UNICEF and KEMSA and other partners to sign off on agreed KPIs that will be reviewed quarterly to monitor progress

• Integrate other partners on an ongoing basis through a national MoH led process

• Use ands regularly update the Master Facility List as provided by MoH

• Ensure and invest in adequate storage that is safe and secure for these commodities

@UNICEF/Kenya/20

11

ASANTE SANA!

THANK YOU!