supply chain modeling: analysis of demand variability and volumetric capacity needs for...
TRANSCRIPT
Supply Chain Modeling: Analysis of Demand Variability and Volumetric Capacity Needs for Contraceptives and
MCH Products
James GibneyAnabella SánchezCarlos Lamadrid February 20, 2009
Agenda
Introduction: Overview of Unmet Need and Areas of Interest
Part A: Volumetrics of Guatemala’s Integrated Supply Chain
Part B: Effect of Demand Variability on Contraceptive Logistics
Introduction: Low Unmet Demand in 2007 For Contraceptives – But Analysis Still Needed to Ensure Success in 2008/9
Observation:
No significant stock-out problems existed in 2007 for contraceptives
Areas of Interest:
A. Given the integrated supply system, what are the volume requirements needed to ensure full supply for contraceptives and MCH products?
B. What is the effect that variability has on the system? Are stock-outs being avoided due to high level of emergency orders?
99% 97% 98% 97%100% 100% 100% 99% 100% 100% 100% 100% 99%
94%99% 97%
1% 2% 1% 1% 1% 3%3%3%6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Con
do
ms
IUD
Inje
ctab
les
Ora
ls
Con
do
ms
IUD
Inje
ctab
les
Ora
ls
Con
do
ms
IUD
Inje
ctab
les
Ora
ls
Con
do
ms
IUD
Inje
ctab
les
Ora
ls
Guatemala Total Jutiapa Totonicapán Sololá
Consumption Unfulfilled Demand
Source: MSPAS National RH Program, “Real Demand for Contraceptive Methods (2007)”
Part A: Volumetrics of Guatemala’s Integrated Supply Chain
Background: With little exception, the distribution network (warehousing and transport) of products in Guatemala’s public health system is integrated. To better understand the volume capacity needs of this system, data on all products from Jutiapa and Totonicapán was analyzed. A special focus was placed on contraceptives and MCH products.
Questions this section answers:1. In terms of volumes, what does the average monthly demand for all products that flow
through a DAS warehouse look like? How does this differ for health centers, health posts, NGO’s, and hospitals? What are the products that take up the most space?
2. What are the space requirements needed for the family planning products? How do these products compare to each other? What are the different requirements per SDP site type? How to they compare to non family planning products?
3. What are the space requirements needed for the MCH products? How do these products compare in space needs to each other? How to they compare to non MCH products?
• Contraceptives represent less than 1% of volume for Totonicapán and 3% for Jutiapa
• Difference is attributed to
higher demand of condoms in Jutiapa
• MCH accounts for approximately 1/3 and other products take 2/3 of volume capacity
Volumes of Product Types in the Integrated System
Volume by % of Average Monthly Demand -- All Products
66.6% 68.5% 67.6% 69.9%60.8%
65.8%
32.0% 28.4% 30.1%29.5%
38.4%33.6%
1.3% 0.5% 0.8% 0.6%
2.3%3.1%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Posts Health Centers Health Postsand Health
Centers
Health Posts Health Centers Health Postsand Health
Centers
Jutiapa Totonicapán
Other Products Maternal & Child Health Contraceptives
Source: MSPAS Logistics Module (January 2007 to April 2008)
Volumetric Composition of Average Monthly Demand By Products (Combined Average Monthly Real Demand for Totonicpán and Jutiapa)
• Table provides 105 products
• Contraceptives are highlighted blue, Condoms take 1.3% of total
• Volume composition follows 80/20 rule
• Acetaminofen syrup and Bromexina take approx. 20% of volume
80% volume
Volume (cubic cm) Requirements of Average Monthly Demand
• Jutiapa has double the capacity need at SDP’s than Totonicapán
• In Totonicapán Health Posts require more volume capacity than health centers for MCH and Other Drugs, but not Contraceptives
• In Jutiapa, the Health Centers require more volume capacity for all product types, with Contraceptives requiring significantly more volumetric capacity (approx. 3x)
4,540,039
5,565,604
2,814,298
2,035,063
2,182,770
2,309,746
1,187,586
1,286,735
27,321 14,177 15,984 3,287
253,399
89,559
21,660
25,633
-
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
Health Posts Health Centers NGOs Hospital Health Posts Health Centers NGOs Hospital
Jutiapa Totonicapán
Other Products Maternal & Child Health Contraceptives
Source: MSPAS Logistics Module (January 2007 to April 2008)
Contraceptive Volumes – Monthly Demand Averages For SDP Types
•Percentages show relative capacity needs for storage and transport
•Commonalities between Jutiapa and Totonicapan:
•Same order of magnitude (Hospitals, then NGO’s, then Health Posts, then Health Centers)
•Hospital percentages most similar
•Health Post percentages are 2nd most similar
•Differences between Jutiapa and Totonicapan
•Totonicapan higher relative flow to NGO’s
•Jutiapa higher relative flow to Health Centers (almost 2 times that of Totonicipan)
65.9%
38.5%
23.3%
32.5%
7.1%
24.0%
3.7% 4.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jutiapa Totonicapán
Health Centers Health Posts NGOs Hospital
Source: MSPAS Logistics Module (January 2007 to April 2008)
For the contraceptives part of the integrated order (1%-3% of total volume, what is the volumetric composition by product?
Volume by % of Average Monthly Demand -- Contraceptives
48.7%
79.3%71.3%
43.4%
31.6%
67.4%
55.4%
31.8%
42.6%
13.4%
32.5%38.7%
39.7%
12.4%19.6%
27.4% 51.1%
22.1%
19.0%
22.7%
21.0%
37.6%
30.6%24.1%
11.6% 7.7% 8.8%
25.7%
17.3%10.0%
25.6%
36.3%
31.4%
42.1%
36.9%33.2%
0.0% 0.0% 0.0% 0.0%9.2% 5.0% 6.9% 3.9%3.5%0.6% 0.4% 0.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HealthPosts
HealthCenters
HealthPostsand
HealthCenters
Hospital NGOs AllSites
HealthPosts
HealthCenters
HealthPostsand
HealthCenters
Hospital NGOs AllSites
Jutiapa Totonicapán
CONDOM LOFEMENAL DEPO PROVERA IUD
Source: MSPAS Logistics Module (January 2007 to April 2008)
What is the Average Monthly MCH Demand By Volume?
Totonicapan - MCH Average Monthly Demand by Volume
34.3% 31.5%36.8%
11.6%13.0%
10.3%
11.0% 12.6% 9.6%
7.5%10.1%
5.1%
6.7%5.2%
8.0%
6.6%7.6%
5.6%
6.1%7.7%
4.6%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Postsand Health
Centers
Health Posts HealthCenters
LIDOCAINA CLORHIDRATO (SIMPLE) 2 %Vial
ACIDO FOLICO 5 mg Tableta
ALBENDAZOL 200 mg Tableta
HARTMAN (RINGER LACTATO) 1000 mlBolsa/Frasco
ALBENDAZOL 200/5 mg/ml Frascosuspensión
AMOXICILINA 500 mg Tableta
AMOXICILINA + ACIDO CLAVULANICO 125/5 mg/ml Frasco suspensión
ACETAMINOFEN 500 mg Tableta
AMOXICILINA + ACIDO CLAVULANICO 250+62.5/5 mg/ml Frasco suspensión
PRENATALES 0 Sin ConcentraciónGragea
SALBUTAMOL 2/5 mg/ml Frasco Jarabe
TRIMETROPRIMA SULFAMETOXAZOL 40-200/5 mg/ml Frasco suspensión
ACETAMINOFEN 125/5 mg/ml FrascoJarabe
ERITROMICINA 250/5 mg/ml Frascosuspensión
AMOXICILINA 250/5 mg/ml Frascosuspensión
SALES DE REHIDRATACION ORAL 55.8 gSobre
ACETAMINOFEN 120/5 mg/ml FrascoJarabe
Jutiapa - MCH Average Monthly Demand by Volume
30.5% 30.8% 30.2%
13.5% 12.5% 14.4%
11.6% 11.5% 11.8%
11.1% 13.3% 9.1%
9.1% 8.7%9.5%
4.5% 5.2%3.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Health Postsand Health
Centers
Health Posts HealthCenters
LIDOCAINA CLORHIDRATO (SIMPLE) 2% Vial
ALBENDAZOL 200 mg Tableta
ACIDO FOLICO 5 mg Tableta
PRENATALES 0 Sin ConcentraciónGragea
AMOXICILINA 500 mg Tableta
ALBENDAZOL 200/5 mg/ml Frascosuspensión
ACETAMINOFEN 500 mg Tableta
HARTMAN (RINGER LACTATO) 1000 mlBolsa/Frasco
ERITROMICINA 250/5 mg/ml Frascosuspensión
TRIMETROPRIMA SULFAMETOXAZOL40-200/5 mg/ml Frasco suspensión
SALBUTAMOL 2/5 mg/ml Frasco Jarabe
AMOXICILINA 250/5 mg/ml Frascosuspensión
SALES DE REHIDRATACION ORAL 55.8g Sobre
ACETAMINOFEN 120/5 mg/ml FrascoJarabe
Acetaminofen takes up over 30% in both Departments
Effect of Demand Variability on Contraceptive Logistics
Background: Given the complexity of large logistical networks, such as the MSPAS system, the effect of high variability on a supply chains can be both significant and hard to measure. Accordingly, it is necessary to measure the variability levels and use advanced analysis methods, such as modeling, to determine the effect.
Questions this section answers:1. Does the use of 3 months historical averages in making orders reduce the
variation to insignificant amounts?2. How does variability effect service levels? Can there still be a stock-out even
if 1/3 min/max levels are followed? Does an increase in variability increase the propensity for emergency orders? Does it increase the propensity to be overstocked?
Variability in Contraceptive Monthly Real Demand
Observations:• Real demand changes
significantly on a monthly basis• Jutiapa shows lowest variability in
all products• High IUD variability partially
attributed to low order amounts (ie. change from 4 to 8 represents 100%)
Ramifications:• Variability levels can
significantly effect service rates of logistics system, even if system follows the min/max ordering system
• Causes of Variability should be addressed
– Are reporting procedures being followed
– or are there really high swings in real demand?
Average Change in Monthly Real Demand for 2007
15%
91%
14%
30%
29%
99%
39%
37%
28%
101%
18%
31%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 110%
condones
tdecobre
inyectable
orales
Jutiapa Totonicapan Solola
Does Using 3-Month Historical Average Smooth-away Variability?
• Table below compares projected demand based on 3 month historical averages to the actual demand for 2007
• Red highlights represent projected under-estimating by more than 20%• Yellow highlights represent projected demand over-estimating by more than 20%• Results: 50% of the time the projected was either over or under by more than 20%. Using projections
based on 3-months historical data does not necessarily remove variability. Complexity of system requires the use of advanced supply chain modeling software.
Projected Demand as Percentage of Actual Demand For Aggregated 2007 Quantities
MA
RZO
AB
RIL
MA
YO
JUN
IO
JULI
O
AG
OS
TO
SE
PTI
EM
BR
E
OC
TUB
RE
NO
VIE
MB
RE
DIC
IEM
BR
E
Jutiapa condones -13% 3% 5% -12% -23% -5% 5% -21% 13% 46%tdecobre -38% 0% 33% 183% 22% -63% 44% -64% 0% 700%inyectable -11% 5% -7% 7% 3% -10% 2% -8% 1% 64%orales -40% 51% 2% 13% -8% -22% 8% -13% 13% 104%
Totonicapan condones -17% -12% 7% 4% 35% -18% -26% -47% 171% 88%tdecobre -47% 11% 33% 22% -70% -41% 267% -22% 67% 67%inyectable -24% 12% -17% -10% 28% -23% 19% -13% 32% 19%orales -50% 27% -4% -5% 10% -19% -6% -8% 29% 32%
Solola condones 52% -3% 9% 18% 7% 50% -39% -20% 8% 10%tdecobre -70% 33% -33% 0% -10% -61% -37% -77% 157%inyectable -11% 31% 24% -9% -14% 22% -5% 27% 6% -23%orales -8% 44% 31% -10% -31% 97% -12% -17% 4% 4%
*Projected amounts calculated using average of previous 3 months
Modeling The Department of Sololá
Structure• 1 National Warehouse• 1 Department
Warehouses• 10 District
Warehouses• 33 Health Centers• 10 NGOs• 1 Hospital
Rules• Products• Inventory Policies• Sourcing Policies• Transportation Policies
Effect of Variability on Sololá Health Center Condom Stock Outs and Emergency Orders
Scenario OutputsStock Out Periods
– no variability scenario – 0– 25% variability scenario – 1 – 50% variability scenario – 5
Instances Crossing Above Max (overstocked)– No variability scenario – 0– 25% variability scenario – 5– 50% variability scenario – 2
Instances Crossing Below Min (emergency order)– No variability scenario – 0– 25% variability scenario – 8– 50% variability scenario – 6
(Settings: 106 condoms/month; 1/3 month min/max; 2 year period, reorder quantity based on previous 3 month demand)
No Variability in Monthly Demand for Condoms
0
100
200
300
400
500
Aug-07 Nov-07 Feb-08 May-08 Aug-08 Nov-08 Feb-09 May-09 Aug-09
Inv
en
tory
50% Variability in Monthly Demand for Condoms
0
100
200
300
400
500
Aug-07 Nov-07 Feb-08 May-08 Aug-08 Nov-08 Feb-09 May-09 Aug-09
Inv
en
tory
25% Variability in Monthly Demand for Condoms
0
100
200
300
400
500
Aug-07 Nov-07 Feb-08 May-08 Aug-08 Nov-08 Feb-09 May-09 Aug-09
Inv
en
tory
How variable is the data? Examples of condom real demand - JutiapaAgua Blanca - Health Center
0
50
100
150
200
250
300
350
400
450
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Asunción Mita - Health Center
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Atescatempa - Health Center
0
200
400
600
800
1000
1200
1400
1600
1800
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Jutiapa - Health Center
0
500
1000
1500
2000
2500
3000
3500
4000
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Mean: 214Standard Deviation: 103 (48% of mean)
Mean: 2,564Standard Deviation: 826 (32% of mean)
Mean: 1,059Standard Deviation: 311 (29% of mean)
Mean: 2,245Standard Deviation: 709 (32% of mean)
Source: MSPAS Logistics Module data
How variable is the data? Examples of depo real demand - JutiapaMoyuta - Health Center
0
50
100
150
200
250
300
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Yupiltepeque - Health Center
0
10
20
30
40
50
60
70
80
90
100
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Comapa - Health Center
0
20
40
60
80
100
120
140
160
180
200
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
El Adelanto - Health Center
0
20
40
60
80
100
120
140
Jan-
07
Feb-0
7
Mar
-07
Apr-0
7
May
-07
Jun-
07
Jul-0
7
Aug-0
7
Sep-0
7
Oct-
07
Nov-0
7
Dec-0
7
Jan-
08
Feb-0
8
Mar
-08
Apr-0
8
Mean: 170Standard Deviation: 37 (22% of mean)
Mean: 73Standard Deviation: 11 (15% of mean)
Mean: 156Standard Deviation: 14 (9% of mean)
Mean: 79Standard Deviation:21 (26% of mean)
Source: MSPAS Logistics Module data