Logistics

Logistics of swine flu aid

by Michael Keizer on May 1, 2009

Deborah Cannon/AMERICAN-STATESMAN 03/27/06 Michael Leavitt, Secretary of U.S. Department of Health and Human Services talks with an audience at the Hyatt Regency in Austin, Texas on Monday, March 27, 2006. The state held an all-day summit on pandemic flu preparedness efforts. I have had to rewrite this post three times today as new developments rolled in (not the least of which is of course that we are now officially in a pandemic), and as I found more pertinent information

The swine flu pandemic will obviously have a severe impact on our supply chains; however, it will also impact on the demand placed on these supply chains. These demands will come from two sides: the obvious external demand related to the programmed response to the pandemic, but also the less obvious internal demand caused by efforts to protect (and treat) our own staff.

Both will put an increased strain on a supply chain that will already be more vulnerable. Normally, I would have said that this would require forethought and planning, but it seems we are a bit too late for forethought – so let’s stick to planning.

Note that I will write here as if we all work in medical organisations; of course, many of us work in other types of aid work, but as demands in medical aid will be most intense, this presents a ‘worst case’, and although not all of the aspects debated here will be relevant to other organisations, many will.

Much of what I wrote in my post on contingency planning for the supply chain, is applicable to this issue as well. The four-step approach (prioritisation, sensitivity analysis, preparation of plans, resourcing and communication) is valid as well. However, there some things to keep in mind.

One issue that will hit every organisation, will be logistics (including procurement) of goods related to the protection of our staff. It will be necessary to sit down now with whoever in your organisation is in charge of OSH and work out what you will need. Think of protective clothing, microfiltrating face masks, and (depending on whether your staff will be in direct/prolonged contact with influenza patients) many other items. A specific issue is the availability of antivirals. If these are needed in any more than very modest amounts, and you do not have them stockpiled yet, it will be highly unlikely that you will be able to procure them now.

A second step is to look at your organisations programmes, and how they will adapt to the pandemic. Is it likely that your organisation will be involved in the treatment of patients? If so, you will need to start planning for that now: get your programme people to give you an idea of where things might go – again, developing a couple of likely scenarios – see what would be demanded from logistics in these scenarios, and how you can address those demands. I cannot stress enough that now is the time to pipe up if your conclusion would be that logistics cannot address the demands in one or more of the scenarios: both top management and your programme departments should know. Conversely, it would also be a good idea what would be your best guess of what you can do.

In case of a pandemic, your biggest headache (next to keeping your supply chain from collapsing) will probably be procurement: demand for the same limited amount of resources will increase tremendously (share prices for manufacturers of antivirals are already soaring), and you will be just one of the very many customers. So start talking now with your suppliers and see what can still be done. You might already be too late, but you will definitely be too late if you wait much longer.

As with the protection of your supply chain, using a methodical approach to the increased demand caused by the pandemic is essential, and the same four-step approach can be used successfully. However, in the end it is again not so much how you plan, or what you plan, but that you plan which will make all the difference. Don’t be caught on the hop.

(Image by Ryan Schultz. Some rights reserved.)

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The importance of contingency planning

by Michael Keizer on April 29, 2009

Slightly over a week ago, I was trying to write an article for this blog about how health issues could impact logistics. I just could not make it work: the main health impact on logistics would be from a pandemic, and although that seemed pretty realistic to me, I also felt that my readers would probably not see it as realistic enough to spare it a second thought. That was a real issue for me, because the main reason why I wanted to write the post was to get people thinking about logistics contingency planning for a pandemic.

Of course, I am now kicking myself for not have written what would have been a fairly prophetic post – and perhaps have influenced one or two people to take some action.

So my apologies for being late – let’s just say that this is a mistake I will not make very soon again.

The impact

Let’s just assume for the moment that swine flu will go pandemic. What effects will this have on our supply chains?

The most obvious one is that it will put severe demands on it. We will need to have massive amounts of medical goods at the right spot, at the right moment. How to deal with this issue merits a separate post, which you can find here.

Perhaps more insidious is the fact that every supply line depends on people – and in case of a flu pandemic, many of those people will be incapacitated (by illness or death), or be subject to isolation or quarantine. This will mean a severe blow for many of our supply chains: without truck drivers, store managers, clerks, and purchasers, our supply lines will soon break down.

Furthermore, quarantine measures might also mean that transport will be infinitely more difficult: if we can’t have trucks or planes come into the country where we work, goods will not come in either.

How to deal with it

So how to deal with this? At this stage, preparation would include four steps.

The most important issue, which needs immediate action, is to prioritise our logistics: which goods for which programmes are most needed. I would suggest to divide them into three to five groups, ranging from “immediately indispensable” to “doesn’t matter if it’s a couple of months late”. Note that we are not talking about articles here, but about article/programme groups: article 1 for programme X might be in a different group than the same article for programme Y. This needs to be done now: you do not want to have these discussions while you are in the middle of a crisis.

A second issue that needs to be dealt with concurrently with the prioritisation, is a sensitivity analysis of our supply chains: which parts our supply chains will be most vulnerable to disruption? It could be very helpful to develop a couple (not too many) scenarios and see how they impact our supply chains. When doing this, don’t forget that our supply chains extend beyond our own organisation: include the possibility that e.g. your main supplier will be severely impacted, or that your main transporter will be knocked out. Also look outside the logistics departments, e.g. by taking into account that your programme staff might be so severely overburdened that they will no longer be able to make forecasts or report regularly.

Based on the prioritisation and the sensitivity analysis, prepare contingency plans that deal with the various scenarios in such a way that (as far as possible) goods from the highest priority groups will be where they are needed, when they are needed. These contingency plans could include e.g. stockpiling (explicitly taking the risk of increased expiries), already hiring extra staff, and many other possible actions. What it exactly will entail for your organisation will depend on many factors, and there is definitely no one-size-fits-all solution. It will be important here to think laterally and come up with creative solutions: this is an extraordinary situation, and will need extraordinary solutions.

The fourth and last step is resourcing and communication: make sure that you have the (financial) resources to implement your contingency plans – which will mean that you will need to ‘sell’ your plans now to senior management of your organisation – and communicate the plans to all people involved, which would include practically everyone within your organisation, and quite a number of people outside it.

I can hardly stress enough that these steps need to be taken now: if and when the crisis arrives, it will be too late. You might counter that nothing ever goes according to plan, and that the crisis that will really happen is unlikely to be the one you planned for; that might be true, but having these plans and resources at the ready will give you an enormously increased resiliency that will enable you to cope much better than otherwise. To quote general Dwight D. Eisenhower: “plans are nothing; planning is everything”.

A call for action

Go now to the person(s) responsible for logistics planning in your organisation, and ask them whether they have prepared contingency plans for a severe pandemic impacting on your supply chain. And don’t let them get away with generalities; things are much too serious for that. And if you yourself are responsible: did you do your homework? Finally: please come back here and let us know what you did: at this stage, we should all learn from each other.

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The power of the pipeline

by Michael Keizer on April 24, 2009

Trans-Alaska Oil Pipeline by rickzWhen preparing a new order, you take into account goods that are still in transit (a.k.a. the pipeline), right? Right, so we need not discuss things further.

Or do we?

In practice, there are a number of issues that surround the pipeline that complicate things and ensure that in reality, we often incorporate incorrect pipeline figures in our calculations.

  • Time. When do you expect the goods to arrive? Tomorrow? Next week? In a year? And that date, does it relate to arrival in your transit port, a country away? Or at the airport next door? And how long will clearing and onward transport to your projects take? In the end, the main issue is when the goods will arrive where they are needed, in your programme; all other considerations are important only for the purpose of determining that date. However, in the settings where we work, they are often difficult to predict. An example: some years ago, I was involved in importing a large consignment for an African ministry of health. We felt that we had done our planning quite well, taking normal transit and clearing times into account and adding a buffer based on the normal spread. What we did not know, however, was that the ministry of agriculture had ordered a massive consignment of fertiliser – and when I say “massive”, I mean tens of bulk shiploads, all arriving at more or less the same time. This consignment arrived at the same time as our containers, congesting the port of entry to a point where we could not land the containers for several days, and then struggled for several weeks to find onwards transport capacity. I learned from this the value of growing and maintaining an extensive information network in whichever location you find yourself. If I had talked with some people in the main transport companies, I would soon enough have heard that their capacity was fully booked out.
  • Confirmation. You know you ordered 20 boxes of paravenozole, delivery at your warehouse due next week, but did you actually get a confirmation from your supplier? Too often we do not insist on binding timelines, with obvious results; and if we do, we do not enforce them well enough. This is improving, though: I have seen various solutions to this problem. The one I like best is to have ‘order managers’: dedicated staff who take over the management of the order once it has been placed, ensuring that confirmations are received and regularly following up status with the supplier.
  • Matching.You know that there are 20 boxes of paravenozole in the next plane to arrive, but… for which project are they? And to cover which order? The supplier of course uses a different system of identifying orders than you do, let alone of article coding. So how can you match this? Obviously, the key here is keeping your paperwork in order, ensuring a clear trail from project order ID, to your order ID, to the suppliers order ID. In reality, this is slightly more complicated than it sounds because we often need to split up orders, and might have on-the-run changes. And of course, we are not talking of one consignment with one type of goods for one project on one order… However, none of this is insurmountable. The most important thing here is discipline: the discipline to document continuously what we do, why we do it, and what are the results – in such a way that we can easily find things back. It does not really matter whether we have an old-fashioned paper-based system or a state-of-the-art ERP system: the principles of documenting and cross-referencing remain the same.
  • Units. A small last issue, but one that does trip us up sometimes: did we order twenty boxes of paravenozole, each of 100 doses, 2000 doses in total? Or twenty overboxes, each containing 50 boxes, 100,000 doses in total? Make sure that you document, double-check, and feedback to your projects and your supplier in case you have any doubt.

Taking into account your pipeline figures is your an essential part of order management; and although it may take a lot of work, most of it should be routine activities that can be done at a clerical level. Your pipeline is your connection to your future deliveries, and can give you an invaluable idea of that future for a very small investment.

(Image by rickz.)

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What to bring on a logistics deployment

by Michael Keizer on April 22, 2009

The ever-interesting Chris Blattman published a list of things to bring for field work. A very useful list, I should add, and some of the suggestions in the comments are very worthwhile too. Just don’t try to bring everything that’s in there.

So what specifics would I add for a logistics deployment?

  • A clicker (one of those thumb model counters). Will help you immensely during verification activities.
  • Cling wrap. Has more uses than I can easily mention here, but for starters: repairing leaky containers, repairing car windows… actually, combined with some duct tape, it can repair almost anything — even, in an extreme situation, some bodily harm (but get to a doctor ASAP).
  • So the next one, obviously, is duct tape. More uses than you or I can even imagine.

  • Sticky labels, A6 size (4 on an A4 page), printable. Again, more uses than you would expect.
  • Permanent markers. You will always see that you need them when there are none around.
  • An el-cheapo digital camera, preferably one that can make rudimentary videos. Worth its weight in gold for training purposes.
  • The electronic version of the ordering catalogue of whichever organisation you are working for. Your organisation is too small to have a catalogue?[1] Get one from a bigger organisation with similar activities (so in the medical area the MSF catalogues, for education UNICEF, for water and sanitation OXFAM, etcetera). This will help you immensely when ordering yourself or when getting people to be more specific on their orders.
  • Your organisation’s logistics, admin, and financial procedures in electronic form, including the standard forms used.

So what do you take with you when you go to the field?

Footnote

[1] Actually, your organisation is not too small. If it is big enough to have more than one programme, it is big enough to have a (rudimentary) catalogue.

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Latest job opportunities (22 April 2009)

by Michael Keizer on April 22, 2009

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Latest job opportunities (20 April 2009)

by Michael Keizer on April 21, 2009

  • The Organization for Security and Co-operation in Europe (OSCE) is looking for a procurement officer for Macedonia.
  • HelpAge International is looking for a logistics manager for Darfur (Sudan).
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Research wanted! A call for papers

by Michael Keizer on April 18, 2009

No sooner had I finished my post calling calling for more evidence on what works (and what doesn’t) in health/aid logistics, than an email message arrived from the HUMLOG institute, alerting me to an excellent opportunity to do so. The Supply Chain Forum, a professional journal on logistics, supply chain and operations management, will publish a special issue on humanitarian supply chains. Please see their call for papers for more information.

Now get those keyboards clicking!

(Image by Nic McPhee.)
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Pirates!

by Michael Keizer on April 16, 2009

Things are getting slighty ridiculous.

I have posted twice now on piracy. That is honestly about as much attention as I would like to give them on this blog. Yes, they are a serious threat to aid logistics, and yes, they specialise in spectacular actions that are fine to generate breathless comment — but they are definitely not the most important issue in aid work, or even aid logistics.

Yet the last couple of weeks they have suddenly entered  the consciousness of the public; suddenly everybody and their various aunts and uncles are scrambling to get on board and get their part of the booty. [Okay, enough pirate-related imagery, already. I will stop now.]

Just have a look at this graph from Google Trends:

Have a close look at the bottom part of the graph, which traces how often news articles refer to pirates, and note the sharp increase over the last month or so (the spikes in the top graph are related to losses of the baseball team). It now has come to the point where TV shows will follow pirates and the actions against them.

So what caused this spike? Only one thing: for the first time, pirates hijacked a ship under the US flag. Now what does that say about the media — and about us?

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How to get things done: more on the logistics of logistics

by Michael Keizer on April 16, 2009

In my previous post on why logistics seems to be so prone to “herding cats” problem (thanks, Laura Walker Hudson!), I suggested five  reasons:

  • The complexities of logistics are “deep” complexities, and are not readily apparent.
  • Daily logistics experiences are not always applicable to large-scale logistics.
  • Our evidence base is sketchy, which has a ‘halo’ effect on all logistics activities.
  • There are hardly any aid logisticians with a recognised advanced degree in the field.
  • Aid logisticians are not the biggest fans of systems or administration themselves.

So what to do about his?

1. Work on the evidence

This is easier said than done. However, we will need something more than our gut feelings and personal experience to be able convince our colleagues. Other areas in aid routinely publish about lessons learned — why don’t we do so in logistics?

  • If you have seen (or developed) a particularly successful technique or method, or seen a received one wreak havoc in a particular setting, don’t keep it to yourself: write an article for an appropriate journal.
  • Think how you can incorporate research in your daily practice and do so. Most aid organisations, and defintely most health organisations are open to facilitate research as long as it does not inconvenience their programs too much. Health and humanitarian disciplines routinely do research within programmes, but logistics rarely does.

2. Explain, explain, explain — and learn

Too often, we do not explain why we want to do certain things a certain way: why is it necessary to fill in that request form, why can’t we just go to the pharmacy and take what is needed, why do we need to make consumption forecasts? Be didactic; and be proactive about — don’t wait for your colleagues to ask, because they will only do so when their irritation level is already high. And if you feel that you cannot explain, rethink — perhaps we are on the wrong track.

This holds true the tactical planning level as well: why do you elect to go for six-monthly order cycles and not three-monthly ones? Why do you select these suppliers and not those? Why do you procure your drugs in Europe and not locally? Include in your explanations why logistical solutions that work at the level of one patient, one time, will not work at the level of a large-scale intervention.

Make sure that everybody understands (or at least has a chance to understand) what you are doing and why, and you will see that it will suddenly is much easier to implement your systems. You will also get much better feedback — and who knows, that feedback might lead you to reconsider your plans and improve them beyond recognition.

3. Get a recognised qualification

Get that master’s degree in aid or health logistics, and see how much more recognition you suddenly get (and how much deeper your understanding of what you do will be).

I am working on my second master’s degree now (in public health, specialising in health logistics for develing countries), but my first one was only sidewise related to aid/health logistics. Already I notice that people take more account of what I am saying, just because they feel that I somehow ‘earned’ that by studying the field. Utter nonsense, of course, but it is how the game plays — and you’d better play along if you want to have the impact you know you can.

Working on my MPH has also given me an opportunity to better integrate my knowledge. It haven’t yet learnt much that was completely new to me, but I am now better able to put things in their context, and to see links between seemingly disparate pieces of knowledge that I did not see before. It also enables me argue more convincingly (not necessarily better, but definitely more convincingly) because it has given me better knowledge of the language of health and health professionals. And finally, it has enabled me to expand my network in global health, which means that I know who to call next time I have a problem that I don’t have a good solution for, or when I think that I need specialist input for.

Get that qualification — it’s worth it.

4. Don’t undercut yourself

When the unexpected happens, don’t throw your logistics systems overboard and get into emergency mode. First think how you can accommodate the issue within your existing systems. By giving the right example, you can show the importance of those systems and that they are not just impediments to getting our work done.

Don’t change systems without in-depth understanding. Many logistics managers in aid, especially in emergency aid, have very clear ideas about how things should be run and do not hesitate to change things in the first couple of weeks (or sometimes even days) after they have arrived. However, your predecessor probably was not a fool either, and would have had reasons to implement the systems the way they did — based on what they knew after having worked for some time in that particular setting. Don’t change systems before you have been in the programme at least six weeks to two months — and for developmental programmes even longer. Changing things too fast, too soon, will only serve to undercut yourself and future logisticians.

And finally: follow the systems yourself. Nothing will undercut your authority as quickly as a ‘do what I say, not as I do’ attitude.

(Image by Todd Lappin)

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How to get health care and patients together

by Michael Keizer on April 14, 2009

Bicycle ambulance

As I have written before, health logistics as a discipline tends to ignore the impact of the logistics of daily life on health. Possibly the clearest example is how physical access to primary health care impacts on health.

What do you do when you are seriously sick? Well, most of us in the developed world would go to a doctor. But what if that doctor is a four-hour trip away? Even here in Australia, a developed country by any account, access to health care is much worse in remote and rural areas than in the cities, and the health outcomes are as can be expected. Similar results have been shown in studies in other developed countries.

Obviously, things are much worse in developing countries. That four-hour trip suddenly translates in four days (or more) on the road, or rather, on a muddy track, on your own feet or bumping along on the back of some animal instead of a smooth ride in a car or train. The health outcomes are horrifying. For instance, a recent study in Ethiopia suggested that urban elderly Ethiopian women had about a 1.6-1.8 times longer life expectancy than rural ones. Or this one: the rural areas around Kunming (China) suffer from 50% more premature deaths than the city itself.

Solutions obviously need to be found, and some are already being implemented. Foremost, we need to concentrate more of our preventative efforts on less accessible areas. Of course, that is easier said than done: the same issues confronting a patient searching medical treatment, are hindering outreach and health education efforts — and when it comes to e.g. water and sanitation efforts, the logistics issues are even worse.

Another way to deal with these issues is by decreasing the distance between patient and health care. There are basically two ways of doing so: by bringing access points to the patients, or by bringing patients to the access points.

The former can be done by more dispersed access points, or by mobile clinics. Both have some serious drawbacks. Peripheral health access points are either unable to cope with more serious complaints, or would have to be impossibly well-equipped in a setting that is resource poor — you cannot put a secondary hospital in every hamlet, definitely not in a resource-constrained setting like a developing country. Mobile clinics can be slightly better equipped and resourced, but are only occasionally available to any given population and hence cannot deal with e.g. many emergencies, simply because they are not there when the emergencies occur; moreover, they are a shocking waste of time for the health care professionals, who spend much of their working hours trekking from one place to the next instead of on patient care.

Patient transportBringing patients to the health care settings is something that is rarely done. In developed countries we do so using individual patient transport (e.g. ambulances or commercial patient transport), but that is not an option for developing countries. Another way would be to use communal patient transport. Imagine a bus (or animal-drawn cart, or a caravan of donkeys or camels…) making scheduled rounds along a number of reasonably short circuits, picking up patients and delivering them to the nearest health care facility, and returning them on the next round after treatment. It would still not solve the problems of emergency care, but for the less acute cases it would bring patients possibly faster and more comfortably, but definitely at less cost for them to the care they need — without wasting a valuable and scarce resource, health professionals’ time.

Obviously there are issues around it that need to be solved, but it seems to be a intriguing possibility with many possible advantages. I know it has been done at very small scales, e.g. in refugee camps and in the immediate surroundings of some health posts here and there, but as far as I know it has never been tried in a larger area (but I would be chuffed to be corrected). High time for a trial, I would say.

(Images by Aaron Wieler and Shawn Alladio.)

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