Home >

Aid logistics

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.)
{

Continue Reading 0 comments }Aid and aid work, Logistics

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?

{

Continue Reading 5 comments }Aid and aid work, Logistics

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)

{

Continue Reading 2 comments }Aid and aid work, Logistics, Public health

Vaccination; 041028-N-9864S-021 Yokosuka, Japan (Oct. 28, 2004) - Hospital Corpsman 3rd Class Tiffany Long of San Diego, Calif., administers the influenza vaccination to a crew member aboard USS Kitty Hawk (CV 63). Currently in port, Kitty Hawk demonstrates power projection and sea control as the U.S. Navy's only forward-deployed aircraft carrier, operating from Yokosuka, Japan. U.S. Navy photo by Photographer's Mate Airman Joseph R Schmitt (RELEASED)

“That would never work here.”

I have had to listen to this reply more times than I can easily remember. It will usually come up when I propose to put procedures into place instead of continous ad-hoc decisions, standardisation instead of reinventing the wheel time after time, or proven solutions from other places in a new setting. There is a little devil in all of us that tells us that we are unique, that what works there will never work here, that every little decision we take needs our 100% attention.

Reality is different, and we only need to look at our daily lives to see everyday proof. Do you agonise daily which to put on first, your socks or your shoes? Do you feel that, in your case, it really is a good idea to keep on breathing while you swallow your soft drink? Do you try to walk through closed doors, just to see if that might lead to better results? Or will you today drive to work in reverse, just to see whether that will work better? Of course you don’t; you are aware of best practice from a lifetime of experience and from the example set by peers (classmates, siblings, friends…) and authority figures (parents, teachers, driving instructors…), and you do not go about testing those practices every day again.

Perhaps more pertinently, most of us would really not appreciate if our doctor or dentist would start experimenting with new procedures or home-made drugs when we go to our next appointment (at least, not while there are other, proven possibilities to use first). We really don’t want our electrician to try out a revolutionary new insulation method he recently thought up. Yet when it comes to aid logistics, suddenly there is no such thing as received wisdom, because “every situation is different.”

What causes this behaviour? Why do we behave so differently when it comes to aid logistics?

I think there are a number of issues here:

  • Everybody is a logistician. Or at least, everybody thinks they are. “Just get the bloody stuff here when we need it, can’t be that hard cannit?” Unlike medicine, dentistry, or electrical engineering, the complexities of logistics are much further beneath the surface — so it is not as clear to the average aid worker that logistics management sometimes requires a bit more than just common sense.
  • Unlike many other areas, our daily logistics experiences are not scalable. Logistics routinely deals with complexities of scale: techniques that can be used at small scales will break down at the large scale. Vaccinating one patient is not much different from vaccinating 10,000: draw up, check, swab, inject, discard — and then times 10,000. However, the logistics of a 10,000 person vaccination campaign is many times more complex than those for a one-patient ‘campaign’. A vaccination nurse would have experience organising the logistics for a one-patient (or perhaps 10- or 100-patient) vaccination, but not a 10,000-patient campaign; and consequently would not realise how much more complex the issues become. I will write more about complexities of scale in an other post.
  • The evidence base for much of aid logistics’ best practices is comparatively sketchy. Unlike e.g. medicine, we do not have a history of formal trials; most of our evidence is based on case descriptions and anecdotal evidence. There is a small base of formal trials in logistics in corporate settings, but there results can only be applied very tentatively to aid work. As a result, those techniques that do have a base in evidence are usually not accepted as authoritative by aid workers because they are applied to logistics. No doctor would deny the usefulness of treatment protocols; the advantages of protocols (or procedures, or algorithms, or whatever you would like to call them) have been amply demonstrated, but apply this to logistics and people will loudly complain about imposed bureaucracy.
  • There are no recognised degrees for aid logisticians. Doctors need to pass medical exams. Electricians need to sit for their tests. Drivers need to pass a driver’s test before they get their licence (well, in most developed countries anyway). We expect a degree in public health from a public-health specialist. But aid logisticians come in all kinds and shapes, some with more logistics knowledge and skills than others. There are now a couple of specialised aid logistics master’s degrees, but as they are very new there are hardly any graduates in the field yet. The results are double-edged: on the one hand, not all aid logisticians have the knowledge to recognise the importance and usefulness of standard logistics operational solutions and methods; and on the other hand logisticians do not get recognition as specialists in their own right, and hence their authority is not recognised or accepted.
  • Aid logisticians tend to be an unruly, desk-hating lot. We come from all walks of life, but especially amongst field aid loggies there is an over-representation of people with backgrounds that pre-dispose them against accepting anything remotely smelling of authority, or of desk work[1]; and that includes things like procedures, administration, standardisation, etcetera. In this sense we are our own worst enemies, and tend to sabotage our own systems.

So what can we do to improve on this? How can we change this behaviour from logisticians and other aid workers alike? More in my next post, after Easter.

(Images by the US Navy and Martin Deutsch.)

Footnote

[1] Or as one colleague once told me, with obvious pride: “We are the last adventurers — and the rest of them are just pale bureaucrats.”

{

Continue Reading 5 comments }Aid and aid work, Logistics

Latest job opportunities (10 April 2009)

by Michael Keizer on April 10, 2009

{

Continue Reading 1 comment }Aid and aid work

Visibility, transparency, and some sunshine

by Michael Keizer on April 9, 2009

Lockheed SR-71 Blackbird strategic reconnaissance aircraft taking on fuel from a USAF KC-135

One of the hotly discussed topics in logistics management is supply chain visibility. In a nutshell, you have a visible supply chain if your supply chain processes are measured and controlled on a fairly detailed level — often up to the level of the individual item. The big impetus for supply chain visibility has come from the advent of third party logistics or 3PL — the outsourcing of parts of the logistics process to specialised contractors, in an effort to gain economies of scale as well as economies of specialisation[1]. Outsourcing is basically an external version of delegation, and as any management textbook will tell you, there can be no delegation without verification; hence the need of a more visible supply chain. Good examples of extremely visible parts of logistics chains are the track-and-trace systems that are offered by most couriers.

An offshoot of supply chain visibility, supply chain transparence, has also gained a lot of traction over the last couple of years. Unlike supply chain visibility, which concentrates on supplying information to those using the supply chain, supply chain transparency concentrates on the ultimate buyer of the products supplied. A good example here is Icebreaker’s baacode, which gives customers an idea about the origins of their woollen undies and what happened to them during the production process.

I think both visibility and transparence will gain in importance in health and aid. Like I wrote before, any medical supply chain needs at least a modicum of visibility to be able to react effectively and efficiently to e.g. recalls; and transparence will undoubtedly become more important as we move towards more accountability to our customers, i.e. the populations we try to aid, our donors, and the general public.

However, there is more to this: I think we will also move more and more to 3PL (stay tuned to read about the whys and wherefores); and like the corporate sector, we will need more and more visibility in able to do so while still keep control of our supply chains. Whether we like it or not, we will need to invest more in systems[2] that make supply chain visibility possible; and as these systems take time to design and implement, we need to invest now.

We should be able to learn from systems that are being used in the corporate world. However, it will probably not be possible to use solutions from a corporate setting unaltered in (health) aid settings. Issues like insecurity, lack of instant telecommunications, etcetera, will mean that adaptations are necessary. This is why the Fritz Institute’s Helios system is such a great step forward: it offers the base for humanitarian supply chain visibility, packaged in a way that is suitable for many aid organisations. This is not to say it is without its problems; it isn’t, and it some organisations will find it more useful than others (e.g., it is tailored towards humanitarian aid, and might not be particularly suitable for developmental organisations), it is as yet incomplete in some aspects — but it is a step in the right direction.

high visibility clothingTime for a mea culpa. Some years ago, I was asked to advise on the choice for logistics management software for a large aid organisation. At that time, I advised against Helios (or the HLS as it was known back then) because I thought that its foreseen development trajectory was unfounded and too optimistic. I think I had good reasons for that recommendation, but I was also very wrong: Helios has been developed into something that is a model for supply chain visibility in aid.

Is your organisation thinking about supply chain visibility? Perhaps you are already implementing solutions? Share your best practices (and your mistakes — we can learn from those as well!) here.

(Images by James Gordon and Leo Reynolds.)

Footnote

[1] This will definitely be the subject of a future posting.
[2] No, systems are not just computer systems. When I write about a system, I refer to a coordinated whole of human resources, material resources, and procedures[3, 4], aiming towards a common goal. Cf. e.g. “the humanitarian system”, “the supply system”, etcetera.
[3] And yes, a computer program is no more than a fancy procedure, a.k.a. an algorithm.
[4] Don’t you hate footnotes in footnotes?

{

Continue Reading 3 comments }Aid and aid work, Logistics

Some humourless links

by Michael Keizer on March 26, 2009

Some jottings that have been sitting in my to-do stack for too long.

  • Alanna Shaikh discusses the mechanics of getting rid of HIV/AIDS, and rightly flags the impossible logistics of such a plan. Be sure to scroll down to the comments section for a chuckle and an occasional blood pressure spike.
  • GlaxoSmithKline offers to make drugs more accessible for the world’s poor. It always surprises me that some think that making drug prices lower will automatically dramatically cut total cost. Just calculate the cost of getting a tablet of paracetamol to an Ethiopian patient, and you will see where the it actually is being incurred. Small hint: it is not the amount received by the manufacturer.
  • The European Union allocates an extra EUR 27 million ‘to strengthen global humanitarian preparedness and the response capacity of international organizations’. One of the purposes would be to improve international coordination and integrated logistics. More to come on integration of logistics, courtesy of a very interesting recent doctoral promotion (don’t touch that dial!), but it is already interesting to note how more and more donors see the importance of earmarking funds for logistics.

(Picture: Liquid Links by Desirae. Some rights reserved.)

{

Continue Reading 4 comments }Aid and aid work, Logistics, Public health

Latest job opportunities (26 March 2009)

by Michael Keizer on March 26, 2009

{

Continue Reading 0 comments }Aid and aid work, Logistics

The latest professional reading: Marie Claire on HAS

by Michael Keizer on March 23, 2009

I never thought I would ever feature an article from Marie Claire, but maintaining a blog takes you places. In a recent issue, they interviewed Danielle Aitchison, a pilot for the UN’s Humanitarian Air Services. Anybody who has ever worked in humanitarian hotspots will know how important UNHAS’ services are for logistics operations, and even though I have some reservations about the content and general tone of the interview, it still well worth reading. Enjoy!

Discover Simple, Private Sharing at Drop.io

{

Continue Reading 0 comments }Aid and aid work, Logistics

The unanswered questions of aid and health logistics

by Michael Keizer on March 22, 2009

'Small Talk' by xkcd

Some of the issues that I think should be in the forefront of aid and health logistics discussion:

  1. How should we ensure adequate logistics input in the planning phase of aid projects?
  2. Will medical professionals and health logisticians ever be able to talk each other’s language? Will non-logisticians ever feel that they own the process too?
  3. Are cold chains unbroken? Do we really vaccinate, or just administer useless stuff? (This is actually the subject of my thesis research project, so you can imagine that it is a question that is close to my heart.)
  4. What are reasonable goals when it comes to logistics efficiency in aid operations? Is it really possible to determine a minimum level of efficiency? And if not, how can we be accountable? And how about effectiveness? And the balance between the two?
  5. How much of health budgets in developing countries should be devoted to logistics? In developed countries it is often more than 80% (including procurement cost), but is that reasonable or necessary in a developing country?
  6. When should the supply chain stop being flexible (supply rubber bands?) and determine operational options instead of vice versa?
  7. Why does large-scale aid logistics seem to deliver so few economies of scale? How can we improve?
  8. How can we improve the level of logistics knowledge and skills in health systems in developing and middle-income countries? What are the determining factors for health logistics in these settings?
  9. Could health logistics be a determining factor in developing new drugs or techniques? E.g. less heat-sensitive vaccines, reagents with longer shelf lives, etcetera.
  10. Pull or push? And in which settings?
  11. Has the kit system had its time? Should we move on to less wastage-prone systems?
  12. How can we improve on training and mentoring of new health and (especially) aid logisticians? Isn’t it about time that we stop to just turn them out to swim or drown?
  13. Third-party logistics: a viable alternative in which contexts?
  14. Are logistics consultants actually worth what we pay them?
  15. Six sigma, lean, kaizen, SPC: what can we learn from them?
  16. Isn’t it time that we stop setting up parallel logistics systems for aid, instead using the ‘normal’ channels? Or is that just a pipe dream?
  17. Is it in any way possible to stop creating new patients by the environmental damage due to inefficiency of supply lines in developing countries?

Any other issues? What logistics issues keep you awake at night?

(With thanks to Alanna Shaikh for inspiring the form of this posting.)

{

Continue Reading 0 comments }Aid and aid work, Logistics, Public health