Haryana, India: Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Logistics Indicator Assessment Report JANUARY 2015 This publication was produced for review by the U.S. Agency for International Development. It was prepared by the USAID | DELIVER PROJECT, Task Order 4. Haryana, India: Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Logistic Indicator Assessment Report The authors' views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government. USAID | DELIVER PROJECT, Task Order 4 The USAID | DELIVER PROJECT, Task Order 4, is funded by the U.S. Agency for International Development (USAID) under contract number GPO-I-00-06-00007-00, order number AID-OAA-TO-10­ 00064, beginning September 30, 2010. HIV-related activities of Task Order 4 are supported by the President's Emergency Plan for AIDS Relief. Task Order 4 is implemented by John Snow, Inc., in collaboration with PATH; Crown Agents Consultancy, Inc.; Eastern and Southern African Management Institute; FHI360; Futures Institute for Development, LLC; LLamasoft, Inc; The Manoff Group, Inc.; Pharmaceutical Healthcare Distributers (PHD); PRISMA; and VillageReach. The project improves essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operation, and enhancing forecasting and procurement planning. The project encourages policymakers and donors to support logistics as a critical factor in the overall success of their healthcare mandates. Recommended Citation USAID | DELIVER PROJECT, Task Order 4. 2014. Haryana, India: Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Logistics Indicator Assessment Report. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 4. Abstract In May 2014, the USAID | DELIVER PROJECT, with support from the Ministry of Health and Family Welfare (MOHFW), the National Health Mission (NHM) and Haryana Department of Health & Family Welfare and Health Mission, conducted as assessment on the availability of reproductive, maternal, newborn, child, and adolescent health and HIV and AIDS commodities and the performance of the logistics management and supply chain systems in Haryana. This report presents the findings of the assessment as well as recommendations to strengthen the logistics systems. USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 16th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Internet: deliver.jsi.com Contents Acronyms............................................................................................................................................................................ ix  Acknowledgments ............................................................................................................................................................. 1  Executive Summary ........................................................................................................................................................... 3  Key Findings ................................................................................................................................................................... 4  Recommendations ........................................................................................................................................................ 9  Background........................................................................................................................................................................ 13  Assessment Methodology .............................................................................................................................................. 19  Findings for Essential Medicines, Vaccines, Family Planning, HIV and AIDS and RTI/STI Commodities .....25  Description of Facilities ............................................................................................................................................. 25  Stock Management and Availability ........................................................................................................................ 26  Logistics Management Information System........................................................................................................... 42  Inventory Management .............................................................................................................................................. 51  Transportation ............................................................................................................................................................ 58  Human Resources ...................................................................................................................................................... 59  Logistics Management at the Sub-centers ............................................................................................................. 63  Recommendations ........................................................................................................................................................... 69  References......................................................................................................................................................................... 73  A. Additional Essential Medicines Tables ................................................................................................................... 75  B. Additional Family Planning Tables ........................................................................................................................... 81  C. Additional Vaccine Tables ........................................................................................................................................ 87  D. Additional RTI/STI and HIV and AIDS Tables ..................................................................................................... 93  E. Commodities Included in the Assessment ............................................................................................................ 99  F. Individual Storage Conditions ................................................................................................................................ 103  Figures Figure 1. Supply Chains Supporting the RMNCH+A Commodities .................................................................... 14 Figure 2. Vaccine Production and Distribution in India .......................................................................................... 16 Figure 3. Map of Haryana and Selected Districts ..................................................................................................... 20 Figure 4. Types of Inventory Logistics Forms Used to Manage Commodities by Supply Chain, According to Commodity Managers ........................................................................................................................................ 42 Figure 5. Types of Forms Used for Reporting Inventory Information to the Higher Level by Supply Chain, According to Commodity Managers ................................................................................................................... 48 iii Figure 6. Where Inventory Reports Are Sent by Supply System and Facility Type, According to Commodity Manager ........................................................................................................................................... 49 Figure 7. Reported Frequency of Login into the Online System .................................................................... 50 Figure 8. Entity Responsible for Determining Which Products to Order and the Quantity by Supply Chain ....................................................................................................................................................................... 51 Figure 9. How Quantities Are Determined by Supply Chain .......................................................................... 52 Figure 10. Frequency of Indents Made by Facility According to Policy by Supply Chain ..........................52 Figure 11. Last Time Indent/Report Was Sent by Facility by Supply Chain .................................................53 Figure 12. Average Length of Time between Indenting and Receiving by Supply Chain ...........................53 Figure 13. How Well Indents Are Filled by Supply Chain ................................................................................ 54 Figure 14. Number of Emergency Orders/Unplanned Local Purchases in Previous Three Months by Supply Chain .......................................................................................................................................................... 54 Figure 15. Most Frequent Source of Supply in Previous Six Months by Supply Chain ..............................55 Figure 16. Storage Condition Composite Index ................................................................................................. 56 Figure 17. Responsibility for Transporting Products to Facility by Supply Chain .......................................58 Figure 18. Method of Commodity Transportation by Supply Chain ..............................................................59 Figure 19. Availability of Standard Treatment Guidelines for OI or STIs (n=271) .....................................60 Figure 20. Availability of Written Guidelines/SOPs for Cold Chain Management or Biomedical Waste Management (n=271) ........................................................................................................................................... 60 Figure 21. Percentage of Facilities with RMNCH+A 5x5 Matrix, According to Facility Managers .........61 Figure 22. Availability of Inventory Guidelines by Facility Level ...................................................................... 61 Figure 23. Percentage of Respondents Trained in Recordkeeping by Supply Chain ..................................62 Figure 24. Last Supervision Visit ............................................................................................................................. 62 Figure 25. Resupply at Level (n=115) .................................................................................................................... 65 Figure 26. Responsibility for Transporting Products to Facility (n=115) ......................................................65 Figure 27. Type of Transportation for Commodities Most Often Used (n=115) ......................................66 Figure 28. Last Received Supervision Visit (n=115) ........................................................................................... 66 Figure 29. How ANMs Learned to Complete Forms/Records for Managing Products (n=115) ............67 Tables Table 1. Haryana Health Center Sampling Frame .............................................................................................. 20 Table 2. List of Select Indicators ............................................................................................................................. 21 Table 3. Health Facilities Sampled by District and Type ................................................................................... 25 Table 4. Essential Medicines Commodities Included in the Assessment ......................................................27 Table 5. Average Number of Essential Medicines Managed and Available on Day of Visit ......................28 Table 6. Percentage of Essential Medicines Managed at the Facility in the Previous 12 Months by Facility Type ........................................................................................................................................................... 28 Table 7. Percentage of Stockouts of Essential Medicines on the Day of Visit by Product and Facility Type......................................................................................................................................................................... 29 Table 8. Percentage of Stockouts of Essential Medicines Commodities within Last Three Months by Product and Facility Type ................................................................................................................................... 30 iv Table 9. Average Frequency of Stockouts of Essential Medicine Commodities within Last Three Months by Product and Facility Type .............................................................................................................. 31 Table 10. Average Number of Days of Stockouts of Essential Medicines Commodities within Last Three Months by Product and Facility Type .................................................................................................. 32 Table 11. Average Number of Vaccines Managed and Available on Day of Visit .......................................33 Table 12. Percentage of Vaccines Managed at the Facility in the Previous 12 Months by Facility Type 34 Table 13. Percentage of Stockouts of Vaccines on the Day of Visit by Product and Facility Type ........34 Table 14. Percentage of Stockouts of Vaccines within Last Three Months by Product and Facility Type .................................................................................................................................................................................. 35 Table 15. Average Frequency of Stockouts of Vaccines within Last Three Months by Product and Facility Type ........................................................................................................................................................... 35 Table 16. Average Number of Days of Stockouts of Vaccines within Last Three Months by Product and Facility Type ................................................................................................................................................... 35 Table 17. Average Number of Family Planning Products Managed and Available on Day of Visit .........36 Table 18. Percentage of Family Planning Products Managed at the Facility in the Previous 12 Months by Facility Type...................................................................................................................................................... 36 Table 19. Percentage of Stockouts of Family Planning Commodities on the Day of Visit by Product and Facility Type ................................................................................................................................................... 37 Table 20. Percentage of Stockouts of Family Planning Commodities within Last Three Months by Product and Facility Type ................................................................................................................................... 38 Table 21. Average Frequency of Stockouts of Family Planning Commodities within Last Three Months by Product and Facility Type ..............................................................................................................................38 Table 22. Average Number of Days of Stockouts of Family Planning Commodities Within Last Three Months by Product and Facility Type .............................................................................................................. 38 Table 23. RTI/STI and HIV and AIDS Commodities Included in the Assessment ......................................39 Table 24. Average number of RTI/STI and HIV and AIDS products managed and available on day of visit ........................................................................................................................................................................... 40 Table 25. Percentage of RTI/STI and HIV and AIDS Products Managed at the Facility in the Previous 12 Months by Facility Type ................................................................................................................................ 40 Table 26. Percentage of Stockouts of RTI/STI and HIV and AIDS Products on the Day of Visit by Product and Facility Type ................................................................................................................................... 41 Table 27. Percentage of Stockouts of RTI/STI and HIV and AIDS Products within Last Three Months by Product and Facility Type ..............................................................................................................................41 Table 28. Percentage of Facilities with Available and Updated Stockcards for Essential Medicines by Level......................................................................................................................................................................... 43 Table 29. Percentage of Facilities with Accurate or Near Accurate Balances (+/- 10) between the Physical Inventory and Stockcard Balances on the Day of Visit for Essential Medicines by Facility Type......................................................................................................................................................................... 44 Table 30. Percentage of Facilities with Available and Updated Stockcards for Vaccines by Level .........45 Table 31. Percentage of Facilities with Accurate or Near Accurate Balances (+/- 10) between the Physical Inventory and Stockcard Balances on the Day of Visit for Vaccines by Facility Type ..........45 Table 32. Percentage of Facilities with Available and Updated Stockcards for Family Planning Commodity by Level............................................................................................................................................ 46 v Table 33. Percentage of Facilities with Accurate or Near Accurate Balances (+/- 10) between the Physical Inventory and Stockcard Balances on the Day of Visit for Family Planning Products by Facility Type ........................................................................................................................................................... 46 Table 34. Percentage of Facilities Where Stockcards Are Available and Updated for Use in Managing RTI/STI and HIV and AIDS Products by Level ...............................................................................................46 Table 35. Percentage of Facilities with Accurate or Near Accurate Balances (+/- 10) between the Physical Inventory and Stockcard Balances on the Day of Visit for HIV and AIDS by Facility Type 47 Table 36. Percentage of Facilities with Accurate Balances (+/- 10) between the Physical Inventory and ODISCMS on the Day of Visit for Essential Medicines by Facility Type .................................................48 Table 37. Percentage of Warehouses Meeting Individual Storage Conditions ............................................57 Table 38. Percentage of Facilities Where Stockcards Are Available and Updated for Use in Managing Essential Medicines ............................................................................................................................................... 63 Table 39. Percentage of Facilities Where stockcards Are Available and Updated for Use in Managing Family Planning Products .................................................................................................................................... 64 Table 40. What Was Done on the Supervision Visit (n=115)......................................................................... 67 Table A1. SC-managed Essential Medicines Commodities Included in the Assessment ...........................75 Table A2. Types of Inventory Logistics Forms Used to Manage Essential Medicines ................................75 Table A3. Types of Forms Used for Reporting Inventory Information to the Higher Level for Essential Medicines................................................................................................................................................................ 76 Table A4. Types of Data Included in Completed Inventory Reports for Essential Medicines .................76 Table A5. Logistics Information Included in Completed Inventory Report for Essential Medicines ......76 Table A6. Where Inventory Reports for Essential Medicines Are Sent .......................................................77 Table A7. Use of the Online Drug Inventory and Supply Chain Management System ..............................77 Table A8. Reported Reasons for Using the Online System ............................................................................. 77 Table A9. Frequency of Inventory Reports for Essential Medicines Are Sent to Higher Level ..............78 Table A10. How Staff Learned to Complete Forms/Records for Managing Essential Medicines ............78 Table A11. Responsibility for Determining Which Essential Medicines to Order and the Quantity.................................................................................................................................................................. 78 Table A12. Responsibility for Transporting Essential Medicines to the Facility ..........................................79 Table B1. Types of Inventory Logistics Forms Used to Manage Family Planning Products ......................81 Table B2. Types of Forms Used for Reporting Inventory Information to the Higher Level for Family Planning Products ................................................................................................................................................. 81 Table B3. Percentage of Facilities with Accurate Balances (+/- 10) between the Physical Inventory and LMIS on the Day of Visit for Family Planning by Facility Type ................................................................... 82 Table B4. Types of Data Included in Completed Inventory Reports for Family Planning Products .......82 Table B5. Logistics Information Included in Inventory Report for Family Planning Products ..................82 Table B6. Where Inventory Reports for Family Planning Products Are Sent .............................................83 Table B7. Frequency of Inventory Reports for Family Planning Products Are Sent to Higher Level ....83 Table B8. How Staff Learned to Complete Forms/Records for Managing Family Planning Products ....83 Table B9. Responsibility for Determining Which Family Planning Products to Order and the Quantity .................................................................................................................................................................................. 84 Table B10. Responsibility for Transporting Family Planning Products to the Facility ................................84 Table B11. Other Sources of Supply for Family Planning Products Used in Previous Six Months .........85 vi Note – two (2) vaccines (Hepatitis B and Tetanus) were found in two (2) essential medicine warehouses and are included in the below analysis. .................................................................................... 87 Table C1. Types of Inventory Logistics Forms Used to Manage Vaccines ...................................................87 Table C2. Types of Forms Used for Reporting Inventory Information to the Higher Level for Vaccines .................................................................................................................................................................................. 87 Table C3. Percentage of Facilities with Accurate Balances (+/- 10) between the Physical Inventory and ODISCMS on the Day of Visit for Vaccines by Facility Type ....................................................................88 Table C5. Logistics Information Included in Inventory Report for Vaccines ...............................................88 Table C6. Where Inventory Reports for Vaccines Are Sent ........................................................................... 89 Table C7. Frequency of Inventory Reports for Vaccines Are Sent to Higher Level ..................................89 Table C8. How Staff learned to Complete Forms/Records for Managing Vaccines ..................................89 Table C9. Responsibility for Determining Which Vaccines to Order and the Quantity ..........................90 Table C10. Responsibility for Transporting Vaccines to the Facility ............................................................. 90 Table C11. Other Sources of Supply for Vaccines Used in Previous Mix Months .....................................91 Table D1. Average Frequency of Stockouts of HIV and AIDS Commodities within Last Three Months by Product and Facility Type ..............................................................................................................................93 Table D2. Average Number of Days of Stockouts of HIV and AIDS Commodities within Last Three Months by Product and Facility Type .............................................................................................................. 93 Table D3. Types of Inventory Logistics Forms Used to Manage HIV Test Kits and ARVs ......................93 Table D4. Types of Forms Used for Reporting Inventory Information to the Higher Level for HIV Test Kits and ARVs .............................................................................................................................................. 94 Table D5. Percentage of Facilities with Accurate Balances (+/- 10) between the Physical Inventory and LMIS on the Day of Visit for RTI/STI and HIV and AIDS by Facility Type ..............................................94 Table D6. Types of Data Included in Completed Inventory Reports for HIV Test Kits and ARVs .......95 Table D7. Logistics Information Included in Completed Inventory Report for HIV Test Kits and ARVs .................................................................................................................................................................................. 95 Table D8. Where Inventory Reports for HIV Test Kits and ARVs Are Sent ..............................................95 Table D9. Frequency of Inventory Reports for HIV Test Kits and ARVs Sent to Higher Level .............96 Table D10. How Staff learned to Complete Forms/Records for Managing HIV Test Kits and ARVs ...96 Table D11. Responsibility for Determining Which HIV Test Kits and ARVs to Order and the Quantity .................................................................................................................................................................................. 96 Table D12. Responsibility for Transporting HIV Test Kits and ARVs to the Facility ................................97 Table D13. Other Sources of Supply for HIV Test Kits and ARVs Used in Previous Six Months .........97 Table D14. Steps Taken Before Storing HIV Test Kits and ARVs Once Products Are Received at Facility...................................................................................................................................................................... 97 vii viii