Are Vertical Supply Chains Still Necessary?by Modibo Dicko, Coordinator, Project Optimize, WHO For the past 30 years, immunization—like many other health programs—has been managed as a vertical program with its own management team, reporting requirements, personnel, and supply chain. Attempts to link with other health programs to improve both efficiency and effectiveness has been limited to service delivery. Experience with integrating complex supply chains in low-resource settings is still rare. However, because carefully managed “cold-chains” are no longer a privilege of vaccines only, many immunization programs are now making integration of supply chains a priority. There are many heat-sensitive drugs and other health products distributed through out the public and private health sectors that need to be kept at 2° to 8°C during storage and transport, including insulin, reagents for HIV test kits, oxytocin, some ophthalmology drugs, and others. Like vaccines, these products are currently stored, transported, monitored, and delivered in separate supply chains, each with its own cold rooms, vehicle fleets, tracking systems, and personnel. In the future, we expect that some less-heat-sensitive vaccines will be licensed for storing and transporting at temperatures higher than 8°C,which could allow them to be integrated into the supply chains of non-heat-sensitive drugs. By integrating one or all of the storage, delivery, or information system functions of immunization programs with other health care initiatives, countries may be able to create a more efficient and less costly supply chain system. Possible benefits to the immunization program include a reduction in average delivery time, reduction in cost per dose delivered, lower maintenance and running costs of vehicles, increased volume capacity, and improved expertise of delivery and logistics personnel. The same potential benefits will accrue to other health interventions as well. Across countries, managers of vertical programs are becoming more sensitized to the advantages of supply chain integration. Despite the complexities of integrating some of these vertical supply chains, many governments are now eager to give it a try. Optimize has outlined the possible benefits and challenges to integration as well as the system changes and political ramifications when adopting this approach. At least two collaborating country partners (Senegal and Tunisia) are considering integration and will help us gain new insights into the merits of this approach. We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register, but the process is very simple. To link back to the Optimize e-newsletter, click here.
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