Post00319 TRANSPORT MANAGEMENT PROJECT 6 February 2001 CONTENTS 1. GAVI TRANSPORT MANAGEMENT PROJECT 2. TRANSPORT MANAGEMENT FOR SERVICE DELIVERY STATUS SUMMARY AND PLANS 3. CONDUCTING A TRANSPORT SITUATION ANALYSIS 4. POWERPOINT PRESENTATION: TRANSPORT MANAGEMENT FOR SERVICE DELIVERY 1. GAVI TRANSPORT MANAGEMENT PROJECT John Lloyd, PATH-CVP, kindly posted this interesting update on the GAVI Transport Management Project in December 2000. It is posted at this time to ensure wider readership. The full text of the e-document "TransportStudySummary" and the Powerpoint presentation "TransportProject" is posted below. To see the graphics and Graphs download the files The files TransportStudySummary.pdf and TransportProject.zip are available on the web for download at: ftp://ftp.acithn.uq.edu.au/Technet/1- ClickHereForTECHNETfiles/TransportProject/ TransportProject.zip [810kb] TransportStudySummary.pdf [45kb] To get the files by email - sen and email to: email@example.com with the message: get technet TransportProject.zip get technet TransportStudySummary.pdf Discussion, comments and additions please: [firstname.lastname@example.org]email@example.com[/email] or use your reply button ___________________________________________________________________________ From: "John Lloyd" To: Technet Moderator Subject: Transport Management Project Date: Wed, 13 Dec 2000 Dear All, Last week at the Taskforce on Immunization, Pretoria, we presented country reports to Ghana, Cote d'Ivoire, South Africa and Zimbabwe, I made the attached presentation and distributed a short summary report which is also attached. You will see from the presentation and report a significant shift in our plans for the next phase, compared to our discussions at the DC meeting. We have abandoned the idea of a multi-country meeting next year because we do not believe that the human resources exist at this time to offer support to multiple countries for the reform of their entire health transport management system. Instead, we prefer a country by country approach to support transport systems, specifically focussed on service delivery and service delivery support in the following types of countries: 1) countries where WHO/PE is outsourcing surveillance transport to Riders for Health: in these countries we would wish to facilitate an extension of these contracts to cover routine outreach services for immunization and other interventions. Nigeria, DRC, Zimbabwe and Chad. We met with the Chad delegation and agreed a joint meeting with WHO and CVP/West Africa early in the new year. 2) countries where WHO/UNICEF are running the 'pilot' Sustained Outreach Services projects (SOS): here we would hope to review and improve the transport management and to extend the reach of these projects to a national scale as quickly as possible. These countries are: Mozambique, Chad, Uganda and Mali 3) countries where Village Reach intends to establish outsourced cold chain: we would seek the appropriate transport management human resources and partners for the projects. These countries are, provisionally, Mozambique, Togo and Benin. 4) countries which are to receive GAVI GFCV support for immunization services: these countries will be in a better position to sustain reforms in transport management for service delivery with the investments made by GAVI. Particular attention will be paid to countries whose immunization assessments specifically cite transport as being a factor limiting the achievement of higher coverage. 5) countries prioritised for CVP support by the West African office of PATH- CVP in Abidjan: Cote d'Ivoire, Togo, Burkina and Ghana. Several countries appear on two or more of these preference lists, Chad being the first to be approached by both WHO and CVP. Country proposals will be developed with the appropriate transport management organisations to assure that: - fleet management - operations management - information systems and - national policy ...can all be tackled in a systematic manner. The first step to achieve this will normally be the situation analysis. We will keep you informed of developments: in the meantime, we send you the warmest wishes for Christmas and the New Year! John Lloyd Lionel Pierre Marie Miller PATH-CVP Ferney Voltaire France ____________________________________*______________________________________ 2. TRANSPORT MANAGEMENT FOR SERVICE DELIVERY STATUS SUMMARY AND PLANS ___________________________________________________________________________ TRANSPORT MANAGEMENT FOR SERVICE DELIVERY STATUS SUMMARY AND PLANS - DECEMBER 2000 During 2000, a study has been carried out in Cote d'Ivoire, Ghana, South Africa and Zimbabwe as the first phase of a project by GAVI Partners. The project aims to remove transport as a major obstacle to reaching children with immunization and other primary health services who live outside the reach of fixed health facilities. The project aims to achieve this objective by applying the principles of effective transport management that have been found to be effective in African countries, according to the findings of this study. The study sought to identify the key components that must be in place for a cost effective transport system to support the delivery of health services. It aimed to quantify the impact of each component on the final transport equation. Methodology The research tested a hypothesis that an effective management system required the following components: * policy * operational management * fleet management * management information and that these components should be supported by a clear definition of current and future transport requirements and a competent committed workforce. To investigate the hypothesis, a team was assembled to apply three questionnaires: * economic cost analysis * transport management procedures * knowledge, attitude and practices (KAP) The questionnaires were applied to a sample of approximately eight health facilities in four districts, in two regions of each country, the results were analysed and reports prepared for each country. The overall results will be consolidated into a composite report by the end of January 2001. RESULTS Overall, the study has proved the hypothesis. It has shown that improvements to fleet management, underpinned by a complete and timely information system, will result immediately in higher vehicle availability and a lower overall cost per kilometre. These improvements will however, only have impact on the utilisation of transport and therefore impact on health service delivery, if attention is paid to operational management by public health managers. Impact on access and higher efficiency will not be sustained unless policy is clearly established and the financing of vehicle replacement is planned and budgeted. A trained, motivated and adequately paid workforce is vital for the project to succeed. Fleet management * Vehicles can and should be run without breakdown and remain available for use for more than 90% of their lives. The study shows that motorcycles should run for at least 60,000 km, and vehicles for at least 180,000 kilometres. (The study suggests that these ages can be significantly exceeded in the correct fleet management environment). Usable, vehicle life should be prolonged where running costs are minimised and replacement costs and depreciation are high. * Long economic life depends on a rigorous regime of preventive maintenance by a high quality maintenance provider from new. Long life also depends on appropriate choice of vehicles. Preventive maintenance virtually eliminates repair work and results in at least 20% higher availability. * Out-sourcing demonstrated particularly high scores for fleet management and for availability of vehicles, but only when the whole fleet management process was included in the out-sourcing contract. This demonstrated that attention to all aspects of fleet management is required to achieve results, whoever provides the management infrastructure. * The appropriate mix of types of vehicle according to task and terrain was a particularly significant factor in assuring impact and efficiency. Motorcycles emerged as particularly effective and appropriate choice for many outreach service situations and have proved both less costly and better utilized than 4 wheel vehicles for this purpose. Operational management * Good fleet management leading to high vehicle availability does not translate to improved service delivery unless action is taken on operational management, management information and human resources. * Whether out-sourced or managed by the government, the allocation of transport to routine service delivery and service delivery support must be pre-planned and controlled. High utilization rates were achieved by countries and areas that achieved high scores for operation management and specifically, trip planning and control. Effective planning and scheduling created improvements in a number of areas * Improving the kilometres travelled per vehicle per month by 20% * Improving individual vehicle utilisation leading to a smaller vehicle fleet, requiring a lower capital investment * In conjunction with prioritisation, causes an improvement in use for service delivery * If fleet management is fully or partially out-sourced, the government needs to monitor and supervise the transport contract and manage the relationship with the third party provider. A system of performance measurement, contract review and quality control is essential but was found to be lacking in the countries studied where out-sourcing was an important component. Transport management interventions can only be sustained if performance is regularly reviewed and remedial actions taken. * The creation of a transport charging system on a kilometre used basis gives a strong base for effective transport management. Funds are then readily available for fuel and planned preventive maintenance, and transport budgeting for a programme is made much easier. If the charge includes depreciation then the requirement for capital investment in transport is eliminated. This system of charging for transport is equally effective for an in-house or out-sourced solution. * The implementation of fuel controls can improve fuel utilisation by 38% and therefore reduce costs. Transport Policy * A strong policy leads to the long-term consolidation of interventions in transport. In particular it assists in the conversion of improved availability to improved service delivery. It also provides a strong base for operational management. The most effective policies were those that had been well disseminated and updated frequently. * Critical policies on replacement, planning and budgeting for transport renewal were seen to be problems in most countries in the study. Even where policies and plans are established, they are frequently not followed due to lack of financing and a universal reluctance to take vehicles out of service when they can no longer be run economically and effectively. * A key specific finding was that kilometres travelled should always be used in preference to age in years for vehicle replacement planning * Policies on the operation and utilisation of vehicles depend for their implementation on monitoring and supervision. The information systems, including log-books that enable the use of vehicles to be tracked, are seldom given sufficient priority but when monitoring is good, the study shows that vehicles are both available and well utilised. Next steps The principles of effective transport management which have been established on the basis of evidence of performance in the study will be applied by the collaborators with GAVI partner funding in countries: * where weak transport system remains a major barrier to coverage with immunization and other services, * where there a clear commitment to reform of transport management is evident and * that are eligible for GAVI immunization systems support. The project will focus on transport systems for service delivery and service delivery support, mainly at the district and facility level. Particular emphasis will be laid on the managed utilisation of motorcycles for the personal mobility of health workers, supervisors and repair technicians at the peripheral level. Selecting countries for support Among the countries eligible for support, priority will be given to the following three situations: * Expansion of existing or planned WHO out-sourcing contracts for polio surveillance transport to include transport for routine outreach services * Strengthening existing or planned WHO/UNICEF/UNFoundation projects for Sustained Outreach Services (SOS) or Child Health Days. * Assistance to initiatives targeted at the out-sourcing of part or whole of vaccine cold chain systems in countries. Nature of support Support will be offered, within budgetary possibilities of PATH-CVP and initially over a period of two years, through selected collaborators to reform transport management systems for service delivery in the following ways and in agreement with country governments: * Situation analysis: consultants will be made available to assess the current transport situation, focussing on service delivery and following the outline protocol attached as Annex 1. In general, this will be the essential first step for all forms of support. Evaluations will also be made in the later stages of implementation. * Training: training may be organised, funded and facilitated for transport managers and training of public health managers in transport management * Out-sourcing: transport management systems may be established by third party providers. * Information systems technology: consultants will be made available to advise on computer networks and on telecommunications for the management and performance monitoring of transport systems * National policy workshops may be organised, funded and facilitated in countries with on-going reform of transport management systems and where a situation analysis has been conducted. * Vehicles and hardware will not be provided by PATH-CVP but support may be given to prepare the necessary long term replacement plans and to assemble the documentation to apply for bi-lateral partner funding. John Lloyd Resident Adviser PATH-CVP, Ferney Voltaire, France Jlloyd@path.org ____________________________________*______________________________________ 3. CONDUCTING A TRANSPORT SITUATION ANALYSIS ___________________________________________________________________________ ANNEX 1: CONDUCTING A TRANSPORT SITUATION ANALYSIS A transport situation analysis comprises of four steps. These steps take us through from identifying the current situation through to developing the actions required to move towards a well managed, correctly resourced, and properly utilised transport system. The four questions are * What have we got? * What do we need? * What can we afford? * What steps must be taken to move from what we have got to what we need? Each of the above questions must be answered in terms of the 5 key elements of an effective transport management system: * Policy * Operational management * Fleet management * Management information * Human resources KEY STEPS TO BE TAKEN What have we got? Some of the data required at this stage (particularly the inventory) can be gathered before the consultancy either by the Ministry or by a locally employed consultant. If time permits it is better for the Ministry to do the data gathering. - Policy All existing documented transport policy should be collated. This includes government circulars, Ministry documentation and any other relevant information. Knowledge of policy should be tested at all levels of the organisations and information gaps identified - Operational management Current operational management systems should be identified. Knowledge of these and quality of implementation should be tested by interview at all levels. Particular attention should be paid to the authorisation of vehicle use, the allocation of vehicles and the management structure. - Fleet management This requires the completion of an inventory. The elapsed time normally required for completing this means that it is often best for the data to be gathered in advance and spot-checked by the consultant. A typical data- gathering tool is attached in attachment 1. The age, condition, allocation and use profile of the fleet can be calculated from the inventory information. The inventory must include 4 wheeled and 2 wheeled transport, motorised and non-motorised. A review of existing maintenance procedures should be carried out. This includes inspection of workshops used and existing alternatives. Information should be gathered such that true labour costs per hour can be calculated and compared. Care must be taken to look at maintenance facilities outside the main cities. An analysis of effective vehicle makes and models for the conditions should be undertaken. This should include availability of spares, mechanics knowledge, durability and the experience of other agencies. - Management information Usually in a situation analysis much of the management information must be gathered from first principles. This requires the analysis of logbook information (if it exists), fuel records, accounts, health data and anecdotal evidence. Information is required to calculate the basic key performance indicators for the fleet eg kilometres travelled, fuel utilisation, running costs, availability and utilisation. In addition the consultant should try to establish how much work couldn't be carried out because of transport constraints - Human resources During discussions with individuals at all levels in the health system an opinion should be formed of the level of knowledge and understanding of all aspects of transport. This should include drivers and riders, transport officers, mechanics and health managers. What do we need? Policy, operational management, management information, and human resources. The shortfalls of the current system can be identified against the components of an effective system. The steps required to move from the existing situation towards the implementation of an ideal system should be identified, scheduled and costed. These are likely to include training of transport staff, managers, drivers, riders, mechanics, the development and implementation of a management information system, and the development of a comprehensive transport policy. Transport needs and ideal fleet profile The process of identifying needs should be carried out at the same time as the identification of what we have got. This requires the consultant to identify the required elements of work at various levels that require transport support. The methodology for this phase is attached as attachment 2. It is important that this is carried out with a consistency of approach and that stated vehicle needs are tested by comprehensive questioning. It is vital that the consultant identifies needs in terms of days (or half days) of use and not in terms of vehicles. Consideration must be given at this stage to the use of bicycles and motorcycles. The number of kilometres to be travelled by mode, at each level should be identified. Fleet management The consultant must review the fleet management options available that will allow cost-effective management of the full life of the vehicle from procurement to disposal. The purpose of fleet management is to ensure the availability of vehicles and their operation at the lowest cost per kilometre over the full life of the vehicle (including depreciation). The outsourcing of fleet management in its entirety is likely to be the most cost-effective solution for a health department. Other options include vehicle leasing or the outsourcing of the maintenance function. The availability and cost structures (including set up costs) of service providers in this area must be reviewed as part of the situation analysis. The cost and vehicle availability of the current structure should be compared against that of any potential system. The cost (and training requirements) of establishing the structure within the health department to manage the outsourced activity must also be identified The consultant should draw on the information gathered in the identification of transport needs and the ideal fleet profile to assist the department in the development of an invitation to tender document and a draft contract for services to be outsourced. The contract should include a service level agreement, a system of measurement and performance review, and should clearly outline the responsibilities of both parties. What can we afford? The major constraint on the transport system tends to be the availability of funding, particularly capital to replace vehicles. The consultant should identify all current sources of funding for the transport system, including donor funds. A review should then be carried out to identify the costs associated with the operation of the required fleet. Any potential shortfall should be identified and the impact on fleet size and/ or kilometres to be travelled calculated and estimation made of impact on health service delivery. Meetings should be held with relevant donors, the Ministry of Finance and other relevant parties to establish potential levels of support for system reform. What steps must be taken? Using the data gathered above the consultant should work with key people in the Ministry to develop and cost an action plan to move towards an effective transport system to support health care. The elapsed time required for change should not be underestimated and support should be provided over a period of at least two years. RESOURCES REQUIRED FOR CONDUCTING A SITUATION ANALYSIS This can vary slightly dependent on the size of country and fleet but should be completed within four weeks of consultancy input. Gathering of the inventory information prior to the consultancy visit enhances the efficiency of the process Inventory compilation: Health department official to compile. Transport costs and per diems for up to one month dependent on collection method. Consultancy 24 days consultancy, return flights. 10 - 14 days in the field, 6 - 10 days at headquarters, 4 days analysis and write up. Per diems required for full period, transport whilst in field. Typical distance covered 2000 - 3000km (Namibia 6,000km). If possible the consultant should be counterparted by the individual in the Ministry with responsibility for transport as this gives best scope for skills transfer. If this is the case then counterpart local costs should be included A one day workshop should be held with Ministry staff (and potentially donors) to discuss and refine findings ____________________________________*______________________________________ 4. POWERPOINT PRESENTATION: TRANSPORT MANAGEMENT FOR SERVICE DELIVERY ___________________________________________________________________________ 1. Transport management for service delivery "By 2005, 80% of developing countries will have routine immunization coverage of at least 80% in all districts" 2. Transport critical to GAVI goal * Half countries eligible GFCV are in Sub-Saharan Africa * One third of these countries are under 50% DTP3 coverage... * One tenth are unable to provide any vaccine to 50% of their children * About half of these populations cannot be reached by fixed facilities BUT * Availability of transport is low * Vehicle life is short and costs are high * Vehicles not utilised for service delivery * Partners reluctant to supply vehicles 3. Study in four AFR countriesWHO and PATH/CVP Objectives: * Identify the major components of effective transport management * quantify the benefits in terms of cost, transport availability and service delivery * Countries: Cote d?Ivoire Ghana Rep. South Africa Zimbabwe Sample: Two regions Four districts Eight facilities + Comparative systems 4. Study methods Three elements of the study: * Cost and cost-effectiveness of transport * Appraisal of transport management system against main components * Knowledge, attitudes and practices (KAP) survey of managers, drivers, mechanics and clients Team: Economics - Abt Associates, USA Management - Transaid Worldwide, UK Knowledge, attitude and practices (KAP): CVP and local Collaboration: Riders for Health, UK 4. 3 main findings 5. Finding 1: Fleet management increases availability, reduces cost * Regular preventive maintenance reduces whole life cost 7. Finding 1: Fleet management increases availability, reduces cost * Regular preventive maintenance reduces whole life cost * Increases availability 8. Finding 1: Fleet management increases availability, reduces cost * Regular preventive maintenance reduces whole life cost * Increases availability * Outsourced fleet management can be cost effective 9. Finding 1: Fleet management increases availability, reduces cost * Regular preventive maintenance increases availability * High availability results in lower cost * Outsourced fleet management can be cost effective * Motorcycles reduce cost, better utilized 10. Finding2: Operational management is vital to obtain impact * Good fleet management does not guarantee impact 11. Finding2: Operations management is vital to obtain impact * Good fleet management does not guarantee impact * Good operations management is * Planning and scheduling the use of transport * Prioritisation of transport needs according to health priorities * Authorisation and monitoring of vehicle movements * Management responsibility for transport * Pooling of vehicles * Scheduling of maintenance * Effective controls on fuel, use, keys etc 12. Finding2: Operations management is vital to obtain impact * Good fleet management does not guarantee impact * Operations management is * Good operations management coincides with high immunization coverage 13. Finding 3: Policy development and replacement planning key to sustainability * Transport policy barriers: vehicle replacement * Country A planned replacement, budgeted for replacement but failed to replace * Country B does not replace govt vehicles, will not amortise replacement of out-sourced vehicles * Country C planned replacement, but could not find the budget * Country D received unsuitable vehicles for their purposes * Budgeting by the km, establishing a transport trading account * Information systems, including log-books, are critical to improve both availability and utilisation 14. Conclusion * Better management increases availability, improves utilisation, reduces capital and recurrent costs, raises confidence of investors * Critical success factors for transport management include * rigorous fleet management assures efficiency, * systematic operational management assures impact, * complete and timely information system and * clear, consistent policy assures sustainability * Financing the routine replacement of vehicles and controlling the choice is critical * Paid, committed, trained health and transport staff. 15. Strategy * Expand out-sourced fleets managed by WHO for polio eradication to cover service delivery - but strengthen operational management & policy * Rationalise fleet and operations management of Sustained Outreach services (SOS) and replicate * Merge the operational needs of measles control strategies with those of SOS * Expand the managed use of motorcycles for outreach * Advocate for GAVI partner policies on transport management 16. Next steps Relative to the needs of service delivery: * Situation analysis * Training * Outsourcing * National policy workshops * Rationale, plan for vehicle needs ___________________________________________________________________________ MICROSOFT POWERPOINT SECURITY HOLE! Microsoft has made available a patch for the PowerPoint security hole. Be aware that if you were one of the first to install this patch you may need to revisit Microsoft?s download area. It appears that the original version of the patch failed to fix the problem. To make sure that your system is protected, check out the exploit posted on @stake?s web site. There are also other requirements to ensure the effectiveness of Microsoft?s patch. The PowerPoint 2000 SR-1 Parsing Vulnerability Security Update must first be installed on top of Office 2000 Service Release 1 or Office 2000 SR-1a. The process is described in Microsoft Knowledge Base article Q285978: PowerPoint 2000 SR-1 Security Update: Parsing Vulnerability. After the patch is applied, PowerPoint will not load malformed .PPT files. --- The Microsoft PowerPoint? 2000 SR-1 Parsing Vulnerability Update protects you from a vulnerability in PowerPoint that could allow arbitrary code to be executed on your computer. Malicious hackers could lure users into opening a PowerPoint file that causes undesired and possibly damaging effects on the user's hard disk drive. This update replaces the PowerPoint.exe file and prevents unauthorized code from being executed. http://officeupdate.microsoft.com/2000/downloaddetails/Ppt2ksec.htm? FinishURL=%2Fdownloads%2Frelease%2Easp%3FReleaseID%3D27296%26redirect%3Dno ____________________________________*________________________
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