Avian Influenza Commodities Update

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Avian Influenza Commodities Update
October 15, 2008
William H. Johnson Director, Task Order 2, Avian
Influenza
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Overview

• USAID DELIVER PROJECT
• AI Commodities Update
• Shipments to Date
• Background
• Changes in the AI Commodity Stockpile
• Regional Distribution Center (RDC) Established
• Country Technical Assistance
• Technical Assistance and Training Capacity (JSI)
• Conclusion

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Whats New?

• Decontamination Kit ? 3-D Kit and SBS Kit
• New diagnostic Commodity Strategy
• RDC in Bangkok
• Selective country TA on case by case basis

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The USAID DELIVER PROJECT

• Five year Indefinite Quantity Contract (IQC)
• Awarded by USAID to John Snow, Inc. Sep. 2006
  2.75 billion ceiling
• Over 200 total staff
• 19 field offices
• Motto No Product, No Program
• Task Order 1 Public health commodities Approx.
  Obligations to Date
• Sep. 2006, 5 year contract
• Core and mission funding 162 million
• TA and procurement
• Task Order 2 Avian Influenza commodities
• Mar. 2007, 3.5 year contract
• OFDA Funding (no mission funding) 28 million
• Very limited TA on case-by-case basis
• Task Order 3 Malaria prevention, treatment
  commodities
• Apr. 2007, 5 year contract
• Core and mission funding 125 million
• TA and procurement

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The USAID DELIVER PROJECT

• Purpose of Logistics System (6 Rights)
• RIGHT QUANTITIES of the
• RIGHT GOODS to the
• RIGHT PLACES at the
• RIGHT TIME in the
• RIGHT CONDITION at the
• RIGHT COST

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Shipments Prior to Task Order 2

• Prior contract with FOH through OFDA
• 209,850 PPEs shipped to 65 countries
• Majority small amounts as place holders
• Indonesia received 100,000 of total
• Most of previous shipment commodities have been
  used in the country
• Shipping and tracking problems led to
  de-obligations
• New procurement and shipping contract with
  DELIVER Avian Influenza Task Order March 2007

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Task Order 2 Contract in General

• Began March 2007
• Procurement, shipping and tracking of USAID Avian
  Influenza International Stockpile (AIIS)
  commodities
• 28.5M centrally funded for 3 years
• Logistics technical assistance as required
• MAP International runs warehouse in Georgia
• UPS as shipping agent
• Crown Agents, Fuel Group, PATH, FHI, Manoff
  Group, MAP International UPS as sub-contractors.

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Task Order 2 SOW

• Take over pre-existing inventory 110 x 50
  semi-trailer trucks of commodity supplies and
  re-process for shipping
• 328,350 PPE kits shipped to 70 countries
• Establish regional distribution centers as
  required
• Facilitate periodic technical review of
  commodities
• Regularly replace distributed stocks
• Purchase and distribute additional commodities
• Track and report on commodities used
• Forecast and plan for expanded outbreaks
• Provide logistics technical assistance as
  necessary

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Task Order 2 Distribution Approach

• Pre-position 1-2 month supply in every country
• Have back-up stocks pre-positioned in Bangkok RDC
• Have back-up stocks in Savannah, Georgia
• Emergency response 5-7 days air freight
• Immediate response 7-14 days standard air
• Pre-planned response 6-8 weeks by sea freight
• When necessary, 1 day warehouse response
• Door-to-door delivery through UPS

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Standard Order Processing Workflow
Order is received by TO Director / USAID/W mgmt.
Order given to Fulfillment Team to determine
fulfillment requirements.
New procurement required or stock available?
Begin procurement.
New
Existing
Receiving Report is received from recipient
verifying shipment arrival
Order is sent to Demand Planner for processing,
fulfillment coordination.
Order entered, Delivery Note (DN) created.
Freight Mgr. coordinates shipment to end
destination, obtains POD.
Freight Mgr. pre-shipment documentation prep and
coordination.
DN, Sales Order Confirmation sent to WH freight
manager.
WH begins picking items, preparing shipment for
transit.
Challenges, questions arise.
WH notifies Freight Mgr. and Operations, order
shipment ready.
Discuss w/ Fulfillment and TO mgmt.
WH notifies Freight Mgr. and Ops. order is ready.
Final freight charges approved by TO mgmt.
Final shipment documentation is prepared/order is
picked up from WH.
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Historic Commodity Distribution
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AI International Stockpile (AIIS) Commodities
Procurement pending
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AI International Stockpile (AIIS) Commodities

• Standard Shipment Historic
• 4,500 PPE Kits
• 40 Decon Kits
• 1 Lab Kit
• Standard Shipment Future
• 4,500 PPE Kits
• 3-D Kits (procurement process underway)
• SBS Kits (procurement process underway)

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AI Commodities Background

• Decon Kit Review (Apr 2008)
• Transition from Decon Kit to 3-D and SBS Kits
  (Apr Sep 2008)
• New Diagnostic Commodities Strategy (Sep 2008)

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Decon Kit Technical Review (Apr. 28 May 1,
2008)

• In response to feedback from the field, TO2
  convened a meeting of hazardous materials
  response experts
• Participants came from private sector, academia,
  Federal contractor, USDA and USAID
• Recommendations
• Create prototype 3-D Kit and Surveillance
  Biosecurity Kit
• Develop instructions for use of the new kits
• Field test the prototype kits

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Decon Kit Technical Review (Apr. 28 May 1,
2008)

• Recommendations (contd.)
• Develop a training manual
• Develop a forecast and procurement strategy
• Develop an approach to kitting the products

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Transition Decon Kits to 3-D and SBS Kits
Special Order Items
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AI Commodity Changes
Special Order Items
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AI Commodity Changes
Special Order Items
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AI Commodities Decontamination Kit (Discontinued)
Items included in the 3-D Kit and/or SBS Kit
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AI Commodities 3-D Kit
Items recovered from Decontamination Kit
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AI Commodities 3-D Kit (Contd.)
Items recovered from Decontamination Kit
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AI Commodities SBS Kit
Items recovered from Decontamination Kit
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USAID AIIS Diagnostics Commodity Strategy

• The USAID API Unit decided in Sep 2008 to
• Eliminate the Lab kit from the AIIS
• Restrict the Poultry Rapid Antigen Test Kit to a
  special order item
• Restrict the Universal Transport Medium (UTM) to
  a special order item
• Maintain the Infectious Substance Shipper active
  in stock as a special order item
• Maintain the Mask Fit Test-Kit as a special
  order item

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USAID AIIS Commodity Matrix
3-D and SBS kits not available before December
2008
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Bangkok Regional Distribution Center (RDC)
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Bangkok RDC

• Established January 2008
• Owned by NEC Corporation
• Managed by UPS
• Stocked on March 21, 2008
• First shipment dispatched August 24, 2008

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RDC Project Stock
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Bangkok RDC Freight Cost and Transit Time
Analysis
Point of Origin Atlanta vs. Bangkok
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RDC Order Fulfillment (12-24 hrs.)

• Collaborating Parties
• American Embassy Bangkok
• USAID/Washington
• USAID/RDMA (Thailand)
• USAID DELIVER PROJECT
• UPS (Bangkok)
• UPS (Washington)
• Standard AIIS Ordering Process
• CTO must approve each order
• Project Supply Operations Team fulfills the order
• UPS forwards freight

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RDC Order Fulfillment (12-24 Hrs.)

• Export Sequence Summary
• USAID/RDMA Alerts Embassy GSO of pending shipment
• UPS (Bangkok) forwards freight documents to RDMA
• RDMA emails official shipment request to GSO
  (Bangkok)
• GSO obtains duty-free status from MFA
• GSO creates packing list on Embassy letterhead
• UPS (Bangkok) dispatches courier to pick up
  documents from GSO
• UPS (Bangkok) alerts consignee
• UPS (Washington) tracks shipment and updates all
  parties
• USAID DELIVER PROJECT coordinates customs
  clearance and delivery
• UPS sends Proof of Delivery (POD) to all parties

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Technical Assistance by the USAID DELIVER
PROJECT

• TO1 Technical Assistance
• FY 08 field expenses of 22.10 million (est.)
• TO2 Technical Assistance
• FY 08 field expenses of 265,000 (est.)
• TO3 Technical Assistance
• FY 08 field expenses 5.5 million (est.)

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Technical Assistance Training Capacity John
Snow, Inc.

• Logistics Management Information Systems (LMIS)
• Storage
• Assessing Stock Status
• Maximum-Minimum Inventory Control Systems
• Commodity Security and Health Logistics Systems

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Technical Assistance Training Capacity John
Snow, Inc. (Contd.)

• Quantification, Forecasting, and Procurement
  Planning
• Forecast consumption
• Estimate requirements
• Logistics data
• Service Statistics
• Morbidity Data
• Demographic Data
• Estimate Cost
• Adjust Quantity to Procure

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Technical Assistance Training Capacity John
Snow, Inc. (Contd.)

• Monitoring and Evaluation
• Adequate stock status
• Stock out duration
• Stock data quality
• Storage conditions
• Reporting Rates
• Forecasting Accuracy
• Multi-year supply plan
• Stakeholder commitment

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Technical Assistance Training Capacity John
Snow, Inc. (Contd.)

• Assessing Logistics Systems
• Logistics Indicators Assessment Tool (LIAT)
• Organization and Staffing
• Information System
• Product selection
• Forecasting
• Obtaining supplies

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Technical Assistance Training Capacity John
Snow, Inc. (Contd.)

• Assessing Logistics Systems
• Logistics System Assessment Tool (LSAT
• Inventory control procedures
• Warehousing and storage
• Transport and Distribution
• Organizational support for logistics
• Product use
• Finance/donor coordination/commodity security

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Technical Assistance Training Capacity John
Snow, Inc. (Contd.)

• Assessing Logistics Systems
• Logistics Management Information System (LMIS)
• Amount ordered, issued and received at each level
  of the pipeline essential data items for report
• Stock on hand by product (beginning and end)
• Issues or consumption
• Losses and adjustments

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Country Technical Assistance

• Three general levels of assistance, approved on
  an individual basis by the API Unit.
• Tier One
• Countries currently experiencing widespread
  outbreaks of confirmed H5N1.
• Consume large quantities of AI commodities.
• May require at least two TA visits in the first
  year.
• Tier Two
• Localized outbreaks of H5N1 AI.
• Consume significant numbers of AI commodities
  (surveillance, response).  
• May require one TA visit for assessing current
  stock status, the supply chain and to forecast
  future needs and establish initial SOPs.
• Tier Three  
• Limited localized outbreaks of H5N1 AI or no
  outbreaks to date.
• Consume few commodities or limited to training
  activities.
• May receive limited TA.

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USAID API Unit Technical Assistance

• Shipment Types
• Pre-positioning
• Emergency
• Replenishment
• Commodity Forecasting Tool
• Information for replenishment shipment
  requirements
• Under development
• Piloted in Bangladesh and Nigeria
• Guidance on reporting stock, inventory status,
  commodity requirements not yet available

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Forecasting Tool (under development)
Commodity Status Report
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Forecasting Tool (under development)
Estimated Commodity Needs

• AI Inventory and Forecasting Tool

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Forecasting Tool (under development)

• Data for Estimating Commodity Needs
• Emergency Outbreak Response
• Average number of outbreaks per month
• Average number of affected poultry per outbreak
• Average number of surveillance site visits to
  locations neighboring infected area (per
  outbreak)
• Average number of additional PPE used per
  outbreak (in addition to those already in 3-D and
  SBS kits)
• Average number of additional Virkon pails used
  per outbreak (in addition to those already in 3-D
  and SBS kits)
• Assumptions
• Poultry capacity of 3-D kit is constant variable
• 4-5 PPE changes per person per 8-hour day

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Forecasting Tool (under development)

• Data for Estimating Commodity Needs (Contd.)
• Routine Surveillance
• Number of planned routine surveillance site
  visits per month
• Average number of SBS kits used per surveillance
  site visit
• Assumptions
• Number of persons involved per surveillance site
  visit may vary
• Person to SBS kit ratio may vary (intended for
  2-person team, but more people might use one kit)
• 4-5 PPE changes per person per 8-hour day

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Forecasting Tool (under development)

• Data for Estimating Commodity Needs (Contd.)
• Routine Disinfection
• Number of planned routine disinfection activities
  per month
• Average number of SBS kits used per disinfection
  activity
• Assumptions
• Number of persons involved per disinfection
  activity may vary
• Person to SBS kit ratio may vary (intended for
  2-person team, but more people might use one kit)
• 4-5 PPE changes per person per 8-hour day
• Training
• Types of training activities planned for next 6
  months (outbreak response, surveillance,
  disinfection, etc.)
• Number of planned training activities per month
• Number of planned trainees per training activity
  per month

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Forecasting Tool (under development)
Commodity Procurement Table
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Conclusion

• USAID/API recognizes that the AIIS commodities
  must evolve to meet best practices and changing
  conditions in the field.
• USAID/API has announced new policy on laboratory
  and decontamination kits to missions.
• For those interested, recommended guidelines on
  field utilization of 3-D and SBS kits is
  available on CD.
• The AI Product Catalogue is being amended and
  will be available on the USAID Deliver TO 2
  website http//deliver.jsi.com/dhome/taskorder/toa
  vianinfluenza

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Conclusion (contd.)

• Logistics publications and tools for supply chain
  essentials, policy and advocacy, organizational
  strengthening, and monitoring and evaluation are
  available on the website
• www.deliver.jsi.com
• USAID DELIVER TO2 is in a reactive rather than
  proactive response posture for technical
  assistance and training. We can only respond to
  field requests and SOWs that have been reviewed
  and approved by USAID/API and our CTO

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Conclusion (contd.)

• As an IQC, TO2 takes direction from our USAID/API
  CTO who approves
• Changes in contents and placement of commodity
  stockpile
• All orders for commodities
• All requests for technical assistance and/or
  training
• All requests for commodities, technical
  assistance, training or other services from the
  USAID DELIVER PROJECT, TO2 should be routed
  through
• Kama Garrison, CTO, kgarrrison_at_usaid.gov
• Rob Blanchard, Technical Advisor,
  rblanchard_at_usaid.gov
• THANK YOU

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