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21 November 2019
Steven Harsono
Alexis Strader
Abstract 91: Applying Salesforce Effectiveness (SFE)
frameworks to optimize human resources for supply chain
2
Global Partnership
People That Deliver
3
The People that Deliver Initiative
Improving health outcomes by promoting sustainable workforce
excellence in health supply chain management
Creating demand for and supply of individuals with appropriate competencies for
public health supply chain management
4
The global health community has worked to address significant human resources challenges to improve healthcare supply chains. However, as the volume of health commodities moving through the global supply chain continues to increase, so too does the demand for a skilled supply chain management workforce. While there are established methods for quantifying the need for human resources capacity among health care professionals, the same kind of benchmarking does not exist for supply chain professionals.
PtD Global Standard of Supply Chain Roles & Job Descriptions
5
People that Deliver and IQVIA worked to address human resource needs and facilitate resource optimization
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
• National governments and international NGOs face complex challenges in managing health supply chains, drugs and other health supplies
• Many fail to optimize delivery to the targeted patient population – health supplies in the form of drugs and vaccines do not reach patients who need them
Human resources for supply chain
management remains a challenge
Resource optimization
Optimal healthcare workforce is
calculated considering constraints
Resource constraints
Skills, working conditions and motivation are
assessed quantitatively and qualitatively
The research is focused on quantifying the resources and
resource constraints in public health supply chain
6
Comparison of supply chain HR optimization with sales force effectiveness
A key feature of this work is the ability to translate a well-established practice in pharma to the public health supply chain
Sales force effectiveness in PharmaSupply chain HR optimization in
Public Health
Objective
• Determine target coverage and the corresponding
workload based on activities required
• Optimize headcount and geographical distribution of
sales reps to maximize coverage given resource
constraints
• Estimate headcount required to complete all tasks
• Identify the different tasks within the public health
supply chain and their respective workload
• Optimize workforce deployment to maximize output
given resource constraints
Similarity
• Similar methodology can be utilized to determine the required headcount
• Resources are geographically distributed and restricted by travel considerations
• The ultimate objective is to allocate resources to maximize the overall impact
Difference
• Resources allocated to regions with largest number
of prescribers with the highest potential sales
• Commercially incentivized: more resources will be
focused on urban areas with higher affordability
• Resources allocated to regions with highest actual
demand (population who require health products)
• Needs-based allocation: more resources should be
focused on geographies with the largest gaps
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
7
Project objectives and scope
The work aims to improve efforts to analyze workforce effectiveness in the public health supply chain
• Conduct analysis to pinpoint optimal distribution of human resources for health supply chains in selected
country or region, and potentially replicate analysis for other developing countries
• Develop a replicable methodology for the quantitative analysis of the public health supply chain workforce
– involving a structured approach to baseline data collection, segmentation, management and analysis
• Create a customized Excel tool to present results of the analysis and simulate different workforce
scenarios that can be applied to different countries
Conduct country-level, structured quantitative analysis for workforce development in the public health supply chain sector,
and develop the framework and tools to replicate analysis to other developing countries
Objective scope
Project
objective
Optimization of public
health supply chain
workforce
Quantitative and replicable
methodology development
Customized tool for
analysis
1
2
3
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
8
Opportunity identification - findings
By comparing district level LMIS data with population statistics, we can identify potential opportunities for resource reallocation
106.253.7
8.1
40.4
5.4
District
1
15.970.6 7.674.3
5.6
13.4
District
2
District 3
71.9
0.0
43.816.3
District 4
71.9
41.843.2
District 5
5.8
42.2
48.0
District 6
55.6
12.4
District 14
48.0
59.5
14.6
District 7
35.129.238.9
12.744.9
District 8
30.035.5
District 9
48.0
0.0
District 10
4.8
District 11
3.2
District
12
District 13 District 15
114.3
79.9 76.0
45.251.6 51.4
42.7 42.4
3.741.8
District 25District 17
27.8
0.024.810.7
2.2
District 16
23.4
9.5
32.8
0.0
District 18 District 26
30.9 23.3
0.0
District 27District 20District 19
26.7
5.6
District 21
25.8
0.8
24.8
0.0
District 22
24.0
28.9
41.8
20.6
District 23
2.1
District 24
17.2
24.0
16.1 16.11.8
38.5 30.922.6 20.8 18.3 17.9
Number of DPT3-vaccinated vs unvaccinated
population (<1 year old) by district
Supply Chain Workforce Effectiveness, People that Deliver and IQVIASource: LMIS and PBS
An estimated 162k children (<1 year old) did not receive
the standard DPT3 vaccination in 2017
ZZ
YY
XX
District
Number of people vaccinated
recorded in LMISVaccinated population
(<1 year old) (’000):
Gap between total population
of the district with recorded
vaccination in LMIS
Unvaccinated population
(<1 year old) (’000)
Legend
Total district population (<1 year old) (‘000)
9
Opportunity identification - findings
To effectively find solutions, various HR resourcing factors and constraints have to be considered
106.253.7
8.1
40.4
5.4
District
1
15.970.6 7.674.3
5.6
13.4
District
2
District 3
71.9
0.0
43.816.3
District 4
71.9
41.843.2
District 5
5.8
42.2
48.0
District 6
55.6
12.4
District 14
48.0
59.5
14.6
District 7
35.129.238.9
12.744.9
District 8
30.035.5
District 9
48.0
0.0
District 10
4.8
District 11
3.2
District
12
District 13 District 15
114.3
79.9 76.0
45.251.6 51.4
42.7 42.4
3.741.8
District 25District 17
27.8
0.024.810.7
2.2
District 16
23.4
9.5
32.8
0.0
District 18 District 26
30.9 23.3
0.0
District 27District 20District 19
26.7
5.6
District 21
25.8
0.8
24.8
0.0
District 22
24.0
28.9
41.8
20.6
District 23
2.1
District 24
17.2
24.0
16.1 16.11.8
38.5 30.922.6 20.8 18.3 17.9
Number of DPT3-vaccinated vs unvaccinated
population (<1 year old) by district
Supply Chain Workforce Effectiveness, People that Deliver and IQVIASource: LMIS and PBS
ZZ
YY
XX
District
Number of people vaccinated
recorded in LMISVaccinated population
(<1 year old) (’000):
Gap between total population
of the district with recorded
vaccination in LMIS
Unvaccinated population
(<1 year old) (’000)
LegendTotal district population (<1 year old) (‘000)
Supply chain staff to population ratio may be able to highlight issues related to
productivity. There may be an optimal recommended ratio, a redeployment of
existing resources, and an analysis of other performance-related issues.
Example (illustrative)
40 vaccinators covering the district
(1 staff : 3,000 population)
Example (illustrative)
23 vaccinators covering the district
(1 staff : 2,600 population)
10
Issue correlation – high correlations
Our analysis suggests that shipment volumes and health facility access are highly correlated to higher vaccination rates
Coefficient of determination4
Supply - Shipment Demand - access
Shipment Basic Health Units3
0.58 0.43
Va
cc
ina
tio
n R
ate
(%
)
y = 2.7389x + 0.6866R² = 0.5825
60%
65%
70%
75%
80%
85%
90%
95%
100%
0% 2% 4% 6% 8% 10% 12%
Shipment Index1 (%)
Va
cc
ina
tio
n R
ate
(%
)
y = 0.6021x + 0.5712R² = 0.4695
60%
65%
70%
75%
80%
85%
90%
95%
100%
10% 20% 30% 40% 50% 60% 70%
Basic Health Units Index2,3 (%)
Future analysis will need for
further understand these
issues
• Districts with higher vaccine shipment volumes
relative to the population tend to have higher
vaccination rates
• Districts with more basic health units (primary
health facility) relative to the population tend to
have higher vaccination rates
• This suggests insufficient shipments and access to
health units may be key issues limiting vaccination
rates in the state
• Note: Deep-dive analysis for each key issue will
help to understand the underlying drivers, as there
can be drivers for correlated issues, such as:
• Lack of delivery headcount
• Lack of competency to accurately forecast
demand
• Inadequate cold-chain infrastructure etc.
Key results
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
Each dot represents a single district
within the state
11
Vaccination rate by district within the state
Conversely, our analysis suggests that level of urbanization should not be considered during optimization
10 95
100
50 15 20 100
60
25
70
30
85
75
35 40
80
95
45
90
65
85 90
DPT3 Vaccination %
Urban %
DPT3 vaccination rates vs Urbanization % by district
Median district vaccination rate in state: 89%
Supply Chain Workforce Effectiveness, People that Deliver and IQVIASource: 1. LMIS, 2. PBS 1998 and 2017 Census
Size of bubble represents relative population size
Mostly rural
Mostly urban
Districts with a much higher rural population than major urban cities but they have similarly high vaccination rates
Supply Chain Roles Map – Public Health System
Highest PH Systems Organization
Intermediate PH System Organization PH Service Level – Hospital
PH Service Level – Clinic
PH Service Level –Community
Org
aniz
atio
n
Strategic Managerial Operational Tactical
Competency Level
Enable Plan
Procure
Plan
Enable
Store & Deliver
Return
Store & Deliver
Procure
Store & Deliver
Make Use
Use
Return
Use
Plan
Procure
Procure
Breakdown of SC Roles by SC Organization
SC
Organization
Strategic Managerial Operational Tactical
Plan Procurement
Procure
Enable Procurement
Deliver
Return
• Officer – Product Selection (use)
• Officer – Inventory & Demand Planning
• Officer – Supply Planning/ Supplier
Management
Manager – Procurement
Manager – Procurement • Officer – Strategic Procurement
• Officer – Tenders Management
• Officer – Receiving
• Officer – Import & Clearance Manager – Procurement
• Manager – Warehouse &
Distribution
• Manager – Customers &
Sales
• Head – Warehouse & Inventory
Management
• Head – Transport & Delivery
Management
• Head – Cold Chain Management
• Assistant – Inventory
• Assistant – Pick, Pack
• Assistant – Delivery
• Lead – Returns ManagementManager – Warehouse &
Distribution
Manager – Customers & Sales EXAMPLE
14
Team resource demands across all activities & stakeholders
In the next phases, we will size the workforce by identifying key activities and supply chain roles across associated stakeholders …
ActivitiesImport and
export regulatory
MOH Program
Delivery worker
Central warehouse
manager
Regional stock
manager / pharmacist
Pharma company
Doctors / nurses
NGOs Donors
HumanResources management
SCM and health workers training x x x x x x
ProcurementData analysis and forecasting x x
Procurement management x x x
Supply chain
Delivery from supplier to central warehouse
x x x
Warehouse stock management x
Delivery from central warehouse to regional centers
x x
Regional stock management x
Provide stock report x
Healthcare provision
Immunization and treatment x
Communication Public awareness education x x x x x
Functions VaccinationDistributionTraining MarketingProcurement
ILLUSTRATIVE
We will leverage on WISN resource optimization framework and activity insights from Namibia PtD as part of our analysis
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
15
Workload build-up sizing methodology
… and determine headcount requirements across districts using workload build-up model and various benchmarks
Estimate headcount requirements
1. Activity based workload buildup: Calculate estimated workload against
resource capacity to determine headcount requirements for each district
2. Benchmarking: Estimate required headcount using other methodologies (e.g.
benchmark against workforce deployment in districts with low vaccination gaps)
3. Final recommended headcount requirement will be triangulated and validated using
estimate derived from the various methodologies to ensure accuracy and ongoing
feasibility
Capacity Target visit capacity per month
WorkloadKey
activities
Time taken for
activities
Frequency
of activities× ×
Headcount
requirement
External insights
Market benchmarks and expert
insights such as:
• KPIs from pharmaceutical
companies, wholesalers, and
distributors
• Workforce size and productivity
Internal data
Relevant internal data such as:
• Target health facilities
• KPIs for % of facilities covered per
segment
• KPIs for visit frequency
Client workforce Required District 1 District 2 District 3
Total # staff ?? 34 40 20
# warehouse 6 10 12 6
ILLUSTRATIVE
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
16
Criteria
• Any country with an opportunity to improve health outcomes through supply chain human resources improvement
Examples, developing countries in:
• Sub-Saharan Africa
• Southeast Asia
• Latin America
• etc.
Criteria
• Any health outcome that is influenced by supply chain healthcare workers
Examples
• HIV care and treatment
• Malaria elimination
• Contraceptive access
• etc.
Applicability to other health outcomes and countries
In the next phase of the work, we will be in a position to set the parameters for an approach that can be replicated across similar countries
Country applicabilityHealth outcomes applicability
Current project scope
Insights using this approach can be developed for multiple combinations of country and health outcomes
data
Health outcomes
Higher vaccination rates
Vaccines are not reaching patients amid
failures to optimize vaccine delivery to
the targeted population
Supply Chain Workforce Effectiveness, People that Deliver and IQVIA
Please contact us for more information
Steven Harsono
Head of Public Health, Asia Pacific, IQVIA
+65 9026 3953
Alexis Strader
Project Officer, People that Deliver
+45 30 78 76 52
2019 Global Health Supply Chain Summit, Johannesburg, S. Africa
Thanks to our generous sponsors
