In many emerging market countries, particularly in sub-Saharan Africa, the government’s ministry of health traditionally defines how public health systems – as well as the supply chains that stock them – function for doctors, hospitals, pharmacies and patients. However, many countries are rethinking this structure, and are interested in streamlining their health supply chains to achieve better performance and cost efficiency.
Two research associates with WDI’s Healthcare Research Initiative presented preliminary findings from a project utilizing simulation software to test out supply chain designs for essential health commodities in Nigeria.
Michael Krautmann and Beatrix Balogh presented the project results at SummerCon 2016, a supply-chain-focused conference hosted by LLamasoft, an Ann Arbor-based software firm specializing in supply chain simulation and optimization. Krautmann and Balogh used software LLamasoft developed for the project, which potentially could have applications elsewhere in sub-Saharan Africa.
Watch their presentation below.
https://www.youtube.com/watch?v=EqpbxX0m0wI
The WDI project was funded by the Bill & Melinda Gates Foundation with a goal to develop tools and approaches for countries – and donor agencies supporting those countries – to help improve and facilitate the supply chain design process.
The lack of data infrastructure is among the biggest challenges emerging market supply chains face; many still operate using paper order forms, which contributes to confusion about how products flow through the system. This lack of understanding contributes to multiple health systems and funding mechanisms operating independently of one another, resulting in redundant and inefficient management processes. Subsequently, innovations, resources, and data from one group might not always get shared universally.
Few tools are available to work past these issues and give evidence-based results on how different supply chain models would affect a health system, Krautmann said. Conducting a pilot study is one possibility, but many are costly and often conditions change rapidly – nullifying most of the findings. One promising possibility is using software modeling to capture the behaviors of different supply chain structures and different supply chain channels, Krautmann said.
“Using simulation software we are able to rapidly adjust these models in an artificial environment, both to optimize and compare different designs in a particular country context, and to see how those designs respond to changes in demand and in geography,” he said.
Balogh said she and Krautmann were at a point in their work where they could present some initial analysis. While encouraged about the potential of software modeling, one challenge with any software is trying to emulate the human element present in supply chains.
“Global health supply chains involve factors in human error which leads to process variability” she said. “Most software models don’t natively account for that.”
Note: This is one in an ongoing series of articles profiling past WDI interns and Multidisciplinary Action Project (MAP) team members and their career paths. Additional profiles in the series may be found here.
On June 17th, Zara Ahmed will take a moment during her hectic day to stop and think about a young girl living in a small, rural village in southwest Cameroon. It is something she has done every June 17th since 2008 when she was a WDI summer intern working for a public health nonprofit and helped a woman give birth to a baby girl who would then be named after her.
“I think back to that day and wish her a happy birthday,” said Ahmed, now the Senior Policy Advisor for Health Systems and Sustainability for the U.S. Centers for Disease Control and Prevention (CDC) in Haiti. “I wish her a future more like my own, full of opportunity, choice, support, and love.”
Despite Ahmed’s wishes, she realizes it is likely that her namesake will have a difficult life. Baby Zara’s mother was 21 when she gave birth to her third daughter, to go along with one son. Ahmed helped clean the baby after her birth with palm oil, the only clean liquid available at the minimally-equipped, one-nurse clinic.
Baby Zara’s mom was so certain she was going to have a boy that she planned to name him after Ahmed’s brother, Zamir. When Zara was born, her mother was concerned her husband – about 20 years her senior – would not be happy with another girl, and initially ignored the newborn.
Her husband eventually visited and begrudgingly gave his approval. Baby Zara’s mother began to bond with her new daughter, but talked excitedly about giving birth next to a son.
“This experience breaks my heart every time I think of it, which is quite often,” Ahmed said. “Baby Zara was born into a family that had few resources to offer her beyond their love. She was born into a life with few prospects, will likely have little education, suffer from preventable diseases, marry early, and endure risky pregnancies and childbirth of her own.
“She will not be afforded the same privileges I have – proper nutrition, years of schooling, advanced health care, reproductive choices – unless our world dramatically changes for the better.”
Trying to make the world a better, healthier place has been Ahmed’s work since graduating from the University of Michigan in 2009 with dual master’s degrees in public policy and public health. After graduation, she spent several months in Bangladesh as a consultant with the U-M President’s Advisory Committee on Labor Standards and Human Rights looking at issues of female migrant worker rights and conditions in the factories where U-M-branded goods were produced.
While in Bangladesh, she was selected for a CDC global health fellowship. She took a position on the CDC’s Health Systems Strengthening team in Rwanda in fall 2009, and on her first day was put to work on the then re-emerging H1N1 swine flu outbreak. Two days later she was part of the group briefing the country’s Minister of Health.
She was later named Health Systems Strengthening Advisor and became a CDC contractor. After three years in Rwanda, she moved to Namibia to become the CDC Health Policy and Communications Team Lead. Two years later, she moved to Haiti and assumed her current role.
All this moving around is nothing new for Ahmed, who was born in Scotland, moved to the U.S. at age 3, went to Brown University in Rhode Island for her undergraduate studies and then to U-M. “At 31, I am currently living in my 27th house so I’ve gotten quite good at packing and moving,” she said.
She originally came to Michigan to get dual degrees in public policy and social work. But she soon realized that the intersection of public policy and public health “spoke to my real interests and passions.”
During her second year at U-M, Ahmed was looking for funding for a public health internship and talked to several friends at the Ross School of Business who spoke highly of WDI and its support for students – particularly those pursuing innovative collaborations or projects.
“From the start, the team at WDI was extremely supportive, professional, and enthusiastic,” Ahmed said. “It felt like a perfect match for me.”
Her 2008 WDI-supported internship was with a group called Peacework based in rural, southwestern Cameroon along the Nigeria border. Working through a local partner, United Action for Children, Ahmed’s primary job was to assess the local public health capacity. She used information on burden of disease, demand for services, availability of resources, and other factors to develop a plan to revitalize health clinics that had lost their funding due to donor withdrawals.
She explored several models, including community-based financing and public-private partnerships. She interviewed dozens of patients and providers, and visited approximately 20 health clinics, often walking from village to village because most of the roads were washed out. She regularly spent several days at a stretch in a single clinic, sleeping on a cot or the floor.
The daughter of a physician and a medical practice administrator, Ahmed thought she was familiar with the basics of health care financing and management going into her internship.
“The daily issues that come up when running a one- or two-person health center in a remote village are hard to imagine until you’ve seen them up close,” she said. “More than interviews with staff or reviews of facility records, simply observing the rhythms of the clinics, the comings and goings of patients and friends, the role clinics play in villages of a few hundred people, and the innovative problem-solving of the staff taught me so much about leadership, management, and resilience. Those observations provided a crash course in the business of health care at the most decentralized level where people’s critical, basic needs are met.”
Those experiences in Cameroon – coupled with Ahmed’s other international experiences at U-M in Cambodia, Bangladesh and Senegal – continue to inspire and provide guidance in her current role at the CDC. Today, she is engaged in all aspects of policy, planning, strategy, and coordination of CDC’s work in Haiti. As a result, she works closely with CDC Haiti’s management, technical, and operations teams and the organization’s headquarters in Atlanta. She also interacts with numerous U.S. government agencies, such as USAID and the Departments of State, Defense, and Treasury, and global partners such as the World Bank, World Health Organization, and the Global Fund.
Ahmed said she often reflects on “the twists and turns of fate” that got her to Haiti, including her WDI internship in Cameroon. That experience, along with the others, “grounded me in the realities of global health, policy, and development, and gave me insight into various ways of thinking about issues across cultures and professions. Those skills and experiences made me a much better candidate in the job market, as I truly grasped the challenges and opportunities facing organizations like the CDC,” she said.
Her globetrotting ways are not for everyone, she said. Living and working overseas can be lonely, isolating and exhausting. But it also can be rewarding, stimulating, and enlightening. In the end, she said, you never know if living and working abroad, with its new situations and cultures, is for you until you try it.
“When I was a student at U-M applying for internships, never could I have imagined that I would be trudging through muddy, washed-out roads in the forests along the Cameroonian-Nigerian border having just helped deliver, in a one-room health clinic, a baby named after me,” she said. “That fact alone is proof that I don’t know what’s in store for my life and career, and something that I think about to this day.”
The purpose of the Malaria Taxes and Tariffs Advocacy Project (M-TAP) was to understand the role of taxes and tariffs on price and access to anti-malarial commodities and t develop an advocacy and communication strategy. The goal was to identify and minimize the direct and indirect negative impacts of taxes and tariffs on anti-malarial commodities through targeted policy reform and advocacy.