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  • Sid Rupani gets animated talking about Objectives in the Immunization System at TechNet 2017

Three key takeaways from TechNet 2017 for the LLamasoft Global Impact Team

By Sid Rupani  November 22, 2017

“If we aim to keep improving, we must keep designing”

TechNet-21 is a global network of immunization professionals committed to strengthening immunization services. The TechNet Conference is held every two years to discuss the latest developments in immunization practices and policy. The 2017 event brought together 350+ attendees from October 16-20 in Cascais, Portugal to discuss the theme “Building the next generation of immunization supply chains”. I had the pleasure of representing LLamasoft at the event. Here are three key takeaways from the event for the LLamasoft Global Impact Team!

1. The immunization and public health supply chain community is now having important and fruitful conversations about developing Data Use Cultures and Data Use Capabilities. How can we extend these to think about building cultures and capabilities for Design?

The summary session at the end of the conference presented this word-cloud of participants’ key takeaways from the event.

Data and Innovation clearly stand out as the dominant themes. If we wanted to distill the discussion at the conference down to one question, “How can immunization systems make innovative use of data to improve outcomes?” would be a good effort.

One of my favorite sessions was one that had panelists from different levels of the immunization Supply Chain from Nigeria (Local Government Area level, similar to a county in the US), Kenya (County level, similar to a state in the US), and Ethiopia (National level) to present lessons on building a data use culture. The panelists skillfully explored – what are the necessary pre-requisites to build a data-use culture? What are the different levers available to build a data use culture? This insightful session got me thinking further. What do we mean by Data Use? Data, visibility, or insight only add value if they support decisions or actions. It is only through decisions and actions that value can be realized. By Data Use, we mean taking decisions or actions on the basis of data. Design is the art of selecting the right actions or making the right decision. In the public health supply chain world, we are now very rightly focusing on building cultures and capabilities for data use. I propose that if we want to realize value from usage of the data, we should also be thinking about how to build design capabilities and design cultures.

LLamasoft works with our corporate customers to help them navigate this exact question. How best can they build a design capability and culture? What roles are needed in their teams? How can they be developed? How can the teams be coached and nurtured to higher value-add areas of supply chain system design? We are eager to work with our partners to start applying our learnings from our engagements in the corporate world to public health systems.

2. To be truly effective, Immunization Supply Chain ‘System Design’ must consider all system objectives. Not just Efficiency (tightly linked with Cost), but also Availability, Potency, Risk, Coverage, and Equity.

This particular takeaway is a challenge to those of us working to provide tools to assist with immunization system design.

GAVI: the Vaccine Alliance, offers this explanation of System Design in its Supply Chain Strategy.

The immunization supply chain encompasses all the activities, tools, resources and planning necessary to ensure that vaccines stay safe and effective and reach all those who need them. This can include, for example, the cooling equipment the vaccines are stored in, the routes through which they are distributed, the data collected to track and evaluate the distribution and the people who manage the systems. Supply chain system design consists of new approaches that aim to improve supply chain performance and contribute to increasing immunization coverage. …Immunization supply chain system redesign projects…[focus] on change management.

Many of our studies have focused on potential Efficiency (Cost) improvements of specific changes to immunization systems but are speak less directly to the effect on the other objectives, which are often equally or even more important in a given context. Truly effective ‘system design’ must consider all the objectives. This is not radical statement, as tradeoffs between objectives are absolutely fundamental to design. We at LLamasoft have spent many years thinking about multi-objective optimization in corporate supply chains. For our corporate customers, we look at balancing performance on objectives such as Cost (translates to Efficiency in the vaccine supply chain context), Service Levels (translates to Availability), Quality (translates to Potency), Risk, Complexity, and Sustainability. While we have made small efforts at bringing multiple objectives into our analyses in the immunization world, we have not gone far enough. We must do better and provide guidance, particularly on the important objectives of improving Coverage, Equity, and reducing Risk.

I get animated talking about Objectives in the Immunization System

Finally, supply chain system improvements are truly powerful if they can be clearly linked to improvements in programmatic indicators, i.e. to health effects for the populations we are serving. Further developing the link between supply chain improvements and improvements in health outcomes is another area of improvement, not only for the LLamasoft Global Impact Team, but also the broader community focusing on immunization system design.

3. System design for immunization supply chains has not yet been universally embraced, but is widely recognized as powerful and is expected to continue to grow in coming years.

A few countries who have entered the space have reported positive results and are continuing to wrestle with their designs. Their positive experiences were highlighted at the event (e.g. Zambia, Pakistan). Many others are still learning about system design and what it means for them. When you really think about what system design involves, how can this pillar not grow? System design is not just limited to the traditional questions of how many cold stores are needed and how big they should be, or even should we adopt multi-stop transport loops? It is instead every “what-if?” question that one could ask to improve the immunization system and to better achieve the objectives.

Melissa West (VillageReach) and I try to emphasize the value of System Design for Immunization SCs

In an environment of rapid and significant changes to immunization systems, system design is a capability of tremendous value to countries. Nobel Prize winning economist and psychologist, Herbert Simon had a powerful and elegant definition of design. “To design is to devise courses of action aimed at changing existing situations into preferred ones.” Taking this definition to heart, it follows: If we aim to keep improving, we must keep designing.

We’re excited to design with you!