On September 9th, 2013 IAPHL launched a moderated discussion for members to discuss the role of multiplicity in public health supply chains. The discussion was based on a paper that was recently published in Global Health: Science and Practice. Alan Bornbusch (USAID) and James Bates (JSI) are authors of this article, and the moderators for this discussion. The discussion focused on: defining multiplicity, sharing members’ experiences with multiplicity in their work, and taking a planned approach to multiplicity with building supply systems.
Original Message: “In our paper, we use case studies from Uganda, Bangladesh, and Chile to explore the motives for multiplicity, all of which represent forms of risk management. We caution that multiplicity has advantages and disadvantages, and can be carried to excess. We end by suggesting that we now have the measuring and modeling capabilities to better assess, design, and evaluate multiplicity as a risk management strategy and understand what prudent multiplicity might look like in one setting or another.
During this discussion, we hope to explore with you these topics:
1) Your experience with multiplicity in different country settings (whether successful or not)
2) Bringing together data when there are multiple supply chains.
3) Taking a planned approach to building multiplicity.
4) Incorporating public health impacts when evaluating multiplicity.”
“Multiplicity allows for other options to minimize risk within the supply chain; however, it must be controlled to allow for the effective use of resources to achieve the common goal of improving health outcomes. I would want to define controlled multiplicity as a situation where the multiple supply chain systems are structured for greater efficiency through coordination among players with the focus on the overall goal of improved health outcomes. Controlled multiplicity allows for better coordination and it could be a vehicle for public-private partnership (PPP) too.” Adebayo Adekola (Nigeria)
“In most commercial supply chains this is called “segmentation,” and the concept is used to recognize that products and customers have unique needs that cannot all be served through one supply chain. Typically, organizations will look at factors such as product characteristics (e.g., cold chain requirements, short expiration time, etc.), distribution channels (e.g., essential medicines through government clinics, vaccine campaigns, home delivery, etc.), and unique customer needs (e.g., need for ARV patients to receive a consistent regimen on a reliable schedule). I do like that you focus on multiplicity, or segmentation, as a risk solution. The risk is that by treating all commodities the same, you cannot meet the real requirements of the different commodities and population segments. Segmentation can be a very effective way to tailor your supply chain to the product and service needs, but we must be careful not to segment too much. It is a balancing act to be sure.” (Taylor Wilkerson, USA)
“Though I feel that there are instances of multiplicity that would not be considered segmentation (ex. instances of competition or intentional redundancy between two major supply sources), I do agree with Taylor that segmentation offers a potential approach for achieving the benefits of multiplicity as experienced by major commercial sector supply chains. This poster provides some basic steps and examples of the approach.” (Joe McCord, USA)
“It’s true that sometimes these kinds of supply chains are built completely from scratch to respond to a situation’s specific needs like an earthquake or a cholera epidemic. But just as often you will find existing supply chains that are constantly maintained at ‘ready’ status as a component of emergency preparedness plans. In this second example the mobilization of the supply chain may be ad hoc, in terms of where the product may end up going, but the front end of the supply chain itself is not.” (Chris Warren, USA)
“I have felt for years that certain international agencies have significantly oversold both the feasibility and value of achieving “integration,” which have often been over-simplified as merging all products into the management of super systems that were supposed to achieve much greater efficiency, largely through reduction of the duplications inherent in multiple supply chains. In some important cases, the preparations for integration, and the results achieved, have been so insufficient that, with the benefit of hindsight, they seem laughable. One of the factors that led Alan and I to write the paper was awareness of the difficulty of realizing benefit through over-comprehensive integration.” (James Bates, discussion moderator, USA)
“There are countries in the Latin America and Caribbean (LAC) region where multiplicity seems more like a luxury than a necessity. For example, in both Nicaragua and Costa Rica, where a traditional CMS model appears to maintain high levels of product availability and public health achievements. In these, smaller, geographically easier to navigate countries, with limited risks to delivering products, governments have determined that a lot of multiplicity may not be a requirement for reaching their health goals and best serving most of the population. In sum, a broad, rudimentary scan of LAC, suggests it’s important to consider the context, available resources, and goals of (and risks to) the public health supply chain when planning for multiplicity.” (Nadia Olson, USA)