Description: Welcome to the expanded consultation on technical assistance and health supply chains. UNICEF and global partners have been working on developing an approach that can drive collective alignment towards a country-owned, sustainable model of technical assistance (TA) using a continuous improvement approach. The COVID-19 pandemic has made evident the need to move from internationally dependent TA towards a continuous and sustainable capacity development approach. The increasing complexities of the supply chains merit more distributed TA models that can be implemented by a network of national institutions, such as, government agencies, academic institutions, vocational training centers, private companies and NGOs.
This discussion focuses on capacity development challenges that are being faced by the health and immunization supply chain workforce, especially at sub-national levels. Taking into consideration parameters such as equity and gender, please reflect on the following questions:
1. How are the current TA approaches meeting the needs of the health supply chain workforce? What works in your context?
2. Can you suggest how TA could be better delivered, especially at sub-national levels?
Discussion Moderators: Dr. Arletty Pinel is the moderator for this expanded global consultation on Technical Assistance and Health Supply Chains. Throughout his career in global health, he have been passionate about capacity development. As the lead UNICEF consultant who, with input from global partners (e.g., GAVI, The Global Fund, USAID, WHO, INGOs), has been developing the novel framework, he believes this topic is not just timely, but instrumental to infuse new perspectives into the current global strategies that are under development.
We appreciate all the contributors to this discussion thus far and have provided a few quotes below.
“In meeting the needs of the health supply workforce, countries and partners are always torn between making quick fixes and driving sustainable approaches. It’s a thin line between addressing apparent needs and having enough time to entrench the knowledge, expertise within the local systems.
We are constantly battling with driving quick fix TA solutions like in-service training, supportive supervision, secondments, dependence on externally-driven modalities as opposed to sustainable TA approaches like institutional capacity building, public-private partnerships, pre-service education. Not that quick fixes are not good in itself, the challenge is that despite huge investments, we see little results with limited skills transfer that we hope for in the long run.
At sub-national level (states, provinces, district), we realize that the majority of the health workforce are products of local institutions employed to support the health supply chain system. TA modalities have primarily been a mix of supportive supervision, guidance (job aids, SOPs), short-term trainings, job shadowing, expert support (consultancies) etc. A critical question is if they are driven by local systems and institutions. The expected skills transfer is often hamper by challenging environments from heavy workload, staff attrition, poor remuneration, and not an apparent lack of capacity, which leads to internal brain drain.
In cases where local TA has been sustained, it starts with country ownership of the process through local institutions. Away from dependence only on MOH and government agencies, local institutions like higher institutions like health colleges, local private organizations and local NGOs have driven context-specific TA solutions that address the needs of the SC workforce. It is high time we moved from looking to government to do everything and empower governments to identify local TA providers and plan with them to define context-specific TA solutions for the health supply chain systems. Where are the local TA service providers?
Governments cannot do it all; we have to adopt a multi-sectoral approach that is locally-owned and driven to meet the needs of the health supply chain workforce. Every actor must take the stage within the ecosystem.”
“In my view, the question is really how TA can make supply chains more people-centered (rather than health worker centered) and then provide the relevant TA needed to the workforce.
Some of the challenges that we see in supply chains are:
– weak health worker motivations
– insufficient health workforce
– HCWs at service delivery points not regularly training in iSC and logistics
– siloed health programs resulting in multiple trips for service delivery HCWs for resupply
– lack of transport for HCWs at service delivery points, making them use their own personal funds”