A diary from the frontline
It’s July 2015 and I am sitting in a Cessna caravan plane 5Y- ZBX, flying to Bentiu in the north of South Sudan along with a bunch of supplies like medicines, mosquito nets and food for the project. Looking out of the window, I see the beautiful lush green South Sudan below me. It looks so peaceful from up here.
I remember the last time I sat in this plane, the same seat but a very different flight. We had to frantically drive four Land Cruisers from our compound to the air strip in Leer after our team experienced an armed robbery. I remember the urgency, the smell of fear and tension in the air. But as a logistician and a humanitarian aid worker, I had to tell myself these things happen and I have to crack on with my work. I coordinated the landing of two Cessna caravans and carry out the evacuation of our international staff that day.
And suddenly the scene through the window changed. I could see a massive camp for people who’ve been internally displaced, one of the biggest in the world. It brought me right back to the present.
This time I was going to be a supply logistician in Bentiu. I can see that the monsoon is setting in and see the camp is flooded. I can see the Médecins Sans Frontières (MSF) hospital, the office and accommodation compound. We touchdown on a very familiar red dusty air strip. Welcome to Bentiu.
An exhausted, but very friendly, expat and South Sudanese driver great me. I was evacuated with the driver last time I was here in Bentiu. I'm extremely happy to see this man alive and we both hug each other so tight, knowing exactly how happy we are to realise that we both are alive and healthy.
After a three day handover from the current Supply Logistics Manager we say goodbye to each other. I'm scared, excited, confident and doubtful if I can pull this off all at the same time.
In the first meeting with my supply team I get a feeling that these guys are brilliant, amazing human beings. I'm happy this is my work force.
I’m informed that the size of the camp has increased rapidly in the last three weeks. There’s now more than 100,000 people in the camp and every organisation present is overwhelmed. The MSF team had to prepare for a big expansion of the hospital and it had to be quick. My time in South Sudan was going to be hectic, extremely wet and very challenging.
To help with this expansion my first job was to find a new location for our central pharmacy (currently housed within the medical warehouse) and it had to be done asap. This wasn’t going to be easy because space was a huge constraint in the compound and the famous black cotton soil of South Sudan as well as the fact it was monsoon season added to the complexities of making this possible.
It seemed to me that organising the storage spaces wasn’t a big priority for many but I knew this was going to be absolutely essential for us to have a strong foundation from which to deliver medical supplies to the teams.
Malaria is peaking in the camp. There are patients flocking in to the hospital. I need to be able to deliver all the medical and logistical items that are needed and I need to do it now.
I asked the construction logistician whether it would be possible to erect the Central Pharmacy in a day. He was leaving the project the day after tomorrow to set up an inflatable maternity ward in another neighbouring project. Luckily the material for a prefabricated container and the air-conditioner were just lying amongst all the other logistical items and he got straight to work setting it up. But unfortunately the Central Pharmacy wasn't completed that day. The two of us woke up very early the next day and he showed me what needs to be done to finish this express project. Then he left for the airstrip.
The Central Pharmacy was finally set up with the help of some strong South Sudanese men that day. The team were excited. The relocation happened successfully. Finally for the first time in Bentiu we had a Central Pharmacy and a Medical Warehouse in 2 separate structures.
We did a similar set up to relocate the Logistical warehouse and suddenly these congested warehouses begin to look very spacious. They could now accommodate tonnes of supplies.
And this was just one of my projects. Whilst all this clean up and organisation of the warehouse and Central Pharmacy was happening, I was liaising with the supply team and flight coordinator in Loki to fly in supplies via Cessna caravans, Antonov, and cargo planes. The four and half months just flew by. It was the fastest four and half months of my life. We transported 80 tonnes of cargo in four South Sudanese monsoon months. MSF team, I'm proud to be part of you.
By Anup Ravi, Supply Logistics Manager for MSF in South Sudan
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NTT DATA Services, Remodelling Supply Chains for Resilience
Joey Dean, the man with the coolest name ever and Managing Director in the healthcare consulting practice for NTT DATA and is focused on delivering workplace transformation and enabling the future workforce for healthcare providers. Dean also leads client innovation programs to enhance service delivery and business outcomes for clients.
The pandemic has shifted priorities and created opportunities to do things differently, and companies are now looking to build more resilient supply chains, none needed more urgently than those within the healthcare system. Dean shares with us how he feels they can get there.
A Multi-Vendor Sourcing Approach
“Healthcare systems cannot afford delays in the supply chain when there are lives at stake. Healthcare procurement teams are looking at multi-vendor sourcing strategies, stockpiling more inventory, and ways to use data and AI to have a predictive view into the future and drive greater efficiency.
“The priority should be to shore up procurement channels and re-evaluate inventory management norms, i.e. stockpiling for assurance. Health systems should take the opportunity to renegotiate with their current vendors and broaden the supplier channel. Through those efforts, work with suppliers that have greater geographic diversity and transparency around manufacturing data, process, and continuity plans,” says Dean.
But here ensues the never-ending battle of domestic vs global supply chains. As I see it, domestic sourcing limits the high-risk exposure related to offshore sourcing— Canada’s issue with importing the vaccine is a good example of that. So, of course, I had to ask, for lifesaving products, is building domestic capabilities an option that is being considered?
“Domestic supply chains are sparse or have a high dependence on overseas centres for parts and raw materials. There are measures being discussed from a legislative perspective to drive more domestic sourcing, and there will need to be a concerted effort by Western countries through a mix of investments and financial incentives,” Dean explains.
Wielding Big Tech for Better Outcomes
So, that’s a long way off. In the meantime, leveraging technology is another way to mitigate the risks that lie within global supply chains while decreasing costs and improving quality. Dean expands on the potential of blockchain and AI in the industry.
“Blockchain is particularly interesting in creating more transparency and visibility across all supply chain activities. Organisations can create a decentralised record of all transactions to track assets from production to delivery or use by end-user. This increased supply chain transparency provides more visibility to both buyers and suppliers to resolve disputes and build more trusting relationships. Another benefit is that the validation of data is more efficient to prioritise time on the delivery of goods and services to reduce cost and improve quality.
“Artificial Intelligence and Machine Learning (AI/ML) is another area where there’s incredible value in processing massive amounts of data to aggregate and normalise the data to produce proactive recommendations on actions to improve the speed and cost-efficiency of the supply chain.”
Evolving Procurement Models
From asking more of suppliers to beefing up stocks, Dean believes procurement models should be remodelled to favour resilience, mitigate risk and ensure the needs of the customer are kept in view.
“The bottom line is that healthcare systems are expecting more from their suppliers. While transactional approaches focused solely on price and transactions have been the norm, collaborative relationships, where the buyer and supplier establish mutual objectives and outcomes, drives a trusting and transparent relationship. Healthcare systems are also looking to multi-vendor strategies to mitigate risk, so it is imperative for suppliers to stand out and embrace evolving procurement models.
“Healthcare systems are looking at partners that can establish domestic centres for supplies to mitigate the risks of having ‘all of their eggs’ in overseas locations. Suppliers should look to perform a strategic evaluation review that includes a distribution network analysis and distribution footprint review to understand cost, service, flexibility, and risks. Included in that strategy should be a “voice of the customer” assessment to understand current pain points and needs of customers.”
“Healthcare supply chain leaders are re-evaluating the Just In Time (JIT) model with supplies delivered on a regular basis. The approach does not require an investment in infrastructure but leaves organisations open to risk of disruption. Having domestic centres and warehousing from suppliers gives healthcare systems the ability to have inventory on hand without having to invest in their own infrastructure. Also, in the spirit of transparency, having predictive views into inventory levels can help enable better decision making from both sides.”
But, again, I had to ask, what about the risks and associated costs that come with higher inventory levels, such as expired product if there isn’t fast enough turnover, tying up cash flow, warehousing and inventory management costs?
“In the current supply chain environment, it is advisable for buyers to carry an in-house inventory on a just-in-time basis, while suppliers take a just-in-case approach, preserving capacity for surges, retaining safety stock, and building rapid replenishment channels for restock. But the risk of expired product is very real. This could be curbed with better data intelligence and improved technology that could forecast surges and predictively automate future supply needs. In this way, ordering would be more data-driven and rationalised to align with anticipated surges. Further adoption of data and intelligence and will be crucial for modernised buying in the new normal.
These are tough tasks, so I asked Dean to speak to some of the challenges. Luckily, he’s a patient guy with a lot to say.
On managing stakeholders and ensuring alignment on priorities and objectives, Dean says, “In order for managing stakeholders to stay aligned on priorities, they’ll need more transparency and collaborative win-win business relationships in which both healthcare systems and medical device manufacturers are equally committed to each other’s success. On the healthcare side, they need to understand where parts and products are manufactured to perform more predictive data and analytics for forecasting and planning efforts. And the manufacturers should offer more data transparency which will result in better planning and forecasting to navigate the ebbs and flows and enable better decision-making by healthcare systems.
Due to the sensitive nature of the information being requested, the effort to increase visibility is typically met with a lot of reluctance and push back. Dean essentially puts the onus back on suppliers to get with the times. “Traditionally, the relationships between buyers and suppliers are transactional, based only on the transaction between the two parties: what is the supplier providing, at what cost, and for what length of time. The relationship begins and ends there. The tide is shifting, and buyers expect more from their suppliers, especially given what the pandemic exposed around the fragility of the supply chain. The suppliers that get ahead of this will not only reap the benefits of improved relationships, but they will be able to take action on insights derived from greater visibility to manage risks more effectively.”
He offers a final tip. “A first step in enabling a supply chain data exchange is to make sure partners and buyers are aware of the conditions throughout the supply chain based on real-time data to enable predictive views into delays and disruptions. With well understand data sets, both parties can respond more effectively and work together when disruptions occur.”
As for where supply chain is heading, Dean says, “Moving forward, we’ll continue to see a shift toward Robotic Process Automation (RPA), Artificial Intelligence (AI), and advanced analytics to optimise the supply chain. The pandemic, as it has done in many other industries, will accelerate the move to digital, with the benefits of improving efficiency, visibility, and error rate. AI can consume enormous amounts of data to drive real-time pattern detection and mitigate risk from global disruptive events.”