PMID- 34127290
OWN - NLM
STAT- MEDLINE
DCOM- 20210806
LR  - 20210806
IS  - 1873-2518 (Electronic)
IS  - 0264-410X (Print)
IS  - 0264-410X (Linking)
VI  - 39
IP  - 30
DP  - 2021 Jul 5
TI  - Optimized supply chain model reduces health system costs in DRC.
PG  - 4166-4172
LID - S0264-410X(21)00678-2 [pii]
LID - 10.1016/j.vaccine.2021.05.083 [doi]
AB  - OBJECTIVE: In 2017, an optimized immunization supply chain (iSC) model was 
      implemented in Equateur Province, Democratic Republic of the Congo. The optimized 
      model aimed to address iSC challenges and featured direct deliveries to service 
      delivery points (SDPs), longer replenishment intervals and increased cold chain 
      capacity. This assessment examines iSC costs before and 5 months after 
      implementing the optimized model. MATERIALS & METHODS: We used a nonexperimental 
      pre-post study design to compare iSC costs before and after implementation. We 
      applied an activity-based costing approach with a comparison arm to assess 
      procurement, management, storage and transportation costs for three iSC tiers: 
      Province (n = 1); Zone (n = 4) and SDP (n = 15). We included data from 3 
      treatment Zones and 11 treatment SDPs; 1 control Zone and 4 control SDPs. We used 
      sample and population data to estimate iSC costs for the entirety of Equateur 
      Province. RESULTS: In the period immediately before implementing the optimized 
      model, estimated annual iSC costs were $974,237. Following implementation, 
      estimated annual iSC costs were $642,627-a 34% ($331,610) reduction. This change 
      in costs was influenced by a 43% ($180,313) reduction in SDP costs, a 67% 
      ($198,092) reduction in Zonal costs and an 18% ($46,795) increase in Provincial 
      costs. After implementing the optimized model, average iSC costs for treatment 
      Zones was $6,895 (SD: $6,072); for the control Zone was $21,738; for treatment 
      SDPs was $989 (SD: $969); and for control SDPs was $1,356 (SD: $1,062). 
      CONCLUSIONS: We observed an absolute reduction in iSC costs in treatment Zones 
      while control Zone post-implementation iSC costs remained the same or increased. 
      The greatest cost reductions were for storage and transport at Zones and SDPs. 
      Although cost implications of this model must continue to be evaluated over time, 
      these findings are promising and will inform decisions around project expansion.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Thomas, Dorothy
AU  - Thomas D
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA.
FAU - Motomoke, Eomba
AU  - Motomoke E
AD  - VillageReach, 8b Mongala, Gombe, Kinshasa, The Democratic Republic of the Congo.
FAU - Crawford, Jessica
AU  - Crawford J
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA. Electronic 
      address: jessica.crawford@villagereach.org.
FAU - Defawe, Olivier
AU  - Defawe O
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA.
FAU - Makaya, Archimede
AU  - Makaya A
AD  - VillageReach, Av. Mundji, Mbandaka, Equateur, The Democratic Republic of the 
      Congo.
FAU - Ngwato, Jean Willy
AU  - Ngwato JW
AD  - Equateur Province Health Department, Av. Mundji, Mbandaka, Equateur, The 
      Democratic Republic of the Congo.
FAU - Bompongo, Joel
AU  - Bompongo J
AD  - John Snow, Inc, Research & Training Institute, 32 Avenue de la Justice, Gombe, 
      Kinshasa, The Democratic Republic of the Congo.
FAU - Monzembela, Jose
AU  - Monzembela J
AD  - Equateur Province Health Department, Av. Mundji, Mbandaka, Equateur, The 
      Democratic Republic of the Congo.
FAU - Ailstock, Gabriella
AU  - Ailstock G
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA.
FAU - Bancroft, Emily
AU  - Bancroft E
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA.
FAU - Magadzire, Bvudzai
AU  - Magadzire B
AD  - VillageReach, 2900 Eastlake Avenue East, Seattle, WA 98102, USA.
FAU - Baabo, Dominique
AU  - Baabo D
AD  - Projet de Developpement du Secteur de la Sante, Av. des Huileries, Gombe, 
      Kinshasa, The Democratic Republic of the Congo.
FAU - Watson, Noel
AU  - Watson N
AD  - OPS MEND LLC, 43 Riverside Avenue, Medford, MA 02155, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210612
PL  - Netherlands
TA  - Vaccine
JT  - Vaccine
JID - 8406899
SB  - IM
MH  - Democratic Republic of the Congo
MH  - Immunization
MH  - *Immunization Programs
MH  - *Refrigeration
MH  - Vaccination
PMC - PMC8256880
OTO - NOTNLM
OT  - Activity based costing
OT  - Costs
OT  - Democratic Republic of the Congo
OT  - EPI
OT  - Vaccine supply chain
COIS- Declaration of Competing Interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2021/06/16 06:00
MHDA- 2021/08/07 06:00
PMCR- 2021/07/05
CRDT- 2021/06/15 06:02
PHST- 2020/12/29 00:00 [received]
PHST- 2021/05/21 00:00 [revised]
PHST- 2021/05/24 00:00 [accepted]
PHST- 2021/06/16 06:00 [pubmed]
PHST- 2021/08/07 06:00 [medline]
PHST- 2021/06/15 06:02 [entrez]
PHST- 2021/07/05 00:00 [pmc-release]
AID - S0264-410X(21)00678-2 [pii]
AID - 10.1016/j.vaccine.2021.05.083 [doi]
PST - ppublish
SO  - Vaccine. 2021 Jul 5;39(30):4166-4172. doi: 10.1016/j.vaccine.2021.05.083. Epub 
      2021 Jun 12.