Procurement and ordering

Background

The following aspects of the procurement cycle will be discussed:

  1. Inventory of the need for (specific) DATs

  2. Sourcing, price and terms

  3. Manufacturing and delivery

Quality control is an important aspect of the procurement cycle and will be discussed integrally in this section. There is currently no global structure in place that facilitated the procurement and ordering process for DATs. Procurement and ordering is usually directly through the manufacturer of the DAT.

The Unitaid funded ASCENT project is working on the development of a platform in support of the procurement cycle for DATs and to bring demand and supply together.

Goals

  • Understand the procurement cycle for DATs

  • Understand the quality control cycle of procurement of commodities

  • Understand the considerations to take into account when forecasting order quantities

 

 

Inventory items per DAT solution

This section will focus mainly on the overall questions that needs to be answered to get a clear overview of the number of DAT’s needed, selection of vendors and quality control mechanism. However it is good to realize that different DAT solution require different items that need to be procured:

EMM sleeves: Paper sleeves, Toll-free phone lines (hosted or portable), SMS shortcode or USSD infrastructure; Inbound phonecalls, SMS’s or USSD interactions.

EMM boxes: EMM module, battery, magnet, container, (USB) charger and cable, SiIM card, SIM (re)activation, mobile data.

VOT: Server (on-premise or cloud-based), mobile devices, mobile data.

Adherence platform: Server (on-premise or cloud-based), licenses, outbound SMS’s, mobile data.

The required items are outlined in more detail in the https://kncvtbc.atlassian.net/wiki/spaces/ADHERENCE/pages/290816001 section.


1. Inventory of the need for (specific) DATs

This is arguably the most important part of the procurement cycle and there are several aspects to be considered. The main questions is “what quantity per DAT do you need at a given moment in time?” The answer is probably not straight forward as there are several setting specific variables to this equation.

Question

Consideration

Question

Consideration

How many patients are (expected to be) enrolled on treatment in a given period?

Is procurement for a specific (pilot) project with a set number of patients to be enrolled on DAT or for programmatic implementation? If you know the number of patient to be enrolled in a project, procurement can be done very accurately. For programmatic implementation a continues supply of DATs is required. Consider potential scale-up scenarios over time.

What percentage of patients are (expected to be) able to use the DAT?

Consider inclusion and exclusion criteria such as the availability of a phone on a daily basis for EMM sleeves or internet accessibility for VOT and real-time EMM boxes, but also technology literacy or age.

What is the attrition rate over time, both for continuation of treatment and use of the DAT?

This might vary a lot per patient population. Is there stratified data available per patient subgroups? DRTB/DSTB, urban/rural, etc

What is the re-use rate of certain components of the DAT?

This is specifically applicable for certain components of the EMM boxes. Usually the EMM module, battery, magnets and SIM cards can be re-used several times. Other components such as the box itself might not be reused at all.

What buffer stock is required and at what level?

Consider national guidelines on commodity buffers at certain level at the health system. Overstocking might not be as much of an issue as most DAT don't have an expiration date. however stock outs can have a direct impact on the provision of treatment to the patient.

Can patients switch between DATs over the course of treatment? and what is the percentage that switches per DAT over time?

Consider if patient will have the option to choose which DAT to start with and if it is possible to change between DATs, either initiated by the health care worker or the patient.

How will storage of inventory be organised?

In case of on-premise hardware, the location where the hardware is placed are an important considerations in terms of security and physical accessibility by IT staff. Some DAT components such as sleeves and containers can require considerable physical space when used at large scale. Other storage condition such as humidity or temperature are also to be considered.


2. Sourcing, price and terms

Once you know the number of DATs you will order, you have to determine where to source the DATs from. Consider the following questions related to sourcing.

Questions

Considerations

Questions

Considerations

Which vendors/manufacturers are available?

The market is always in development and new manufacturers can enter the market at any moment in time. Besides that, there might very well be (local) companies that can produce certain DATs components even though they are not manufacturing these components currently. especially paper and cardboard parts can often be produced locally.

Are there restrictions for selecting a vendor/manufacturer?

Is there a national policy that restrict doing business with certain companies or certain countries?

What is the price per DAT component?

Obviously the price per DAT is important. Is there a minimum order quantity? and is there a discount at certain quantities? Does the price get influenced when ordering multiple components from the same vendor? What are the shipping costs?

What is the quality of the DATs?

This might be easier to determine for one DAT component then another. Getting samples to check the quality is important before placing an order. Examples of quality control processes are described in the section below.

What are the terms or conditions of a vendor/manufacturer?

this can be very specific and needs to be assessed on a vendor per vendor basis. Lead times and warranties are important condition to take into account.


3. Manufacturing and delivery

Once a manufacturer is selected and a order is placed, we move into the next phase: Manufacturing and delivery of the order. As part of the terms and conditions of the order, the lead time should be clear. If the component needs to be manufactured or assembled before shipment, the lead time will usually be longer then when buying a product from shelf. Also make sure to factor in the customization and design as part of the lead time. The quality control processes is important during this phase. It might require back and forth communication and testing of samples before the design is finalized. You can find a template of a quality control protocol for EMM sleeves in the tools and resources section below.

 

Local procurement of EMM boxes in Ukraine

With support of PATH, the NTP of Ukraine has been implementing a demonstration project on the use of EMM boxes for DSTB and DRTB patients. From the start an inventory has been made to determine which components should be procured globally and what can be procured in-country. A local manufacturer was quickly found and after testing of samples it was decided to procure the EMM cardboard boxes and magnets in-country from the start of the project.

  • Assemble and test DATs protocols PATH

Country example: 99dots portable phonelines in Tanzania

  • 99dots enveloppes procurement issues with changing FDC blisterpack size and design. how to properly forecast?

SMS shortcodes in the Philippines

  • 99dots enveloppes procurement issues with changing FDC blisterpack size and design. how to properly forecast?

EMM sleeves patient interaction procurement

There are 3 options for patients to record dosing information that are discussed: (missed) phone call, SMS or USSD. These option all require a different infrastructure setup. For phone calls and SMS there are two options: nationally hosted toll-free phonelines / SMS shortcodes or a portable setup. for more info on how the different options work, have a look at the https://kncvtbc.atlassian.net/wiki/spaces/ADHERENCE/pages/240648193 section.

To decide what options to choose, you have to consider the availability and costs of infrastructure and the preference and acceptability for patients. For more information on the costs for the different options see the https://kncvtbc.atlassian.net/wiki/spaces/ADHERENCE/pages/290816001 section.

National hosted toll-free phone lines / SMS short codes

This requires a contract with a telecom provider. Consider the network coverage and the accessibility from different providers. To ensure accessibility of the services, making sure that there are no costs for the patients in using these services is a must. Under the tools end resources section of this page, you can find a checklist that can be used when selecting a telecom provider.

Portable setup

An alternative is to make use of a portable setup, where instead of hosted phonelines / SMS shortcodes mobile devices are configured to be at the receiving end. Applications like Tasker can intercept phonecalls and SMS and send data to the adherence platform. This requires procurement of mobile devices, sim cards and data plans. To ensure accessibility of the services, making sure that there are no costs for the patients in using these services is a must. Where national phone lines can usually be accessed by all mobile carriers in a country, pay close attention to this aspect when considering the portable setup as this is not the often the case.

Because the phone numbers, SMS shortcodes or USSD instruction need to be printed on the sleeves, procurement has to be done after the final design of the sleeves is made.


Tools and resources

  File Modified

Microsoft Word Document Template QA SOP DAT sleeves.docx

Sep 25, 2019 by Job van Rest

Microsoft Word Document 99DOTS Envelopes Printing Facility Assessment.docx

Oct 24, 2019 by Rachel Powers

Microsoft Word Document Guidelines for 99DOTS telecom implementation_updated 7 Nov 2019.docx

Nov 07, 2019 by Rachel Powers