Figures & Tables
Figures
- FIGURE 1
Commodity and Data Flow in Rwanda’s Health Supply Chain
Abbreviations: BUFMAR, Bureau des Formations Médicales Agréées du Rwanda; FDA, Food and Drug Authority; HQ, headquarters; Mediasol, Medical & Allied Service Solutions; RBC, Rwanda Biomedical Center; RMS, Rwanda Medical Supply.
- FIGURE 2
Five Guiding Principles of the Quality Management Improvement Approach
Abbreviation: QMIA, Quality Management Improvement Approach.
- FIGURE 3
Overall Quality Management Improvement Approach Key Performance Indicators at RMS Branches and SDPsa,b
Abbreviations: e-LMIS, electronic management information system; RMS, Rwanda Medical Supply; SDP, service delivery point.
aData from May 2021.
bThe indicator “Accuracy of e-LMIS consumption data” was only measured in SDPs, since RMS branches do not directly treat patients.
- FIGURE 4
Overall Quality Management Improvement Approach Key Performance Indicators By Program Using Data From RMS Branchesa,b
Abbreviations: e-LMIS, electronic management information system; RMS, Rwanda Medical Supply.
aData from May 2021.
bThe indicator “Invoice generated” was only applicable to some of the programs; for others there was no invoicing when the site visit was conducted.
- FIGURE 5
Building Blocks, Successes, and Lessons Learned: How the Quality Management Improvement Approach Contributed to Supply Chain Improvement in Rwandaa
Abbreviation: KPI, key performance indicator.
a First, the goals and success of the activity were clearly defined. Then, the strategy, data, KPIs, and visual data management were used as building blocks to promote team engagement and action to solve challenges in supply chain operation. This resulted in improved supply chain performance.
Tables
- TABLE 1.
Key Performance Indicators Measured During Quality Management Improvement Approach Supervisory Visits in Rwandaa
Indicator Name Indicator Measurement Performance Target Measured by the Indicator Product availability Is this product available at this facility on the day of visit? (Yes=1, No=0) Percentage of availability of health commodities at the facility on the day of visit. Inventory accuracy e-LMIS current stock on hand data compared to physical count. (Matching=1, Not matching=0) Percentage of products with stock accuracy on the day of visit. Order line fill rate Compare the quantity requested vs. quantity received in e-LMIS for previous month. (Matching=1, Not matching=0) Percentage of items ordered that are received to determine whether an order is filled in the correct quantities with the correct products. Expiration rate Has this product expired at this facility within the last 3 months? (Yes=1, No=0) Rate of expiration at the facility in the last 3 months. Stock according to plan Is this product stocked according to plan (minimum and maximum) on the day of visit? Product with stock levels above the established minimum level and below the established maximum level. Stock card updated Product with stock card updated with all required information at the day of visit? (Yes=1, No=0) All products managed should have an updated stock card. Data triangulation Compare the e-LMIS consumption with cases or beneficiaries in HMIS (quantities have to be entered). This is for malaria and family planning commodities only within the last month. Consumption data of ACTs recorded in e-LMIS should match with number of malaria cases recorded in HMIS. For family planning, all consumptions recorded in e-LMIS should match with the beneficiaries in HMIS. Accuracy of e-LMIS consumption data Compare the e-LMIS consumption with consumption recorded into registers during the last month. All products dispensed to patients must be recorded (this means all products dispensed to patients in each dispensing window are captured in e-LMIS). On-time delivery Was the order delivered on agreed date? Check if the promised delivery date and the shipped date matched. Applies to the last month. Percentage of all orders delivered within the agreed delivery date. Order completeness Number of orders shipped versus number of orders received during last month. Percentage of shipped orders received electronically. Invoice generated Invoice generated and received during last month. Informs if the orders are fully processed in the system and the unit prices are updated (for malaria and essential medicines). Abbreviations: ACT, artemisinin-based combination therapy; e-LMIS, electronic logistics management information system; HMIS, health management information system.
↵aThese indicators are then aggregated at district and national levels.
- TABLE 2.
Objectives, Inputs, and Outputs of Steps in the Quality Management Improvement Approach Discussion Sessions in Rwanda
Steps Objectives Inputs Outputs 1. Define the problem Understand and define the problem to be solved. Establish a goal for what needs to be achieved. Something wrong or that could be improved. A clear definition of the problem and opportunity with goals to fix it. 2. Brainstorm ideas Brainstorm some of the ways to solve the problem, aiming to create a list of possible solutions to choose from. A goal, research of the problem and possible solutions, imagination. Picklist of possible solutions that would achieve the stated goal. 3. Decide on a solution Find a solution that is effective (it will meet the goal), efficient (is affordable), and has the fewest side effects (limited consequences from implementation). Picklist of possible solutions and decision-making criteria. The decision of what solution will be implemented. 4. Implement the solution Plan and execute the implementation, often iteratively (the focus should be on short implementation cycles with testing and feedback, not trying to get it “perfect” the first time). Decision, planning, hard work. Resolution of the problems. 5. Review the results Review what worked, what did not, and what impact the solution had. It also helps to improve long-term problem-solving skills. Resolutions, results of the implementation. Insights, case studies, journal articles. Role in the QMIA Role in the Supply Chain Participants, No. Trainers Central level supervisor 10 RMS branch manager 30 Facilitators Data quality field officer 30 Trainees Hospital pharmacist 50 SDP pharmacy store manager 596 SDP data manager 580 Abbreviations: RMS, Rwanda Medical Supply; SDP, service delivery point.
