Lessons Learned: Female Condom Repackaging Cuts Cost in Zimbabwe

Publication date: 2011

Lessons Learned Female Condom Repackaging Cuts Cost in Zimbabwe In three weeks, staff repackaged 1.7 million female condoms into packs of 20 pieces. By repackaging the female condoms, DTTU teams now spend less time taking inventory, loss of product has been reduced, and the inventory data are much more accurate. JULY 2011 This publication was produced for review by the U.S. Agency for International Development. It was prepared by the USAID | DELIVER PROJECT, Task Order 4. U SA ID | D EL IV ER P RO JE CT 2 01 1 Zimbabwe’’s Delivery Team Topping Up (DTTU) distributes contraceptives, test kits, antimalarial drugs, and other health products to each of the country’’s 1,600 public health facilities. DTTU is a warehouse on wheels——staff perform physical counts of all the commodities they deliver to make sure each facility is properly stocked. Because of the way the manufacturer packaged one of the system’’s 24 commodities——the female condom——DTTU staff were spending additional time to count thousands of individual pieces. This led to a significant number of stock data errors and a loss of product because recounting made the condoms dirty. Occasionally, team leaders would even skip the physical counts, relying instead on estimations. To correct these problems, the Zimbabwe National Family Planning Council, with help from the USAID | DELIVER PROJECT (the project), repackaged 1.7 million female condoms into units of 20 condoms each. Having the manufacturer package the female condoms into smaller inner units would have added 3.5 cents to the cost of each condom; by doing it locally, the project was able to cut the cost to 1.3 cents. The repackaging effort also realized cost savings by reducing the time DTTU teams spent at health facilities and reducing loss of product. This, in addition to having error-free data, made the effort well worth it. The female condoms come from the manufacturer in cartons of 1,000 pieces. During delivery runs, teams carry out physical counts at each service delivery point (SDP), counting up to 500 female condoms at each facility because the boxes contain individual pieces. The amount of stock delivered to SDPs ranges from as little as 20 pieces to as many as 12,000 pieces per delivery run. On average, a delivery team covers 100 SDPs in two to three districts during a single delivery run, which can last up to 20 working days; this means that a team visits approximately five SDPs each day. Prior to the recent repackaging, the physical counts of female condoms yielded significant errors because of the many single pieces that had to be counted. It also resulted in a significant increase in time spent at SDPs and, through the continuous handling of the pieces, some of the commodities became dirty. Dealing with the many individual female condoms meant that the delivery runs were delayed; physical counts were prone to errors; commodities ended up dirty due to increased handling and sometimes had to be discarded; and team leaders occasionally would skip the physical counts, relying instead on estimates, which compromised average monthly consumption (AMC) and stock on hand (SOH) data quality. The answer to all of these problems was to repackage the boxes of condoms so each carton would contain smaller units that could be counted easily and quickly. The cost of having the manufacturer change the way it packages the female condoms——adding 3.5 cents to each unit——spurred the project to undertake its own repackaging effort. With 40 people, it took three weeks to repackage all 1.7 million female condoms. The project procured plain, clear, low-density polyethylene (LDPE) bags to repackage the female condoms into bags of 20 pieces, so each carton of 1,000 pieces would have 50 inner bags. Because the expiration date A delivery team does a physical count of female condoms at a health facility during a delivery run. Female condoms are repackaged into packs of 20. Once repackaged, the 50 packs, totalling 1,000 pieces, are put back in the carton, and the carton is sealed with packing tape. U SA ID | D EL IV ER P RO JE CT 2 01 1 and batch number was not visible simply by looking at a piece (you have to open a sleeve to see these details), the project printed labels for each inner bag showing the product name, expiration date, and batch number. The large-size labels, placed inside the plastic bags, were clearly visible to the user. Once repackaged into units of 20, with labels in place, the plastic bags were tied and returned to the carton, and the carton was sealed with packing tape. At the end of the process, each carton still had 1,000 pieces, but this time in bags of 20 each. For quality control, cartons “The repackaged female were sampled during the condoms are helping a lot,repackaging process. In especially when it comes toaddition, each staff member had to note his or her initials discreetly physical counts. It is smarton the corner of the carton. This would ensure accountability in because there is no handlingcase an SDP or a delivery team received feedback that a certain carton did not contain the right amount of product——an effective of the actual pieces. The incentive for staff to perform well. It would also serve as a program should be performance measure for managers to assess whether to hire a continued.” certain worker in the future. Each staff member repackaged three —Sister Chiunye, Mashonaland cartons a day, totaling 3,000 pieces. Central Province Repackaging 1.7 million female condoms into units of 20 required 85,000 plastic bags and labels. Each bag cost U.S.$0.015, for a total of U.S.$1,275, and the total cost of the labels was approximately U.S.$8,500. Wages for the 40 staff who carried out the repackaging came to U.S.$12,000, bringing the cost of the entire effort to about U.S.$21,775——approximately U.S.$0.01280 for each female condom. This was the first time the program undertook such a repackaging exercise, so there may well be room for reducing costs further by looking at quantity discounts and increasing the number of pieces that can be packed in a day. DTTU deliveries are done every quarter, and by repackaging the female condoms, it is possible for each of the 13 teams to save about three days of delivery time in a year. With per diem, fuel, and vehicle wear and U SA ID | D EL IV ER P RO JE CT 2 01 1 tear, this translates into approximately U.S.$10,000 in savings. If we consider the benefits of having error- free data for quantification, reduced loss of product due to zero handling, better ability to practice first-to- expire-first-out rule (FEFO) with more clearly labeled products, and increased motivation for team leaders when doing physical counts for all commodities, the repackaging benefits far outweigh the cost of maintaining the status quo. The female condom repackaging effort reduced the time team leaders spent at an SDP during a delivery run, increased the accuracy of stock counts and AMC calculations, made it easier for health facilities to practice FEFO in dispensing female condoms, eliminated repeated handling of pieces, and helped motivate team leaders to do complete physical counts. It also increased the accuracy of data collected for female condoms and was a successful and cost-effective alternative to asking the manufacturer to repackage the product. With the low cost and demonstrable advantages of this intervention, the project recommends that repackaging female condoms continue in the future. The USAID | DELIVER PROJECT, Task Order 4, is funded by the U.S. Agency for International Development, and implemented by John Snow, Inc. The project improves essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operations, and enhancing forecasting and procurement planning. The project also encourages policymakers and donors to support logistics as a critical factor in the overall success of their health care mandates. The authors’ views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government. USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: askdeliver@jsi.com Internet: deliver.jsi.com

View the publication