From Standardized to Just the Right Size: Customizing Standard Operating Procedures for NTD Supply Chain Management
July 1st, 2014
One of the best ways to become an expert in any field is to carefully learn, study, apply and adapt the successful techniques and methods of other well-known experts. This is true for individuals and large organizations, alike.
Government agencies and programs have long recognized the benefits of learning from the experts, which is why they create or adopt generic standard operating procedures (SOPs) for performing common tasks. SOPs aim to document and disseminate the most effective, efficient, practical and feasible processes and methods of performing core activities or tasks to the relevant personnel. Adopting well-tested SOPs tends to produce efficient, consistent results, which is especially important when employees work miles apart from each other. It also increases staff productivity; improves compliance with safety measures; reduces costly errors; and improves knowledge and skills transfer and thus, the continuity of programs and results over time, even for programs with high staff turnover.
Despite the high utility of SOPs, it’s very rare for an organization to be able to adopt generic SOPs as is, no matter how carefully crafted. This is especially true for complex, geographically dispersed national NTD programs, which must deliver millions of doses of various medications to tens of millions of citizens while responding to the many challenges presented by their countries’ own unique circumstances. As such, END in Africa asked its partner John Snow Inc. (JSI) to develop customized SOPs to help the national NTD programs manage their medicine supply chains in the project’s five target countries.
A Delicate Balance: Customizing SOPs for NTD Supply Chain Management (SCM)
National NTD programs use medicines somewhat differently than other national public health programs. For example, NTD medicines are handled somewhat uniquely in that they are generally dispensed during mass drug administration campaigns (MDA) rather than at routine health clinic services. In addition, leftover medicines are returned following distribution campaigns and must be accounted for and consolidated.
To ensure these differences were taken into account, JSI analyzed the findings of the supply chain management assessments that were carried out in each country, identified common themes around SCM needs, and defined the procedures that would be of greatest use to the END in Africa countries. These topics (Box 1) were selected as the foundation for the generic SOPs. Then, JSI staff adapted pre-existing SCM SOPs to the special circumstances of NTD programs and developed new content, when needed.
After the topics were identified, JSI assembled a team to create a set of SOPs that would effectively address the supply chain and drug management situations routinely encountered by NTD program staff. Consisting of a seasoned organizational development specialist with experience in curriculum and training material design, a technical adviser with NTD supply chain experience, and a program officer, the JSI team sought to develop moderately customized procedures that address the specific circumstances of each country, while still applying generally to all the national programs. The procedures also comply with generally accepted health commodity management standards, such as first-to-expire, first-out inventory control. The new SOPs gave countries the opportunity to upgrade their supply chain and drug management procedures to meet a higher standard of transparency and accountability while avoiding the lengthy redesign process, which may have disrupted ongoing mass drug administrations (MDAs).
What’s included in END in Africa’s SCM SOPs
Ten topics (Box 1) are addressed in the SOPs. For each topic, the procedures include essential actions, definitions of key terms, tips to improve performance and other content, such as a customizable diagram showing the flow of materials and information through the health system and additional resources to further assist health workers (Box 2).
Customization is Essential
While SOPs generally improve transparency and accountability in supply chain management, it’s important to customize the generic SOPs for each country, given variations among countries in policies, administrative structures, geography, climate, national drug regulations, and health system management.
While generic SOPs are of limited use when taken as is, when they are customized to take individual country realities into account, they become powerful guides for local staff and trainers, alike. The value of starting the customization process with generic SOPs is that doing so eliminates the need to redesign entire SCM systems or implement major changes. Instead, customization typically means making minor improvements and adjusting the existing system to increase its applicability and usefulness.
The SOP Adoption Process in END in Africa Countries
Country ownership being a cornerstone of the END in Africa Project, JSI is working collaboratively with each of the five country NTD programs to facilitate each country’s SOP adaptation and adoption processes, from tailoring the initial SOP customization to delivering training on the topics included within them, with the implementing partner facilitating the process with the national NTD program.
Sierra Leone’s NTD program has completed the SOP customization process and has finalized the training materials that will be used in the MDA training in August. Based on the field test in August, final changes will be made to the materials and they will be included in all future MDA trainings. Since Sierra Leone doesn’t conduct combined NTD treatment campaigns, the training materials used for the schistosomiasis MDA later in the year may include minor revisions.
Ghana has also completed the customization process and has added the newly customized SOPs to its existing NTD training materials. In 2013, new training materials on three priority procedures—inventory control, logistics management information system management, and handling, consolidating, and returning leftover medicine—were developed by JSI and incorporated into the existing materials. Development of additional SCM training content is on the agenda for 2014.
After translating the generic SOPs into French so they could be used in Togo and other in French-speaking END in Africa countries, a JSI technical advisor visited Togo to work with in-country parties to support the customization process and to observe training sessions in two regions. Attending these sessions enabled JSI to identify priority procedures for training material development. Following their incorporation into the generic SOPs, they will be translated into French and adapted to Togo’s specific program.
Since Niger already had SCM procedures in place prior to starting the SCM SOP customization process, JSI and the national NTD program are taking a different approach there, integrating the generic SOPs into the existing procedures and making refinements as appropriate. A French version of the SOP training materials will then be adapted for Niger’s customized procedures in order to incorporate SCM content into the existing training materials on the Niger-specific SOPs.
Burkina Faso had an initial meeting this Spring with JSI staff to initiate the process of SOP customization and training material development. The customization process has just gotten underway there.
END in Africa is continuing to work toward making customized SOPs and training materials available for MDA training and NTD programs in all five countries in 2014-15. These SOPs will not only strengthen health system staff’s capacity in supply chain management of NTD programs, they will also help them develop lasting skills that can be applied in any health promotion program, and thus benefit the health of each country’s people for a long time to come.
By Paula Nersesian, JSI Senior Public Health Specialist