The Benin experience: How computational modeling can assist major vaccine policy changes in low and middle income countries

Abstract

While scientific studies can show the need for vaccine policy or operations changes, translating scientific findings to action is a complex process that needs to be executed appropriately for change to occur. Our Benin experience provided key steps and lessons learned to help computational modeling inform and lead to major policy change. The key steps are: engagement of Ministry of Health, identifying in-country "champions," directed and efficient data collection, defining a finite set of realistic scenarios, making the study methodology transparent, presenting the results in a clear manner, and facilitating decision-making and advocacy. Generating scientific evidence is one component of policy change. Enabling change requires orchestration of a coordinated set of steps that heavily involve key stakeholders, earn their confidence, and provide them with relevant information. Our Benin EVM+CCEM+HERMES Process led to a decision to enact major changes and could serve as a template for similar approaches in other countries.

Keywords: Benin; Computational modeling; Supply chain; Vaccine.

Figure 1. Overview of the EVM + HERMES implementation in Benin

1) The EPI department informed AMP of its immediate needs (mainly related to insufficient cold chain storage capacity throughout the country, in particular, at the central level). The Ministry of Health requested financial support to conduct the EVM assessment from the WHO Benin country office. 2) Questionnaires were pilot tested in April 2012 and revised. Prior to data collection, an AMP- and PATH-facilitated training session (2 days for the EVM questionnaire, 1 day for the HERMES questionnaire, 1 day pre-test and 1 day debrief) familiarized data collectors and supervisors with the questionnaires and Excel data entry sheets. Data was collected from selected locations, followed by data entry and review. 3) On 25July 2012, the Benin MoH convened a preliminary workshop to present results and to define the process of the supply chain optimization project. Attendees included delegates from different departments of the MoH (Essential Drugs Supply and Procurement Division, Department for the maintenance of equipment, HIV/Aids program, TB Program, EPI), PATH, VMI, AMP, WHO, UNICEF, USAID and Transaid. 4) On 20–21 September 2012, a second meeting to review the HERMES simulation experiment results ensued. Attendees included representatives from the Benin’s MoH, ANV-SSP, AMP, WHO, the HERMES Team, the Bill and Melinda Gates Foundation, PATH, Transaid, and UNICEF, among others. Following the presentation of the HERMES, CCEM and EVM assessment results, Benin’s MoH, identified strategic orientations for supply chain optimization, including redesign the vaccine supply chain as supported by HERMES simulation experiments. 5) A report is prepared and distributed to Ministry. Begin plans for implementation.

Figure 2. Graphical visualizations of HERMES Benin vaccine supply chain model

Graphical visualizations depict (a) maximum capacity utilization and (b) overall vaccine availability across storage locations and transportation routes for the current system after introduction of rotavirus vaccine in Benin. These visualizations were produced for each re-design scenario and presented to the Ministry of Health in September 2012.