SUPPLY CHAIN REVIEW FOR READY TO USE THERAPEUTIC FOODS (RUTF) IN SUDAN

 Background

Following the 2013 National Nutrition Multisector Survey (S3M-1, 2013) that found 11 out of 18 states to have malnutrition levels above the WHO emergency thresholds, UNICEF supported the Federal Ministry of Health (FMOH) to develop and implement a three years CMAM scale up Plan (2015-2017). The scale up aimed to double treatment coverage and improve the quality of CMAM programme and coverage throughout Sudan. In the past two years the programme has supported treatment of about 400,000 children and has increased treatment coverage from 25% to 40%. The programme services are provided in 1,235 CMAM sites in 178 localities out of 189 localities 18 states in Sudan. This increase has led to rapid expansion of the volume of supplies almost overwhelming the fragile and underdeveloped warehousing and distribution systems in the country.

UNICEF in Sudan remains the main responsible body for procuring, distributing and managing the RUTF pipeline in the country with average annual procurements of around 13,500,000 USD.  FMOH has as from 2015 started contributing to the RUTF supply chain to show commitment toward implementation of the national CMAM scale up plans. However, this procurement has been done parallel to the UNICEF system. As such there are now two distribution systems that are serving the same beneficiaries. UNICEF is supporting the 18 states (supplies from local and off shore procurement, FFP/USAID in-kind donation) while FMOH largely supports 3 states with ad-hoc support to the other 15 states (supplies procured through UNICEF procurement services and the National Medical Supplies Fund). RUTF is procured both locally and off shore; local production capacity is often insufficient to meet annual demand. In 2016, $8.6 million worth of RUTF (42% locally, 58% from offshore) has been procured, comprising 46% of the country programme supply throughput, thus making RUTF the single highest value commodity procured in by the office.

UNICEF distributes the RUTF through the state ministries of health in 178 localities and 30 non-governmental organizations (NGOs) covering 86 localities.  Currently supplies distribution is centralized i.e. RUTF supplies are delivered to the states from the UNICEF central warehouse in Khartoum and also by the SAMIL for supplies procured locally from them on quarterly basis in some states and monthly in others. RUTF distribution usually starts from national level, then from state level supplies are distributed to locality levels and center levels.  At locality level the RUTF stocks are combined with WFP supplementary feeding supplies further expanding the volume of supplies for the localities and health centers to store and manage.

Warehousing capacity at state, locality and centers level has been generally weak in Sudan, this includes not only storage capacity, storage conditions but also adequately trained staff for stock management sat different levels. Quality of warehousing and supply management varies from state to state with availability of adequate storage and good warehouse management practices, and compliance to processes, being a major challenge in most of the states. Stocks in most government facilities are managed either by volunteers or by staff not trained in handling nutritional specialized products. Moreover, due to poor remuneration/incentives of the storekeepers, there is low/poor retention of competent human capacity to manage warehousing and distribution at state level in favor of NGO or private sector opportunities.  This poses a risk to the handling of supplies therein, resulting in likelihood of wastage or loss in the process of warehousing or distribution.

UNICEF has established partnership with SAMIL, a private company that also produces RUTF, to provide warehousing services in their regional warehouses in four different states in Sudan. RUTF in the majority of the states is however warehoused at state ministry of health.

 Objectives, Purpose & Expected results

The supply chain for RUTF in Sudan is fragmented and parallel, which makes it not only highly inefficient, but also costly. Following the findings and recommendations of the two reviews highlighted, and which concentrated on the lower level supply chain, UNICEF Sudan wishes to undertake a comprehensive supply chain review End to End, identify the extent to which these parallel supply chains can be integrated, while recommending solutions for the gaps identified.

The objective of this ToR is to seek for a qualified and experienced contractor to review the entire RUTF supply chain, establish inherent gaps, and recommend through an agreed implementation plan measures that can be put in place to address those gaps. Specifically, the contractor will review;

• Forecasting and quantification of RUTF need to establish how this could be effectively undertaken and with more accurate data.
• The process of supply planning given the multi-player involvement, and establish the most efficient way to compress the parallel approach into a single one.
• Warehousing and storage capacity across the supply chain, and recommend its alignment to the commodity pipeline.
• Inventory management practices currently being employed by the different players at state level, harmonize the documentation and reporting to ensure accuracies of inventory reporting among other aspects of inventory management.
• The transport and distribution capacity and how this can be optimized to ensure timely, cost effective and coordinated distribution system
• The cost and efficiency benefits of partnering with National Medical Supply Fund (NMSF) and SAMIL for the warehousing and distribution of RUTF along the supply chain.

• The magnitude of losses of RUTF within the supply chain at the state level and its causes and recommend relevant methodologies to eliminate it.
• End user monitoring practices and develop checklists and household questionnaires that could be used to account for supplies consumed at the lowest level of healthcare including the households.
• Capacity development requirements for the entire supply chain, but specifically;

• Review of existing process flows, merging where duplicative to ensure bottlenecks are eliminated.
• Facilitate and develop revised Standards Operation Procedures (SOPs) for nutrition supply chain at SMOH and Partner by clearly stipulating the roles and responsibilities of stakeholders.
• Develop a training package based on the validated SOPs, and other topics on supply chain with facilitator and participant guides and relevant handouts for reference that’s would be used improve knowledge and skills of staff at the lower levels of the supply chain.
• As part of dissemination, facilitate a ToT workshop for staff at FMOH and SMOH  on strengthening of supply management and addressing any gaps identified by the assessment, who would cascade the training down stream

The consultant is expected to develop in conjunction with other stakeholders an integration road map, with clear milestones, estimated costs, and a monitoring framework with the goal of transitioning the commodities into national supply chains.

 Description of the assignment

Under the direct supervision of the Chief of Supply and Logistics the contractor is expected to perform the following tasks:

• Develop an inception report to validate the scope and methodology to be used for the review
• Review the existing literature on RUTF supply chain in Sudan, to get insights on the landscape.
• Document the existing supply chain process flows, and validate through consultation with stakeholders.
• Develop a cost benefit matrix for comparison between the current supply chain model, and partnership with NMSF and SAMIL.
• Develop the assessment tools to be used for the review, such as assessment documents, feedback forms, etc.
• Review and incorporate findings and recommendations where necessary from the ongoing End User Monitoring and, Food safety for RUTF supply chain guidelines development assignments, and National Supply Chain Strategy, and leverage where possible.
• Facilitate the development of SOPs for RUTF supply chain for Sudan with clear roles and responsibilities, and recommend training for staff at all levels on the SOPs, and other concepts of Supply Chain Management.
• Undertake a detailed assessment of the RUTF supply chain from Forecasting and Quantification, to End User Monitoring clearly showing the gaps and providing recommendations on areas and methodologies to strengthen the supply chain.
• By working closely with UNICEF and stakeholders, review and strengthen the terms of reference for  the Logistics Technical Working Group for FMOH and SMOH (EL Fasher)
• Through consultation with FMOH, UNICEF and other stakeholders, develop a road map for implementing the operationalization of a single supply chain (led by FMOH), with clear milestones, indicators and associated costs.
• To develop a catalogue with the harmonized supply chain management documents, and facilitate their adoption and ownership by the stakeholders.
• Prepare, support, and facilitate a validation workshop for the final report with key stakeholders involved in the RUTF supply chain in Sudan.

The assignment will therefore involve but not limited to the following:

• Desk review of existing literature on RUTF supply chain in Sudan.
•  Conduct interviews by phone, skype, or face to face with a list of pre-agreed stakeholders as part of information gathering for this assignment. The consultant(s) is expected to document the interview questions (for telephone, face to face and skype), and questionnaires where email correspondences are used.
• Undertake field visits to El Fasher to document the challenges, undertake the assessments and highlight opportunities for enhancing supply chain efficiency for RUTF. This visit should include a visit to the lower level of supply handing at locality and health facility level.
•  Develop an inception report to validate the methodology and tools to be used for the review including interpretation of quantitative and qualitative feedbacks.
• Provide regular progress report, in a format that is clear, and comprehensible to the supervisor as and when required.
• Share a draft report with supervisor within the agreed timelines, and incorporate comments that stakeholders will make on the report.
• Share the final report incorporating all the comments of stakeholders as advised by the supervisor/s

 Deliverables

• Inception report with clear methodology and tools for the review.
• Progress reports on assessments (End to End Supply Chain) , findings and recommendations as and when required by the supervisor
• Cost benefit comparison matrix between current supply chain model, and partnership with National Medical Supplies Fund, and SAMIL.
• Training package for supply chain staff at the lower level, including SOPs
• Reviewed and developed Terms of Reference for  Supply Chain Technical working Group and FMOH and SMOH
• RUTF supply chain pipelines integration roadmap, with costed activities and a monitoring framework.
• Dissemination workshop of the materials
• Facilitation of a TOT workshop for the SOPs, facilitator guides and handouts for FMOH and SMOH staff.
• Final report documenting the process followed in the assessment, findings and recommendations for strengthening the supply chain in the short term (quick wins) and medium to longer term.

 Reporting requirements

• All reports and deliverables shall be required in English. Drafts will be shared with the agreed upon Expert Advisory Committee composed of UNICEF Sudan Country Office, UNICEF Regional Office and UNICEF Supply Division, with sufficient time for multiple cycles of review, feedback, and modification in order to meet the agreed upon assignment plan.

• The Report shall be delivered electronically in WORD format along with a summary in POWERPOINT format. Presentations or summaries requested for external meetings will be provided electronically in POWERPOINT format.

 Location and Duration

• This assignment entails face to face meetings with UNICEF Sudan Country Office, Federal Ministry of Heath Sudan, State Ministry of Health El Fashir- Sudan, National and International Non-governmental organizations and other stakeholders in the RUTF supply chain in Sudan. For the entire assignment period, the contractor will be expected to be located in Sudan.

• The assignment is scheduled to take an estimated 120 days. (After award of contract)

Qualification requirements

The Contractor is expected to have:

• Minimum 10 (ten) years’ experience in public health nutrition supply chain management.
• Experience in commodity tracking using data, tools, analysis, and interpretation of trends, report writing and presentations.
• Documented experience in supply chain capacity development approaches and references.
• Experience with international projects and multi-cultural environments or humanitarian experience in developing countries
• Documented experience in working with governments to transform public heath supply chains.
• Extensive knowledge and experience in nutrition programming in both development and humanitarian contexts is an asset.

Ability to communicate in local language is an added advantage.

Evaluation process and methods

The Evaluation of Humanitarian Action: Child Survival in North Darfur (2010-2015) an assignment commissioned by UNICEF highlighted key challenges the organization continues to face as the lead of cluster coordination in North Darfur. Among the key findings were; 1) exclusion of local communities with focus only on IDPs and refugees, 2) weak inter – cluster coordination, 3) Leakages of RUTF from the supply chain and 4) sustainability of interventions being undertaken. The report recommended among other things; 1) to establish the extent of the leakage through independent assessment/audit, 2) undertake supply chain strengthening , 3) develop capacity within the ministry to manage the supply chain and 4) strengthen the cluster coordination by ensuring that all players fulfil their obligations.

There has been significant efforts within the sector to address the above challenges, though a lot of ground still needs to be covered. Some of the interventions currently being/have been implemented are;

• Warehouses assessment by supply section of the country office and training of the Darfur and Kordofan state ministries of health and partners’ staff on warehousing.
• Centralized storage at state level with quarterly planning/distribution to the states.
• Supply management is now a part of the CMAM training packages.
• Close supply monitoring to avoid stock outages or over-stocking at site level
• Close monitoring of the admissions-RUTF consumption coherence and provision of quarterly feedbacks/alerts to the states with imbalance in admissions-RUTF consumption
• Improvement of warehousing conditions in some states like Blue Nile, White Nile and Kassala.
• Public private partnership with local RUTF producer (SAMIL) for warehousing in South Darfur, North Darfur, West Darfur and South Kordufan states.
• Use of electronic score card monitoring of CMAM performance including supplies management through the use of mobile phone technology.

Administrative issues

The award of the Contract will be done based on the results of the tender, and UNICEF reserves the right to enter into multiple contracts for the assignment.

Project management

The Nutrition team in the UNICEF Sudan Country Office shall manage the contract.

Payment Schedule

The payment will be in 3 installment upon completion of each work part, first installment will be 40% second installment will be 30% and final installment will be 30% 

Any other information

NA