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Archive for July, 2010

By Dr. Jarrod Goentzel

Six months after the earthquake that devastated Haiti and galvanized the international community, lessons are emerging about striking the right balance between faster and better crisis responses, and how both objectives can be met.

Last fall we began a project with Partners In Health (PIH), a Boston based NGO, to identify how the organization’s healthcare supply chain in Haiti can be scaled up. PIH is known for focusing on better, demonstrating that “allegedly untreatable” diseases can in fact be treated in impoverished settings. It is also focused on the long term by involving the community and working with the public sector to strengthen systems. While PIH had extensive experience in Haiti, having provided health care in the Central Plateau north of Port au Prince since the mid-1980s, the earthquake challenged PIH on two fronts: it was not a disaster relief organization and it had no previous operations in Port au Prince. This organization needed to become faster to meet the needs of injured Haitians by establishing mobile clinics in a city where it had no existing capacity.

Previous PIH experience did prove useful in establishing emergency health services.  According to Kathryn Kempton, Director of Procurement for PIH, “We were able to act faster because we had already tackled some parts of the ‘better’ by having a solid formulary, well trained local staff, experience with mobile clinics, and some logistics procedures in place, all in the Plateau.” Still, it was difficult to be both faster and better in setting up the supply chain to support new mobile clinics in the informal settlement camps.

The Cement Warehouse

The day we visited the new PIH warehouse in Port au Prince – an old cement warehouse converted overnight into a medical facility – it was uncomfortably warm and far too humid for effectively storing pharmaceutical products. The majority of the warehouse was well organized, with medical supplies in one room, pharmaceutical products in another, a small dispensary in the corner to effectively serve the mobile clinics, and an electronic pharmacy management system tracking the stocks. However, we did notice some expired medicines stacked against a wall next to a room of surgical equipment that no one had the skills to understand, and hundreds of water bottles piled haphazardly just outside the door.

Faster clearly ruled the choice of warehousing. It simply wasn’t an option to wait until climate-controlled and better-secured warehouse space could be found in the capital city; supplies were flooding in from around the world and they were urgently needed to treat those injured in the earthquake. The supplies reflected what was available rather than what was needed, such as equipment that was too specialized for emergency needs. PIH tried to screen every item before shipment to Haiti, but the sheer volume of donations and the need to respond quickly made this very difficult. Shifting priorities made the task even tougher. Ultimately, the faster solution was to accept everything (necessitating a large warehouse) and sort out what was useful as demand materialized. In the circumstances, opting for faster rather than better was a good tradeoff, since most of the products will be used fast enough that the shorter shelf life does not matter for current purposes. And, as the managers told us, this warehouse – with its ad-hoc inventory – is not a long-term solution: it was the best they could do on short notice.

Looking Forward

The central question now for PIH is how to transition earthquake response resources into a better long-term system for healthcare in Haiti. Though successful in meeting urgent needs, the emergency effort departed from their typical approach in scaling up operations. Kempton reflected, “Had we had tools or just some guidelines/parameters for how to set up rapid response systems that can evolve into longer-term solutions, it would have been an enormous help.”

At MIT, we are focused on developing such guidelines and tools using insights from both commercial and humanitarian supply chain methods. In a classic application of commercial supply chain methods, students modeled the PIH supply chain to show how they could scale up operations within existing facilities simply by changing ordering policies from annual to monthly or even quarterly. Another research project shows that there are insights to be gained for commercial logistics from humanitarian organizations who are experts in building supply chains quickly for emergency response. Supply chain design techniques like mathematical optimization may provide better solutions but require more data and time than are available in a disaster response. To be faster, humanitarian logisticians use their experience and intuition to make decisions. We observe decision-making during humanitarian logistics training exercises to formally document some of these heuristic approaches. We are developing tools, including a shipment planning tool for the UN World Food Programme, that should improve results by combining models that are better with intuition that is faster.

The tension between “faster” and “better” is likely to recur in the years ahead. It’s worth our while to invest in solutions now, while lessons are fresh, to enable a faster AND better response next time.

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