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LOGISTICS, INFORMATION & RELIEF UNDERSTANDING THE FOUNDATION FOR COORDINATED EFFORTS IN ETHIOPIA

ETHIOPIA PROJECT GUIDEBOOK

THE UNIVERSITY OF WASHINGTON INTERDISCIPLINARY PROGRAM IN HUMANITARIAN RELIEF

DELIVER/JOHN SNOW INC.

USAID

FRITZ INSTITUTE

JUNE 2004

1 ETHIOPIA PROJECT GUIDEBOOK Table of Contents

PART 1: PROJECT OVERVIEW & DEFINITION

I. Introduction A. Overview...... 1 B. Who are we?  University of Washington Interdisciplinary Program in Humanitarian Relief...... 2  Fritz Institute………………………………………………………………………………....2  In country Partners…………………………………………………………………...………2  John Snow International / DELIVER project………………………………………………..3  USAID Ethiopia………………………………………………………………………...... …3

II. Propose & Context of Project A. Overview...... 4 B. Background: Health Sector Challenges...... 4 C. Logistics Challenges...... 5 D. Purpose of Project...... 6 E. Key Questions...... 7

III. Goals, Objectives, Success Measures A. Goals...... 8 B. Objectives...... 8 C. Success Measures...... 8

IV. Project Scope………...... ………..9

V. Work Plans A. Phase 1:...... 11 B. Phase 2:...... 12 C. Phase 3:...... 13

PART 2: ETHIOPIA BRIEFING PACKET

I. Overview of Sectors...... 14

II. Public Policy...... 15

III. Participating Organizations...... 18

IV. Logistics in Ethiopia...... 23

IV. Methodology...... 24

2 PART 1: PROJECT OVERVIEW AND DEFINITION

I. INTRODUCTION

OVERVIEW

Natural disasters and man-made crises cause untold human suffering and damage to property and infrastructure each year. Humanitarian relief and development organizations (HROs), as well as government ministries and international aid organizations, have made it their responsibility to meet the needs of these crises. This is no simple task. These agencies have to get the right assistance to the right place at the right time at the right cost. The challenges faced are many and complex:

 The nature and scope of humanitarian needs are increasing and changing rapidly,  Funding is scarce and increasingly competitive,  The stakes are high, and work is usually carried out under emergency situations with zero lead time, dangerous conditions, unreliable information, and ad hoc coordination,  Communication (with decision-makers, staff, beneficiaries, or partnering organizations) is exceptionally challenging due to lack of infrastructure, electricity, and appropriate technologies,  The ‘sector’ of humanitarian supply chain management is still in formation and not yet generally recognized beyond shipping or traditional ‘logistics’.  Interagency collaboration is just developing, and partners are also often competitors.

Given this dynamic environment, it is critical for HROs and governments to not only be effective and efficient, but also to be reflective and constantly learning from their experiences. But how specifically can humanitarian organizations increase relief efficiency and institutionalize these improvements across the sector? This project assumes that the solution begins with a better understanding of supply chain management in the humanitarian sector. We will address questions such as:

How are things currently working in this field? Where are there opportunities to strengthen the sector? Is there room for increased collaboration? What can be learned from private sector activities? What role can information technology play in this challenge?

To explore these questions in Ethiopia, a unique partnership has been formed among the University of Washington Interdisciplinary Program in Humanitarian Relief (IPHR), John Snow/Deliver, USAID and the Fritz Institute. This partnership combines organizations engaged in scholarly research, applying private-sector expertise and engaged in on-the-ground humanitarian activities. This partnership is expanding to include NGOs operating in Ethiopia and the Ethiopian Ministry of Health, with the aim of building a better understanding of health commodities logistics and potentials for collaboration.

This guidebook describes the background, purpose, scope and deliverables for the Ethiopian Logistics, Information and Relief project, including field study in Ethiopia to be conducted during the summer of 2004.

1 WHO ARE WE?

University of Washington Interdisciplinary Program in Humanitarian Relief The University of Washington has established an Interdisciplinary Program in Humanitarian Relief (IPHR). This program integrates educational (both for university students and for professionals on the job) and research components, including the support of graduate student international interns to conduct field study of humanitarian relief operations throughout the world. The IPHR was established jointly by the College of Engineering and the Daniel Evans School of Public Affairs (which houses the Marc Lindenberg Center for Humanitarian Action, International Development and Global Citizenship), but it also draws on considerable relevant strength across the university from units such as the Medical School and the School of Public Health and Community Medicine (AIDS medicines distribution programs and refugee medicine programs), Civil Engineering (water, sanitation and transportation), and the Global Trade, Transportation and Logistics Program.

The primary goals of IPHR are to (1) combine the very different perspectives of public management and engineering to teach about and do research on the faced by international relief organizations; and (2) establish an international reputation as a resource for applied knowledge at the intersection of logistics, information technology and organizational management in humanitarian relief operations.

This summer as part of research projects led by experienced faculty and in partnership with local relief agencies, teams of IPHR graduate students will be conducting field research in Kenya, Ethiopia and Mozambique. In addition to their other training, each of these research interns has just completed a new IPHR course in “Humanitarian Logistics, Electronic Information and Supporting Systems.” Next year, two additional new IPHR courses will come on line, “Managing Relief and Development” and “Humanitarian Logistics.” In addition, IPHR will be working with advisors from humanitarian relief organizations to design and deliver continuing education courses to humanitarian relief professionals.

Fritz Institute The Fritz Institute strengthens the infrastructures of humanitarian relief organizations by mobilizing logistics and technology expertise and resources from the corporate and academic communities. The Fritz Institute achieves its mission by developing solutions and convening stakeholders. Fritz’s philosophy of collaboration and http://www.fritzinstitute.org sharing knowledge is supported by a systematic process. It starts with research to identify common challenges across relief organizations. Next, academics, corporate experts and professionals from humanitarian organizations are convened to develop solutions and record what is learned. These solutions are then implemented organization-by- organization using resources from the private sector. The impacts are tracked so that both the solutions and the knowledge gained from the process are disseminated to other humanitarian organizations that might benefit. Over time this process yields a network of knowledge that contributes to the institutional memory of the humanitarian relief community.

In Country Partners The primary in-country partners for the Ethiopia project will be USAID Ethiopia, and John Snow International and their Deliver project. Many other local and international NGOs as well as governmental agencies will be involved in this project. (See list on page X.)

2  John Snow International / DELIVER Project The DELIVER project’s objective is to provide technical assistance to help clients better use logistics management information systems, streamline distribution systems, and enhance forecasting and procurement planning. The DELIVER project helps developing countries establish effective and efficient supply chains for public health and family planning programs. Their motto is No Product, No Program, and is a reminder that health programs cannot operate successfully without a continuous, reliable flow of essential commodities. Funded by the United States Agency for International Development (USAID), DELIVER develops new approaches to supply chain management that promote commodity security for contraceptives, HIV/AIDS commodities, drugs for treating sexually transmitted infections and tuberculosis, and other essential health products.

DELIVER improves health program supply chain performance by strengthening logistics management information systems; developing streamlined procurement, inventory control and distribution systems; training managers at all levels of those systems; helping governments and donors develop policies that support commodity security; and mobilizing necessary financing to procure and distribute essential health supplies. DELIVER began in 2000 as a follow-on to the Family Planning Logistics Management (FPLM) projects, which were also funded by the United States Agency for International Development and managed by JSI. DELIVER not only continues the 14-year success of FPLM in developing new approaches to contraceptive supply chain management, but also expands its reach to other essential health products, including HIV test kits, drugs for treatment of sexually transmitted infections, tuberculosis, and other infectious diseases, and other essential commodities.

 USAID Ethiopia USAID/Ethiopia is committed to addressing the fundamental challenges facing the public health sector through the Essential Services for Health in Ethiopia (ESHE II) program which concentrates on “improved family health”. The key beneficiaries are children, youth, women and men in both urban and rural areas. The program is national in scope, with particular focus in the capitol Addis Ababa, and the three most populous regions of the country: Amhara, SNNPR and Oromiya. The USAID health portfolio contributes to the Mission’s goal of reducing chronic food insecurity by improving “food utilization” through: nutrition education; immunization coverage; family planning services; and HIV/AIDS prevention, treatment and care for people living with the virus.

3 LOGISTICS, INFORMATION & RELIEF UNDERSTANDING THE FOUNDATION FOR COORDINATED EFFORTS IN ETHIOPIA

II. PURPOSE & CONTEXT OF PROJECT

Overview There are many agencies and organizations procuring, warehousing, and distributing health, family planning, and crisis-related commodities in Ethiopia through diverse and separate logistics systems. There is a need to better understand these various logistics systems, their current interrelationships, and the potential for increased efficiency, integration, and cost- effectiveness. In order to help make the supply chain more flexible and responsive to specific needs, a clearer view is needed of the logistics capabilities of the organizations involved in humanitarian efforts in Ethiopia today, including their supply chain and information infrastructures. It is also important to identify how environmental factors (e.g. geographical, political, social, economic, organizational) impact these infrastructures.

This project will obtain and synthesize in-depth knowledge of relevant systems, processes, operations, and environmental impacts for the various organizations involved in health and emergency commodities management in Ethiopia. We will capture and analyze this information with the goal of helping to improve the coordination, organization, management and integration of commodity logistics in Ethiopia.

Background: Health Sector Challenges With over 67 million people, Ethiopia is the second most populous nation in sub-Saharan Africa. By 2025, the population s expected to increase to over 115 million. While Ethiopia has reasonably good resource potential for development-agriculture, biodiversity, water resources, and minerals, it is faced with complex poverty, which is broad, deep and structural. The proportion of the population below the poverty line was 44% in the year 2000.ref? Much of this poverty stems from a severe HIV/AIDS crisis. Ethiopia is one of the nations hardest hit by the HIV/AIDS pandemic, and now reports the sixth highest number of HIV/AIDS infections in the world. By the end of 2002, a total of 1.7 million Ethiopians had died from AIDS-related causes. ref? Thus, poverty eradication, with a special emphasis on reproductive health and family planning, has been a critical development goal for the diverse organizations and agencies working to reduce poverty.

In response to this considerable need, key initiatives in the health sector include:

 HIV/AIDS prevention (among high-risk groups), care and treatment programs.  Family planning promotion and reproductive health services: maternal health and nutrition; the eradication of harmful traditional health practices such as female genital cutting; rape; abduction; unsafe abortions, and early marriage. 4  Key child survival interventions: expanded immunization programs, including polio malaria, TB and diarrheal diseases, as well as programs that offer integrated management of childhood illnesses and essential nutritional actions.  Health sector reform at the federal and regional levels: financing strategies, policy refinement and special pharmacy programs to ensure adequate drug/medical supplies.

The severity of poverty in Ethiopia, the health status of the population, and recurrent emergencies make development efforts challenging. The health and emergency response sectors continue to struggle with challenges such as high internal migration (largely due to drought), a large population of displaced people, many demobilized soldiers, low education levels, and cultural and societal barriers to reproductive education, family planning and condom use.

Family planning and reproductive health programs and initiatives have made significant progress in recent years; however many challenges still remain. Contraceptive security, which is the ability of clients to be able to choose, obtain and use quality contraceptives, remains a significant problem in Ethiopia. Studies have found that a many women would choose to limit or space births if family planning services were available. However, access to quality family planning services is limited, resulting in a 36% unmet need. ref?

Improved access to family planning services will have a major impact on maternal mortality. A recent study conducted in Addis Ababa by the Ethiopian Society of Obstetricians and Gynecologists revealed that unsafe abortion directly caused 54% of maternal deaths. Women of reproductive age (15-49) constitute 21% of the total female population. In addition almost half of the total population (44%) is under the age of 15, suggesting large numbers of individuals will be of reproductive age in the near future. A young population, combined with high fertility and low contraceptive usage not only indicates rapid population growth for at least another generation, but also implies that limited access to family planning would further exacerbate the maternal mortality in the country.

Logistics Challenges Many agencies and organizations are currently working to address Ethiopia’s health and crisis- related needs. As is typical in many countries, Ethiopia lacks a standard logistics management information system for this sector. Many diverse organizations – which include governmental agencies at the local, regional, and federal level; local and international relief and development NGOs and PVOs; as well as international donors and UN organizations – all currently manage in parallel their own systems for procuring, warehousing, and distributing health, family planning, and crisis-related commodities. The complexity and fragmentation of this system frequently results in commodities shortages and expired products at the few places where services exist. This greatly contributes to the national health sector’s inability to ensure complete and dependable supplies of health and crisis-related products and services. While the nongovernmental and private sectors have made great progress in strengthening this system, many challenges remain.

5 Purpose of Project The first step towards improving the delivery of healthcare and crisis commodities in Ethiopia is to develop a better understanding of the various logistics systems, their current interrelationships, and the potential for increased efficiency, integration, and cost-effectiveness. In order to help make the supply chain more flexible and responsive to specific needs, a clearer view is needed of the logistics capabilities of the organizations involved in humanitarian efforts in Ethiopia today. This would include an understanding of their supply chain and information infrastructures, as well as an understanding of how environmental factors (e.g. geographical, political, social, economic, organizational) impact these infrastructures.

Previous research has taken initial steps toward an increased understanding of logistics systems in Ethiopia. In December of 2003, the Deliver project (operated by John Snow International, a private consultant for USAID) conducted an assessment of transport management systems used within the Ministry of Health. The focus of this study was primarily transportation systems and the distribution of family planning and contraceptive commodities. The project scope was focused specifically on the Ministry of Health.

This project builds on this previous studies in four critical ways:

1. The project will include all health and crisis-related commodities, looking beyond family planning and reproductive health commodities; 2. The project will include two levels of commodity systems: 1) “regular” year-round efforts, and 2) “emergency” or occasional relief and resettlement efforts; 3. The project will consider all aspects of supply chain management; looking broader than transportation and distribution and including areas such as supporting information systems; 4. The project will attempt to look at the entire range of organizations and agencies involved in this sector, including governmental, nongovernmental/voluntary, and international donor agencies, as well as the interdependencies among these organizations.

Int’l Donors Government MOH – PASS UN Family Health Dept USAID (Deliver), HIV/AIDS Dept, UNFPA, UNICEF, Regional Health We will work to build a broad foundationWHO of support acrossBureaus all three sectors so as to increase the legitimacy of the project, produce a richer set of project findings and recommendations, and lay the groundwork for increased collaboration among NGOs these sectors. CORHA Pathfinder Int’l, Save the Children, World Vision, DKT, Int’l Red Cross, Africare, ADRA, Engender Health

Key Questions The primary research questions this project will address include:

6 1. How is logistics management really working among the various organizations operating in Ethiopia?

 What is the primary focus of each organization: in programming, in products, and in regional scope?  How do they actually get supplies and services out to the places in need?  Specifically, what are their regions, frequencies, products, transport, mobility, storage, infrastructure, funding, and collaborations?  What external factors influence their logistics management?

2. How could increased coordination among the various organizations and their logistics systems result in increased efficiency and cost-effectiveness?

 What cooperative efforts currently exist? How successful are they?  What are the incentives for and barriers to increased coordination?  How can potential efficiencies best be demonstrated?  Where efficiencies can be gained, how can increased coordination best be achieved?

7 III. GOALS, OBJECTIVES, SUCCESS MEASURES

Goals This project will obtain and synthesize in-depth knowledge of relevant systems, processes, operations, and environmental impacts for the various organizations involved in commodities management in Ethiopia. We will capture and analyze this information with the goal of helping to improve the coordination, organization, management and integration of commodity logistics in Ethiopia.

Objectives

1. Conduct research of the humanitarian organizations in Ethiopia (NGOs, PVOs, UN agencies), government ministries (MOH, PASS) and donors (USAID, Irish aid) to identify:  Current processes for supplier selection and management.  Processes for warehousing, inventory management, distribution and delivery.  Quantitative data relevant to aid operations, (e.g. cost, time.)  Relevant technology used to support supply chain processes.  Qualitative factors that impact aid operations (e.g. organizational and political goals.)

2. Capture the information collected in a format that can be used to help organizations that participate in delivering Ethiopian aid:  Understand the larger logistic system of which they are a part, to help them identify common issues, compatible strengths, and mutually beneficial strategies and practices; and  Benchmark and share best practices.

The overall intent of this research is to lay the groundwork that will enable organizations providing humanitarian relief in Ethiopia to identify and prepare for new ways to improve their relief supply chain systems.

Success Measures

As this project develops further, the student and work teams will determine a complete set of success measures. At this point, these measures include an increased understanding of the humanitarian logistics field and the identification of new ways to improve logistics operations of humanitarian relief organizations.

8 PROJECT SCOPE

This online evolving project guidebook (http://faculty.washington.edu/markh/TC498/Ethiopia/Ethiopia.html) has been developed through a cooperative effort of the University of Washington Interdisciplinary Program in Humanitarian Relief (IPHR), the Fritz Institute, and John Snow International/Deliver. During the summer of 2004, two IPHR graduate research interns will conduct field study in Ethiopia with the on-site support of JSI/Deliver and USAID. The results of the field study will be analyzed and presented by IPHR to all participating partners in both report and workshop presentation form. This workshop presentation will take place at the University of Washington in December 2004, and will be integrated with presentations on three complementary, concurrent projects. Two of these projects in Kenya and Mozambique also involve summer field study in Africa. The third complementary project is a background study of information technology challenges facing humanitarian relief organizations.

The Ethiopian Logistics, Information and Relief Project is progressing in three distinct phases: (1) a planning, analysis, partnering, preparation phase; (2) a data gathering/field study phase; and (3) an analysis, reporting, sharing, looking forward phase.

PHASE 1 PHASE 2 PHASE 3 Planning / Design Data Collection Analysis / Reporting

IPHR/Fritz/JSI-Deliver IPHR Interns in Ethiopia IPHR/Fritz/JSI-Deliver / with JSI-Deliver/USAID USAID/other agencies April – June July –September October – December Development of project purpose, scope, goals, Field study and data Analyze and compile key questions and collection interviews. data, draft report, share partnering. key findings. Deliverable: Deliverable: Compilation of data and Deliverable: Project Guidebook information Final report, workshop

Phase 1 This phase occurred in conjunction with an IPHR graduate seminar on humanitarian logistics, electronic information and supporting systems. After five weeks of background study, the students were divided into three teams to further develop the research projects in Ethiopia, Kenya, and Mozambique. The teams of five include a two-person intern team who were selected for the 2nd (field study) phase of the project, a team leader (not on the intern team) and other graduate students with interest and expertise relevant to the project. The course website can be viewed at http://faculty.washington.edu/markh/TC498/TC498.html. Phase 1 concluded on June 11, with each team presenting their deliverable--a "guidebook" for the project that includes information such as background on the problems to be addressed, organizations involved, and current situation; definitions of the project purposes and deliverables; methodological and logistical details. This document is the evolving version of that guidebook and will be shared with current and potential project participants to elicit comment and facilitate buy in. 9 Phase 2 The second phase occurs during the summer of 2004 and centers on the field study conducted by the research interns in Ethiopia. The field study component of the project will be approximately 2 months, tentatively from mid July to mid September. The focus of this phase is onsite analysis of logistics systems in action and interviews of organizational representatives involved in those systems. The following sections present a more complete work plan and methodology.

Phase 3 The third phase of the project will occur when the interns return from their field study. The IPHR team will take the lead in compiling results and making it available so that the Ethiopia and Fritz partners can play integral roles in analyzing and summarizing findings and drafting recommendations. This phase will culminate with a final project report and a December workshop where we share and integrate the results from the three African projects and one background study, discuss what we've learned, and, if appropriate, think about what might be done next to build on these efforts (the IPHR has funding for interns in the summer of 2005).

WORK PLANS

The following pages present a detailed work plan for each phase of the project, including purpose, timeline, strategies, and deliverables. We anticipate changes in the work plans as more details regarding the project arise and as partners contribute their comments and suggestions.

Key participants

IPHR: Mark Haselkorn, Chris Coward, Elaine Chang, Sara Ross, Dara Ayres*, Margaret Reynolds*, Jodi Charles, Cathy Loeffler, Jennifer Genung Rigg

ETHIOPIA: Jeff Sanderson and staff, John Snow International/DELIVER Mary Ann Abeyta-Behnke and Fikru Bekele,USAID Ethiopia

FRITZ: Mitsuko Mizushima

* In-country research intern

10 Phase 1

Purpose During this phase, we have developed a general understanding of humanitarian logistics systems and strategic information management, established partnership relationships, and developed the project’s purpose, scope, and methodological details. The phase occurred in conjunction with a graduate seminar on humanitarian logistics, electronic information and supporting systems. The first half of the quarter explored topics of humanitarian relief logistics and information management. The second half of the quarter was used for project teams to develop the three summer projects. The course website can be viewed at http://faculty.washington.edu/markh/TC498/TC498.html.

Key Accomplishments  Explored foundational concepts in humanitarian relief logistics and supply chain management systems;  Developed an understanding of “information ecology” and how systems thinking can be applied to humanitarian logistics management;  Developed the initial project plan;  Conducted background research to build an understanding of the project context;  Developed partnerships with in-country organizations to help tailor the project to specific needs;  Refined and disseminated project details;  Developed a guidebook to serve as a resource for the field study phase of the project, as well as to document the project purpose, goals, and objectives.

WHAT WHO WHEN DELIVERABLE Develop understanding of humanitarian IPHR April – June Guidebook logistics and information ecology. Develop research project in Ethiopia, IPHR, Fritz, April – June Project description, including purpose, objectives, and scope. JSI/Deliver, USAID Guidebook Conduct background research relevant to IPHR May – June Guidebook Ethiopia project. Develop in-country partnerships to tailor IPHR, Fritz, April – June Final project specific project focus and needs. JSI/Deliver description + Guidebook Refine and finalize project definition and IPHR, Fritz, May – July Final project logistical details. JSI/Deliver workplans Develop assessment tools to guide IPHR May—July Draft Assessment summer field study and interviews/data Survey collection. Develop guidebook to serve as field IPHR May – June Guidebook resource and project description.

11 Phase 2

Purpose During this phase we will complete field study of logistics systems and conduct a series of interviews with key stakeholders in Ethiopia to gather data and obtain information on current humanitarian relief logistics systems.

Key Objectives  Develop a list of organizations, agencies, and key stakeholders to interview;  Develop a list of logistic operations to observe and analyze;  Establish contacts and schedule meetings. Develop an interview and field study itinerary;  Refine assessment tools and survey questions to fit organizational specifics;  Conduct interviews;  Determine the most appropriate way to compile data (e.g. design database, construct model);  Compile both qualitative and quantitative data as interviews progress.

WHAT WHO WHEN DELIVERABLE Compile lists of organizations to JSI/Deliver, IPHR, June – July Complete contact interview; key locations to observe, key Fritz, USAID lists contacts, etc. Establish contacts, schedule interviews JSI/Deliver, On intern arrival in In-country and field visits. USAID, IPHR Ethiopia schedule interns Develop interview itinerary and draft JSI/Deliver, IPHR, By 3rd week in July Interview itinerary workplan for summer. USAID

Refine assessment tools and survey IPHR By 3rd week in July Interview survey questions guide and system analysis tool Conduct interviews with key stakeholders IPHR interns July – September Interview reports and organizations. Assess project progress, possible JSI/Deliver, IPHR, 2nd week in Aug. Mid-project additional interviewees. USAID, Fritz assessment Finalize most useful methods to organize IPHR, JSI/Deliver, August Data plan and compile data. Fritz Compile qualitative and quantitative data. IPHR interns September Qual./quant. data organization

LOGISTICS / SUPPORT Intern airfare, stipends, housing, in- IPHR country travel, unexpected project costs, laptops. Office space, administrative support: JSI/Deliver, USAID printing, supplies, etc. Ongoing project facilitation, conference Fritz calls, etc.

12 Phase 3

Purpose During this phase we will analyze study findings; integrate them with companion projects; articulate lessons learned, key findings and recommendations; and disseminate results to key stakeholders involved in the study.

Key Objectives  Analyze qualitative and quantitative study findings;  Complete formal data component (i.e. model or database);  Engage in dialog with key project stakeholders to explore the significance of study outcomes and articulate lessons learned;  Articulate principle findings, outcomes, and significant accomplishments;  Develop a written and visual/oral report to present key findings;  Organize workshop to present and discuss results.  Consider possible next steps to build on project results.

WHAT WHO WHEN DELIVERABLE Analyze qualitative and quantitative study IPHR, Fritz, September – Data format, findings. JSI/Deliver October interim report Discuss key finings, outcomes, and IPHR, Fritz, October Interim report lessons learn. JSI/Deliver, USAID, other in-country participants Articulate principle findings, outcomes, IPHR, Fritz, October— Interim report and significant accomplishments. JSI/Deliver November

Develop a written and visual/oral report IPHR November— Final report to capture key findings December

Hold Workshop All partners December

LOGISTICS / SUPPORT Graduate research assistant to help with IPHR statistical and qualitative analysis. Organizing, hosting workshop. IPHR

Continued project facilitation, conference Fritz calls, etc.

13 PART 2: ETHIOPIA BRIEFING PACKET

I. Overview of Sectors

Public Ethiopia has a parliamentary system of government. The Ethiopian People's Revolutionary Democratic Front (EPRDF), a coalition of parties led by the Tigray People's Liberation Front (TPLF--the guerrilla movement that led the fight against the Derg), won the elections by a landslide and now controls all but a handful of legislative seats and government positions. Meles Zenawi, a Tigrayan who is chairman of the EPRDF, is Prime Minister. The EPRDF officially favors democracy and private enterprise, but has residual control-oriented tendencies developed during the TPLF's past as a Marxist guerrilla movement.

Private Ethiopia's economic growth has surged since the downfall of the communist Derg regime in 1991, averaging 6-7% from 1993-1998. Ethiopia has maintained an average annual inflation rate below 4% during this same timeframe. Debt rescheduling agreements with Paris Club members in 1997-1998 halved Ethiopia's debt to exports and debt to GDP ratios, though they remain high, at nearly 600% and 80%, respectively. The country runs a severely negative balance of trade, however, which exceeded $550 million in 1998. Foreign exchange reserves have dropped to $500 million, equivalent to three months of import requirements. Ethiopia's main imports consist of semi-finished goods, crude petroleum and petroleum products, transport and industrial capital goods, medical and pharmaceutical products, motor vehicles, civil and military aircraft, raw materials, and agricultural machinery and equipment.

Non-Governmental Organizations The history of NGOs in Ethiopia directly correlates with the occurrence of droughts and famines during the last three decades. International NGOs began providing long-term relief services on a small scale in Ethiopia in the 1960s and increased in numbers after the famines of 1973 and l984. In the 1990s the numbers of both international and indigenous NGOs increased in response to a more stable political climate and NGO friendly environment. Today almost 90% of NGOs operating in the country are local. At this point, Ethiopia is said to have over 350 NGOs operating in the country. NGO activity in Ethiopia is very large compared to the neighboring countries of Sudan, Eritrea, Djibouti and Somalia. When compared to other countries across Africa, activity in Ethiopia is less developed. Although a large majority of the NGO sector undertakes development programs today, because of recurring drought in certain pocket areas of the country, there are NGOs which undertake relief activity alongside their development programs. A further improvement in their development work is the establishment of few advocating NGOs. Today, NGOs advocate on different policy issues that have implication on their work and/or beneficiaries.

14 II. Public Policy

Geographic, Historic, and External Factors

Basic Statistics The Federal Democratic Republic of Ethiopia, founded in 1994, is divided into nine ethnically- based regions. Ethiopia's population, mainly rural, supports a mixed farming economy and is vulnerable to famines and fluctuations in commodity prices. Less than 30% of Ethiopia's children are enrolled in primary school. A border conflict between Eritrea and Ethiopia in May 1998 rendered many people homeless. Fewer than 20% of Ethiopians live within a two-hour walk of a modern health care facility. One of the nations hardest hit by the HIV/AIDS pandemic, Ethiopia continues to fight poverty, hunger and famines. Basic facts about Ethiopia: Capital: Addis Ababa Area: 1,104.3 thousand sq. km. Population: 62.8 million (17% urban) Adult literacy: 43% male, and 32% female Per capita: US$120 Languages: Amharic, Tigrinya, Orominga, Guaraginga, Somali, Arabic, English Religion: Muslim 45%, Ethiopian Orthodox 35%, animist 12%, other 5% Life expectancy: 43 years Ethiopia is one of the poorest countries in the world, with an estimated per capita income of about $100. Recent national household surveys find 44 percent of the people live below the basic needs poverty line and indicate that improvements since 1995 have only been marginal. Non- monetary indicators of poverty are equally severe. Ethiopia has the third largest number of people living with HIV/AIDS of any country in the world, which has contributed to falling life expectancy over the past decade (in 2001, life expectancy was 42 years compared to 45 years in 1990). In 2000, only 24 percent of Ethiopians had improved access to water sources. Ethiopia is currently experiencing the effects of a severe drought, with the number of people threatened by starvation estimated at about 13 million. Given both the immediate and longer- term implications of the drought, support will be required at least until the end of 2003 and likely well into 2004. The government, working closely with the Bank and donors, is putting together plans for a "War on Hunger" coalition to scale up efforts to eradicate extreme hunger. The World Bank is providing a US$60 million grant (the Emergency Drought Recovery Project; see below) to make available quick disbursing funds to respond to the current drought and provide support to affected households and their communities to retain productive assets. The diversity of Ethiopia is apparent in the cultures, languages, and socioeconomic ranges of its 70 ethnic groups; even the geography of the country is a topographical mix. Over the past four decades, the nation has suffered a number of disasters ranging from civil war and political instability to drought and food shortages. These difficulties have led to the persistent poor health status of the population and an immense surge in the number of HIV/AIDS cases, both of which continue to pose challenges to the country’s health programs. Programs affected include those targeted to maternal and child health, family planning/reproductive health (FP/RH), and HIV/AIDS. The first family planning program in Ethiopia was initiated in 1966 through the Family Guidance Association of Ethiopia (FGAE), a nongovernmental organization (NGO) affiliated with the International Planned Parenthood Federation. Subsequently, the national population policy of 15 1992 greatly influenced implementation of FP/RH programs, and family planning is now provided through a variety of methods. Community-Based Reproductive Health (CBRH), which utilizes community members as service delivery agents, is one of these methods. Given the large unmet need for FP/RH services (according to the 2000 DHS, total unmet need is 36%), USAID and the Ministry of Health (MOH) strive to improve access to and availability of FP/RH services, especially within remote areas. Centralized health services remain inaccessible to much of the Ethiopian population, with 85% living in rural areas. Since geography is a strong barrier, community-based services represent a viable solution for reaching clients. These services aim to significantly increase the contraceptive prevalence rate within target regions. Experience in many settings has shown that CBRH services can improve access to quality services for hard-to-reach populations. The government encourages the utilization of community-based distribution (CBD) agents to provide these services. In addition to providing contraceptives, these agents provide education and referrals for clients who may need higher- level health services.

Ethiopia’s Health System

Indicator Value Source

% of population with access to health care 51.6 MOH (2001)

Total number of hospitals (including private and 115 MOH (2001) teaching hospitals)

Total number of health centers 412 MOH (2001)

Total number of health stations 2,452 MOH (2001)

Total number of health posts 1,311 MOH (2001)

Total number of hospital beds 11,710 MOH (2001)

Doctor-to-population ratio 1:36,000 MOH (2001)

Health Budget (% of total national government budget, 7.0 MOH (2001) 2001/02)

Health Expenditure per capita (US$) 1 UNECA (2001)

Ethiopia: General Health Indicators

Indicator Value Source

Infant Mortality Rate (per 1,000 live births) 97.0 DHS/CSA (2000)

Under 5 Mortality Rate (per 1,000 live births) 166.0 DHS/CSA (2000)

Maternal Mortality Ratio (per 100,000 live births) 871 DHS/CSA (2000)

16 Total Fertility Rate (Number of live births per woman 5.9 DHS/CSA (2000) during childbearing years)

Prevalence of Contraceptive Use Among Sexually 8.0 DHS/CSA (2000) Active Women of Childbearing Age (15-49)

Prevalence of Modern Contraceptive Use (%) 6.0 DHS/CSA (2000)

Prevalence of Traditional Contraceptive Use (%) 2.0 DHS/CSA (2000)

Prevalence of Malnutrition in Children Under 5 (%) 47.2 DHS/CSA (2000)

The country has a four-tier health service system: the 1st tier includes community-based health centers, each with five satellite health posts; the 2nd tier has district hospitals. Regional and central referral hospitals are the 3rd and 4th tiers respectively. Approximately 52% of the population has geographical access to primary health care service. State policies support human resource development and expansion of the health care infrastructure. According to the Ministry of Health report of 2000-2001 there are 110 hospitals, 382 health centers, 2,293 health stations and 1,023 health posts in the country. The number of health professionals was 423 Specialists, 943 General Practitioners and 7,723 Nurses. The national health budget was 4% of GDP in the year 2000, and the annual per capita health expenditure is about US$1.35 (MoH 2000-2001, Annual Report). Ethiopia is located 3' and 14.8" latitude 33' and 48' longitude in the Eastern part of Africa (Horn of Africa) bordering Somalia, the Sudan, Djibouti, Kenya and Eritrea with a total border length of 5,311 km. It is the 10th largest country in Africa. Arable land, 45%; Irrigated land, 3 %. The lowest elevation is the Danakil depression, 125 m below sea level, and the highest point is Mount Ras Dashan, 4620 m above sea level. There are 25 mountains of 4,000 meters or higher altitude.

17 III. Participating Organizations

A. PARTICIPATING ORGANIZATIONS

UNIVERSITY OF WASHINGTON http://www.washington.edu Evans School of Public Affairs Department of Technical Communication

JOHN SNOW, INC. http://www.jsi.com John Snow, Inc. (JSI) is a for-profit development organization providing management assistance, training, program design and consulting services for organizations in both the U.S. and around the world to enhance the effectiveness and quality of public health programs. JSI International works in partnership and collaborates with donor agencies, local governments, private sector firms, non-governmental and private voluntary organizations to carry out long-term multinational and country specific short-term and long-term projects. JSI focuses on a multidisciplinary, gender-sensitive development approach designed to empower countries, communities, families and individuals to advance their own skills and create lasting solutions to their priority health and development issues.

JSI/ DELIVER http://www.deliver.jsi.com This is a current JSI international project under which the UW team will be conducting the logistics system analysis in Ethiopia. This project, funded by USAID, helps countries where USAID operates to establish more effective and efficient supply chains for public health and family planning programs. DELIVER has improved health program supply chain performance by strengthening logistics management information systems; developing streamlined procurement, inventory control and distribution systems; training managers at all levels of those systems; helping governments and donors develop policies that support commodity security; and mobilizing necessary financing to procure and distribute essential health supplies.

THE FRITZ INSTITUTE http://www.fritzinstitute.org The Fritz Institute is a unique organization committed solely to strengthening the infrastructures of humanitarian relief organizations by mobilizing logistics and technology expertise and resources from the corporate and academic communities.

USAID/ ETHIOPIA http://www.usaid.gov/our_work/global_health/aids/Countries/africa/ethiopia.html USAID/Ethiopia is committed to addressing the fundamental challenges facing the public health sector through the Essential Services for Health in Ethiopia (ESHE II) program which concentrates on “improved family health”. The key beneficiaries are children, youth, women and men in both urban and rural areas. The program is national in scope, with particular focus in the capitol Addis Ababa, and the three most populous regions of the country: Amhara, SNNPR and Oromiya. The USAID health portfolio contributes to the Mission’s goal of reducing chronic food insecurity by improving “food utilization” through: nutrition education; immunization coverage; family planning services; and HIV/AIDS prevention, treatment and care for people living with the virus.

18 B. OTHER ORGANIZATIONS

ETHIOPIAN MINISTRY OF HEALTH (MOH) http://www.ethiopianembassy.org/index.shtml The Ethiopian Ministry of Health is the governmental agency, out of 18 ministries, that is responsible for dissemination of medical commodities. The Minister of Health is Dr. Kebede Tadesse.

PACT/ ETHIOPIA http://www.telecom.net.et/~pact/ http://www.pactworld.org/programs/country/ethiopia/ethiopia_ngo_sector.htm

Since 1971 Pact has been helping globally to strengthen the capacity of local organizations and leaders to meet community needs in dozens of countries in Asia, Africa and Latin America. They work with the belief that when local communities are the driving forces for their own advancement, income levels increase, education and health care improve, and democratic institutions take hold. They use grassroots participation and enterprise to help communities to combat HIV/AIDS, protect the environment, operate village banks, resolve conflicts, enhance food security, empower women, and strengthen human rights and democratic participation. Pact, a recognized leader in capacity building, and currently works with 85 local NGO partners, focusing on five sectors: health; disadvantaged youth; rural development and food security; education; and democratic practices. Pact's mission in Ethiopia is to strengthen the institutional capacity of Ethiopian NGOs. We accomplish this by building the capacity of individual NGOs to carry out effective programs, by supporting NGO umbrella and networking groups to be proactive in representing and supporting their members, and by facilitating the creation of an enabling environment in which NGOs are able to work collaboratively with government on policy and development projects. At the heart of Pact's approach is an NGO capacity building effort with three distinct elements: (1) participatory organizational capacity assessments that allow NGOs to understand their organizational and programmatic strengths and weaknesses, (2) basic training and mentoring that concentrate on key organizational structures, systems and processes for effective organizational growth and service delivery, and (3) advanced training and mentoring, increasingly in technical areas that deepen NGO impact and outreach.

WORLD HEALTH ORGANIZATION (WHO) http://www.who.int/country/eth/en/ The World Health Organization, the United Nations specialized agency for health, was established on 7 April 1948. WHO's objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health. Health is defined in WHO's Constitution as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

UNFPA http://www.unfpa.org/ United Nations Population Fund (UNFPA) is the world's largest international source of funding for population and reproductive health programs. UNFPA works with governments and non- governmental organizations in over 140 countries, at their request, and with the support of the international community. UNFPA also helps governments in the world's poorest countries, and in other countries in need, to formulate population policies and strategies in support of sustainable development. All UNFPA-funded programs promote women's equality. 19 UNICEF http://www.unicef.org/ Ethiopia is one of the countries in the world most severely-affected by HIV/AIDS: 7.3 per cent of the adult population is infected and an estimated 2.2 million people are living with HIV/AIDS, including 200,000 children. This has reduced family and community cohesion, disrupting the traditional patterns of protection and care and placing children and women at heightened risk of trauma and exploitation. The drought may accelerate the transmission of HIV/AIDS given the population movements, potential for increased sexual violence and sex work as a survival strategy. UNICEF concentrates the majority of its work in the health sector in general and in HIV/AIDS prevention.

IRISH AID http://www.iaac.ie/publications_index.html Irish Aid is the development arm of the Irish government and operates in eight countries in Sub- Saharan Africa. Assistance in Ethiopia began in 1975 and all programs are implemented at the local and district level. The focus of their aid programs there is to address basic needs in health, education, water supply, agriculture, conservation and capacity building. Their support is focused in three main areas: Sidama, in Southern Ethiopia, Eastern Tigray, in Northern Ethiopia, and Gurage. In 1998, Irish Aid provided 11.3 million pounds to Ethiopia through the Irish Aid Priority Country Program. Irish Aid is also involved in HIV/AIDS education through GOAL, a Street Children’s Program in Addis Ababa, and in Primary Health Care and Rural Development with the Kereyou People.

JAPAN INTERNATIONAL COOPERATION AGENCY (JICA) http://www.jica.org.kh/ JICA’s main objectives in Africa are support with human resources development, promotion of inter-region cooperation, aid cooperation and sectoral approaches, and promoting cooperation between Asia and Africa. One of JICA’s programs is JICA Partnership Program, JPP, which is a technical cooperation program between local agencies and JICA partners in Japan. It was implemented to contribute to the social and economic development of developing countries at the grass-roots level in collaboration with partners in Japan, such as NGOs, universities, local governments, and public interest corporations.

DEVINET (DEVELOPMENT INFORMATION NETWORK ON ETHIOPIA) http://www.devinet.org DEVINET is a joint initiative of the British Council and CRDA to address problems faced by development managers in accessing development information on Ethiopia. The first of its kind in Ethiopia, DEVINET holds and disseminates information that is crucial for decision-makers, researchers, academics and development managers and act as a gateway to development information on Ethiopia. Information about local development and the activities of other organizations can be found by going into a resource centre or contacting individuals in person or by other means who might be of use. It is also difficult to trace what is happening in one sector or who has the best experience on a certain development issue unless one goes through a network of people and finds out to his needs. Therefore, the civil society, specifically Non-Government Organizations (NGOs) and Community Based Organizations (CBOs) need to network themselves in a better way so they share best experiences one another, create partnership to achieve common goals, etc. So far, a number of partnerships, networks and discussion groups have been established to exchange information and best practices. To cite an example in the education sector is the EDGE group 20 (Education Discussion Group in Ethiopia) which meets once a month at the Ministry of Education to discuss on issues of education among stakeholders in the field. However, the information content on best practices, area of activities, information sources of these organizations have not been recorded centrally to commonly share among the groups and other stakeholders in the area. One of the developments in this area is the activities of the CRDA (Christian Relief and Development Agency). CRDA maintained a database of on-going projects, profile of its members and independent consultants. Although this has been a useful resource, it has not been fully utilized due to the fact that the databases can only be accessed in the premises of the CRDA. This network will therefore further what has been done and introduce other mechanisms of information sharing to address problems faced by development managers in accessing development information on Ethiopia.

SAVE THE CHILDREN http://www.savethechildren.org Save the Children has been active in Ethiopia since 1984. Save the Children’s programs in Ethiopia address adolescent reproductive health and child survival, HIV AIDS prevention, care, and support, basic education with a focus on girls, and food security. Programs include interventions aimed at reducing neo-natal, infant, and under-5 mortality; improving mothers' access to and use of health services; and ensuring that children who are in school remain healthy enough to stay there, and to perform well. In the HIV/AIDS program, they focus on prevention, care and support programs that address the needs of orphans and other vulnerable children, as well as high-risk groups such as transport and commercial sex workers in urban and rural areas.

INTERNATIONAL RED CROSS http://www.icrc.org/web/eng/siteeng0.nsf/html/ethiopia The ICRC has had a permanent presence in Ethiopia since 1977. It responds to needs outstanding from the 1998-2000 international armed conflict with Eritrea and arising from internal armed violence, needs which are often aggravated by poor seasonal rainfall. The ICRC works to ensure that people protected by the Geneva Conventions are treated according to the provisions thereof, and protects and assists people detained, displaced or otherwise directly affected by internal conflict and violence. It also works to improve water and sanitation systems and provide agricultural assistance in violence-prone regions.

AFRICARE http://www.africare.org/about/where-we-work/ethiopia/ Africare is the oldest and largest African-American organization assisting Africa. Current Africare Programs in Ethiopia: Africare HIV/AIDS Service CorpsAgricultural production and household nutritionChild survival Food securityPolio eradicationWater and sanitation

ADVENTIST DEVELOPMENT AND RELIEF AGENCY (ADRA) http://www.adra.org/ The Adventist Development and Relief Agency (ADRA) is an agency established for the specific purposes of community development and disaster relief. The Adventist Development and Relief Agency International (ADRA) is the worldwide humanitarian ARM of the Seventh-day Adventist Church. With operations in 120 countries, ADRA International operates in five core portfolio activities: food security, economic development, primary health, disaster response and preparedness, and basic education.

ENGENDER HEALTH http://www.engenderhealth.org/ia/cbc/ethiopia.html

21 Improving Women’s Health Worldwide. EngenderHealth has been working in Ethiopia since 1987. The program was reinaugurated in July 2001 with funding and a mandate from the David and Lucile Packard Foundation to expand method choice within five years. The sites selected include major urban centers, some semi-urban centers and rural health facilities in the Amhara and Oromia regions, and Addis Ababa, the capital. The program aims to reach more than 2 million people in order to create an awareness of and demand for other methods, such as IUDs, Norplant implants, and female and male sterilization. EngenderHealth is one of several NGOs now working with the Ethiopian government to implement its health and population policies in order to meet the critical health needs of its citizens. In January 2000, we assessed the state of long-term and permanent contraceptive services in selected areas. The assessment team visited health care sites to observe counseling sessions, surgical procedures, and the condition of facilities, equipment, and supplies. The team found that health providers emphasize curative rather than preventive care, and very few providers are trained in the delivery of long-term and permanent contraception. We also found that medical supplies and client-education materials are in short supply—especially in public facilities. After just a year of operation, contraceptive prevalence at several of the 50 pilot sites where we are working has increased to 50%, compared to the 8% national average. EngenderHealth is currently working with the Ministry of Health, the Family Guidance Association of Ethiopia, and several other NGOs to expand the coverage area of clinic-based contraceptive services to selected areas of the country. We are working to make sterilization services and contraceptive products, such as intrauterine devices (IUDs) and Norplant implants, more widely available. We are also working to expand outreach services and strengthen existing referral systems. A particular goal is to extend permanent and long-term contraceptive services to the underserved population. The EngenderHealth Program Manager, Ethiopia: Wuleta Betemariam.

WORLD VISION http://www.devinet.org/wve/ World Vision Ethiopia is a Christian Humanitarian & Development Organization involved in sustainable Community-Based Transformational Development and Emergency Relief with special focus on Children. World Vision Ethiopia (WVE) has been serving in the country since March 1975. WVE is responsive to the needs of the poorest of the poor, promoting transformational development by operating in six National Regional States (Amhara, Oromiya, Tigrai, Afar, Southern Nations Nationalities & Peoples Regional State and Addis Ababa). To accomplish its mission WVE has organized itself into a network consisting of an Advisory Council, Office of the National Director, Office of the Deputy National Director, Capacity Building Division, Grants Division, HR & Admin. Division, Finance Division, HIV/AIDS Division and three Branch Offices. Development interventions are geared towards ensuring food security at household level, concentrating on Agriculture, Primary Health Care, Gender and Development, Infrastructure, Appropriate Technology, Children's Well-being, Environmental Rehabilitation, Water Development, Basic education as well as Micronutrient and Health (MICAH) programs. Currently WVE is also working on prevention & control of HIV/AIDS. Emphasis is given to community participation and empowerment through utilization of available local resources.

PATHFINDER INTERNATIONAL http://www.pathfind.org/site/PageServer Pathfinder International works to improve the reproductive health of women, men, and adolescents throughout the developing world.

22 IV. Health Logistics / Supply Chain Management in Ethiopia

Logistics in Ethiopia

Ethiopia's surface transport infrastructure is inadequate and underdeveloped. In fact, Ethiopia has the lowest road density per capita in the world. This lack of physical infrastructure, in addition to extreme poverty and poor infrastructure in telecommunications and information technology make Ethiopia a very difficult place to distribute goods in a timely manner. Previous studies on the supply chain environment in Ethiopia clearly demonstrate the country’s weakness in this field. An analysis of logistics in Ethiopia’s private sector showed that the overall logistics process is almost twice as long in Ethiopia as it is in Kenya and South Africa. The social implications of this supply chain lethargy are enormous.

Identifying aspects of the supply chain system that are unique to Ethiopia is a necessary precursor to an in-depth assessment of the flow of NGO-distributed health commodities in the country. Currently, the Ministry of Health (MOH) and Pharmaceutical Administration and Supply Service (PASS) manage the majority of the supply chain for reproductive health commodities in Ethiopia. Both organizations manage the flow of commodities from a Central Medical Store in Addis Ababa all the way to the Woreda level. The role of NGOs in the logistics process most often begins at the clinic level. Determining how NGOs distribute family planning and other health commodities from the clinic level to individual consumers is a critical component of our study.

Current Health Commodity Supply Chain Model

Central Medical Store

Regional Store MOH/PASS

Zonal Store

Woreda

NGOs Health Facility (Health Centers, Posts, Clinics)

MOH/CBD Agents

Clients

V. Methodology 23 Supply Chain Analysis

The first step in assessing any supply chain system is an examination of how all of the activities within the material-flow system function. Procurement, transportation, warehousing, order processing, inventory control and materials handling activities are all essential components of the logistics process and are also functions of a greater material-flow network involving raw materials, factories, wholesalers, retailers, and end users. As a major component of our supply chain analysis, we will collect data to examine how all of these inbound and outbound elements are managed by each organization interviewed.

This examination of each organization will help us identify recurrent patterns in the sector as a whole, outline strengths and weaknesses in the system and make recommendations for the improvement of the supply chain for health commodities in Ethiopia. Given the limitations and challenges inherent in evaluating supply chain models, it is important to utilize multiple perspectives and various methodologies in order to obtain the most accurate picture of the current system used.

Interviews

An important form of data collection will be interviews with logistics staff and senior management of NGOs and other organizations involved in the distribution of health commodities. We intend to contact these organizations upon arrival in Addis Ababa and schedule a time for an in-person or telephone interview.

Surveys

A written survey will be created to serve as a guide for the in-person or telephone interviews. We will not use mail-back surveys, as the return rate on this form is typically low. These survey will be a combination of both quantitative and qualitative data elements.

Quantitative Analysis

Collection of quantitative data elements will be a key part of the study. The quantitative data is designed to include measures that have objective, quantifiable units measurement. Many of these elements will come from self-reporting from the interviewees and from assessments by the student researchers. The specific quantitative data elements that will be pursued is currently being developed by the student researchers. Data such as commodity delivery times, returned product rates, length of warehouse use and number of clients served are examples of the type of quantitative data that will be included in the study.

Qualitative Analysis

Collection of qualitative data elements will also be a key part of the study. The qualitative data elements are designed to focus on the more subjective aspects of the study and will come from interviews. Data such as satisfaction with current logistics system in use, perception of NGO culture in Ethiopia and assessment of current logistics systems in place will be included in the study.

INBOUND FUNCTIONS

Production Scheduling 24 Procurement Returned Products

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