Demonstrating that green supply chains for health systems can work in complex healthcare delivery environments through multiple net zero initiatives.

Project Optimize, a partnership between PATH and WHO, was developed to help demonstrate an efficient and green vaccine distribution system aiming to reduce greenhouse gas emissions and benefitting the healthcare sector overall.

Project Optimize worked with Tunisia’s Ministry of Public Health to improve the vaccine supply chain for meeting the demands of an increasingly large and costly portfolio of vaccines. The two intervention districts (Kasserine and Foussana) included some 264 district stores and 2,067 health centres. An energy audit in the two districts uncovered sources of energy inefficiency, such as poorly insulated buildings and outdated equipment, and led to the implementation of the following initiatives.

1. Streamlining and integration of the vaccine supply chain with the distribution of other health commodities (2009-2015). Tasks included the establishment of a standard delivery circuit system, assessing the choice of district vehicles and refrigeration equipment.
2. Development of a net zero energy supply chain for vaccines at subnational levels, using solar energy. Tasks under this initiative included linking solar photovoltaic energy production to the grid by conducting extensive studies of requirements to establish a network of net zero energy stores, and phase plan to expand to central, regional, then district stores. The project also included a switch from fossil fuel powered vehicles to electric powered vehicles, following a feasibility and market study, and a small scale introduction through a pilot.
3. Creation of a computerized logistics management information system to track and trace vaccines in real time, mitigating the risk of overstocking, expiry, and vaccine wastage.
4. Project Optimize was developed in the context of a five year partnership between PATH and WHO to identify ways supply chains can be optimized for extending the reach of lifesaving health technologies. The project worked directly with the Ministry of Public Health, Primary Health Care Directorate (DSSB), State Health Department, Regional DSSB (for Kasserine and Foussana districts), District Health Department, healthcare facilities, clinics, medical stores, vaccine distributors, and communities to identify the challenges in the existing supply chain and test innovative solutions. Other partners included vaccine manufacturers, distributors, and policymakers to help ensure that new products and policies enable supply chain systems to function effectively. For the procurement of innovative technologies, the team actively engaged with energy efficient LED light providers, solar panel distributors, electric vehicle dealers as well as installation and maintenance staff.

A total of $646,500 was spent over a period of five years to implement the net zero energy supply chain system, with 47% of direct expenditures for electric vehicles (including customs, insurance, and maintenance). Procurement and installation of the solar panels in the selected sites accounted for 35% of total costs, and the remainder (18%) was used on equipment for other aspects of the project (e.g., refrigerators, cold boxes, ice packs) and training.

Before starting its work on the ground, Project Optimize teams conducted an Effective Vaccine Management assessment in 2010 to evaluate the vaccine supply chain in Tunisia at sample sites. The difference in consumption between business as usual and green products in energy consumption and between fossil fuel vehicles and electric vehicles was measured.

The interventions reduced greenhouse gas emissions by 29% for transport and 68% for storage against baseline (established in a 2010 assessment) at the regional level, and by 18% for transport and 59% for storage against baseline at the district level. Transitioning to green supply chains, increasing energy efficiency, and reducing carbon emissions directly impacted the improvement of healthcare services for the vulnerable communities in the intervention districts.

Project Optimize showed that net zero healthcare supply chains are feasible in Tunisia and other locations with a similar climate where solar energy can produce enough low cost energy for the entire supply chain system, supplemented with electric vehicles. Such locations could also similarly address the bottlenecks in the current system, streamline the network design, and strengthen the integration of the vaccine supply chain with other health commodities.