How To Develop A Continuous Improvement Plan (cIP)
Effective VaccineManagement (EVM)Guidance NoteHow to Develop aContinuous ImprovementPlan (cIP)Version 1.0February 2018How to Develop a Continuous Improvement Plan (cIP)1
Guidance note: how to develop a continuous improvement plan (cIP)ISBN 978-92-4-151429-3 World Health Organization and the United Nations Children’s Fund (UNICEF) 2018Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence(CC BY-NC-SA 3.0 IGO; igo).Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the workis appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or UNICEF endorsesany specific organization, products or services. The unauthorized use of the WHO or UNICEF names or logos is not permitted.If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you createa translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was notcreated by the World Health Organization (WHO) or the United Nations Children’s Fund (UNICEF). Neither WHO nor UNICEF areresponsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of theWorld Intellectual Property Organization sted citation. Guidance note: how to develop a continuous improvement plan (cIP). Geneva: World Health Organization andthe United Nations Children’s Fund (UNICEF), 2017. Licence: CC BY-NC-SA 3.0 IGO.Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests forcommercial use and queries on rights and licensing, see http://www.who.int/about/licensing.Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures orimages, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from thecopyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely withthe user.General disclaimers. The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of WHO or UNICEF concerning the legal status of any country, territory, city orarea or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps representapproximate border lines for which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommendedby WHO or UNICEF in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the namesof proprietary products are distinguished by initial capital letters.All reasonable precautions have been taken by WHO and UNICEF to verify the information contained in this publication. However,the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for theinterpretation and use of the material lies with the reader. In no event shall WHO or UNICEF be liable for damages arising from itsuse.Printed in Switzerland2
Contents11.1What is the Effective Vaccine Management (EVM) initiative?91.2The immunization supply chain continuous Improvement Plan (cIP)121.2.1Why develop a cIP?121.2.2Aligning EVM assessment results with the six supply chain essentials14Introduction22.1When should the cIP be developed?172.2Who is responsible for developing the cIP?182.3What is the best way to develop a cIP?192.3.1Compile and disseminate a situation analysis192.3.2Convene a cIP workshop202.3.3Align cIP goals and objectives with broader national health plans242.3.4Draft the five-year strategic cIP, including annual operational plan272.3.5Conduct a planning and budgeting exercise28The continuousImprovement Plan(cIP) developmentprocess3The continuousImprovement Plan(cIP) content4Implementing andmonitoring the cIP53.1Situation and root-cause analyses313.2The cIP strategic plan333.2.1Long-term vision for the immunization supply chain333.2.2Goals, objectives, strategies, key performance indicators, and costs343.3The cIP annual operational plan363.3.136Operational plan3.4Associated costs and sources of funding374.1Socialize and institutionalize the cIP394.2Implement the cIP404.3Monitor implementation and outcomes41Continuous learning and improvementHow to Develop a Continuous Improvement Plan (cIP)423
Supplemental resourcessupplement 1:Establishing or strengthening a National Logistics Working chain-and-logistics/3735supplement 2:Situation analysiswww.technet-21.org/en/?option com sobipro&sid 4800&pid 57&Itemid 2586supplement 3:cIP workshop agenda repositorywww.technet-21.org/en/?option com sobipro&sid 4819&pid 57&Itemid 2586supplement 4:Collaborative workshop techniqueswww.technet-21.org/en/?option com sobipro&sid 4801&pid 57&Itemid 2586supplement 5:WHO Framework for National Health Policies, Strategies and Planswww.who.int/nationalpolicies/FrameworkNHPSP final en.pdfsupplement 6:Root-cause analysiswww.technet-21.org/en/?option com sobipro&sid 4802&pid 57&Itemid 2586supplement 7:Human-centred design methodologies and toolkitwww.hcd4i.orgsupplement 8:Guidance on Dashboards for Immunization Supply idance-on-dashboardssupplement 9:Activity and monitoring plan template (cMYP Guidelines, page 69)apps.who.int/iris/bitstream/10665/100618/1/WHO IVB 14.01 eng.pdfsupplement 10:cMYP costing toolwww.who.int/immunization/programmes systems/financing/tools/cmyp/en/supplement 11:WHO/UNICEF Joint Statement: Achieving immunization targets with thecomprehensive Effective Vaccine Management (EVM) frameworkwww.who.int/immunization/programmes systems/supply chain/EVM-JS final.pdf4
Acronyms and abbreviationsCCECCE Cold Chain EquipmentCold Chain Equipment Optimization PlatformContinuous Improvement PlanComprehensive Multi-Year PlanDashboard for Immunization Supply ChainExpanded Programme on ImmunizationEffective Vaccine ManagementEffective Vaccine Management AssessmentGavi, The Vaccine AllianceGlobal FundGlobal Financing FacilityGlobal Vaccine Action PlanHuman ResourcesHealth Sector Improvement StrategyHealth System StrengtheningHealth Sector Strategic ProgrammeInter-agency Coordinating Committee for immunizationImprovement PlanImmunization Supply ChainKey Performance IndicatorLogistics Management and Information SystemMonitoring and EvaluationMinistry of HealthNongovernmental OrganizationNational Health Sector PlanNational Immunization Technical Advisory GroupNational Logistics Working GroupStandard Operating ProcedureTechnical AssistanceUnited Nation Children’s FundWorld Health OrganizationHow to Develop a Continuous Improvement Plan (cIP)5
About this Guidance NoteThis document provides guidance to countries on how to develop a continuousimmunization supply chain (iSC) improvement plan. Its purpose is to help countriesbuild a case for supply chain investments and develop an improvement plan that engagesrelevant stakeholders, thus setting the immunization programme on a path for successfulimplementation.This Guidance Note includes: An overview of the continuous improvement plan (cIP) developmentprocess , including who should be involved, when the plan should be drafted, and howbest to gather the required inputs and feedback. Strategies for aligning Effective Vaccine Management (EVM)assessment outputs with national immunization and health sector planning andfinancing mechanisms, such as the comprehensive multi-year plan for immunization(cMYP); application for support from Gavi for health system strengthening (HSS); thenational health sector improvement strategy (HSIS), and other health sector strategies andplans. Guidance on preparing a cIP, to include a five-year strategy and a yearly operationalplan that can be used to allocate responsibilities and map progress towards a commonvision. Suggestions on how to develop a budget and finance the cIP to ensuresustainability and identify resource gaps.Countries may be familiar with the previous EVM improvement plan process that immediatelyfollowed an EVM assessment (EVMA). Whereas the previous EVM improvement plan wasdesigned to address certain short-term supply chain deficiencies, the new, continuous EVMimprovement plan described here is designed to be more strategic and inclusive of a wider set ofstakeholders who can help reveal the root causes of supply chain problems and mobilize humanand financial resources to address them.Supplemental resources for each step of the EVM improvement planning process arealso provided.6
ForewordIn the context of renewed global efforts to increase immunization coverage and leave no childunvaccinated, the role of strong national immunization supply chains is hard to overstate. Supplychains are complex and include many elements – people, technologies, systems – that needto be brought together through a plan of continuous action. Such a plan can catalyse not onlythe immunization supply chain professionals working in the national Expanded Programme ofImmunization (EPI), but also their colleagues from the ministries of finance, planning, humanresource management departments, senior leadership, development assistance partners,funders and academia. Without this commitment and support, the immunization supply chainprofessionals are unlikely to succeed in addressing existing gaps in performance and settingup the programme on a path to a sustained, country-driven excellence in ensuring continuedvaccine availability, quality and systems efficiency.The purpose of this guidance is to help make the plan of action robust and credible. A robust planis based on evidence and a strong programming logic, i.e. it focuses investments on activitiesthat together add up to a defined set of objectives and thus help realize the vision of the futureand address the deficiencies of the past. The plan is credible when it responds to country needs,and represents a shared vision of the stakeholders who have bought into the plan of action andhave a way to track implementation progress against predefined performance targets.These attributes elevate the plan to a powerful investment case for iSC improvement – anadvocacy tool for ministries of finance to include and retain iSC activities in their nationalbudget, and for partners to continuously support the cause. These are also the prerequisites ofthe “holy grail” of institutionalization: the programme putting iSC improvement activities onthe radar of national leadership by linking them to the annual operational plans and budgetperformance metrics.How to Develop a Continuous Improvement Plan (cIP)7
However, even a fully funded plan is at risk of remaining a piece of paper unless it touchesthe hearts and minds of those whose mission is its implementation. Aligning continuousgrowth – continuous learning – of the EPI workforce at all levels with the process of continuousimprovement of the iSC system, is the essential element that makes the coalition for sustainedexcellence in iSC whole. The EPI workforce is the first to learn what does not work, and oftenhas the clearest insights on how to make it work in the programme context. Participatorymodels that empower and give implementers a stake in the design and implementation of iSCimprovement plans are being embraced increasingly by countries, centralized and devolvedcontexts alike.The EVM initiative has progressed significantly from being associated with an assessment tool.It has been transformed to help national programmes make major health systems strengtheninginvestments work as intended – to address the underlying systemic bottlenecks to iSCperformance. WHO and UNICEF hope that this guidance can inspire and equip you with theknowledge and skills on how to make this initiative work for you.8
1Introduction1.1What is the Effective Vaccine Management(EVM) initiative?The EVM initiative was launched in 2010 to raise global and national attention to immunizationsupply chain performance metrics and identify areas where supply chain improvements mightpositively impact immunization and health outcomes.1 It is geared towards the six essentials ofimmunization supply chain:syste mdesigncold munization supply chains are not only limited to equipment anddistribution: they are dynamic systems that are flexible, adaptable tochanging needs and changing contexts and reactive to ensure vaccineavailability in all conditions. A well-designed strategy allows countriesto holistically model their supply chains to improve supply chainperformance and resilience.Reliable, well-maintained and cost-effective cold chain equipment isvital to ensure that there is adequate, sustainable vaccine storage forcurrent and planned vaccines, that maintenance requirements are keptlow, and running costs are reduced. A virtuous cold chain equipmentstrategy allows countries to access existing guidance and technicalassistance, and allocate financial support to better plan for, select,install, manage and maintain their cold chain equipment.Vaccine quality needs to be maintained throughout the immunizationsupply chain to avoid vaccine wastage due to exposure to heat orfreezing temperatures, whether at fixed storage location or duringtransport. A valuable temperature management strategy helpscountries ensure good storage and distribution practices; effective,well-managed temperature monitoring and record-keepingprocedures.Countries need effective transport of vaccines between each level oftheir supply chain to ensure vaccine potency is not compromised by aweak distribution system. A productive distribution strategy includesadequate use of passive containers, satisfactory packing practiceswith coolant packs, temperature indicators, and accessible transportcontingency plans.In 2016, WHO and UNICEF issued a joint statement on the EVM initiative and the vital role that immunization supply chainsplay in achieving immunization targets set by the Global Vaccine Action Plan (GVAP). This was preceded by a Call to Actionissued by the Immunization Practices Advisory Committee in 2014 that recommended a process of assessment, planning,implementation and monitoring to improve immunization supply chains.How to Develop a Continuous Improvement Plan (cIP)9
humanresourcesNext generation supply chains require dedicated and competentmanagers as well as adequate numbers of skilled, accountable,motivated and empowered personnel at all levels of the supplychain. An efficient iSC human resources (HR) strategy helps countriesstrengthen and build capacity for their supply chain managersby providing access to training, encourage collaboration, positivesupervision and professional development opportunities.dataData are essential to supply chain managers for managing all aspectsof the immunization supply chains, be they vaccine availability, orstock management efficiency. A sound iSC data strategy allowscountries to align with data standards, and develop useful tools suchas dashboards to monitor effectively their supply chain and makedata-informed decisions.Since 2015, the EVM initiativehas evolved to become a robustprocess helping countries buildflexible and responsive supplychains for immunization andhealth programmes. There arefour steps to the comprehensiveEVM approach: assess, plan,implement and monitor, whichrepeat in a cycle of continuouslearning and innovation (seefigure 1 ).figure 1COcomprehensiveapproach to evmITMMMONITORMonitorimplementationmeasureprogress towardoutcomesntinuous impto corovementASSESSCollect and reviewevidence toidentify ksCIPAs a preliminary step, ExpandedProgrammes on Immunizationare encouraged to mobilizeIMPLEMENTPLANDisseminate plan,Create vision,national commitment toensure funding, and putstrategy andplan into operationoperational plan forcontinuous improvement byiSC improvementbringing stakeholders togetherto adapt the comprehensiveapproach to EVM and itsfour steps, and establish themechanisms for continuousiSC improvement. Organizing a consultation with key stakeholders is recommended to securecommitment to the EVM initiative, assign clear roles and responsibilities, and agree on animplementation and monitoring process. If schedules allow, a short learning visit for participantsto another country that has implemented the EVM process would be beneficial. The key elementsof the comprehensive EVM approach are summarized in table 1 .10
table 1StepPREPARATIONSuggested Timetable For The EVM ApproachEstimateddurationProcess(in days)FormatCost types0.5–2Orientation of in-country stakeholders on EVM initiativeWorkshopOperational costs,facilitation5–10Preliminary learning visit of select representatives of the Ministryof Health (MoH) and national institutions to participate in EVMAs inanother countryVisitTravel costs15–20EVM assessment planning; training and implementation; sharing andvalidating findings/results with EPI and MoHWorkshop, Individual orAssessinstitutional contractmentfor EVMA management;operational costs;facilitation5–10Situation analysis from the EVMA, plus other assessments and studiesthat are available (see Table 3)Review1– 2Preparation of the materials for a second workshop and explore how thesix iSC essentials can be used to improve the nine EVM criteria23–5cIP development workshop:ASSESSIndividual or institutionalcontractStaff timeWorkshopOperational costs;facilitationWorkinggroupStaff time Establish appropriate oversight and project managementmechanisms (through the National Logistics Working Group (NLWG)or other continuous improvement group). Review situation analysis and identify root-causes. Define five-year iSC vision, strategic goals, key performanceindicators (KPIs) and tactics based on evidence from theperformance assessments. Determine additional technical assistance (TA) needed to completethe cIP (e.g. for planning and budgeting or developing a monitoringand evaluation (M&E) framework).PLAN Discuss how to achieve the three iSC objectives of availability,quality and efficiency by using the six supply chain essentials toimprove the nine EVM criteria (see Figure 2)5–15Alignment with cMYP, national health sector plan (NHSP), fundingproposals (e.g. health strengthening systems (HSS) and cold chainequipment optimization procedures (CCE OP).15–25cIP drafting and budgeting: Secure endorsement of the cIP from theWorkingInter-Agency Coordinating Committee (ICC), its development timelines, grouproles and responsibilities, and dissemination plan.15–25 Share cIP with all stakeholders, including EPI workforce atsubnational level.Staff time; operationalcosts; possibly individualor institutional contractWorkinggroupStaff timeWorkinggroupStaff time Ensure that national HR plans reflect the HR needs of supply chains /if no national HR plan, translate the cIP objectives/tactics into an iSCspecific HR planIMPLEMENT Engage a national institution to support M&E Mobilize funding sources as per your budgeting plan.On a yearlybasisMONITOR Monitor implementation progress according to plan. Evaluate key performance indicators for dynamic,
2.3 What is the best way to develop a cIP? 19 2.3.1 Compile and disseminate a situation analysis 19 2.3.2 Convene a cIP workshop 20 2.3.3 Align cIP goals and objectives with broader national health plans 24 2.3.4 Draft the five-year strategic cIP, including annual operational plan 27 2.3.5 Conduct a planning and budgeting exercise 28 3 The continuous Improvement Plan (cIP) content 3.1 .
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Agile and Continuous Delivery Oracle Confidential – Restricted Continuous Delivery: frequent releases of new software through the use of automated testing and continuous integration. Continuous integration continuous delivery continuous deployment code label branch(es) p
Continuous Uniform Distribution This is the simplest continuous distribution and analogous to its discrete counterpart. A continuous random variable Xwith probability density function f(x) 1 / (b‐a) for a x b (4‐6) Sec 4‐5 Continuous Uniform Distribution 21 Figure 4‐8 Continuous uniform PDF
DevOps lifecycle: 1. Continuous Development 2. Continuous Testing 3. Continuous Integration 4. Continuous Deployment 5. Continuous Monitoring 1. Continuous Development This is the phase that involves planning and coding of the software application's functionality. There are no tools for planning as such, but there are several tools for
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continuous integration and continuous delivery of the software was achieved as shown in fig 4. ACKNOWLEDGEMENT. I would like to express our gratitude to our guide for guiding us in each step Sowmya Nag Kof project. CONCLUSIONS AND FUTURE SCOPE . Continuous integration and continuous delivery is an ideal scenario for application teams in an .
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Collectively make tawbah to Allāh S so that you may acquire falāḥ [of this world and the Hereafter]. (24:31) The one who repents also becomes the beloved of Allāh S, Âَْ Èِﺑاﻮَّﺘﻟاَّﺐُّ ßُِ çﻪَّٰﻠﻟانَّاِ Verily, Allāh S loves those who are most repenting. (2:22
