The National Supply Chain Assessment is a comprehensive tool kit that assesses the capability and performance at all levels of a health supply chain or can focus on a specific level or site within the system. A capability maturity model (CMM) and key performance indicators (KPI) are the metrics used to assess capability and performance, respectively. The results of the assessment help supply chain stakeholders develop their strategic, operational, and/or investment plans and monitor whether activities are achieving their desired outcomes.
The assessment informs two key processes:
Evidence-Based Investment & Planning:
- Informs and guides supply chain country and donor investments
- Informs country strategic planning and performance management processes
- Informs national supply chain policies and decisions
- Provides comprehensive picture of national supply chain capability maturity and current performance
- Monitors the impact of specific supply chain improvement activities and/or investments
- Monitors progress over time and against national performance indicator targets
The results from a National Supply Chain Assessment provide a comprehensive, quantitative picture of both capability and performance of the supply chain. The detailed information provided by the assessment allows stakeholders to validate qualitative understanding of the “current state“ of a supply chain, highlighting whether a supply chain is under-performing, meeting expectations or exceeding the expected performance for the capability maturity of the system.
Objectives of the Toolkit
With the creation of the Global Health Supply Chain architecture at USAID in 2016, USAID awarded a Task Order (Contract #AID-OAA-TO-00013) to Axios International, Inc to build on the achievements and lessons learned from NSCA 1.0 by developing an updated toolkit, to be known as NSCA 2.0. The National Supply Chain Assessment toolkit is intended to deliver on the following objectives:
- Inform and guide country and donor supply chain investments by, identifying and prioritizing poor performing areas in the public health supply chain while monitoring the impact of specific supply chain improvement activities and/or investments.
- Secondary Objectives
- Measure supply chain performance and capability. Identify bottlenecks and gaps across the health supply chain. Monitor progress over time and against national performance indicator targets.
- Inform country strategic planning and performance management processes. Inform national supply chain policies and decisions with data on broadly accepted metrics and analytics.
NSCA Toolkit Update 2.0.1
The NSCA recently underwent a revision, NSCA 2.0.1. Key improvements in the NSCA 2.0.1 toolkit include:
- Updated capability maturity model (CMM) questions
- Improved navigation of CMM analysis templates
- Inclusion of RACI and SWOT analysis exercises
- Upgraded sampling template
- Updated Implementation Guide
- Full toolkit available in French
The data collection tools necessary for conducting an NSCA have been prepared using the SurveyCTO platform.
Survey CTO is not the only platform that can be used to collect data electronically. It was selected for this toolkit for the following reasons:
- Secure (in terms of encrypting data and in terms of not ‘losing’ data as it is transferred from tablets to the cloud)
- Low cost
- Compatible with most data processing software (e.g., Excel, Stata)
- Responsive and professional ‘help desk’
Program limitations include:
- Only compatible with Android systems
- Somewhat limited formats / display capabilities (for off line data collection)
Additional information on Survey CTO can be found at the following links:
- Overview of SurveyCTO: https://www.surveycto.com/index.html
- Support Center/Subscription Support: https://www.surveycto.com/support/
- Instructional Videos (Most Popular): https://www.surveycto.com/support/video-library/
- Instructional Videos (Full Library): https://www.youtube.com/user/SurveyCTO
One video that may be particularly helpful is Form Designer: Intro to Form Design, and Android App: Getting Started with SurveyCTO Collect.
Once you subscribe to SurveyCTO, full web-based text tutorials are available.
National Supply Chain Assessments have been completed in many countries since 2012. The table below outlines where these assessments have taken place, if the assessment was completed with the initial 1.0 tool or the updated 2.0 tool, and what type of assessment was completed (snapshot, targeted, or full-scale). Descriptions of each type of assessment are provide in the FAQ section.
|Country||Scope||Year||Available on the USAID DEC|
|Côte d'Ivoire||Full Scale||2014||Link|
|Ghana||Full Scale 2.0||2019||Link|
|Guinea||Full Scale||2017/2019||Link (2017) / Link (2019)|
|Rwanda*||Full Scale/2.0 Pilot||2013/5/7||Link (2013) / N/A / Link (2017)|
|South Africa (Gauteng)||1.0 Pilot||2012||N/A|
|Uganda||Full Scale 2.0||2018||Link|
NSCAs in GREEN were supported by the Global Fund, NSCAs in Red are NSCA 2.0 pilots.
*Rwanda has implemented the NSCA three times.
1. What is the NSCA?
The NSCA is a tool designed to assess capability maturity and key performance indicators of a public health supply chain in developing country contexts. This assessment tool can be used to support a snapshot, targeted, or national level supply chain assessment (see other FAQs for descriptions of each type of NSCA). The goal of an NSCA is to provide insights on strengths and opportunities for improvement within a public health supply chain system that are then translated into actionable recommendations to improve maturity and performance of public health supply chain systems.
2. What is different between NSCA 2.0 and NSCA 1.0?
The NSCA 1.0 was an internally available resource used to guide the completion of national supply chain assessments. The NSCA 2.0 is a publicly available, updated tool. The NSCA 2.0 is different from the NSCA 1.0 in the following key ways: Introduction of binary responses for more objective and quantitative scoring of capability maturity, addition of 4 new modules to the CMM with greater focus on cross-cutting and systems components, greater user-friendliness for data collectors, automated analysis of results, and a clear sampling approach. A more detailed description of the differences between NSCA 1.0 and NSCA 2.0 can be found in the implementation guide.
3. How can an NSCA be used?
NSCA results may be used to inform investment decisions, inform strategy development, develop benchmarks for a program, and support health systems strengthening grant proposals. An NSCA should not be used as an audit activity, for costing, to inform individual performance reviews, or to assess leakage/diversion of products.
4. What different types of NSCAs can be implemented?
There are three ways to implement an NSCA: snapshot, targeted, and full. A snapshot NSCA includes a more focused sample of sites from across chosen levels of the system; it uses a significantly smaller sample size, is not nationally representative, and utilizes purposive sampling only. A targeted NSCA focuses on a portion of the public health supply chain system rather than the entire system. This type of NSCA may focus on one level of service in the system, one program (e.g., HIV, malaria, family planning, maternal and child health), or one or few technical modules (e.g., forecasting and supply planning, procurement and customs clearance, or warehousing and storage) that will provide decision-makers with information about a certain systemic challenge. Depending on how the targeted NSCA is developed, either purposive or representative sampling techniques may be employed. A full scale NSCA is the largest of the three types of NSCA. A full scale NSCA assesses the entire (all levels of service, all technical modules) national public health supply chain system across all technical areas. This type of NSCA requires a random sample and the results accurately illustrate challenges in a country within certain confidence limits.
5. How much does an NSCA cost?
Estimated cost for a snapshot, targeted, and full NSCA follow: Snapshot ($50,000-100,000); Targeted ($100,000-200,000), Full ($350,000-500,000).
6. How long does it take to complete an NSCA?
Depending on the size of the country, complexity of the public health supply chain system, country specific processes and requirements, political support for the assessment, and type of NSCA assessment completed, an NSCA may take anywhere from 3 to 9 months (from planning to end results). Data collection typically can be conducted in 2-3 weeks, depending on the type of NSCA and the number of data collection teams. The time frame will vary dependent on which version you choose.
7. Is there a fee to use the NSCA toolkit?
The NSCA 2.0 toolkit is a publicly available set of resources to support national supply chain assessment initiatives in developing country contexts.
8. Who has funded NSCAs in the past?
Organizations that have funded NSCAs in the past include USAID, Global Fund, and Ministries of Health.
9. What is the difference between the End Use Verification (EUV) survey and the NSCA?
The EUV survey tool is used to provide a quick check of commodity availability at service delivery points. The initial EUV focused on malaria commodities, but modules have been added for Maternal Newborn and Child Health (MNCH) and family planning commodities. There are additional questions about malaria case management practices, storeroom conditions, cold storage, reasons for stockouts, and supply chain challenges. The EUV is conducted twice per year with the intention of providing results with a rapid turn around to inform immediate actions. In contrast, the NSCA is conducted once every several years, encompasses many more aspects/functions of the supply chain than the EUV, and measures overall supply chain performance. The NSCA is not primarily used for immediate actions, but rather the development of strategies for medium to long-term approaches that strengthen the supply chain. The primary area of overlap between the two tools would be the assessment of stock status at the SDPs on the day of visit, which is used to calculate one or more of the KPIs for the NSCA but is the main purpose of the EUV. The EUV survey is not a substitute for a proper supply chain assessment.
10. Who should I contact with any questions about or recommended improvements for an NSCA?
If you or your team would like to provide feedback on possible improvements for future NSCA assessments, please send comments to USAID (NSCA@usaid.gov).