Optimizing Snake Antivenom Distribution in Colombia


Snakebite has been called “the most neglected of neglected tropical diseases”, and is a serious issue worldwide (). In spite of not being an infectious condition, the World Health Organization declared snakebite a neglected tropical disease in 2009 due to the magnitude of the public health problem it poses (Organization 2010). Global estimates of snakebite have been as high as 1,841,000 cases per year, while yearly deaths are estimated to reach up to 94,000 (Kasturiratne 2008). Snakebite, unlike other tropical diseases, has a high mortality/morbidity rate, and thus needs proper health care and antivenom administration immediately after a bite. This is particularly a problem in Colombia, which has one of the highest snakebite incidence rates of the Americas, with estimates around 4,500 cases per year (Gutiérrez 2011).

Distribution of snake antivenom in Colombia is ordinarily managed through private health providers (Entidades Promotoras de Salud, EPS), responsible for the acquisition and distribution of antivenom according to its demand within the health centers under their jurisdiction (ngela María Zambrano Ospina). Additionally, the Emergency and Disaster Group of the Ministry of Health distributes a strategic stock of antivenom through Regulatory Centers of Emergencies and Disasters (Centros Reguladores de Emergencias y Desastres, CRUE) in each department according to epidemiological data in periods of antivenom shortage (ngela María Zambrano Ospina). This is particularly relevant in Colombia’s present situation: the country has been in a state of public health emergency due to antivenom shortage for the past twelve months, a state which was recently extended to last for at least another year (sad 2011).

In consequence, there is no unified inventory of antivenom distribution in Colombia, and each producer manages its own distribution (ngela María Zambrano Ospina). Due to this confusing, fragmented distribution system, antivenom is often unavailable in regions where it is needed. There is a need to establish a distribution policy to optimize storage availability, inventory of isolated regions in high risk areas, and organization of health centers. The aim of this project is to use statistical methods and network theory to develop an optimization strategy for snake