Hereby to share a new resource on IIS produced by the Vaccine-preventable diseases at ECDC in collaboration with partners globally: Designing and implementing an immunisation information system. A handbook for those involved in the design, implementation or management of immunisation information systems https://www.technet-21.org/en/library/explore/immunization-information-systems-coverage-monitoring/5027-handbook-designing-and-implementing-an-immunisation-information-system We would like to hereby acknowledge the contribution of a number of experts in contributing to this report and providing case-studies based on their experience in Immunisation information systems. We hope this document will prove relevant in further informing decisions and discussions at National Level. The handbook proposes strategies that build on the experiences of IIS experts; provides case studies from actual programmes to highlight particular aspects of IIS practice, including functionalities, benefits, challenges, and implementation. It aims to share experiences and explore ideas that IIS experts consider valuable for developing a new IIS or upgrading an existing system,.  The handbook is intended for all those involved in the design, implementation, management or continuous improvement of IIS, such as immunisation programme managers and operational IIS staff; and also public health experts and policymakers. For more information please contact Tarik Derrough, Senior Expert VPD team, ECDC tarik.derrough@ecdc.europa.eu 

The Gavi Secretariat has released a global  standards document for immunisation supply chain (iSC) information systems.  A hallmark of effective supply chains is end-to-end (E2E) visibility of supply and demand data that are used to make decisions and take effective action. For immunisation programmes, a critical success factor is access to accurate, complete and timely data on vaccine utilisation and distribution, the performance and deployment of cold chain equipment (CCE), and the routine use of this data to inform operations and management decisions. Growing demand for digital supply chain software solutions—often referred to as logistics management information systems (LMIS)—from Gavi-eligible countries has stimulated software developers and service providers, remote temperature monitoring device innovators, and refrigerator manufacturers to develop and test a variety of software and hardware products. However, the absence of a normative standard of features required of a LMIS has resulted in costly development of bespoke local solutions, and limited choice of off-the-shelf systems that are interoperable, extensible, and scalable. The purpose of the Target Software Standards for Vaccine Supply Chain Information Systems is to help guide the market of potential LMIS solution providers by defining normative standards for LMIS solutions adapted to the unique needs of immunisation supply chains in low and middle income countries. The objectives of this Target Software Standards (TSS) are to ensure countries have access to: Best-in-Class digital LMIS that meet the unique needs of the iSC and a country’s particular supply chain design and strategy; Choice in software hosting, administration, and value-added business intelligence services; A range of cost models that enable cost-benefit analysis of different solutions and sustainable total cost of ownership. While the TSS is focused on vaccines by incompassing cold chain equipment and temperature monitoring data, the standards can be applied to any other pharmaceutial product that requires an LMIS. Gavi has collaborated with The Global Fund and other development partners to ensure that the TSS supports essential medicines, programme products, and diagnostic supplies in the Global Health supply chain. Countries are encouraged to use the Target Software Standards when determining their LMIS needs and seeking off-the-shelf software, or in guiding upgrades to existing systems. Software suppiers are encouraged to use the TSS to inform their software development roadmap priorities to ensure their product supports the range of features called for in the TSS.  Download a copy of the Target Software Standards for Vaccine Supply Chain Information Systems.

Dear colleagues,  The results of external evaluations assessing MyChild Solution based on Smart Paper Technology in Afghanistan are now available. These evaluations assessed the data quality, operational costs, efficiency gains as well as transfer of work processes to the existing health system in Afghanistan. In 2015, the Shifo Foundation, the Swedish Committee for Afghanistan (SCA), IKEA Foundation, and the Ministry of Public Health (MoPH) in Afghanistan started a joint collaboration to strengthen child health services in Afghanistan. Data and information are fundamental to inform decisions and assist key stakeholders to allocate appropriate resources to continuously improve the quality of health services. Therefore, one of the main objectives of the collaboration was to strengthen the quality of data and its utilisation in the Expanded Programme on Immunisation using an innovation based on Smart Paper Technology called MyChild Solution. MyChild Solution is an innovation developed by Shifo Foundation based on Smart Paper Technology. The solution was implemented and evaluated to inform evidence-based decisions on the scale up of the programme. MyChild Solution was implemented in 141 health service delivery points including fixed, outreached, and mobile clinics in the Mehterlam District of Laghman Province in Afghanistan. Currently, using MyChild Solution, more than 45,000 children have been registered, more than 9,000 children are fully vaccinated and more than 11,000 children are being followed up with SMS messages which inform parents about vaccination schedules. From the beginning of the programme, project stakeholders set several programme key success indicators which informed project development and external evaluations. These success indicators measured data quality such as completeness of data, timeliness, internal consistency, and external consistency and analysed if MyChild Solution could be integrated into the existing health system, thus sustained by the government. In June 2018, two external evaluations were conducted to assess data quality, operational costs, and efficiency gains as well as the transfer of work processes to the existing health system. This article summarises the results of these external evaluation reports. The data quality and review toolkit developed by World Health Organisation was used to evaluate the quality of data generated by MyChild Solution. The assessment showed high-quality data generated from MyChild Solution in every indicator, including completeness (100%), timeliness (91,66%), internal consistency (100%), and external consistency (99,4%). Moreover, the ratio of data recording error was low in the study and ranged from 0.05% to 1.7% for two selected data recording errors. The second evaluation investigated time efficiency. This evaluation assessed the time health workers spent on administrative tasks during and after delivery of care with MyChild Solution and compared the results with existing Health Management Information System(HMIS) tools. Results showed that 64% to 96% of time spent on administration could be reduced with MyChild Solution when compared to the current HMIS. Incremental cost analysis was done considering two scenarios. The first scenario took into account the monetary value of the reduced time for administration whereas the second scenario was conducted without the time reduction values. The evaluation also took into account two versions of the MyChild Solution. The first evaluation assessed MyChild Forms which is an innovation on facility-based data management tools. The second evaluation assessed MyChild Card which is an innovation modelled after the child health card. When adding the value of the reduced administration time, the total national cost of MyChild Card was 611,974 USD and the total national cost of MyChild Forms was 316,436 USD. Comparatively, the existing HMIS total national cost was 873,253 USD. Over a five-year period, MyChild Forms would save around 2,938,543 USD and MyChild Card would save around 1,378,875 USD compared to the existing HMIS system. When administration time is removed from the analysis, MyChild Card (501,622 USD) and MyChild Forms (206,126 USD) amounted to be more costly than HMIS forms (195,581 USD). It is noteworthy that when administration time is excluded from the analysis, MyChild Forms were 5% more expensive than HMIS. The second report displayed the results of the transfer of work processes to the existing health system. This is one of the key elements to evaluate the sustainability of the programme as well as how successful management was by the local stakeholders in Afghanistan. The results indicate that 95% of the processes essential to the management of MyChild Solution had been transferred to the local stakeholders in Mehterlam District. In most cases, these processes had been transferred in a way that is both accurate and sustainable. The remaining 5% of processes are planned to be fully transferred to Mehterlam by the end of 2018 to increase process accuracy. The external evaluation reports provide information on the effects of MyChild Solution from four different perspectives which give valuable insights to key stakeholders. These perspectives are data quality, costs, efficiency gains and transfer of work processes to the local level. Based on the findings derived from these external evaluations Shifo, SCA, and MoPH will collaborate to further expand and investigate the intervention on a larger level to inform decision making for the national implementation of the programme. The programme positively addressed all the key success metrics set in 2015 and brings opportunities to empower health and social workers at all levels of healthcare delivery who continuously work to improve quality of child health services across the country based on the reliable and relevant information. The full reports and additional information about MyChild Solution can be accessed using these links below: 1) Questing The MyChild Solution in Afghanistan- An external evaluation of Data Quality, Operational Cost and Efficiency: https://shifo.org/doc/rmnch/MyChildExternalEvaluationAfghanistan2018.pdf 2) MyChild Solution in Afghanistan: An External Evaluation — Transfer of Work Processes to Existing Health System: https://shifo.org/doc/rmnch/ShifoExternalEvaluationTransferProcessAfghanistan.pdf 3) About MyChild Solution based on Smart Paper Technology: https://shifo.org/en/solution/ 4) Project progress in Afghanistan: https://shifo.org/en/work/afghanistan/ 5) Link to the summary of the reports: https://medium.com/shifo-news/external-evaluation-results-313c92ddcb88    Looking forward to your follow up questions/discussions. Kind regards, Nargis  

Dear TechNet-21 Colleagues, The OpenLMIS Community is hosting a French-language webinar this Thursday, May 24 at 6 AM PST / 13h00 UTC on the latest features in the OpenLMIS 3.3 release. Details for the meeting including the call-in number are below, and the event is listed in the TechNet-21 events calendar.  Hope to see you there!  Tenly Snow
OpenLMIS Community Manager   Invitation en français  Salutations chers collègues, La communauté OpenLMIS organise un webinar en français le 24 mai à 13h00 UTC (6h PST) pour présenter et discuter des dernières fonctionnalités d'OpenLMIS. Une invitation calendrier est jointe. Un webinar supplémentaire en portugais (7 juin) est prévu. Réjoignez l'appel sur Zoom en utilisant ce lien:  
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/128422371 Meilleurs vœux dans votre travail,
Mme. Tenly SNOW
Responsable de la Communauté OpenLMIS   Invitation in English Dear colleagues, The OpenLMIS Community is hosting a webinar in French on May 24 at 13h00 UTC (6 AM PST) to present, demo, and discuss the latest features in the OpenLMIS software. A calendar invitation is attached.  An additional webinar in Portuguese is planned for June 7.  Join the call by using this link: 
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/128422371      

Greetings TechNet Colleagues, Please save the date on Thursday, May 10 at 13h00 UTC (6:00 AM PST) when the OpenLMIS Community will host a webinar presenting the latest features in the OpenLMIS software (webinar will be presented in English). Additional webinars will be presented in French (May 24) and Portuguese (June 7). Further details will be announced closer to the event time, but please feel free to contact us at info@openlmis.org if you would like to attend either of these additional webinars.  Please register for the English-language webinar in advance by clicking here.  Upon registering you will receive call-in details and a calendar invitation.  Contact us at info@openlmis.org or visit http://openlmis.org/ to learn more about the latest release and the OpenLMIS Initiative. Warm regards, Tenly Snow
Community Manager
OpenLMIS

Greetings iSC Colleagues, The OpenLMIS Community is proud to announce the release of OpenLMIS version 3.3, the latest release in the version 3 series specifically supporting immunization supply chains (iSC). Immunization supply chains are facing a time of decreasing resources and increasing risk, underlining the importance of managing data at all levels. In response to consistent requests to add functionality to address the needs of iSC, OpenLMIS is proud to release the first set of vaccine-specific features in the core OpenLMIS software. New features allow for greater visibility, accountability, and efficiency in vaccine management. New features include:  Robust reporting and analytics Cold chain inventory management Integration with Nexleaf Analytics Remote Temperature Monitoring (RTM) platform Integration with OpenSRP for mobile vaccine stock management Other important announcements include the release of the first iteration of an Implementer Toolkit - a single resource to guide users in the process of implementing an electronic LMIS and many new videos available on the OpenLMIS YouTube channel. Find links to the Toolkit and videos in the OpenLMIS 3.3 Release Newsletter Read more about the release in the full blog post. Full software release details can be found in the 3.3 release notes. SAVE THE DATE: Please join the OpenLMIS Community on THURSDAY, MAY 10 at 6 AM PST for a webinar presenting the latest features in the OpenLMIS software (webinar will be presented in English). Additional webinars will be presented in French (May 24) and Portuguese (June 7). Please contact us at info@openlmis.org if you would like to attend either of these additional webinars. Further details will be announced closer to the event time.  Please register for the English-language webinar in advance by clicking here.  Contact us at info@openlmis.org or visit http://openlmis.org/ to learn more about the latest release and the OpenLMIS Initiative. Yours in good health, Tenly Snow
Community Manager
OpenLMIS  

Greetings,  A new blog is available on openlmis.org, presenting an exciting collaboration between OpenLMIS and Nexleaf Analytics to incorporate remote temperature monitoring (RTM) data into the OpenLMIS logistics software: http://openlmis.org/integrating-cold-chain-data-openlmis-collaboration-nexleaf-analytics/ This collaboration allows anyone adopting OpenLMIS and utilizing any RTM system to have an informed view of the cold chain status alongside their core vaccine stock and delivery data.  Integrating data systems can reduce data entry, improve data quality and usability, and accelerate insight generation. Combining datasets from different sources provides new opportunities for analysis and insight into the supply chain and streamlines processes for health workers and decision-makers alike. The interfaces developed by OpenLMIS and Nexleaf are open and standards based. This means that any provider of RTM hardware or data analysis systems will be able to integrate with OpenLMIS using the interfaces being developed by this project. This work is designed to benefit all manufacturers and providers of RTM hardware and software systems. We look forward to your feedback on the article. Happy reading and best wishes in your work.  Tenly Snow
OpenLMIS Community Manager   

Dear TechNet-21 Members, Please join OpenLMIS on November 30th at 8 AM PST/ 5 PM CET/ 7 PM EAT for a webinar presenting details on the current roadmap and latest developments in the OpenLMIS v3 vaccine module. This webinar will serve as a refresher for those involved with the development of the vaccine module and a presentation of the roadmap and recently developed features for those interested in learning more about how OpenLMIS manages vaccines. Please register in advance for this webinar by visiting: https://zoom.us/meeting/register/9b1a18dcc87534aec5b9141539e44ee6 After registering, you will receive a confirmation email containing information about call-in details to join the meeting. We look forward to speaking with you soon! Please feel free to forward this invitation to your colleagues as well. Best regards, Tenly Snow, OpenLMIS Community Manager

The OpenLMIS community has the pleasure to announce the milestone release of OpenLMIS version 3.2. In line with the version 3 series, 3.2 includes new features in stock management, new administrative screens, targeted performance improvements and a beta version of the Cold Chain Equipment (CCE) service. It also contains contributions from the Malawi implementation, a national implementation that is now live on OpenLMIS version 3. 3.2 represents the first milestone towards the Vaccines MVP feature set and after 3.2 there are further planned milestone releases and patch releases that will add more features to support Vaccine/EPI programs. These enhancements will continue development toward making OpenLMIS a full-featured electronic logistics management information system. Please reference the Living Product Roadmap for the upcoming release priorities. Patch releases will continue to include bug fixes, performance improvements, and pull requests are welcomed. New Features  Stock Management: Added a notification and new support for recording vaccine vial monitor (VVM) status Administrative Screens: View supply lines, geographic zones, requisition groups, and program settings Performance: Targeted improvements were made based on the first version 3 implementer’s usage and results. Improvements were made in server response times which impacts load time and memory utilization. In addition, new tooling was introduced to provide the ability to track performance improvements and bottlenecks Cold Chain Equipment (CCE) service (Beta): Includes support to upload a catalog of cold chain equipment, add equipment inventory (from the catalog) to facilities, and manually update the functional status of that equipment. Review the wiki for details on the upcoming features A full list of features, APIs, services, and tickets can be found in the 3.2.0 Release Notes. The OpenLMIS Initiative’s mission is to make powerful LMIS software available in low-resource environments – providing high-quality logistics management to improve health commodity distribution in low- and middle-income countries. OpenLMIS increases data visibility, helping supply chain managers identify and respond to commodity needs, particularly at health facilities where lack of data significantly impacts the availability of key medicines and vaccines. Learn more at openlmis.org, or by writing to info@openlmis.org

Dear TechNet Colleagues, I am pleased to share a workshop report on the Francophone OpenLMIS User-Centered Design Workshop facilitated by VillageReach and hosted at the PATH Senegal Headquarters in Dakar, Senegal, in July.  12 attendees from Ministry of Health Expanded Programme on Immunization (EPI) programs plus WHO International representation attended this 3-day workshop on user-centered software design in Dakar. Participants came from Benin, Cote d’Ivoire, DRC, Guinea and Senegal.  The workshop specifically focused on the workflows within OpenLMIS associated with resupplying vaccines, and had three primary objectives: Define and understand the processes for resupplying vaccines Define the workflows and data required for good vaccine resupply management Create prototypes responding to these workflows in order to inform the development of the vaccine module in OpenLMIS Since July, the OpenLMIS team has been processing an enormous amount of information that came out of the workshop. The team is working to turn these outputs into tickets and other actionable development for the OpenLMIS vaccine module.  The report contains details from the workshop, including all presentations, notes, and photos of the participants in action. Please see the final, publicly-available report here: https://openlmis.atlassian.net/wiki/spaces/OP/pages/114688775/Senegal+Francophone+User+Design+Workshop+Report+--+Resupply For questions relating to the OpenLMIS Initiative, please contact Tenly Snow, OpenLMIS Community Manager at tenly.snow@openlmis.org. For questions relating to the OpenLMIS vaccine module development roadmap and feature development, please contact Mary Jo Kochendorfer, OpenLMIS Product Manager at maryjo.kochendorfer@openlmis.org  -- Tenly 

This is the fourth topic in my six-part Vaccine Supply Chain Futures series (Please see the attached file for the full text)  focused on the introduction of a system of remote temperature monitoring integrated with equipment maintenance management. Remote temperature monitoring systems represent an opportunity for a system-wide improvement in the performance of equipment maintenance and consequently, more reliable vaccine distribution. Remote temperature monitoring automatically transmits data to a central server where it is analysed and disseminated to managers. This is a significant step forward compared to stand-alone temperature recording in each refrigerator. It replaces manual recording and paper reporting systems that have always suffered from lack of compliance and inaccuracy due to incomplete, delayed and faulty data aggregation. Remote Temperature Monitoring is a means to: Supervise health facilities to maintain correct storage temperatures, Track the efficiency of equipment maintenance at local level, Country wide data on the performance in use of each model will inform the choice of equipment for procurement to maximize reliability, Suitably anonymous versions of the country data will be used at international level to inform equipment manufacturers and regulatory experts on the rates of failure and their principal causes. Please reply to this post with your views and I would be grateful if you could answer just four questions in this SurveyMonkey: https://www.surveymonkey.com/r/L38J79Q I will return the analysis to you at the end of this week and the results will be posted before the TechNet Conference for all five topics. Please see the attached file for the full text. Thank you! 

Improving supply chain data visibility and data use are showing real impact in Tanzania's integrated logistics system. A study has just been published in the peer-reviewed journal Global Health: Science and Practice Global Health: Science and Practice Advance Access articles for September 6, 2017 Original Article Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects Marasi Mwencha, James E Rosen, Cary Spisak, Noel Watson, Noela Kisoka, Happiness Mberesero Abstract | Full Text (PDF) Investments in a national logistics management unit and electronic logistics management information system resulted in better data use and improvements in some, but not all, management practices. After 1 year, key improvements included reduced stock-out rates, stock-out duration, and expiry rates. Although the upgraded systems were not inexpensive, they contributed to greater system efficiency and generated modest savings that defrayed much of the investment and maintenance costs.

by Dr Blanche ANYA and Dr David BROWN During 21-24 February 2017, representatives from Cameroon, Ethiopia, Liberia, Nigeria, Rwanda and Uganda gathered in Kampala, Uganda to rethink and improve their country’s current home-based record design and functionality as well as the broader system that supports the home-based record to address issues such as stock-outs described previously here. Participants not only walked away from the workshop with a new paper prototype of their improved home-based records (e.g., vaccination card, child health book) and an implementation plan to move forward, but they left the workshop with a conviction that addressing the needs of primary users ensures that the home-based record is valued by, and meaningful to, the intended users while also made available in the right place, at the right time and in the right quantity. Following a user-centered approach, participants of the Africa workshop conducted pre-workshop activities that included health facility visits to talk with and observe caregivers and health workers, as well as to collect information to map out how their home-based records are prepared, produced, distributed and used. Participants brought this information,which was shared across country teams, as input to the cross-country workshop to help the teams think beyond usual assumptions and ground their decisions on actual observations rather than perception. We encourage readers to take a quick read through the final workshop report available below.

Over the last decade, the technology environment in developing countries has changed significantly, offering new opportunities to strengthen and automate information systems throughout the health system. Health system supply chains in many countries are leveraging this changed environment, with digital solutions that support reporting at different levels of the supply chain. To complement the many excellent articles in Vaccine Journal's special issue on next generation immunization supply chains, JSI, VillageReach, VaxTrac and Drury Consulting have issued Critical Success Factors for Deploying Digital LMIS. Based on valuable lessons learned from early adopters of digital logistics management information systems, this paper provides ministries of health, development partners, and implementers with nine essential tactics for successfully deploying information technology to operate next generation medicine and vaccine supply chains.

OpenLMIS is proud to announce the launch of OpenLMIS version 3, an open source logistics management information system (LMIS): http://openlmis.org/ The OpenLMIS community, representing a global consortium of partners including software developers, implementers and funders, collaborated on a full redesign of the OpenLMIS core software, reflecting a more flexible and responsive micro-service architecture. OpenLMIS provides an electronic solution for recording and reporting logistics information for health supply chains, including requisitions, stock management and fulfillment, and improved reporting systems. OpenLMIS increases data visibility in supply chains, helping supply chain managers to see and respond to commodity needs, particularly in health facilities, where lack of data significantly impacts the availability of key medicines and vaccines. As an open source product, users can contribute future improvements back to the core, increasing the return on funders’ investments and encouraging collaboration between countries. OpenLMIS version 3 provides better support for customization and extensions than previous versions through its new service-based, API-driven, modular architecture. The end result is a powerful, flexible product that emphasizes interoperability, extensibility, and performance at scale across countries, programs and products. See Features and Benefits for a high-level overview of version 3, or read the 3.0.0 Release Notes on the OpenLMIS Wiki for a detailed overview. OpenLMIS code is publicly available on GitHub. Non-profit VillageReach and software developer SolDevelo led the software development for version 3. As a founding member of the OpenLMIS Community, VillageReach software development teams will continue to lead the ongoing development of OpenLMIS version 3 in partnership with the OpenLMIS Community. The OpenLMIS Initiative is supported by many health, implementation, and technology partners whose contributions have played a significant role in the evolution of the OpenLMIS product and community. The OpenLMIS initiative began in 2011, with the first software launch in 2012. Early contributions to OpenLMIS by PATH, USAID, Rockefeller Foundation, the Bill & Melinda Gates Foundation, the UN Commission on Life-Saving Commodities, JSI, ThoughtWorks, and others defined the original code base for deployments in Tanzania and Zambia in late 2013. Since then, OpenLMIS has been deployed in Côte D’Ivoire, Mozambique and Benin with an additional implementation planned in Malawi for 2017. Write to info@openlmis.org to see a demo of version 3, or for more information. Learn more about the release of OpenLMIS version 3 HERE About the OpenLMIS Initiative The OpenLMIS initiative incorporates a community-focused approach to develop open source and customizable LMIS systems specifically designed for low-resource settings. The initiative provides an environment where software modules and datasets from newly-developed code and existing systems are made available in a public repository. OpenLMIS is currently deployed in Benin, Côte d’Ivoire, Mozambique, Tanzania, Zambia, and Zanzibar, with a planned implementation in Malawi in 2017.

As supply chain professionals working in the global health sector, we have heard countless requests and statements over the years to integrate data from HMIS and LMIS tools. This is partly to streamline reporting channels and to reduce the reporting burden, and partly to attempt to compare information between the two systems. Often this conversation is burdened by a lack of understanding about how the two data sets differ.


As countries adopt electronic information systems to manage HMIS and LMIS, it is easier to compare service and logistics data, and DHIS2 provides a useful platform for integrating and visualizing these data together.

With funding from the UN Commission on Life-Saving Commodities for Women and Children, JSI, University of Oslo, University of Dar es Salaam, and VillageReach worked with the Ministry of Health, Community Development, Genderly, Elderly and Children in Tanzania to develop an integrated dashboard to look at RMNCH and supply data together. This was achieved by adding a data feed from the eLMIS to DHIS2; two systems that had been deployed nationally in 2013–2014.

Read more about this ground-breaking work and the lesson learned onJSI's The Pump.

Hello,
I was recently introduced to this site. I am very interested in supply chain management and logistics of health commodities and was wondering if anyone knew of an online course (preferably free) I could take to enhance my knowledge?
I'd appreciate suggestions.
Thanks.

On any day, the Pharmaceuticals Fund and Supply Agency (PFSA) in Ethiopia manages the thousands of transactions (orders, receipts, issues, and transfers) which are the lifeblood of the public sector healthcare supply chain. To inform the supply decisions that drive these transactions—and to ensure that the right quantities of the right commodities are going to the right locations—the PFSA uses the Health Commodity Management Information system (HCMIS), a warehouse and logistics information management system developed by the USAID | DELIVER PROJECT.
Launching the Information Revolution in the Ethiopian Public-Sector Healthcare Supply Chainis a new logistics brief that details use of the HCMIS in Ethiopia and the benefits of having real-time transactional data across the PFSA network. With this systematic recordkeeping tool placing data literally at their fingertips, PFSA employees across Ethiopia are revolutionizing the supply chains they manage by using real-time data to make smarter, faster decisions and building an increasingly agile supply chain.
Learn more athttp://bit.ly/1TEcdG2

Over the last two decades, increased investments in health have yieldedsignificant gains in health outcomesfor tens of millions of people around the world. At the same time, economic growth has raised hundreds of millions out of extreme poverty and helped fuel a vast expansion in information technology that has revolutionized the way people communicate. Inspired by the 20th anniversary of the first World Development Report to focus on health,the Lancet Commission on Investing in Health releasedGlobal Health 2035: A world converging within a generationin 2013. This visionary report asserts that we can achieve significant health gains in low- and middle-income countries (LMICs) by 2035, thus achieving agrand convergence. These gains are predicated on three key assumptions:

Continued economic growth in low- and middle-income countries will enable increased investment in health.
Insurance will be a primary tool in achieving universal health coverage (UHC) in low- and middle-income countries.
Non-communicable disease (NCD) will dominate disease burden.

Butachieving the grand convergenceand theSustainable Development Goals for healthdepends on a profoundevolution in the supply chainsthat deliver the medicines, vaccines, and other commodities required to maintain and improve health and well being. With large-scale investments in health programs, a widening portfolio and volume of products, and expansion of services to new populations, supply chains must be more flexible, efficient, and responsive. Here are just a few of the scenarios that will require new approaches to health supply chains in LMICs:

Universal health coverage insurance schemes and continued economic growth will foster a more robust marketplace, encouraging the private sector retail pharmacy market to expand. But insurance schemes must be designed to assure quality products in ahealthier marketplace, and to promoteequitable access to productsand services for people—especially in rural areas—whom the private sector do not serve. Thefull cost of supply chainsmust be factored into insurance payment mechanisms.
As more countries achieve middle-income status, donor funding will phase out, creating risks as graduating countries take full stewardship of their health systems including the cost of ensuring access to health commodities.Supply chain stewardsmust focus on maintaining and extending equitable access while managing risks of disruptions at every level of the supply chain. Atotal market approachthat embracesmultiplicity and redundancyin the supply system is essential.
Continued advances in technology and information systems will enable greater end-to-endsupply chain data visibility. Supply chain data will be integrated with patient records and financial systems, automating resupply and payments, while biometrics will be used to validate client identities, improve adherence, and promote rational use. But greater visibility must be combined with the capacity of supply chain managers at every level of the health system toanalyze data and take effective action, within an institutional culture that values data quality and use.
Storage and transportation systems will routinely leveragealternative energy technologiesas well asautonomous vehiclesfor reaching remote locations. These technologies will require management systems and skilled personnel dedicated to keeping them running, maintaining and replacing equipment and vehicles as they near the end of their usable life, and staying abreast of technology upgrades and innovations.
Human resources for supply chain management will still be a challenge, as it is currently throughout the public andthe commercial supply chainsectors, but outsourcing, vender-managed inventory, and direct delivery from venders will be commonplace and will mitigate the HR challenges. Supply chain stewards must embraceprofessional competenciesand promote career paths andperformance-based incentive mechanismsto recruit and retain supply chain talent today.

The grand convergence predicted for 2035 will require universal access to health supplies, and the range of skills and knowledge required to achieve that goal is more diverse than ever before. We require a command of health financing, insurance formularies, health informatics, risk management, business reengineering, market segmentation, pharmaceutical markets and regulation, and human resource management. Supply chain simulation technologies and costing applications are now essential tools in system design, optimization, and market segmentation. Career development and incentive mechanisms are as important as training curricula in preparing and retaining a capable supply chain workforce and leadership.
In order for public health supply chains to evolve, the people who support and work within them must also evolve. There will be many different models and many innovative approaches, and JSI will continue to help envision, design, and build supply chains for the future to meet Global Health demands in 2035.
Chris will lead a discussion on this topic onIAPHLin the coming weeks. This post was originally published on JSI's The Pump.

Greetings TechNet Community, I hope this message finds each of you well and successful in your work. I am the new OpenLMIS Community Manager working with the OpenLMIS Initiativeand Community to develop and share this functional and customizable eLMIS solution. Many of you may be familiar with the open source eLMIS system, OpenLMIS.Currently utilized in five geographies throughout Africa, OpenLMIS is acost-effective and widely customizable eLMIS solution built to address the data visibility challenges of low-resource environments. A non-proprietary solution, the product empowers countries to own, customize, extend, and manage their eLMIS, providing shared investment, shared learning, and reduced up-front development costs. Please visit the OpenLMIS Wikior website for more information. OpenLMIS is currently deployed in Beninthrough AMP, where it supports an informed push system for immunization commodities. One of our colleagues has written an excellent pieceon how OpenLMIS has improved data collection and visibility in Benin –an article I believe would be of great interest to the public health professionals of TechNet. The article may be accessed here: http://www.villagereach.org/2016/03/24/what-do-vaccines-and-vending-machines-have-in-common-using-data-to-improve-vaccine-delivery-in-benin/ Best of luck in your work, and please reach out with any feedback, questions, or discussion. Warm regards, Tenly --- Tenly Elizabeth Snow OpenLMIS Community Manager tenly.snow@villagereach.org CELL: 1.406.544.4856 FAX: 1.206.860.6972 SKYPE: tenly.snow.vr OpenLMIS.org~HingX~OpenLMIS Wiki

The case for a ‘Common Logistics Operating Platform’ to serve District Management of Supply systems and Service delivery support. Question: Could an ‘Integrated Public Health Supply Chain Platform’ at district level replace the current, fragmented, inefficient and costly provision of separate supply systems for vaccines, medicines and supplies? The platform would assure that resources, such as transport would be shared rationally according to priorities set on a single, shared calendar. Managed maintenance and repair services would maximize the availability of these resources and minimize downtime. The SOP for this cross-cutting, managerial leadership role could include: Receipt and storage of vaccines, medicines, supplies and consumables Distribution trip planning, transport allocation and monitoring of execution Repair visit requests for buildings, equipment, 2wheel transport, cell-phones and apps’ Collection, storage and destruction of infectious sharps waste Requisition and deployment of new equipment and re-siting of existing equipment To succeed, the platform needs to be managed by an existing member of the health team at the district facility rather than hiring a new cadre and establishing additional salaries. The candidate platform manager needs to have authority among other team members, an established rank and the skills to manage their existing and their new role. As electronics replace paper-based recording systems, maintenance of the Logistics Management Information System should be the responsibility of the platform manager. Shared data transmission and a DHIS2-style central server would support applications to handle analysis of data to feed supply chain dashboards. The District Pharmacist would seem to be the ideal candidate with the capacity and the skills and authority to manage.Public health interventions need champion managers to excel but they should be served by Supply Chain Logistics services, not replicate nor fight for them. John.lloyd1945@gmail.com 17/12/2015

“You can’t vaccinate a child with a mobile phone.”
Andrea Coleman, co-founder, Riders for Health Technology is all the rage in global health programs, from immunization and child survival to reproductive and maternal health, to malaria, HIV and TB programs. mHealth platforms proliferate, eHealth applications and acronyms abound: DHIS, eLMIS, HRIS, MRIS, EMR, MFR…OMG! Don’t get me wrong, I’m a technology champion and a bit of a geek, convinced that technology, applied correctly and judiciously, can have a significant impact on health outcomes. In the realm of supply chain,data visibility through technologyis a game changer, helping to eliminate the stock-outs and expiries that are still endemic at service delivery points. Smart technology applications are featured at this year’sGlobal Health Supply Chain Summitin Dakar. On Day One of the Summit (Nov. 11), two related sessions competed for attendance: Information Systems and Analytics and Vaccine Supply Chains... Read the complete blog here http://thepump.jsi.com/dispatch-from-the-global-health-supply-chain-summit/ By Chris Wright,JSI Senior Technical Advisor, with insight from Jane Feinberg at the 2015 Global Health Supply Chain Summit.

A well-designed, well-operated supply chain that delivers health supplies to patients and clients who need them is critical to the success of any health system. With an electronic logistics management information system (eLMIS), logisticians can quickly access data they need to make informed decisions. In the new eLMIS Selection Guide, published by the USAID | DELIVER PROJECT, you can learn what it takes to be eLMIS ready. The guide also includes profiles of eLMIS applications implemented in Pakistan, Ethiopia, Tanzania, and Zambia. Learn more at http://bit.ly/1L1BfqP

Recently, I was sitting with the Expanded Programme on Immunization (EPI) Manager, his senior staff, and technical assistance (TA) partners in an African country, discussing support for better visibility and analysis of immunization supply chain data. The EPI Manager was willing to listen, but wasn’t sure his team needed help in data analysis. As for visibility, that was already being addressed: they using a web-based inventory management system that, among other things, providecold chain volumetric data (total capacity and used capacity). As we discussed plans to deploy the online tool at the district level and in facilities with internet connectivity, I asked if data was also collected on the other, non-EPI commodities that we know are often stored in the cold chain: some lab reagents, certain antiretroviral medicines, oxytocin, insulin, etc. The team seemed surprised by the question; “those aren’t our commodities,” the program logistician explained. True, I replied, but they do frequently take up room in the fridges (even if only in the short-term), so if it isn’t captured as part of inventory, then your volume data won’t give you the true picture of what percentage of capacity is really being used... Read the complete blog post here

In the last decade, vaccine information management has slowly evolved from paper at every level in the health system, to Excel-based reports at higher levels (districts or above) that are emailed, to simple stand-alone databases with exported PDF reports, and most recently web forms that capture data and display essential dashboards online. Different countries are at different stages in this evolution, and most still rely on paper to capture data from health facilities and vaccination points. In Tanzania, the Immunization and Vaccine Development (IVD) program uses all of these tools to manage its diverse data. But each of them—manual and electronic—are customized and unique to immunization program needs; none are in use in other health programs or commodity supply chains, even though the data needs and uses are similar. JSI is working closely with IVD and other partners, including CHAI, PATH, and VillageReach, to create an integrated vaccine information management system (VIMS) that serves the unique needs of IVD. VIMS is a module within the electronic LMIS (eLMIS) architecture already deployed nationwide, but with many added features that deliver the full set of requirements IVD has identified, including robust cold chain equipment status and maintenance features and barcode capability... Read the complete blog post here: http://thepump.jsi.com/building-the-next-generation-vaccine-information-management-system-vims-in-tanzania/

“Apps” (computer software applications) are being developed and used as tools to help manage the vaccines and medicines supply chain more and more. But are they directed at challenges that have persisted the longest and would have the greatest impact if resolved? Take, for example, the following two challenges; do you recognise them? Do you agree that they need to be addressed or do you believe that they have been addressed in your country (ies) and that other should be chosen? Challenge 1: Most health centres in the world keep a wall chart with a manual plot of the percent of surviving infants fully immunized during the calendar year. As each month passes the cumulative coverage reached is amended for that month indicating visually the performance of the service relative to the target population(s) in that year. This works until the coverage approaches 80-90% when the cumulative coverage plot is high and the marginal changes in the last three months of the year are quite small. Then it is hard to read the performance impact in the last months of the year and hard to assess visually the changes since last year. Solution 1: The number of people receiving each vaccine dose, each month is already kept in a database for the national immunization reporting system. So it will not require more data or more work to change the monthly coverage value from the cumulative coverage for the current year to date - to the total coverage for the last, running twelve months (this year and a part of last). Now the plot is a true ‘annual’ coverage measure for every month of the year, reflecting what has been achieved and what has still to be achieved correctly and visually. Challenge 2: The rate at which vaccine has been consumed at the level of service delivery over one or more of the most recent supply intervals, corrected for planned changes in target population or vaccine presentation, remains the most practical basis for calculating vaccine needs for the next supply period. The problem is that this arithmetic, while simple, takes no account of seasonal differences, wastage variations or migration movements historically or trends over the years. Where the changes in consumption are small or gradual, the current method works but when the change is important and rapid it no longer prevents stock-out. Solution 2: The consumption of vaccine (comprises the number of doses in opened vials that have been used or wasted for any reason) is already accessible via vaccine stock records kept by computerized stock control at district level. The aggregate number of doses for the whole zone for each vaccine and each month should be used by an application to forecast vaccine needs for the next supply period, adjusted for any vaccine or system changes planned for the next period. An application will do the necessary arithmetic and aggregation, adjusting for later reporting.   The resulting Dashboard in each district can also present the rates of vaccine utilization (Vaccine administered as % of vaccine consumed). Closed vaccine wastage, as a part of vaccine consumed needs to be analysed only when there is an overall problem of utilization rate, not simply monitored without site investigation.

TechNet 2015 Day 3 tackled Managing the System: Human Resources for Supply Chain Management and Data for Management. These two themes are closely linked.People are the sources of data, and people must also have the skills and capacity to use that data for management decisions. In well performing supply chains, the interdependence between people, processes, technology and infrastructure are essential, but people are at the center. They carry out the processes; they collect, enter, manage and analyze the data; they use and maintain the physical infrastructure and assets. On Day 1 of the TechNet conference, we talked about optimizing supply chain processes. On Day 2, we explored cold chain infrastructure. On Day 3, we are looked at both human resources and data. Every presentation and session throughout the conference seemed to reinforce the need for skilled human resources operating immunization supply chains, and the need for data to make decisions, whether about supply replenishment, cold chain functionality, or human resource performance. One presentation that really struck me was the vLMIS from Pakistan, developed by JSI under the USAID | DELIVER PROJECT. In full disclosure, I was part of the initial strategy development for the vLMIS, but it has far exceeded my own expectations. But that's not my point here: Wasif presented a slide in which targets and consumption data were displayed across districts, indicating that in many cases, consumption far exceeded the targets used to forecast demand. Not only is this powerful evidence of the need to improve demand planning, it also helps assure us that using consumption data does not necessarily under-estimate demand required for 100% coverage; it actually allows us to position adequate supplies to meet and exceed coverage targets.

A week before (on 28-05-2015) when a couple came with an immunization card developed in a tertiary care centre which created confusion as to what all vaccines thier child should receive made Sampaje team to evolve a user frindly immunization card. This card is evolved considering National Immunization Schedule of India, Karntaka specific, also keeping in mind the candidate vaccines anounced by the Govt (Rotavirus vaccine and Injectable Polio Vaccine one dose with third dose of OPV/Pentavalent) and Table 1: Summary of WHO Position Papers - Recommendations for Routine Immunization. The prototype developed was shared with stakeholders for additional inputs. However with the help of post graduate students, local health care providers we could almost fine tune and posting now for use by the needy service providers. There is always scope for improving hence this may be firther fine tuned by the stake holders.

Dear colleagues: The Alliance Data for Management (D4M) working group is developing a guidance package on immunisation supply chain dashboards that includes a menu of primary supply chain performance indicators for countries to select from that meet their needs. The indicators and dashboards are intended for managers at multiple levels of the immunization supply chain and provide visualisation examples and suggested corrective actions for each indicator. This guidance will be endorsed by the Alliance Partners (WHO, UNICEF, Gavi Secretariat, BMGF). We want your input and feedback to inform the guidance and proposed indicator menu to make the guidance document as relevant and useable as possible! Survey will close Monday, June 1 https://www.surveymonkey.com/s/JFRGZXV For those that have already completed the survey, thank you! For others, we thank you in advance for taking time to provide valuable feedback to us.The survey should take less than 15-25 minutes to complete. For further information on the guidance document and how to get involved contact: Jan Grevendonk (grevendonkj@who.int, WHO), Dorthe Konradsen (dkonradsen@unicef.org, Unicef SD) Kaleb Brownlow (kbrownlow@gavi.org, Gavi) or Anna Rapp (anna.rapp@gatesfoundation.org, BMGF). Best, D4M working group

Background: Complete and timely childhood immunization is one of the most cost-effective interventions in improving child survival in developing countries. Computerized HMIS has been recently introduced to collect aggregated data on service beneficiaries in Himachal Pradesh. HMIS provides coverage estimates for immunization while information on timeliness is currently not available. Hence we conducted a study to validate coverage and assess the timeliness of immunization in Kangra District of Himachal Pradesh. We surveyed mothers (224) of children aged 12 - 23 months (as on January 2008) and selected 32 clusters in the district between January and March 2008. Design/Methods: We conducted a cross sectional survey and selected 32 clusters by probability proportional to size method whereas seven eligible children per cluster were randomly selected. We interviewed mothers using a structured interview schedule, examined immunization card & looked for Bacillus Calmette Guierre (BCG) Scar. Vaccination after 30 days from national schedule was considered “delayed”. We computed proportions of children completely immunized, immunization delayed, frequency of reasons for delay and 95% Confidence Interval (CI) for significance of associated factors. We conducted a case control analysis of factors associated with timely immunization by taking timely immunized children as cases and delayed immunized ones as controls. Results/Outcome: Reported coverage was universal (100%). Validated full immunization coverage was 94.2% by card/record & 99% by history. Only 29.5% (CI = 20.6% - 37.4%) of children were fully immunized as per schedule (delay less than 30 days). Median delay was 21 days for BCG, 28 days for Diptheria Pertussis Tetanus (DPT 3) and 25 days for measles. Among those with delayed vaccinations, reasons were forgetfulness (36%), lack of correct knowledge (27%) & mother gone to parents’ home (27%) & insufficient children in a camp to open full dose BCG vial (22%). Our case control analysis of timely vaccinated versus delayed vaccination revealed that “precall” (reminder) was significantly [OR = 0.1, CI = 0.2 - 0.5] protective against delayed vaccination. Logistic Regression of delay > 30 days revealed that having returned unimmunized from immunization camp earlier due to insufficient children to open vaccine vial (because of high wastage factor) was significantly associated with delayed immunization (p = 0.0000), while knowledge of date of immunization camp was significantly protective from delayed immunization (p = 0.0026). 68% of the children were having at least one immunization delayed over 30 days from recommended schedule, while the proportion of children whose immunization was delayed by over 90 days was 9.4%. Conclusions: Validated field coverage estimates are lower than reported which can be due to inclusion of children of migrants in numerator & not in the denominator. High proportion of children (>70%) were delayed, suggesting implications for WHO’s strategy of measles control & national Tuberculosis (TB) control programmes, as 4.5% of them had suffered from measles. To avoid delays we recommend (i) use of mono dose vials for BCG; (ii) precall notice to mothers; (iii) modification of HMIS software to track immunization status and timeliness of individual beneficiaries rather than aggregate numbers. the link: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=55741#.VS_k8fmUdG0 Regards, Omesh Bharti Shimla, India +91-9418120302