This report explains Shifo's approach and solution - MyChild Outreach, to strengthen outreach services to reach the fifth child and reduce equity gaps in vaccination services in rural and hard to reach areas:https://shifo.org/doc/MyChildOutreach.pdf/

This report provides insights into the importance of government leadership, governance, and intragovernmental cooperation in digital health for government leaders and policy makers at the intersection of the health and ICT sectors. It draws on the experience of countries in a variety of geographic and resource settings and builds on existing digital health literature by shedding light on leadership approaches and on governance mechanisms for engaging health and ICT stakeholders. Available at: · Executive summary: http://www.broadbandcommission.org/Documents/publications/WorkingGroupHealthExecutiveSummary-2017.pdf · Full report: http://www.broadbandcommission.org/Documents/publications/WorkingGroupHealthReport-2017.pdf

Dear Colleagues, VaxTrac is excited to announce our new project in Sierra Leone, in partnership with eHealth Africa (eHA)! The pilot phase of the project will launch this month, starting with the first-round of training in Freetown, and will run until May 2017. We are thrilled to be working with eHA, the Ministry of Health and Sanitation, and Africell on this new project! For more information, check out our official project announcement attached to this email. For more information about VaxTrac's digital immunization recording system and our other projects in Nepal and Benin, please check out our website: http://vaxtrac.com/ For more information about eHealth Africa, please check out http://www.ehealthafrica.org/ Best, Aly Azhar Program Associate VaxTrac

In case it's of interest.
Best
Patrick

The fabulous app "Immunization Summary" was updated with 2014 data and in the 6 WHO officials languages. The Immunization Summary is an app for visualizing (tables, graphs, maps) data on policies, activities and impact of national immunization systems. There's a just discovered bug, which is the country name selection needs the English country name to select the country in the appropriate chosen language! Ah well... If you do not know the English name of the country sought, just scroll down the list in the chosen language; there the country names appear in the proper language. When we finalize the JRF 2014 data exercice, sometimes next month, another update will be done on the app. If you already have the app on your device, redownload it from the App store: http://appstore.com/immunizationsummary or Google Play: https://play.google.com/store/apps/details?id=com.who.immunizationsummary cheers

by Morris Gargar, Consultant; Elly Tumwine, UNICEF; and Ryan McWhorter, Logistimo The Government of the Republic of South Sudan is working with the United Nations Children’s Fund (UNICEF) and project Optimize to test a cloud-based logistics management information system (LMIS) that uses mobile phones to manage vaccine stock. The new system, named Logistimo, was deployed in May 2012 and is now being used in the central store, the ten state stores, and all six counties of Central Equatoria State. So far, the response from Expanded Programme on Immunization (EPI) staff to the new tool has been positive. “The procedure is very simple and it helps to accelerate our work, with timely response from national level,” says Teresa Adams Deng (EPI Manager, Jonglei State). In recent years, the EPI in South Sudan has made substantial progress in increasing vaccine coverage rates. However, a serious barrier to further progress is the lack of reliable information on stock levels and consumption rates at all levels of the supply chain below the national level. Without this information, stockouts frequently occur because health centers are not resupplied in time. The Logistimo demonstration project in South Sudan aims to evaluate the benefits to immunization programs of more reliable and up-to-date information on stock levels and consumption rates, as well as the feasibility of implementing a mobile-phone based LMIS in remote locations. As part of the demonstration, county stock managers have been provided with mobile phones they can use to register stock transactions and submit orders for additional stock. National or state managers can then use this information to track stock and demand in real-time and analyze consumption patterns. There are several potential benefits to this approach. Being cloud based, the new system does not require investment in computer servers and other information technology infrastructure. This removes logistical barriers to implementation such as purchasing cost and equipment maintenance. Instead, the Logistimo LMIS is hosted on a remote server that can be accessed by a web browser or a mobile phone using general packet radio service (GPRS) or short message service (SMS) technology. Because of this, the system can be quickly scaled up to support additional users, new facilities, or increased stock with minimal additional work or equipment. The Logistimo mobile phone application (LogiMobile) can be used on widely available, low-cost mobile phones, while the application itself requires only two hours of training for the operator to become proficient. Navigating a simple set of menus, county stock ­managers can record vaccine stock levels using only their mobile phone keypad. They can enter how much stock they have at that moment, how much they have issued to patients or to other clinics, or how much has been damaged or expired. The stock update is then sent from the mobile phone to the Logistimo LMIS using a GPRS connection or by SMS text message if GPRS is unavailable. Although it requires a network connection for the operator to register an update, LogiMobile can also work in offline mode by storing updates and sending them as soon as a connection becomes available. It is just as easy for county stock managers to order vaccines. Requests for vaccines are immediately recorded in the Logistimo LMIS for national or state managers to review and approve. To help ensure the request is dealt with promptly, Logistimo can also be configured to automatically send an SMS message to the manager to provide notification of pending orders. When an order is received, state managers can validate and ship those orders using LogiMobile or the browser-based component of Logistimo, named LogiWeb. The system can then notify the county stock manager by sending an SMS text message with details of the manager’s response (for example, “Your order has been processed and will be delivered on 12/12/2012”). When the shipment arrives, the county stock manager can then record the arrival on the mobile phone. Each stage of the process is recorded in the Logistimo system. As well as being used to record stock levels and the progress of orders, the Logistimo LMIS can also be used to guard against stockouts. Should stock levels fall below a minimum level without the county stock manager ordering a new shipment, the Logistimo system can be configured to automatically warn county stock managers of low stock levels. For example, it can send an SMS message to the user with a warning that new stock needs to be ordered. LogiWeb contains all the functionality of LogiMobile, but can also be used to report on stock availability and consumption in real-time across the country. Users can manage their orders, track inventory problems throughout the country, and report on consumption trends to aid in forecasting and procurement. A cloud-based LMIS that uses mobile phones to register stock transactions and submit orders for additional stock has the potential to simplify stock-ordering, saving time currently spent by stock managers preparing and sending paper orders. It also has the potential to make stock data more accessible, enabling state managers to make ordering or dispatch decisions according to reliable and easy-to-understand data in real-time. During the last two months, more than 400 transactions have been entered using the Logistimo system and the project will soon begin collecting data on stockouts, wastage, and service levels across the country. Project Optimize will publish a progress report on the project in early 2013. For more information, please contact Jan Grevendonk (jgrevendonk@path.org). To show the Logistimo LMIS at work in South Sudan, Op.ti.mize has created a photo set on Flickr. View the slideshow here. We encourage your questions or comments. Please click reply at the bottom of the page.

by Erida Nelaj, Albania Institute for Public Health and Jan Grevendonk, PATH In May 2011, the Albanian Institute for Public Health (IPH) launched a new web-based immunization registry and vaccine ordering system in the district of Skodra. Based on the acceptability and success of the system in Skodra, the government is deciding when and how to roll out the software nationwide. After an initial training with nurses, the system appears to be working well, and acceptability is high. [Click photo to enlarge] The project began in 2009 when IPH asked project Optimize to help develop a strategy for an electronic immunization registry and vaccine stock management system. Working with a local software developer, IPH and Optimize documented the key processes and requirements for the system and referred to them throughout the development process to ensure the project was on track. A year later, after several rounds of preliminary testing with users, the software and training materials are complete and have been deployed at 24 health centers in Skodra. In many ways Albania is a difficult place to deploy a web-based information system. Few health centers are equipped with computers, electricity is unreliable in many areas, Internet access is limited, and even mobile networks do not reach the more remote areas of the country. However, the system was designed to work around these issues by providing access through mobile phones and, when needed, paper-based reporting systems to complement online access. After a month of use in the district, IPH and Optimize staff checked in with nurses in health centers across the district to learn how they liked the new system. They found that nearly everyone understands the system and finds it highly functional. Despite some frustrations with Internet access and electricity, nurses clearly see the value in the system, noting that it will save them a tremendous amount of time creating their monthly plans and make it easier for them to track and monitor vaccinations, even among families that move to and from other districts. For now, nurses are simply playing with the system, and data are not being collected for use. In September, the system will be used for actual data collection, monitoring, and ordering. Over time, additional features and capabilities will be added to the system, including the mobile-phone component that will allow nurses to download immunization schedules for children associated with their health post, find any child in the database, and register the vaccinations they administer from any location with connection to a mobile SMS (short message service) network. Nurses have also requested that the system be expanded to include additional functionality such as adverse events reporting and disease reporting. As the Government of Albania prepares for nationwide introduction in the coming years, neighboring countries, too, are taking an interest in the system. In the fall, representatives from these countries will be invited to visit health centers in Skodra to understand how the system works. Optimize will monitor the system for up to a year and conduct multiple evaluations, including a functional evaluation of its use and acceptability, impact on supply chain performance, and cost. For IPH, the success of the pilot will be measured by how well it can improve the quality of the monitoring system for immunization coverage, increase ordering accuracy, and decrease the administrative burden on health workers. [Click photo to enlarge] For nurses who currently record each vaccination session on five different paper records, the benefits of the system are obvious. After completing the first training session, one nurse asked, “okay, just tell me when it is going to start.” For administrators, the system will also bring value. Not only will coverage data be more accurate, but the data are disaggregated, which means that district officers and nurses can see that not only do five percent of children need vaccination, but they can see the individual names and locations of children who are due or overdue for vaccination. Combined, these benefits will accrue to families whose children will receive all the vaccines they need right on schedule. To learn more about the software system or comment on its use in Albania, please click reply at the bottom of the page.

by Jan Grevendonk and Elaine Griffith, PATH and Anup Akkihal, Logistimo One of the perennial struggles in any supply chain is to deliver the right amount of product to the right place at the right time. This is especially true for essential medicines and temperature-sensitive products like vaccines. As the financial costs of maintaining excessive stock levels rise with the introduction of newer, more expensive products, the human cost of missing opportunities to vaccinate due to poor vaccine handling and management rises in turn. In this environment, managers need more precise tools to determine the quantity of product to store and deliver at a given point in time. Fortunately, an increasing number of tools are becoming available to help countries track and monitor consumption data at the service-delivery level. Some have been demonstrated in immunization programs, and others can be deployed relatively easily should the opportunity arise. [color=#999999][Click photo to enlarge][/color] Optimize is exploring the possibility of demonstrating a cloud-based software service called Logistimo which enables health workers to record and send consumption data, place orders, and check on the status of orders from any location using inexpensive mobile phones. At present, Logistimo is being used and demonstrated in a variety of applications both within and outside of health care. It is particularly relevant to immunization systems because it can improve reporting, inventory management, distribution, and forecasting for remote health programs by linking these functions directly to actual real-time consumption data. The tool is flexible enough to fit almost any logistic system and does not require a large software development effort. How would it work? [color=#999999][Click photo to enlarge] [/color] An intuitive user interface would allow health workers to enter vaccine consumption data directly into inexpensive mobile phones following a vaccination session. The data would be uploaded immediately to a networked system that allows managers to review actual demand and stocks at the service-delivery level at any point in time. A real-time information system prevents the practice of estimating demand based on consumption at the district or subnational level which may or may not reflect actual consumption at the service-delivery level. It also works quickly and efficiently enough to allow managers to use the data for placing and verifying orders. Based on this consumption data and levels of existing stock, health centers can place an order with the district store. District health workers can compile all orders in the district, compare them to consumption data, and ship the orders to health centers along with other essential medicines. After delivering vaccines, the district health worker can create an accurate order for resupply from the national level. [size=14]Why is the last-mile so important?[/size] All levels of the supply chain are designed to support a service at the endpoint of the chain. Information from this endpoint is therefore useful to ensure that the supply chain as a whole is delivering effectively. An information system that tracks consumption data can enable each level of the supply system to make evidence-based decisions using accurate, real-time information on availability of vaccine at different levels of the supply systems. Such a system can also track historical vaccine distribution patterns (seasonality) and trends to improve forecasts. Another significant advantage with a service like Logistimo is that there are no costs to the country on software development. If the system works, it can easily be scaled countrywide, requiring only 15 minutes of training to produce quality, actionable data, and one to two hours of training to use the web-based dashboard’s intuitive features such as maps, graphs, charts, and tables. In addition, information systems which use mobile phones instead of computers are much more accessible financially and technically in remote areas. To inquire about Logistimo, please contact [email=anup@logistimo.com]Anup Akkihal[/email]. To inquire about other last-mile logistics solutions, please contact [email=jgrevendonk@path.org]Jan Grevendonk[/email]. We encourage your questions or comments. Please click reply at the bottom of the page.

Using mobile phones to track immunizations by Jørn Ivar Klungsøyr on behalf of http://www.openXdata.org (http://www.openXdata.org) and Jan Grevendonk, PATH In August 2010, the Norwegian Research Council approved funding for a new project that will allow countries to manage immunization programs with increased accuracy and reliability by enabling health workers to record and register individual immunizations using mobile phones. The project, called Mobile Innovations in Recording Child Vaccination and Health Data in Immunization Registers (mVAC) builds on the work of its many partners and applies existing technologies in a fresh and innovative way that could radically improve the way vaccines are managed. The goal of the three-year mVAC project is to develop an end-to-end mobile phone-based solution to create a fully digital system for recording immunizations at the individual level: one that can be implemented in almost any country with or without a public unique person identification structure or system. The project uses an open-source software package called openXdata that allows users to create their own forms on a web-based interface and deploy that to mobile phones or devices. OpenXdata is being actively used in many different fields and will soon be implemented in Albania with Optimize and others. The software is constantly enhanced with input from users and developers on almost every continent. OpenXdata is a collaboration between many different institutions, companies, and individuals. As a result, openXdata software has the flexibility and simplicity to make it a good fit for different geographic environments and management systems. How it works Primary health care workers will be equipped with a low-cost, Java-enabled mobile phone with an integrated camera (approximately US$40) to record and submit vaccination data to a central vaccination registry. Child health cards with 2-dimensional bar codes will serve as the primary identifier for individual children. Using the camera on the phone, health workers will scan the card on each visit to see a list of immunization tasks scheduled for that particular child. When the immunization is given, the health worker documents it on the mobile phone and on the card and digitally signs the encounter. Children who have migrated from other areas can be tracked by their card, and children who have lost their card can be looked up by name and other key identifiers, such as location, mother’s name, sibling names, etc., in the central register. The health worker can then issue a new card on the spot. When the system is fully operational, the registry can generate lists of children in specific catchment areas who are overdue for vaccination and give it to the health worker prior to a session. Taking this a step further, the system can send automated SMS (short message service) text messages with reminders to parents that have signed up for this feature. At the central level, the immunization registry allows the supply chain management system to deliver exactly the right amount and kind of vaccines to each individual facility based on monthly consumption data. Why it is needed Too often, decision-making that affects the lives of a large portion of the population depends on unreliable and fragmented data. Most reporting and documentation efforts today are based on pen and paper-based systems of past centuries that are error prone and preclude rapid aggregation and analysis of data. In the context of immunization, distribution planning is often based on demographic data. Stock levels are maintained to allow for immunization of 100 percent of the theoretical population plus a buffer stock. Since there is, at best, limited up-to-date knowledge of consumption data at lower levels, managers maintain high levels of buffer stock to compensate for a lack of data. With the introduction of pricier and bulkier vaccines, this is quickly becoming increasingly unfeasible and uneconomical. A centralized immunization register addresses these problems and transforms supply chains from inefficient supply-driven systems to accurate and reliable demand-driven systems. To learn more about the mVAC project, visit http://www.openXdata.org (http://www.openXdata.org). Questions about the project can be directed to [email=contact@openxdata.org]contact@openxdata.org[/email]([email=contact@openxdata.org]mailto:contact@openxdata.org[/email]). We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register; the process is very simple. Return to the Optimize newsletter.

by Olivier Ronveaux, WHO, and Mojtaba Haghgou, Vaccine Management Consultant Maintaining required temperatures in vaccine refrigerators and freezers is one of the more thankless tasks of a cold chain manager as it requires painstaking manual recording of the temperature of each piece of equipment twice daily. Despite the monotony, temperature monitoring is a crucial task, especially in central stores at the national level where millions of doses of costly vaccines are at stake. A 2004 study of vaccine freezing in Indonesia, for example, found that freezing temperatures were recorded in 74% of shipments. Without careful temperature monitoring, accidental freezing or overheating of certain vaccines can reduce their potency to levels that render them ineffective against disease. Several countries, among them Sudan and Iran, have found a way to automate the temperature monitoring system saving both time and money while increasing the accuracy and reliability of the monitoring system. While Sudan is a bit smaller in population than Iran, the two countries have a similarly sized number of surviving infants (1,086,000 in Sudan and 1,300,000 in Iran) and handled an almost identical number of doses of vaccines in 2007/2008 (about 108.8 million doses). Sudan automated its temperature recording system with financial and technical support from the World Health Organization (WHO) Regional Office for the Eastern Mediterranean (EMRO) in 2007. A United Kingdom-based company was contracted for the design, assembly, and installation of the system which cost about £52,000 at the time. The system includes a network of gas-type temperature sensors (Figure 1) in each cold and freezer room that measures the internal temperature and transmits it wirelessly via a transmitter installed on the roof of each cold and freezer room to a hub. The hub is connected to a computer for saving data. The store manager can also view the data on a monitor in his office (Figure 2). When temperatures exceed 10[sup]o[/sup]C or fall below 0[sup]o[/sup]C, an alarm system sounds a siren in the store and calls the mobile phones of the store staff and the Expanded Programme on Immunization (EPI) manager. The system also sends a short message service (SMS) text to the mobile phones providing information about the specific cold or freezer room and its internal temperature at the time of breach. The system has functioned continuously since February 2007 without interruption or malfunction. A manual system is maintained for backup purposes and is kept on file. Iran's system is older (2005) and perhaps more impressive because it was manufactured, designed, assembled, installed, and maintained entirely by local companies. Although the cost of the system is unknown, it is likely to be the less expensive of the two systems since it involved no international travel or foreign labor costs. The system is similar to the Sudanese system with the following differences: local products and labor, the connection between the temperature monitor and the modem is wired (not wireless), the connection between the modem and the computer is wireless, and the temperature sensors are digital, rather than gas type. EPI staff members from many other countries in the region have already toured Sudan to learn about its system, and there is great interest globally in replicating the concept. Since 2007, WHO has established specifications for performance, quality, and safety (PQS) for temperature monitoring systems and protocols for testing such systems. To support decision-making, Optimize is working to establish minimum criteria under which countries should consider installing automatic temperature recording systems. The type of recommended system will depend on the size of the stores, the number of vaccine doses handled per year, and the importance and location of the store. Download a copy of a recent Optimize report on temperature monitoring systems in Sudan and Iran.

It's really a great step in using mobile phones for the welfare of public health. I am looking anxiously to know more about it. Please keep on posting more about this. This is really a great job.

This issue of HIV & AIDS Treatment in Practice compiles examples of how mobiles phones in developing countries are being used creatively to advance public health. Suggest we compile similar examples in immunization programs. ##text##

The Role of Handheld Devices in Immunizationby Olivier Ronveaux, Technical Officer EPI, WHO For 30 years, paper and pencil have been the dominant form of record keeping in immunization programs through out the world. After all, paper is inexpensive and ubiquitous, functional in case of power-outage, and easy to use. But when it comes to searching for data, crunching numbers, and creating reports, paper systems are almost useless. For many years, immunization programs have considered the merits of moving beyond a paper-based tracking system but have been stymied by a dizzying array of ever-evolving hardware, software, and networking options—none of which were developed with the unique needs and constraints of low- to middle-income countries in mind. Recognizing that these problems are unlikely to disappear, Optimize is approaching information technology with a “systems view,” exploring handheld devices, such as PDAs, cell phones, Smart phones and other technologies, as part of a much broader information technology platform that brings together application, data, devices, and users. There are a variety of potential applications for handheld devices within immunization, including: Supervision.Survey delivery and assessments such as effective vaccines management (EVM), data quality surveys.Equipment management and specifically the cold chain equipment management (CCEM) tool.Supply chain management.Monitoring and reporting.Birth registration. Over the next several years, Optimize will be working with collaborating country partners to explore the ways in which handheld devices can be applied in these areas to streamline the flow of data within a larger information technology platform. We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register, but the process is very simple.To link back to the Optimize e-newsletter, click here.