Across Tanzania, health providers often face the same problem: a lack of access to the data they need to make informed decisions and deliver high-quality care. Since the 2013 launch of the country’s National eHealth Strategy, the national government has made an earnest commitment to reverse this trend. USAID's Flagship Maternal & Child Survival Program supported the Ministry of Health, Community, Development, Gender, Elderly, and Children (MoHCDGEC) to lauch the Tanzania National Health Information Exchange (TzHIE), ensuring that information and data needed for policy development and the delivery of health care is readily available and used.  Please check out the link attached to find out more about MCSP's support in launching the TzHIE!    

Innovative solutions are not limited to products, drugs, or diagnostics. They include novel approaches and applications of a technology, service, or intervention to help countries advance their reproductive, maternal, newborn, child and adolescent health and development targets. As the immunization and child health technical lead for USAID’s flagship Maternal and Child Survival Project (MCSP), JSI supports the expansion of the evidence base for approaches and facilitates locally owned and context-sensitive adaptation of life-saving innovations. Learn more about how JSI’s MCSP team is advancing immunization programs below or download the most recent MCSP ‘Innovations Takeover’ newsletter.

Finding the Perfect Temperature: Protecting Lifesaving Vaccines in Remote Areas
Immunization is one of the most successful and cost-effective public health interventions in history, saving 2-3 million lives every year. In Tanzania, JSI is installing remote temperature monitoring devices to strengthen the immunization cold chain and ensure that vaccines make it to the last mile. Click here to view the photo essay.  

Cross-posted from the JSI website with thanks! inSupply, JSI’s regional supply chain consulting center in East Africa, in partnership with Llamasoft and the Nichols Group, recently examined the potential for employing unmanned aerial vehicles (UAVs) to deliver life-saving and other commodities within a public health system. They examined the cost-effectiveness of UAVs versus a motorcycle-based system and other well-run forms of land transport, using three sets of data from African countries over 12 months and have prepared a white paper based on their analysis.  Executive summary: As more low- and middle-income countries (LMICs) explore opportunities to improve efficiency and performance in their public health supply chains and diagnostics networks, they face myriad choices about how best to use unmanned aerial systems (UASs) to improve public health outcomes and reach the last mile. JSI Research & Training Institute, Inc. (JSI) and our partners LLamasoft and the Nichols Group wrote this paper to provide countries and public health stakeholders with objective guidance on how to make informed decisions about which health products to prioritize for delivery and by which type of UAS platform to achieve the six ‘rights’ of a supply chain. The team undertook a cost-effectiveness analysis to compare various transport options for a variety of delivery categories using UAS vs. well-managed traditional modes of last-mile delivery, such as land cruisers and motorcycles. The analysis took into account geography, UAS characteristics, and characteristics of products and their demand patterns. We also mined and analyzed 12 months of health-facility data from three country datasets in sub-Saharan Africa to identify five use cases that would allow us to define the cargo characteristics and examine costeffectiveness for each of the following product types: a) safe blood for transfusion; b) long-tail products (small quantity, unpredictable demand products); c) program and essential medicines; d) vaccines; and e) diagnostic specimens. Overall, our findings show that UAS cost-effectiveness is driven by the number of flights per year and increasing flight numbers is dependent on facility density within the UAS range area. Similarly, with the exception of safe blood for transfusion, the results clearly demonstrate that using UAS for single-product category deliveries is not optimal from a cost-effectiveness perspective, and that layering multiple use-cases will increase the UAS cost-effectiveness by increasing the number of flights the UAV will be used for. For safe blood for transfusions, small, fixed-wing UASs can offer both cost and speed/responsiveness advantages over land transport to deliver rare blood types and support-products on-demand. We estimate that for a region of average facility density, approximate annual costs to serve 500 health facilities will range from US$ 1–5 million, depending on the UAS and cargo categories. Ultimately, even projecting rapid improvements in cost and performance, most UASs are still 3+ years away from being transport-cost competitive with motorcycles. The case for using UASs must be examined within the context of the total system costs (considering factors such as inventory holding costs and capital investment for storage capacity), other supply chain objectives such as speed and availability, and broader health benefits. UAS cost-effectiveness is substantially driven by the number of flights per year that can defray fixed costs. Flight numbers can be increased by operating in areas of higher health 8 facility density and selecting UASs that have longer ranges. Flight numbers can also be increased by layering multiple use-cases. Unmanned aerial systems have significant potential to improve the availability of health products in hard-to-reach locations. Every potential use case must be considered individually factoring in geography, UAS characteristics, and product and demand characteristics. However, the following sets of factors are broadly indicative of a potential value-adding use case for UAS:  High density of health facilities (within range of UAS). Difficult to access by road (large proportion of year). High financial value, scarce, or high health value (e.g., life-saving) products. Unpredictable demand (at level of individual facility) products. Expensive, short shelf-life, or difficult to store at last-mile products. Here is a link to the paper: http://www.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=19145&lid=3    

As more low- and middle-income countries explore opportunities to improve their public health supply chains and diagnostics networks, knowing how best to use unmanned aerial systems (UAS) to improve reach in the last mile is critical. Under the inSupply project, JSI Research & Training Institute, Inc., and our partners LLamasoft, Inc. and the Nichols Group provide objective guidance for countries and public health stakeholders on how to make informed decisions about which health products to prioritize for cost-effective delivery using UAS vs. well-managed traditional modes of last-mile delivery, such as land cruisers and motorcycles.  The analysis took into account geography, UAS characteristics, and characteristics of products and their demand patterns. The paper focuses on examining the cost-effectiveness for each of the following product types: safe blood for transfusion long-tail products (small quantity, unpredictable demand products) program and essential medicines vaccines diagnostic specimens The executive summary is attached and the full white paper can be downloaded here. Please let us know if you have any questions about this white paper or want to know more about our work.

Greetings, colleagues. With increasing importance on user-focused improvements in routine, administrative immunization data quality and use, it is useful to have some experience-sharing from country learning and implementation. Linked below are a few recent blog posts and an article on in-country review meetings that may be of interest. These include experiences from Zimbabwe, Tanzania, Kenya, Ethiopia, Madagascar and Uganda. 1) Zimbabwe defaulter tracking: http://thepump.jsi.com/community-leaders-use-simple-tools-to-track-immunization-defaulters-in-zimbabwe/ 2) Use of immunization data for local decision-making (including Madagascar example): http://thepump.jsi.com/data-for-decision-making-empowering-local-data-use/ 3) Use of data by health workers in Tanzania: http://thepump.jsi.com/health-workers-improve-service-delivery-and-data-quality-at-a-health-center-in-tanzania/ 4) Home based records and reminder dates (with links to experiences from Ethiopia and Madagascar): http://thepump.jsi.com/how-is-your-memory-due-dates-home-based-records-and-vaccination/ 5) Immunization Review Meetings - capacity building and data quality improvement (examples from Ethiopia, Kenya, Tanzania, and Uganda): http://www.panafrican-med-journal.com/content/series/27/3/21/full/#.WYNRKVWGOUm   We hope that these are helpful to those working with/in countries. Please share. Comments and questions are welcome.   Best regards,
Lora    

Hello! We're pleased to announce an opening for a DHIS2 Advisor to join our Applied Technology Team. JSI is looking for a DHIS2 Advisor that can (a) provide high-level value-added guidance and active technical assistance to international health information systems projects in their development and implementation of DHIS2 and (b) providing technical leadership for JSI in the field of Health Information Systems (HIS). Candidates can apply online at jsi.com if interested. Thanks for sharing among your networks as appropriate!

Blockchain is the hot new technology topic in the financial world, the health sector, and the supply chain industry. The idea, first applied by the virtual “cryptocurrency” Bitcoin, combines the security of cryptography with the safety of distributed data. This combination results in distributed ledger technology (DLT) that is highly secure and very difficult to hack because there is no central server containing all data that needs to be protected; everyone with rights to access the blockchain has visibility into the transactions that affect them. Blockchain technology has a variety of applications in health, not least of which are medicine traceability and patient data management. This is just as true for the US domestic health sector as it is for health systems in low- and middle-income countries (LMICs). Counterfeit drugs are a scourge in virtually every country, but nowhere is the problem more acute than in LMICs where regulatory agencies are poorly financed and under equipped to police the market. Pharmaceutical manufacturers are concerned about lost revenue but also about reputational risk when counterfeits are used and cause spikes in adverse reactions or poor treatment outcomes. Suppliers can’t trace their products beyond the primary purchaser (typically a wholesaler), small retailers can’t be sure of the integrity of their suppliers, and people who buy medicines on the retail market cannot be certain if they are getting the real thing. Blockchain technology can provide the transparency and accountability needed to ensure the integrity of every medicine and every transaction that moves it from where it’s manufactured to where it’s dispensed to the patient. This infographic provides an easy to understand illustration of some of the possible applications in the health sector. Read the entire blog on JSI's The Pump.

JSI is proud to announce the launch of a new flagship publication, The Supply Chain Manager’s Handbook, this time in a new website format. Based on more than 30 years of experience improving public health supply chains in more than 60 countries, The Supply Chain Manager’s Handbook is also informed by the latest innovations and commercial best practices in managing supply chains for medicines, vaccines, diagnostics, and other essential products. It serves as the starting point for anyone interested in learning about and understanding the key principles and concepts of health supply chain management, including strategy and design, data visibility and use, financing, and risk management. Portions of The Supply Chain Manager’s Handbook were adapted from of our Logistics Handbook, originally developed under the USAID | DELIVER PROJECT funded by USAID. As the go-to resource for supply chain practitioners in the field, over 28,000 print or electronic copies in six languages have been distributed or downloaded since 2008. JSI: Improving Public Health Supply Chains Worldwide JSI is a private company with a public health mission, dedicated to helping our partners improve the lives of the people and communities they serve. Guided by the belief that strong supply chains save lives, our supply chain management practice leads complex projects in innovative and cost-effective ways to make sure medicines, vaccines, and other products reach the people who need them.Learn more at www.jsi.com

When it comes to medical supplies, transport challenges can add up to serious gaps in health care for rural people. That’s why John Snow, Inc., through the USAID | DELIVER PROJECT partnered with Medical Stores Department (MSD) in Tanzania to map more than 30,000 kilometers of road connecting more than 5,600 health facilities across the country. The USAID | DELIVER PROJECT, which partners with government health ministries and other organizations to improve health in developing countries by increasing access to health supplies, was asked by the Government of Tanzania in 2014 to help improve how it delivered health care supplies. Almost half the roads in Tanzania were not online, making medical supply delivery unpredictable and unreliable. To improve the system, we collaborated with MSD to analyze delivery routes and available transport resources. Although MSD had a comprehensive list of facilities across the country, about 30 percent did not have a validated geocode, making them difficult to find unless you asked a local person how to get there! While a digital map of Tanzania’s road network existed, it was incomplete. Truck drivers trying to get supplies from MSD to faraway clinics did not know if the route they chose was reliable or how much time a route would take to navigate. Using GPS data from devices recently installed on MSD trucks, our team was able to mark the unmapped secondary road network showing what routes were navigable across the entire country. We joined forces with Humanitarian OpenStreetMap Team, a global community of mappers, and Ramani Huria, a community mapping group in Dar es Salaam, to upload the Tanzania data area-by-area, making it accessible to everyone around the globe. Now, this digital map can be used not just by those delivering medical supplies, but also by food producers transporting crops to market, tour operators showcasing Tanzania’s spectacular wildlife, and others engaged in commerce who are driving Tanzania’s economic growth and development. Read more here:Getting from A to B Gets Easier with New Mapping Open Data

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.

Dear Colleagues,
JSI is pleased to announce a new publication in the Getting Products to People series: How Private Sector Solutions Can Strengthen Supply Chains for Public Health For years, experts in the field working on strengthening supply chains to support public health programs have emphasizedthe importance of the private sector role in extending the reach and improving the performance of the supply chainsthat serve the public with the health products they need. The private sector has often been deemed thesolutionto efficiency challenges and improving value for money.JSI has extensive experience working on designing private sector solutions that work in both low and middle income countries. We have found that although the private sector is definitely part of the solution, there are many models that work and extensive privatization is not necessarily always the panacea to our supply chain problems.We determine it will take anuanced approachto building agile supply chains and strong and sustainable healthcare marketplaces to meet our universal health coverage goals. This will include the private sector but does not presuppose full health sector privatization. The public will always need to serve as a good steward for public health and equitable access to products and services.It is strong, visionary supply chain leaders who will design and oversee supply chains that work and leverage the capacity of the private sector to help in these endeavors.

Dose per Container Partnership (DPCP)
The issue: Multi-dose containers are used to offer lower prices, higher supply volumes, and minimize cold chain storage and distribution requirements. As new, more expensive, vaccines are introduced in multi-dose presentations, maximizing the use of every dose in a container increases in importance. HCWs need to be more strategic about when to open a container; diligent about how they care for open containers, and potentially more active with communication and community outreach to ensure optimal attendance and timely vaccination of every child. Thus, the number of doses per container (DCP) may also impact on health systems in terms of timely, safe and equitable vaccination coverage, supply and cold chain, wastage rates, cost and HCW behavior.
Immunization stakeholders need information and tools to assess which dose per container presentations are appropriate for a country’s specific context and priorities.
Initial 2015 response: With Bill & Melinda Gates Foundation (BMGF) funding, JSI Research & Training Institute, Inc. (JSI) helped identify evidence gaps by interviewing key stakeholders and analyzing existing research. An informal network of partners interested in advancing this work was created after a consultative meeting in July 2015.
Launch of the partnership: The Dose Per Container Partnership (DPCP) was launched in March 2016 as a project, funded by the BMGF and implemented by JSI in partnership with PATH, Agence de Médecine Préventive (AMP), Clinton Health Access Initiative (CHAI), HERMES modeling team and the International Vaccine Access Center (IVAC) / Johns Hopkins University. The DPCP aims to address the complexity of vaccine product and program decision-making to include DPC considerations. Understanding and assessing the trade-offs between cost and health impact allows better informed decisions about the impact of the dose per container selected.
DPCP objectives and work streams: The DPCP project will run from February 2016 – December 2017, guided by a Technical Advisory Group (TAG), and aims to achieve two objectives:
i) To gain a deeper understanding of the decision making processes, trade-offs, data
and tools used to assess DPC decisions at global and national levels in order to recommend process improvements;
ii) To provide guidance and tools including trade-offs to be considered by countries and facilitate
sharing of best practices for country level decision makers.
These will be implemented through three technical work streams:

A global cross-country review of current DPC-related decision making tools and processes;
Prospective research studies in two African countriesl will include data collection to improve modeling efforts, economic analysis and see the actual effect on the various systems variables; and
Synthesis of data supporting global level policy and country decisions.


Stakeholders: DPCP aims to inform, support and influence stakeholders at:
a) Global level, by providing evidence that fills critical gaps in knowledge, analysis, and policy. This includes ensuring that stakeholders will continue to be informed about sustainable decisions on DPC when considering vaccine products and program designs; and
b) Country level, by producing easy-to-use and -understand guides and tools to assess DPC tradeoffs, including cost and systems impact to inform vaccine product selection
Information about the DPCP will be made available through partners engaged with the project, the JSI website, announcements via the technet forum and various formal and informal opportunities where immunization practitioners meet globally, regionally or nationally.
http://jsi.com/JSIInternet/IntlHealth/project/display.cfm?ctid=na&cid=na&tid=40&id=22641

Today is Innovation Day during World Immunization Week, and there are a lot of innovative ideas out there to reach every child. But innovation doesn’t always require radical new ideas. Sometimes it simply means challenging traditional approaches based on current information. For immunization supply chains, that means changing over 40 years of custom to embrace state-of-the-art commercial best practices.
Imagine a scenario in which a global soft drink company launches a new marketing strategy; it wants 100% of young consumers under five years old in every city, town and village around the world to drink 200 ml of its product at least once a year. The company launches a global advertising campaign and free give-away of their product to the targeted consumers to meet their goal. Imagine the company then produces sufficient quantities, and packages it in 2-litre bottles for supply chain convenience. Calculating 200 ml per person and 100 percent coverage, millions of bottles are distributed to tens of thousands of shops and community marketers based on census figures and catchment area estimates down to the last kilometer. Ethical considerations and community acceptance aside, it would never work from a supply chain perspective, because the population figures and the coverage assumptions are too inaccurate. But that is precisely the model that immunization supply chains have been following for the last 40 years.
The Weakest Link: The problem of the denominator
From the national cold store to the last kilometer, vaccine demand and supply is calculated using a denominator ontarget population size or, less commonly, expected size of immunization sessionsat each vaccination point, then aggregated up the chain. Routine immunization programs are unique in their use of demographic data to operate the supply chain. It’s no secret that the denominator is inaccurate, but immunization experts at every level—including many at the global level—remain wedded to this data point.
The reliance on coverage target data to operate the supply chain is a legacy of data-poor environments. When immunization campaigns were introduced as the primary vehicle to drive coverage, demographic estimates were the only data at hand, and the micro-plan forecast could only be determined based on campaign targets because historical consumption/use data was simply not relevant. But as EPI programs evolved to rely more on routine immunization, they have continued to rely on target coverage resupply forecasts, either because this was the familiar way of doing business, or because they didn’t know or didn’t trust other methods, or because consumption reports from SDPs and vaccinators were simply not forthcoming.
Routine immunization can use routine supply chain data. Almost every other health commodity managed in awell-designed supply chainis resupplied based on reported consumption data, receipts, and remaining stock on hand, with a buffer built in to accommodate demand variability month-to-month. This consumption-based resupply system isdesignedto ensure a full supply of antiretroviral medicines, antimalarial drugs, contraceptives, and other essential health commodities thatmustbe in full supply. This system is based on the commercial best practice of using point-of-sales data for managing fast-moving consumer products; it works, and it accommodates fluctuations in demand over time. But it only works when national inventories are sufficient to meet demand, and when data are reported from SDPs on time and in full.
If immunization programs continue to rely on inaccurate demographic data to drive the supply chain, no amount of innovation in technology or system optimization is truly going to fix the problem of supply imbalances at the service delivery point.
Unit of measure: doses vs. vials
Another flaw common to immunization supply chains is the use of doses as the unit of measure for managing the supply chain. This is particularly notable at the lower levels of the system, and is related to the previous problem; demand is based on target populations, and each client needs a particular number of doses per antigen. The use of doses rather than vials is attributed to variations in presentation—doses per vial—for the same antigen. For example,DTP comes in single dose, 10-dose, and 20-dose presentations, and countries sometimes manage two different presentations of the same antigen in a given year. But managing a supply chain based on doses is a bit like Coca Cola or Pepsi managing beverages based not on various sizes of cans, bottles, and cases but on milliliters of fluid imbibed by the average consumer; it doesn’t happen in the commercial world. Granted, vaccines are different from soft drinks, but best practice is to manage the supply chain based on stockkeeping units (SKUs) which, in vaccine terms, is the vial. Each presentation of each antigen is a unique SKU, so a 10-dose vial of DTP would be a different SKU from a 20-dose vial.
Beyond aligning with commercial and pharmaceutical supply chain best practices, managing by SKU allows supply chain analysts the ability to compare coverage against consumption. Doses administered (coverage) reported via the HMIS can be compared with vials issued (reported via LMIS) to vaccinators to provide an important quality check on coverage reporting, and can also be used to analyze open-vial wastage rates more accurately. Consumption and wastage trends can inform forecasts and procurement specifications, and the right presentation can be targeted to specific SDPs based on their specific trends. Managing by SKU becomes easier—and essential—when barcodes and other technologies are introduced to automate supply chain information systems.
Global and country stakeholders working in immunization are recognizing that immunizationsupply chains must evolve. Successful supply chains that ensure availability and potency of vaccines and related supplies demand therightdata in the right quality at the right time.
This article was reposted from JSI's The Pump

Earlier this month, the Dose Per Container Partnership (DPCP) project was launched. This Bill and Melinda Gates Foundation project is implemented by JSI and partners (PATH, Agence de Médecine Préventive (AMP), Clinton Health Access Initiative (CHAI), HERMES modelling team and the International Vaccine Access Center (IVAC) / Johns Hopkins University). The project will help identify evidence needed to support better-informed decision making related to the trade-offs between cost and health systems impact of vaccine doses per container (DPC). The project runs from February 2016 to December 2017 and has potential to influence country, regional and global equity and systems related policies, and have impact on supply and demand sides of various DPC options with three main deliverables: i) A global review of current decision making tools and processes related to DPC; ii) Prospective research studies in Tanzania and Senegal, including data collection to improve modeling efforts and economic analysis of this topic; and iii) Synthesis of data and harmonization of tools supporting global level policy and country decisions. Attached is an overview of the project and more details are available at http://jsi.com/JSIInternet/IntlHealth/project/display.cfm?ctid=na&cid=na&tid=40&id=22641

The newly launched Global Financing Facility (GFF) for Every Woman Every Child is a bold initiative coordinating a mix of donor funds, loans, and domestic financing for the purpose of accelerating country efforts to end preventable maternal, child, and infant deaths by 2030. Health supplies and the supply chain systems that deliver them, however, are often afterthoughts in these efforts. “Global Financing Facility: Advancing Smartly Means Keeping an Eye on Family Planning Products and the Supply Chains that Deliver Them,” a new blog post at The Pump, JSI’s online hub for public health news and opinion, focuses on this issue and acts as a reminder that the sort of work performed by the USAID | DELIVER PROJECT is essential in closing the US $33.3 billion annual financing gap for reproductive, maternal, newborn, child, and adolescent health. Read the blog at http://bit.ly/1nlNGK2

Since 2006, the USAID | DELIVER PROJECT has worked to improve the health and well-being of communities around the world. Our contributions span the globe and touch all areas of health supply chain management. Over the past nine years, we have supported malaria, family planning, maternal and child health, and emerging pandemic threat programs, among other areas. As we move into the final year of the project,IQC DirectorEdward Wilson takes a look back at the project's accomplishments. Learn more at http://bit.ly/1mFvECR

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/

cStock is a simple mHealth system that helps to ensure community health workers in Malawi have lifesaving products to treat children under five. cStock was originally piloted in 6 districts and 3 of these districts also implemented supporting teams. The greatest benefits were shown in districts with both increased data visibility from cStock and communication from teams. The Enhanced Management approach including cStock and teams is currently being scaled up nationwide. View our new infographic Learn more at http://www.sc4ccm.jsi.com