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.

A new release (v 1.13.1) of the Immunization Calculation Engine (ICE) is now available (download ICE version 1.13.1). ICE is a state-of-the-art open-source software system that provides clinical decision support (CDS) for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support Earliest Date and Overdue Date for additional vaccines: Pneumococcal and Hib. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. With this release, ICE returns the earliest and overdue dates for nine vaccine groups, and the remaining three vaccine groups will be completely supported in a future release of ICE this summer. In addition, this release includes an adjustment to the Pneumococcal catch-up schedule (see Exception 1B in the Pneumococcal Vaccine Group documentation for details). All changes are documented in the release notes. There were no changes to the ICE Implementation Guide (v2r20) which describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. Feel free to e-mail us at ice@hln.com if you have any questions.

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  

A new release (v 1.11.1) of the Immunization Calculation Engine (ICE) is now available (Download ICE version 1.11.1). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations (CDSi) for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems. The release includes support for Earliest Date and Overdue Date. If enabled, ICE will output two additional forecast dates along with the Recommendation Date: the Earliest Date and Overdue Date. The Earliest Date is the soonest date that the vaccine can be given and still be considered valid. The Overdue Date is the date after which an immunization administered would be considered late. In this release, ICE returns the earliest and overdue dates for 4 vaccine groups: Meningococcal ACWY, Polio, Rotavirus and Varicella. The ICE team expects the remaining vaccine groups will be completely supported in future releases of ICE in Spring 2018. In addition, this release includes a General Rule update which fixes an issue that resulted in the General Rule “Shots Administered Below Series Absolute Minimum Age for Dose 1” not being triggering when there are 2 or more invalid shots given below the absolute minimum age for Dose 1. The latest ICE Implementation Guide (v2r19) describes how implementers should update their installation and software to properly read the Earliest, Recommended, and Overdue dates. The relevant information starts on page 43. Note that a “track changes” version of this same guide is also available. The tracked changes are intended to make it easier for the reader to see what has changed in the Guide since the prior release of the ICE Implementation Guide (v2r18). You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

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

A new release (v 1.9.1.0) of the Immunization Calculation Engine (ICE) is now available (download ICE v 1.9.1.0). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations (CDSi) for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Persona The release includes the following changes: l Health Record (PHR) Systems. Added support for Meningococcal B. Support for Meningococcal B has been added as a new vaccine group, separate from the existing Meningococcal ACWY vaccine group. Meningococcal ACWY will continue to be returned as its own vaccine group. Implementers may need to modify their software to start looking for the new Meningococcal B vaccine group code (835). Logic fixes for HPV and Hep B vaccine groups. Addition of non-U.S. vaccine DTaP-IPV-Hib (CVX 170) Release notes that describe the latest changes in more detail Please refer to the updated ICE Implementation Guide (v2r17) for information on how to make the appropriate adjustments to your software to be compatible with this release. The guide provides details about the new Meningococcal B vaccine group implementation as well as a few other vaccines and reason codes that have been added. In addition, a “tracked changes version” of this same guide is also available. The tracked changes are intended to make it easier to see what has changed since the prior release (v 1.8.2.0). You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

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

HLN has released a product Roadmap for its award winning Immunization Calculation Engine (ICE).  ICE is an open source service-oriented, standards-based immunization forecasting software system that evaluates a patient’s immunization history and generates the appropriate immunization recommendations. The Roadmap describes modifications that have already been scheduled for inclusion in new releases of ICE in the near future, in addition to ongoing changes that may be required to maintain compliance with the US Advisory Committee on Immunization Practices (ACIP) recommendations. Addition of new vaccine schedules, changes to core business logic, and additional functionality are all included on the Roadmap. As additional modifications are scheduled they will be published on the Roadmap as well. HLN hopes this information will help clinical organizations seeking to use ICE in their practices and software vendors seeking to incorporate ICE into their products to plan for new feature availability. ICE provides state-of-the-art clinical decision support for immunizations (CDSi). ICE can be used in Immunization Information Systems (IIS), Electronic Health Records (EHR), Health Information Exchanges (HIEs), and Personal Health Record (PHR) Systems. See Press Release For more information contact ice@hln.com

On June 6, 2017, HLN was awarded the 2017 Upshot Award for Excellence in Vaccine Supply, Access, and Use by the National Vaccine Program Office (NVPO) for its ICE Open Source Immunization Forecaster. In the letter of award, Dr. Jewel Mullen, Principal Deputy Assistant Secretary for Health commented that, "HLN Consulting’s efforts on the Immunization Calculation Engine (ICE) are impressive. This powerful tool-including its open-source nature and seamless integration into clinical workflows-holds great promise for improving clinical decision-support and ultimately vaccination rates. Thank you for daring to innovate, collaborate, and lead in an area that is not only complex, but constantly evolving." Mike Suralik, one of HLN’s project managers, was on hand to receive the award at the meeting of the National Vaccine Advisory Committee in Washington, DC. HLN is pleased to accept this award on behalf of the ICE project. While we have been the lead organization, we consider ICE to be a community effort of interested public health organizations, clinical users, and software developers. This project would not be a success without ongoing cooperation between these participants. ICE is an important product for the immunization community. It is collaboratively developed, maintained, and supported yet is freely available for use. We hope ICE can gain a broad acceptance not only here in the US but across the world.

HLN has released a new version of its ICE Open Source Immunization Evaluation and Forecasting software (v 1.7.1.0) on February 24, 2017. As always, the most recent version of open source Immunization Calculation Engine (ICE) can be downloaded from the Downloads page on the ICE wiki. This new release of ICE (v 1.7.1.0) has the following new additions & changes: Update to logic that determines when a 5th dose is recommended: (1) removed restriction that patient is born >= 1/1/2006; (2) recommend 5th dose if 4 doses administered before 8/7/2010 (prior logic used 1/1/2010 as this date). Please refer to the ICE Polio rules documentation for additional details. The next two future releases of ICE are expected to include the following updates: Future ICE release v 1.8.1 will include: Updates to combine the PCV vaccine group and the PPSV vaccine group into a single "Pneumococcal" vaccine group. Future ICE release v 1.9.1 will include: Support for Meningococcal B. ICE is a fully Open Source, web-services-based product compliant with US-based ACIP clinical rules. It is fully flexible and could be augmented with other rulesets (like WHO) with appropriate interest, collaboration, and funding. For more information or to join the emerging ICE Open Source Community see the ICE project page or send email to ice@hln.com.

HLN today released a new version of its ICE Open Source Immunization Evaluation and Forecasting software covering the following changes: HPV updates: (1) Added support for new 2-dose series; recommend based on 2- or 3-dose series accordingly. (2) Ignore (HPV, bivalent (Cervarix)) shots administered to males. (3) Removed minimum age restriction for dose 2 and dose 3 Meningococcal updates: (1) Added absolute minimum age/minimum age of 16 years for dose 2. (2) Changed recommended interval between dose 1 and dose 2 from 3 years to 56 days Please refer to the HPV rules documentation and Meningococcal rules documentation for details. ICE is a fully Open Source, web-services-based product compliant with US-based ACIP clinical rules. It is fully flexible and could be augmented with other rulesets (like WHO) with appropriate interest, collaboration, and funding. For more information or to join the emerging ICE Open Source Community see the ICE project pageor send email to ice@hln.com.

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.

Reposted from JSI's The Pump Jeff Sanderson,Senior Technical Advisor African immunization supply chains need to be transformed. Between 2010 and 2020, new vaccine introductions will quadruple the volume of vaccines per immunized child. The number of vaccine doses that health workers will administer is increasing six-fold. Evidence fromEffective Vaccine Management(EVM) assessments in70 developing countriesfound that in nearly all countries, immunization supply chains are not functioning well enough to ensure vaccine availability and potency and to meet coverage targets. Worse, only a few countries have prioritized supply chain strengthening as a strategy to strengthen immunization program performance. The future of immunization supply chains was the topic of an evening dialogue at the January 25-29, 2016 “Exchange of best practices workshop on Reaching Every Community (REC); Equity and Integration of Child survival interventions in East and Southern African Countries” in Cape Town, South Africa. The key theme of the meeting was to support the increase of coverage for immunization and child survival interventions through the reaching every community/child approach. This evening session, organized by John Snow, Inc. in collaboration with PATH, featured a panel of EPI officials from four African countries that aretransforming their public health supply chainsto accommodate the increasing demands on these supply chains from immunization and other health programs. Each of the four panelists discussed ongoing changes in their country supply chains; their key points are in the full blog post here.

“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.

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

Many thanks to Robert Steinglass for sharing this information with TechNet-21. As diseases emerge and infections re-emerge, new and improved vaccines are needed. The decisions about which vaccines should be developed first can affect millions of people's health, quality of life, and economic progress. However, fiscal pressures on health care and research budgets have pushed analysts to take a more careful look at the health benefits and cost-effectiveness that have traditionally driven decisions about new vaccine development. A new early-stage prototype software tool created by the Institute of Medicine – the Strategic Multi-Attribute Ranking Tool (SMART) Vaccines 1.0 – allows users involved in vaccine formation and delivery to prioritize the vaccines most urgently needed in the United States and other countries. The software enables users to compare vaccine candidates based on a number of attributes and their own data to determine vaccine priorities best suited to their circumstances. For example, users can evaluate vaccine candidates based on the benefits to vulnerable populations or the potential to improve production platforms. The tool ultimately produces a value score, or SMART score, to help users interpret the relative performance and rank of their candidates, resulting in their own unique list of vaccines. SMART Vaccines is a decision-support system and not a decision maker. A free, executable file of SMART Vaccines 1.0 is currently available for computers running the Windows operating system. This prototype software is an output of Phase II of a three-phase IOM study. In Phase I, IOM developed a utility model and blueprint for the software. Phase III will be aimed at software usability studies and attempt to provide estimation strategies toward assisting users in thinking about data compilation for SMART Vaccines. The software, its corresponding report, Ranking Vaccines: A Prioritization Software Tool, and a video overview are all available for immediate release at http://www.nap.edu/smartvaccines. Media inquiries should be directed to the Office of News and Public Information; tel. 202-334-2138 or e-mail [email=news@nas.edu]news@nas.edu[/email].

VaxTrak in Vietnam VaxTrak helps health workers keep track of vaccine stock. In 2011, the Vietnamese National Expanded Programme on Immunization introduced VaxTrak in the provinces of Phu Tho, Quang Tri, and Ben Tre. This short video shows how VaxTrak works and examines the impact it has had. [youtube]zbYuN9OXV4c[/youtube] Logistimo in South Sudan Logistimo is a cloud-based logistics management information system that can help immunization health workers keep track of vaccine stock. In May 2012, the Government of South Sudan deployed Logistimo in the national store, the ten state stores, and all six counties of Central Equatoria State. This short video shows how Logistimo works and examines its impact. [youtube]Sr7rCnpLWyM&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube] Immunization Information Systems (IIS) in Albania In 2011, the Albanian Institute of Public Health deployed IIS in the northern Albanian district of Shkoder to record child immunizations and manage stock. This short video shows how it works and examines the impact it has had in Albania. [youtube]dczmp7JsIr4&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube] ImmReg in Vietnam ImmReg is a digital immunization registry that uses mobile phones to track children due for vaccination and record their vaccinations. In 2011, the Vietnamese National Expanded Programme on Immunization introduced ImmReg in the district of Mo Cay Nam in Ben Tre province. This short video shows how ImmReg works and examines its impact. [youtube]59gGuyFHle0&list=PLYNXI1NRQQ-AFEa6PaFxPplrvyZvChKwX[/youtube]

by Dao Ding Sang and Vu Minh Huong, PATH Over the last three years, Optimize has been working with Vietnam’s National Expanded Programme on Immunization (NEPI) to pilot a new computerized logistics management information system. The new system, named VaxTrak, is designed to help immunization health workers keep track of vaccine stock as it is received and dispatched, and to facilitate aggregated monthly reporting on immunizations given. The goal is to increase the accuracy and timeliness of vaccine inventory and immunization reports, to reduce the amount of time health care workers spend on reporting duties, and to increase the availability of data, especially at national and regional levels. Vietnam’s paper-based vaccine stock-management and reporting system In Vietnam, storekeepers use a paper-based stock ledger to record information on vaccine stock transactions, such as when and where vaccines were received or dispatched, the number of doses involved, the expiration date, and the lot number. These vaccine registers are kept at every level of the health system, and are updated as vaccines move from national to regional, provincial, and district levels, on their way to the commune health center where immunizations are administered. Compiling the monthly immunization report on vaccine use can be complicated. Health workers must pore over the vaccine register, previous immunization reports, and receipt and distribution vouchers to try to reconcile the data in order to provide an accurate report. Using this paper-based system, recording vaccine-related data is an administrative burden. The work is tedious and can easily lead to inaccuracies. In addition, there are often delays in making the completed reports accessible to national level authorities who have oversight of the entire vaccine supply chain. Managing information in VaxTrak With VaxTrak, information about vaccine stock is managed in a computer database. When dispatching a shipment of vaccines, users at the point of departure enter information into the system about the products and quantities being dispatched. When the vaccines arrive, users at the destination can find the shipment in the system and confirm receipt. Then the vaccines are automatically added to the inventory at the destination location. The system also allows users to enter aggregated data on immunizations administered in the user’s territory. At the end of the month, reports on both vaccine stock and immunizations given can be easily generated by the system without the need for health workers to painstakingly review the paper records. VaxTrak benefits Once in the VaxTrak system, information is available in real-time via the Internet to staff of the immunization program at all locations with proper authorization. Health workers can access up–to-date information about vaccine stock, such as the number of doses distributed or in stock. They can also view expiry and lot number information on vaccines. This can help with planning the amount of vaccine to order and allocating available vaccines among different locations. Better planning can help to avoid stockouts that can result in missed opportunities to vaccinate, as well as over-ordering, which can result in vaccines being wasted. NEPI and Optimize first introduced VaxTrak in the national store, three regional stores, and three provincial stores (one in each of the three regions). After six months, Optimize collected data to evaluate the system’s performance. By comparing actual vaccine stock quantities with the quantity recorded in the paper registry and in the VaxTrak database, we found that VaxTrak significantly increased the accuracy of vaccine data: the number of lots with matching data went from 77 percent before VaxTrak to 100 percent after using the software for several months. The number of lots counted before and after implementation was 39 and 40, respectively. The assessment also showed that using VaxTrak reduced the time burden of reporting. In provinces, the average amount of time needed to complete the monthly immunization report changed from 22 minutes to 16 minutes. Likewise, the average amount of time needed to complete the vaccine register decreased from 88 minutes to 43 minutes. The users’ perspective VaxTrak users have expressed satisfaction with the system because it enables them to access data whenever and wherever they have an Internet connection, it has an easy-to-use interface in Vietnamese, and they feel it helps them to manage vaccine stock more accurately. They are pleased with the ease of reporting, since the software automatically compiles and aggregates data. For users at higher levels, seeing the real-time balance of the vaccine stocks not only at their own facility store but also at lower level stores is extremely helpful for management and planning. Despite its impressive performance, users faced some challenges with the VaxTrak software. First, the development and introduction of VaxTrak took significantly more time than originally planned. As a result, users did not have much time to become familiar with the software and help detect defects that needed revision. In addition, outside of Optimize’s intervention, NEPI was also testing other software applications; evaluating multiple programs at once overburdened some health workers. Scaling up the system presents another challenge, as managers need to address shortages of human and financial resources to provide technical support for facilities, as well as sufficient training for users. The latter is a particular problem, given the high rate of staff turnover at lower levels. Looking to the future Based on the strong performance, useful functions, and good acceptability of the VaxTrak system, NEPI is interested in exploring avenues for scaling up the system to additional provinces following the close of project Optimize. If funding can be identified, NEPI would like to take these additional steps: [indent][/indent]- Reinstate monitoring and evaluation, especially at district level, to identify all [indent][/indent] issues that need to be resolved in the next stage. [indent][/indent]- Work with software developers on improvements to the system and ensure that [indent][/indent] software design allows for the proposed increased number of users in the system. [indent][/indent]- Develop a plan to progressively implement the system in new sites and ensure that [indent][/indent] adequate training and technical support are available for all users on an ongoing [indent][/indent] basis. In 2013, Optimize will publish comprehensive information on the demonstration projects and other initiatives it has been involved in, including VaxTrak. To view a full list of the resources that Optimize has published to document its work in Vietnam, please refer to the Vietnam resources page of the Optimize website.

by Ryan McWhorter, Logistimo, and Dan Brigden, PATH To accompany the article “South Sudan deploys new mobile phone-based stock management tool” in this month’s newsletter, project Optimize has published a photo set on Flickr that reveals how the new logistics management information system created by Logistimo is being used by health staff in South Sudan. The photo set illustrates how county stock managers can use the Logistimo application on their mobile phones to review and update vaccine stock levels, order new vaccine stock, and record its arrival. It also shows how state and national managers can use Logistimo to respond to orders submitted by county stock managers, and view vaccine stock availability and consumption data. Access the photo slideshow directly. You can click “Show info” in the top right corner to view/hide photograph descriptions, and click the following button in the bottom right corner to view the slideshow in full-screen mode.

by Dr. Joyce Charo, DVI, Kenya and Dr. Anthony Ngatia, CHAI A web-based stock management tool has just been deployed in five regional stores across Kenya. The goal is to ensure the availability of vaccines by reducing stockouts and improving vaccine program performance. Dr. Joyce Charo from the Division of Vaccines and Immunisation (DVI) in the Kenyan Ministry of Health and Dr. Anthony Ngatia from the Clinton Health Access Initiative (CHAI) provide an update. In February 2011, Kenya became the first country in Africa to introduce the 10-valent pneumococcal conjugate vaccine (PCV10). Demand for the new vaccine was unprecedented, with the ministry of health reporting stockouts in a number of facilities. This highlighted weaknesses in the existing paper-based stock management system which was unable to provide up-to-date information on stock levels that may have prevented such stockouts. “We have very limited visibility of vaccine stock once it leaves the national store,” said one central vaccine store officer. In response to these challenges, the DVI is working with CHAI to transform the way vaccine stock is managed. A major part of this initiative is the development and implementation of a web-based stock management tool (SMT) that will provide DVI staff with the ability to manage vaccine stock from national to health facility level in real time, greatly reducing the likelihood of stockouts. Applying previous experience of developing a web-based tool for the ministry of health to improve early infant diagnosis of HIV, CHAI assembled a team from Kenya’s Strathmore University to develop the SMT. From the outset, CHAI staff and the Strathmore team worked closely with DVI logistics officers and stock clerks to understand their needs. The SMT has been designed as a holistic platform for vaccine program performance management, enabling managers at all levels to manage stock and monitor the supply chain. Simple interfaces enable staff at the national, regional, and (eventually) district level to input issuances and receipts of vaccine stocks. The tool uses population and target coverage data to automatically generate warnings when stock levels fall below the levels required to meet forecasted demand. Reports are automatically generated and sent monthly via email to Expanded Programme on Immunization (EPI) managers to ensure that stock records are up to date. The tool also includes a mapping application to visually depict stock levels at each store. The SMT was implemented at the national level in October 2011 and has now been implemented in five regional stores, with rollout to the three remaining regional stores expected by the end of July 2012. The main district stores in each of the 47 counties are expected to begin using the tool by the end of 2012. The response from users has been positive. “This tool has made work much easier. We can now aggregate our monthly reports at the touch of a button,” said one Kisumu store clerk. The monthly stock status email sent to senior managers has also been well received and has led to a request by EPI managers that such regular alerts are maintained. The EPI has also suggested new features, such as the use of specific information and data from the tool to compile monthly stock status report requests by WHO and UNICEF. The DVI has committed to cover Internet connection costs at regional stores after CHAI’s initial three-month support expires. A significant challenge has been the requirement for DVI staff to keep paper-based stock records, in line with ministry of health auditing policy. These records are used to update the SMT and can be a laborious activity. While the utility of both systems is acknowledged, the expectation is that the SMT will be viewed as complementary to the paper-based records. Although the SMT will enable a change in vaccine program performance, it must go hand in hand with a change in thinking about stock inventory management. The development of the SMT has sparked thinking in Kenya about how it can provide a broader platform for the national immunization program. Following a cold chain inventory conducted in 2011, there is an opportunity to add a module to the SMT to update cold chain equipment inventories and monitor cold chain capacity and equipment performance. Most significantly, the platform could be used to bring together stock, cold chain, and coverage data by interfacing directly with the District Health Information System for a more holistic analysis of program performance. This approach could help to eliminate stockouts by revising forecasts based on previous months’ consumption, identifying opportunities to optimize allocation of supplies, generating new insights into wastage, and ensuring optimal selection and utilization of appropriate equipment at each site. For more information on the SMT, please contact [email=jcharo_dvi@dfh.or.ke]Dr. Joyce Charo[/email] or [email=angatia@clintonhealthaccess.org]Dr. Anthony Ngatia[/email]. To comment, make sure you are logged in and click Reply.

To accompany the article “Online immunization registry transforms the work of health staff in Albania” in this month’s newsletter, project Optimize has publishedhttp://www.flickr.com/photos/projectoptimize/sets/72157630314080396/" target="_blank"> a photo set on Flickr that reveals how the new tool has benefitted health staff in the pilot region of Shkoder. The photo set is divided into two: “Before” and “After.” The “Before” photographs describe how health workers used the previous paper-based registry, while the “After” photographs describe how they are now using IIS, a computerized immunization registry. The photo set includes several screenshots of the IIS tool itself. http://www.flickr.com/photos/projectoptimize/sets/72157630314080396/show/" target="_blank">Access the photo slideshow directly. Click “Show info” in the top-right corner to view/hide photograph descriptions, and click the following button in the bottom-right corner to view the slideshow in full-screen mode: To comment, make sure you are logged in and click Reply.

An interview with Silvia Bino, Albania Institute of Public Health The Institute of Public Health in Albania recently developed an online immunization registry to replace their existing paper-based system. In May 2011, the new system—named IIS—was piloted in Shkoder district. One year later, Op.ti.mize talks to Silvia Bino about how it has transformed the way vaccinations are scheduled and recorded. Before IIS was launched, how were immunizations scheduled? Nurses and the district head of vaccinators worked together using a paper-based system to make sure that all children received the vaccinations they required. Each month, the nurse made a list of all the children due to be vaccinated that month in her health center by carefully going through the health center’s immunization and cohort registries. She used this list to schedule each vaccination, notify parents, and work out how much vaccine to order. She did all this using pen and paper. Were immunization records kept in the same way? Yes. The nurse had to record the details of every child vaccinated on up to six forms and registers. At the end of each quarterly period, she had to review this information to produce a vaccination coverage report. This report was compiled by hand and compared the number of children scheduled for vaccination with the actual number of children vaccinated. The nurse would then send this report to the district head of vaccinators, who would review and aggregate the figures. What problems did nurses have with this system? The nurses spent a lot of time recording and reviewing immunization data. And despite their hard work, some errors in data collection and reporting were inevitable. We needed to automate as much of this administrative work as possible and help them get on with the more important parts of their jobs. Were there any other problems? The lack of detailed data was another big problem. At the national level, we only received aggregated data that wasn’t helpful to manage or improve the program. For example, we only received coverage estimates by district, when we needed to know the vaccination coverage by community, who the unvaccinated children were, where they lived, and why they had not been vaccinated. The old system could not give us this information. Other problems were that we could not control the distribution of vaccines in the way we needed to and that there was no easy way to keep track of children who moved to another part of the country. How has the work of health staff changed? A lot of the nurses’ work has been automated. For example, as soon as children are born, the maternity nurse enters their data into a central database. A schedule of their future immunization appointments is then automatically generated. When the appointments are due, the children are automatically included in their local health center’s monthly plan. The nurses no longer need to go through the immunization registries to find the children who need to be vaccinated. Instead, they use the monthly plan to organize their vaccination schedules. The monthly plan also calculates the total number of vaccine doses required, and this information helps nurses to determine the exact vaccine quantities to order. I have to say that IIS has also improved the quality of nurses’ work. For example, they can spend more time with parents and caregivers to answer questions or address any concerns they may have. And with IIS they are now better able to access and share information. Has the new system improved stock management? Absolutely. As children are vaccinated, nurses with access to a computer can update their immunization status directly into the monthly plan by entering the vaccination date and the vaccine lot they used. Because IIS is used for stock management, the system can show which vaccine lots are stored at every health center and can deduct their balance every time a nurse uses a certain lot for immunization. With IIS, the district head of vaccinators prints out a monthly plan for every health center and health post and distributes them to nurses together with the vaccines. In this way, he can easily make sure that the requested amounts are correct. Village health nurses who don’t have access to a computer can use the paper plan to organize their work and report back on the vaccinations they have administered by taking note of the vaccination date and the lot they used in the columns provided on the form. What are the main benefits? IIS simplifies the monthly planning and reporting that nurses need to do. But there are other benefits to tracking individual children. Firstly, IIS doesn’t just generate coverage reports automatically by comparing actual vaccinations with planned vaccinations, it can also show exactly which children have not been vaccinated—those who have been registered but have not received all their doses yet. This enables nurses to quickly identify any defaulters and to check that access to vaccination is equitable across communities. IIS also manages the stock of vaccines and consumables which allows the Institute for Public Health to monitor the expiry date, distribution, and usage of ever more expensive vaccines. By linking the vaccine lots to the individual child records, lots can be traced through the stores and eventually to any children who have received a dose from a particular lot. This is essential for vaccine safety. Are there any benefits for parents? Parents will shortly be able to access IIS themselves to view their child’s vaccination history and download a vaccination certificate for their child, required for school and visa applications. Are there plans to scale up the pilot? Yes. We plan to start using the system in other districts in Albania later this year. If all goes well, we will be able to implement IIS nationwide by the end of 2014. In the meantime, we are also adding new features to IIS, such as the tracking and reporting of adverse events following immunization. In May this year, we also hosted a workshop for the countries of the South East European Health Network. We hope to collaborate further with these countries in the future as we are all looking to improve our health information systems. For more information on Albania’s implementation of IIS, please contact Silvia Bino. Note: Optimize will provide a full report on the implementation of IIS in 2013. To comment, make sure you are logged in and click Reply.

The Lives Saved Tool (LiST) has been developed to estimate the impact of health interventions and can consider multiple interventions simultaneously. This new computer-based tool allows users to set up and run multiple scenarios to look at the estimated impact of different intervention packages and coverage levels for their countries, states or districts. These scenarios, developed with the LiST tool, provide a structured format for program managers or ministry of health personnel to combine the best scientific information about effectiveness of interventions for maternal, neonatal and child health with information about cause of death and current coverage of interventions to inform their planning and decision-making, to help prioritize investments and evaluate existing programs. The LiST tool is meant to be used as part of the planning process—not as a replacement for planning. The model has its origins in earlier work from the Lancet Series papers that looked at estimating the impact of increasing coverage of proven interventions on child mortality and neonatal mortality as well as the impact of interventions related to nutrition and nutritional status of mothers and children. During the past four years, LiST has been developed into a free, open access software tool that has been used by programs or organizations to estimate the impact of scaling up different interventions and thereby help in the health planning process. BMC Public Health has an entire supplement carrying articles on this tool: http://www.biomedcentral.com/bmcpublichealth/11?issue=s3 Evaluating the tool, Robert Steinglass et al point out that “Without thorough guidance about how to modify or use the tool, so that a typical user can model the number of lives being saved with continued successful use of an intervention at baseline (by showing ‘lives lost’) plus additional lives saved if coverage increases, we fear that LiST will be viewed by decision makers as ‘turn-key’. It could also run the risk of being used as a stand-alone tool rather than as part of a series of planning tools as apparently intended. Their responses can be accessed here along with the authors’ responses.

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 Leah Hasselback, VillageReach and Jan Grevendonk, PATH As more and more countries consider the move from paper-based systems to electronic health information systems, there is a pressing need for global coordination and collaboration among efforts. This is particularly true in the emerging and fragmented field of logistics management information systems (LMIS). Over the past decade, a myriad of LMIS have been developed under the sponsorship of the global health community. Yet in most cases these systems address only a particular layer of the supply chain and are unable to connect with information systems in other domains of the health care system. Moreover, they struggle to take advantage of local technological advances, including improved regional internet access and expanding mobile networks. These advances enable rapid scaling at minimal cost and provide new low-cost devices that make it possible to present robust LMIS functionality at the “last mile” or service-delivery level of the supply chain. OpenLMIS was designed to gather LMIS knowledge in one place and disseminate up-to-date systems and tools for free. OpenLMIS is a software development initiative focused on health system supply chains in low-income countries. It seeks to encourage the creation and implementation of a basic open-source LMIS that collects data efficiently and reliably, can scale to national-level coverage, operates in a variety of environments with different levels of network connectivity, and communicates with other components of the broader health information system. The basic LMIS can then be modified and improved upon over time. The initiative utilizes a practical, inexpensive approach to improving the distribution of medical goods by leveraging open standards, using a community-based open-source approach, and embracing available information technologies and skills. The initiative came into being after nongovernmental organization VillageReach invested heavily in an LMIS to support health system supply chains from the intermediate warehouse to service-delivery level in Mozambique. Recognizing that collaboration was required across the entire supply chain, VillageReach expanded its information system and licensed the software application as open source in 2009. OpenLMIS is envisioned to be a collaboration nexus for experts in logistics and supply chains, e-Health information systems, software development for low-resource settings, and process improvement. Like other open initiatives, the intention is to become a place for sharing information about LMIS planning, identifying common requirements and system design, promoting interoperability between systems, developing open-source solutions where appropriate, establishing and following international standards in supply chain and health informatics, and galvanizing interest in a shared vision for effective, scalable, and sustainable LMIS solutions. Already, partners like PATH, Optimize, and USAID|Deliver have joined the OpenLMIS community. As awareness of this initiative grows, the goal is to engage academia, other global health organizations, pharmaceutical companies, private-sector logistic companies, technology groups, funders, and global health alliances. Over the next decade, OpenLMIS hopes to have a community of developers working on a series of implementation projects in countries that can share existing software components, solutions, and approaches to meet user functionality requirements. From this work, OpenLMIS will be able to provide more than just software; it can be a place to go for guidance on LMIS system development, leads on local developers, best-fit solutions that are most relevant to the country, cost and impact data, design documents, and tools. In concert with the 2020 Vision of Immunization Logistics and Supply Systems, OpenLMIS is encouraging the development of LMIS design frameworks and unique applications that are:-Internet enabled to allow for data visibility to multiple users at various decision points throughout the supply chain. -Platform independent to allow usage through low-cost devices and to take advantage of competitively priced consumer electronics. -Based on open standards that allow for interoperability between other information systems (e.g., an LMIS that can send and receive data to and from a medical records system). -Open source to allow other developers and implementers using LMIS systems to communicate with each other, problem solve together, and collaborate on software improvements. To join OpenLMIS or learn more about it, please visit the website or email info@openlmis.org. We encourage your questions or comments. Please click reply at the bottom of the page.

by David Lubinski, PATH; Wendy Bomett-Dodie, USAID | Deliver; and Chipopa Kazuma, Medical Stores Limited, Zambia In February 2011, Zambia’s Ministry of Health invited partners involved in supply chain management to help them develop a shared vision, roadmap, and user requirements for a logistics management information system (LMIS) in the country. Doing so has made Zambia the first country to modify the global Collaborative Requirements Development Methodology (CRDM) to develop a country-specific set of requirements. [Click photo to enlarge] While the need for user input in developing information systems may be obvious, it is very rarely done in practice, particularly when users are spread across many different domains and have differing needs for information. In 2008, the Rockefeller Foundation funded PATH and the Public Health Informatics Institute to develop a framework that countries could use to identify common functional requirements for information systems in any domain of a health system. The CRDM became this framework. It was validated through the creation of a set of global common requirements for supply chains and logistics management information systems based on input from four countries. Tailoring common requirements to country-specific scenarios This year, Zambia was able to take the global common requirements and adapt them to their own national vision for a computerized LMIS system. Doing so has saved an immense amount of time and resources allowing the country to modify an existing product rather than create a new one from scratch. Zambia will also contribute to the further development of the global CRDM. Currently, the global requirements address only 6 of the 11 processes that are typically found in supply chain systems: requisition, receiving, storage, dispatch, transport, and dispense/usage. The Zambian team recognized that it needed to include two additional processes in its LMIS and has, therefore, determined requirements for forecasting and purchasing to their national system. Because these processes were not included in the original CRDM for logistics, Zambia’s requirements will now serve as the first version of the global standard for these two processes. Flexible and expandable information systems At present, Zambia’s LMIS system is being designed for all health commodities except vaccines. Although vaccine experts contributed significantly to the global CRDM for logistics, Zambia’s priority is to develop an LMIS for essential medicines, laboratory supplies, and medical supplies. Once the system is functioning effectively, then vaccines may be added at a later date. This flexibility is one of the advantages of the CRDM: it is robust enough to work for all health commodities, eliminates the need for multiple vertical systems, and can be expanded at a pace that meets the needs of each country. Beyond LMIS Now that Zambia is familiar with the CRDM, it can apply the methodology in other domains. Part of the value of completing the supply chain domain first is that the core technical group can easily see where the LMIS might interact or exchange data with other information systems like patient health records. If this group continues to apply the methodology, they will continue to fill out their own management information strategy and understand the linkages between domains. Over time as CRDM is applied in each domain of the health system in Zambia, a national road map can be developed for a complete health management information system leading to a user-designed system that is comprehensive, scalable, and sustainable. We envision that such a system will enable health workers to simply deliver the services to patients and record what they did. From there, data is connected to the entire health system, not just logistics, and the system will know how to process the information and set in motion the correct procedures for action and decision-making. For now, Zambia’s core technical group is ready to take its common requirements from theory to practice and will begin seeking software solutions and/or developers to create the system they need. “The CRDM process has helped us envision a holistic information system, gather inputs from the right people, and move forward into system development with confidence,” said Dr. G. Syakantu, Director-Clinical Care and Diagnostics Services. To learn more about Zambia’s process, please email [email=dlubinski@path.org]David Lubinski[/email] We encourage your questions or comments. Please click reply at the bottom of the page.

Written by: S Kibet, WHO Kenya; P Zaninka & T Rweizire, Uganda EPI; R Anderson, UW; and S Newland, PATH Improving the efficiency and effectiveness of vaccine supply chains is no easy task, especially when data is difficult to gather, financing is tight, and there is pressure to improve and expand. Supply chains, by nature, are made up of multitudes of constantly-shifting variables, and few Expanded Programme on Immunization programs have the right tools to track and maintain those variables in a systematic way. Recognizing the urgent need for countries to inventory and better manage supply chain equipment such as refrigerators, cold rooms, and cold boxes, PATH developed a Microsoft Access-based software tool called Cold Chain Equipment Manager (CCEM). The tool can help vaccination programs manage equipment requirements down to the facility level, forecast equipment needs for different scenarios, and generate procurement lists according to national policies. CCEM differs from other available equipment management tools because, in addition to the usual data management, analysis, and reporting functions of a conventional inventory, it allows countries to view the cost and logistical implications of potential programmatic changes through “what if” scenarios such as procedural changes or the introduction of a new vaccine. These additional benefits were convincing enough for Kenya to conduct a pilot of the CCEM tool this year. Over the next several months Kenyan health staff will complete district-level questionnaires which will generate data on the existing cold chain equipment in Kenya and its functional status. CCEM will help decision-makers answer some challenging questions: What are the capital and operational costs of introducing pneumococcal vaccine? What would be the cost of changing vaccine presentation from 20-dose vials to single-dose vials? How should the vaccines be distributed? With this data, health staff can use CCEM to generate a cold chain expansion and replacement plan with annual estimated costs associated with introducing newer and bulkier vaccines. When Uganda piloted CCEM in 2007, public health managers found they could introduce human papillomavirus vaccine without buying new refrigerators. They also saw that the primary storage issues were going to be at the national and provincial levels and transitioned resources to those levels to accommodate the increased burden. Since then, the CCEM tool has been a useful reference bank for information about cold chain inventory and status as it can quickly calculate storage capacities, shortages, and surpluses. This has proven useful as Uganda prepares for the introduction of pneumococcal vaccine. Not only does CCEM calculate equipment needs over time, it also calculates the annual costs of upgrades and determines the long-term costs of various equipment choices. The challenges to the CCEM tool center on data entry which requires some training and knowledge of the equipment specifications and local geography. Improper data reporting by field staff can also result in inaccurate equipment requisitions and placements. The tool itself is difficult to transfer electronically because files are so large and so intricately linked to data. Despite these challenges, health system managers in Uganda have found it to be a very useful tool. The upgraded CCEM version 2 is up to date with 61 pieces of PQS (performance, quality, safety) prequalified equipment from the World Health Organization (WHO). PATH will continue to keep the equipment list updated as long as funding allows at which point WHO might provide updated lists that can be easily imported into the CCEM database. CCEM can be implemented at subnational, regional, and/or district levels and requires an upfront investment of time and resources to gather and input data. It also requires ongoing use to keep the data relevant. CCEM is a timely, free resource that any country can use to inventory and then improve management of supply chain equipment. To inquire about CCEM, send an email to [email=publications@path.org]publications@path.org[/email] to receive a free copy of the software. Questions about how to use and implement the software should be directed to [email=CCEMinfo@path.org]CCEMinfo@path.org[/email]. We invite you to comment on or post a question relating to the new website by clicking the “reply” button on this page. You will have to log in or register; the process is very simple. Return to the Optimize newsletter.

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.