The differences between West Africa and Southern Africa are well known, even if partially built on generalizations and stereotypes. There are personality differences, language differences, different foods and ways to eat, different and distinct rhythms heard in discotecas. While regions and individual countries are culturally unique throughout Africa, many share the same challenges and goals when it comes to improving their health systems. A few of these similarities stood out when the Ministry of Health in Mozambique hosted a team from the Ministry of Health in Togo this past week. The Togo team—Dr. Napo-Koura Gado Agarassi, Secretary General of the MoH; Dr. Ayi Hervé D’Almeida, Director of Procurement and Inventory Management; Dr. Amevegbe Kodjo Boko, National EPI Director, MoH, Togo – came to Mozambique to better understand how this country runs its supply chain for health commodities and what lessons can be learned between the two countries.Read full story
Over the past year and a half in Benin, VillageReach has supported the Agence de Médecine Préventive (AMP) in their work to pilot and scale Logivac, an informed push distribution system for immunization commodities.
Starting as a pilot in a single health zone in 2014, this system will be deployed in approximately one-third of the 34 health zones nationwide under the name Logivac+ by July, 2016. Working with AMP, VillageReach has helped deploy and adapt OpenLMIS, locally called the Systeme Informatisé d’Information Logistique (SIIL), collecting data and providing the information needed to improve the informed push system. Over the past weeks, VillageReach and AMP have been working to determine program needs and ensure that SIIL is up-to-date as Logivac+ moves to scale.Read full story
Reposted from OpenLMIS.org
One of the greatest challenges facing the health systems in emerging countries is the lack of regular, reliable data on products and services. In my first post as the new OpenLMIS Community Manager, I am truly happy to announce the release of version 2.0 of the open source electronic logistics management information system (eLMIS) software, OpenLMIS!Read full story
Last week, the annual Global Health Supply Chain Summit took place in Dakar, Senegal, bringing together supply chain specialists and thought leaders from around the world to keep challenging each of us to strive for better performance of supply chains. It is a week to reflect on what is currently happening in supply chain management, and it sets the agenda for priorities for the coming year.Read full story
A few weeks back, my colleague Rachel Powers wrote about VillageReach’s customized deployment of an open-source electronic logistics system (OpenLMIS) in Mozambique, where it is referred to as SELV (Sistema Electrónico de Logística de Vacinas). Along with members of our team, she and I have been closely working together in the development, user testing, and launch of SELV in-country. When I facilitated a week-long training in Maputo in June this year, the excitement I felt about SELV and the positive changes it could bring about was reflected in the faces and attitudes of everyone present in the room. The 15 people being trained included a mix of provincial-level vaccine logistics staff who would use the system regularly and central-level government officials in-charge of country-wide vaccine logistics and monitoring and evaluation of newborn and child health statistics.Read full story
Since beginning my technology associate internship at VillageReach, I’ve learned that strengthening health systems in developing countries requires reliable health information and improved decision-making capacity at all levels. Without real information on who needs what and where things are going it’s impossible to keep health centers supplied with the commodities they need to treat their patients.Read full story
Today we’re excited to announce the Bill and Melinda Gates Foundation is awarding VillageReach a grant to improve vaccine delivery in Mozambique. The two-year Final 20 Project targets more than 400 of the Mozambique Ministry of Health’s rural health centers that serve a population of approximately 13 million. See our press release announcement and this blog that is also featured at Impatient Optimists.
Who are the Final 20 and Why do we Need to Reach Them?
Today, more than 80 percent of children around the world receive a complete routine of life-saving vaccines during their first year of life. That is a significant increase from the 17 percent coverage 30 years ago, giving millions of children each year a better chance of seeing their first birthday. This increase in coverage is the result of decades of hard work to establish immunization systems in countries where previously, they simply did not exist.
Despite this huge success, these immunization systems have reached their maximum capacity. A considerable gap remains in reaching the final 20 percent–the children who are the hardest to reach, and the ones currently not served by existing immunization programs.
These children usually live in remote, rural communities, several miles from a health facility with little transport available, in villages that can’t be reached by large delivery vehicles, beyond the reach of cell phones, and where electricity is available only sporadically, if at all. In these communities, vaccine coverage rates are very low and child mortality unacceptably high because weak underlying infrastructure limits the potential of what the health system can deliver.
To reach this final 20 percent–24 million children–with the current group of life-saving vaccines, not to mention the exciting new vaccines that are just being introduced, it’s time to apply new innovative approaches and delivery models.
Increased attention is now being directed to this challenge. As part of a broad strategy by the Bill & Melinda Gates Foundation to improve vaccine supply chains, VillageReach is working to scale new system innovations to improve vaccine distribution across Mozambique.
The Final 20 Project is building a sustainable model of innovative supply chain design, enhanced data collection and reporting, and public-private partnerships to improve the underlying infrastructure the health system requires. Our goal is to provide tools, research and evidence that will benefit Mozambique and other countries as they work to improve their immunization systems to accommodate the new vaccines and improve the health of their children.
The Final 20 Project is an extension of a model we have applied in Mozambique for over ten years, while working with provincial government health departments (DPS) to streamline their logistics system. The ad hoc collection-based approach, where frontline health workers must leave their health posts every month to collect vaccines and related supplies from their district office, was replaced by a dedicated distribution system (Dedicated Logistics System or DLS) with a small number of specialized government workers visiting the health centers monthly to deliver vaccines and supplies, repair equipment, collect data, and provide supportive supervision.
The project incorporates an electronic logistics management information system that enables more practical and reliable data collection. This system allows the DPS to improve the monitoring of commodity availability at the health facility level and delivery components in order to improve the flow of vaccines through the supply chain and reduce shortages of stock even in the hardest to reach areas. With more regular data being reported, administrators are now able to see what is happening and make informed management decisions to improve system performance.
VillageReach also leverages the private sector to supply critical infrastructure services, such as communications, energy and transport, that are critical for both the health system and the private sector.
For example, one of the barriers to a functioning cold chain for vaccine distribution in the remote northern provinces is a lack of fuel to power vaccine refrigerators in regions far from the electrical grid. In response we established an energy services company, VidaGas, in partnership with a local organization, to provide propane gas to the health centers.
Since its establishment in 2002, the company has grown significantly to become the largest independent energy services supplier in northern Mozambique. The revenues VidaGas gains from selling to non-health sectors help sustain the company and support its obligations to the health system. With propane-based refrigeration now being replaced by new, more efficient solar and passive refrigeration technologies, in the Final 20 Project, we will work with the private sector, DPS, and other partners to support this transition, as well as, continue to develop creative private sector-based solutions to fill gaps in infrastructure needed to support vaccine distribution.
These are just a few examples of system innovations to improve vaccine distribution in Mozambique. We are excited to be a part of these and other efforts to extend the availability of life-saving vaccines to all children around the world.
Now is the time to reach that final 20 percent.
We often cite the challenges we see in determining optimal approaches to strengthening health systems, many of which are due to the lack of current data about the health of communities and the performance of the health system. This critical gap in useful data to inform better decision making led us to form the Information Systems Group (ISG) at VillageReach, charged with developing new innovations and approaches in information communications technology (ICT).
In many cases, the reporting and requisitioning of medical commodities in low-income countries has been driven by paper-based processes. These are labor intensive, and prone to communication delays and human errors, but remain the accepted practice in areas with minimal ICT infrastructure. Today, however, communication networks are being deployed in a growing number of rural communities in low-income countries, making the broad-scale deployment of an electronic logistics management information system (LMIS) not only practical but inevitable.
To address this opportunity, a significant amount of our work in ISG is focused on OpenLMIS, a collaborative, community-focused initiative to create an open source electronic LMIS for health commodity supply chains in low-income countries. With a growing number of partners, the initiative is focused on meeting our goal of designing, developing, and sharing open source software, tools and methodologies, from which Internet-enabled LMIS can be developed and customized for country deployments.
With OpenLMIS, we see the opportunity to enable ministries of health and their partners to improve their replenishment process, but also to gain access to critical information that contributes to optimal decision-making – this ranges from the facility manager at a health center who wants to submit a requisition, to a packing clerk at the warehouse who needs to fill an order, as well as related stakeholders who want real-time visibility into how well the supply chain is performing. With that greater amount of information at their disposal, we expect healthcare administrators to be able to make more accurate and timely decisions that improve health system performance, including limiting stock outs of essential medicines and vaccines, and reducing interruptions in service delivery due to stock shortages and health worker absences.
The OpenLMIS collaboration has made significant progress in software development over the past few months:
- With our partners, we have developed a detailed set of requirements for a new electronic LMIS that can be customized, configured and deployed in multiple countries.
- The first phase of software development has been completed, providing a core platform for future development of deployable LMIS solutions.
- Development has started on the second phase – a general but configurable system that includes features and functionality needed to meet basic LMIS requirements. A number of countries and financial supporters have expressed strong interest in deploying the solution.
In addition to these software development milestones, the OpenLMIS community itself is expanding. The Bill & Melinda Gates Foundation, the Rockefeller Foundation, PATH, and USAID are providing essential funding for the initiative, and John Snow Inc., PATH, and the Tanzania and Zambia ministries of health are contributing valuable input to define requirements and functionality for the solution. Management Sciences for Health (MSH) has also recently joined the initiative.
We’re very excited about the new phase of work we’ve started and look forward to releasing updates later in the year. For those interested in more detailed tracking of OpenLMIS’ progress, please visit the OpenLMIS Repository regularly for updates.
Technology Director &
Group Lead, Information Systems Group