An integrated solution to supply chain management: How eVIN harnesses technology, governance and human resources
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The success of the eVIN pilot and ongoing roll-out in India could be appositely accredited to the approach of giving equal importance to three core interconnected components of an eLMIS: technology, governance, and human resources. The introduction of a new technology alone, without equal attention to change management and capacity building, would severely limit the effectiveness of the digital LMIS platform, given that the software is a tool for improved data entry, management, and decision-making processes, rather than a solution in itself. Likewise, addressing human resource capacity gaps for supply chain management and instituting measures to improve accountability and efficiency can only go so far without a robust digital platform to equip health workers and managers with real-time data, actionable analytics and complete picture for informed decision making and oversight. An integrated solution is required.
In India, eVIN encompasses this holistic approach by simultaneously targeting the technological landscape, governance context, and human resource capacity for logistics management of the vaccine supply chain:
The system includes a smartphone application to digitize data entry and the installation of SIM-enabled temperature loggers for cold chain equipment, which connect through cloud technology to a web interface that provides real time visibility of all data and analytics for improved decision making and management. This facilitates evidence-based decisions for the management of the immunization supply chain, such as optimization of vaccine distribution plans to prevent stock-outs and wastage throughout the supply chain. The technology requires access to most widely available basic 2G network to function as well as investments in smartphones, temperature logger devices, and computers to record, monitor and use the eVIN-produced data.
How it works
Last-mile supply chain and cold chain handlers at the peripheral level (e.g. health facilities) are provided with smart phones that are equipped with the eVIN application, which allows for the digitization of vaccines inventories.
Information recorded in offline mode at times of network unavailability and gets saved and uploaded through automatic data synchronization on the cloud network when internet is available again. This data is sent to a cloud-based server and visible on a web dashboard on computers at any level of the supply chain for informed decision-making. Through customizable dashboards viewable through the eVIN web interface as well as a mobile version, managers can see information on stock inventory and demand information from each store, supply at warehouses and in transit, and status of all cold chain equipment, among other data. The tool also provides actionable data analytics, including on stock abnormalities, optimal replenishments through consumption-based forecasting, trends on a range of data, and human performance, including data quality and response times.
For the immunization cold chain, in addition to providing real-time information on vaccine stocks, the system helps to track storage temperature of vaccines. SIM-enabled temperature loggers attached to the cold chain equipment capture temperature information through a digital sensor placed in the refrigerator. The temperature loggers installed on all vaccine storing refrigerators activate alarms and send messages to relevant authorities if the temperature in the fridge goes beyond the set temperature limits. In the eVIN approach used in India, the vaccine logistics management, temperature monitoring and cold chain management are integrated into one system.
The technology component of eVIN is complemented by strengthening governance systems. This includes ensuring proper procedures and guidance are in place to streamline and systematize the use of the new eLMIS software. eVIN helps to systemize record keeping, for example, by facilitating distribution and use of standardized stock and distribution registers.
An equally critical element of promoting strong governance is fostering accountability at all levels of the supply chain to facilitate compliance with these standards, based on a sense of ownership over the data quality and outcomes of the system. From the development of standard operating procedures to the establishment of review and coordination mechanisms for implementation of eVIN, the streamlining achieved through these governance processes allows the best use of the eVIN-generated data and the ability to identify and address gaps as it is rolled out. This framework ultimately helps to catalyse data-driven action for vaccine supply management across all levels.
The implementation of eVIN requires capacity building of government vaccine and cold chain managers at all levels of the supply chain. Training is required to enable cold chain managers to use the technology at the regional, district and block and village levels until the last storage point, based on the tasks to be performed at each level.
Formal training and on-the-job training are required to enable the use of this technology and to further integrate it in good storage practices and standard operating procedures.
Training curricula are tailored to the functions and responsibilities of the vaccine handlers at each level of the vaccine supply chain. Cold chain handlers at health centre level, often nurses in charge of immunization, are trained to use eVIN to record data on vaccines stocks, consumption, temperature, which through a cloud-based server, will be available to at cold chain managers and health officials.
Cold chain managers at district level use data to provide constant support to immunization and medical officers to estimate vaccine requirements and distribution, supervise vaccine handlers and coordinate intervention of cold chain technicians to maintain and repair cold chain equipment. Health officials at the regional and central levels use this information to plan and optimize distribution, to review national strategies to strengthen vaccine supply chain and to collect data on vaccines consumption and stocks for estimating vaccines requirement for procurement.
The introduction of a new e-LMIS system requires not only initial trainings, but also arrangements that will ensure regular oversight and availability of technical support to users at the health facility, district, and central level. In India, the ingenuity of eVIN was not merely introducing a new software for LMIS but also introducing a new staffing structure to manage the functioning of the e-LMIS, as well as to reinforce compliance with existing standard operating procedures. In this way, eVIN creates a strong human resource network, connecting health officials and health workers across the immunization programme and encouraging increased accountability and positive behavioural change.
Based on the capacity needs in India, UNDP helped to establish a change management structure that consisted of UNDP support staff and designated government counterpoints at the district, regional, state and national level. The change management approach and human resource architecture established alongside the technology allowed eVIN achieve the scope and sustainability of capacity building required to empower those who drive the system, whilst facilitating close interface between personnel with IT expertise and health programme experts to ensure that relevant field requirements are built into the software.