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Global health Supply Chains. Dar es Salaam Tanzania 2016
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Implementation of the Web based ARV Ordering and Reporting System (WAOS) in ART facilities in Uganda
Global health Supply Chains. Dar es Salaam Tanzania 2016
Amuha Monica Grace Ministry of Health Uganda
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Background
Global health Supply Chains. Dar es Salaam Tanzania 2016
Scale up of the ART Program in Uganda in last 20 years;
• Accelerated accreditation of ART facilities – current no. >
1700 ART facilities
• Scale up in identification and enrolment of patients – from
CD4 200cell/ml to Test and Treat ~ 898,197 patients
• Increasing need in HIV commodities and supply chain
management > 100M USD annually for ARV commodities
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Problem Analysis
Limited quantification capacity at lower level facilities
Push – Pull system; only HCIV and above quantify
and make orders
<10% of stock cards correctly filled
Quantification not systematic nor based on good
practices
Delays in submitting of orders
long order lead times ( > 60 days) Global health Supply Chains. Dar es
Salaam Tanzania 2016
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PULL SYSTEM PUSH/ KIT SYSTEM
HCIV
NATIONAL REFERRAL HOSPITALS
CENTRAL WAREHOUSE
HC II
HCIII
REGIONAL REFERRAL HOSPITALS
MOH
Commodity/Information flow
EHMS FLOW
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Objectives of WAOS Implementation
Global health Supply Chains. Dar es Salaam Tanzania 2016
1. Assure availability of adequate commodities at facilities
3. Increase access and utilization of accurate logistics data
4. Obtain patient information for program decisions
2. Reduce order lead times
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ARV Medicines Order Form & Patient Report
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Flow of WAOS Orders
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Implementation Process
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Improved Ordering/Reporting Process • Increased reporting rates in all facilities >80%
• Harmonized ordering – all levels of care in public & private
• Reduced order lead times
• Eliminated duplicate orders & reports (to MoH & Partners)
• Implemented in computerized & none computerized facilities
• Reduced warehouse work load
Improved Quantification Process • Provided critical logistics and Patient data
• Made it easier to quantify national ARV need
• Correlation of morbidity & consumption quantifications
Successes
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95%
82%
100%
0%
20%
40%
60%
80%
100%
120%
OCT - NOV 2015
DEC - JAN 2016
FEB - MAR 2016
APR - MAY 2016
JUN - JUL 2016
AUG - SEP 2016
WH 2
WH 2
WH 1
Warehouse Reporting rates after 2013
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Successes
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Increased Data Utilization • Monitor adherence to national ART treatment guidelines
• Stock Redistribution – improved commodity security
• Data informs targeted support supervision
Improved Data Quality • Automated calculation to minimize calculation errors
• Quality checks of ordered quantities compared to patient
load
• Order approval level at district 15
Successes
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WAOS Stock Status Reports
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WAOS Desk Review • Trend analysis of 3 order
cycles • 1540 facilities (Private
and Public) Field Data Quality assessment • Reported data vs facility
data records; • 2 order cycle • 20 Public and Private
facilities
Findings • Incomplete retrieval and
reporting on logistics data • Inaccurate recording of
consumption and patient data
• Over estimation of patient numbers – over stock
• Facilities that received logistics management support had better quality and accuracy
Data Quality Assessment
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DQA - Interventions
• Supporting roll out of electronic patient & logistics
management records at facilities– OpenMRS, Rx Solution
• Continuous targeted support supervision through SPARS
(Supervision Performance Assessment and Recognition
Strategy)
• Reviewed and updated logistics tools and WAOS
• Reviewed and updated Accreditation guidelines
• Annual data quality assessments 18
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Lessons Learnt
WAOS implementation requires; • Considerable training, retraining of biostatisticians,
facility staff, MMS, warehouses & managers at all levels;
• Continuous follow up with facilities • Continuous update of system in line with introduction of
new treatment regimens • Integration with existing systems for support and
sustainability – WAOS in DHIS2 • Periodic data quality assessments
Global health Supply Chains. Dar es Salaam Tanzania 2016
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Lessons Learnt
• SPARS played an important role to improve logistic data quality
• Patient data quality needs to improve; need for electronic patient management records at facilities
• Patient reporting should be synchronized with WAOS reporting; Quarterly vs bimonthly
• It is important to think through the whole system; data collection at facility level to reporting and data use
• Data use requires a lot of training and awareness
Global health Supply Chains. Dar es Salaam Tanzania 2016
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